Primary radiographic survey in a trauma patient
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Radiological Category:. Primary Radiographic Survey in a Trauma Patient. Emergency. Principal Modality (1): Principal Modality (2):. Plain films. CT. Submitted by:. Thomas Morgan MS4. Faculty reviewer:. Sandra Oldham M.D. Date accepted:. 30, August 2007.

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Primary Radiographic Survey in a Trauma Patient

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Primary radiographic survey in a trauma patient

Radiological Category:

Primary Radiographic Survey in a Trauma Patient

Emergency

Principal Modality (1):

Principal Modality (2):

Plain films

CT

Submitted by:

Thomas Morgan MS4

Faculty reviewer:

Sandra Oldham M.D.

Date accepted:

30, August 2007


Case history

Case History

25 year old male victim of a high speed, head-on MVC w/prolonged extrication

Restrained driver

+ Loss of consciousness

Intubated en route, transferred to MHH via Life-Flight

Assessment by Trauma team revealed:

Tachycardic, normotensive

R hemotympanum, L ear laceration, abnormal but stable pelvis, no obvious deformity, Glasgow Coma Score (GCS) 3


Primary radiographic survey in a trauma patient

Radiological Presentations

CXR: 2am


Primary radiographic survey in a trauma patient

Radiological Presentations

CRX: 7am


Primary radiographic survey in a trauma patient

AP Pelvis


Primary radiographic survey in a trauma patient

Radiological Presentations


Primary radiographic survey in a trauma patient

Radiological Presentations


Primary radiographic survey in a trauma patient

Radiological Presentations


Primary radiographic survey in a trauma patient

Clinical:The NEXUS criteria state that a patient with suspected c-spine injury can be cleared providing the following: No posterior midline cervical spine tenderness is present. No evidence of intoxication is present. The patient has a normal level of alertness. No focal neurologic deficit is present. The patient does not have a painful distracting injury.90.7% sensitive for clearing low risk patients without the need for radiographic studies.

Clearing a Cervical Spine Injury


Primary radiographic survey in a trauma patient

Radiological (plain films):Lateral View:-anterior contour line -posterior contour line -spinolaminar contour lineEach of these lines should form a smooth lordotic curve. An exception occurs in young children who may have a benign pseudosubluxation in the upper cervical spine. Check individual vertebrae thoroughly for obvious fracture or changes in bone density.ADI- space between dens and atlas <3mm in adults, 4-5mm in kidsSoft tissue swelling anterior to vertebral bodiesOdontoid View:Important for visualizing the dens (C2) and looking at the symmetry between the dens and the lateral masses of C1. Can also see if the spinous processes are midline

Clearing a Cervical Spine Injury


Primary radiographic survey in a trauma patient

Coronal and Sagittal Views


Primary radiographic survey in a trauma patient

CT Neck


Primary radiographic survey in a trauma patient

Radiological Presentations


Primary radiographic survey in a trauma patient

Radiological Presentations


Primary radiographic survey in a trauma patient

Radiological Presentations


Primary radiographic survey in a trauma patient

Radiological Presentations


Primary radiographic survey in a trauma patient

Radiological Presentations

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Primary radiographic survey in a trauma patient

Admitted to STICU

L chest tube and ventilator support

Neurosurgery followed traumatic brain injury with bolt ICP monitor, but did not operate

Orthopedics followed but did not operate

Course complicated by pneumonia and SIADH

Neurological status improved minimally

Transferred to Long term care facility

Hospital Course


Primary radiographic survey in a trauma patient

1. Cervical Spine Injuries. May 11th 2006. Jorma B. Mueller. Emedicine.com2. American Academy of Family Physicians. Cervical Fractures Vol. 52/No. 2 (Jan. 15 1999). Mark. A. Graber MD, Mary Kathol MD3. Special Thanks to: Dr. Sitton, John Larkin MS4

References


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