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Primary Radiographic Survey in a Trauma Patient

Primary Radiographic Survey in a Trauma Patient

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Primary Radiographic Survey in a Trauma Patient

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  1. 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

  2. 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

  3. Radiological Presentations CXR: 2am

  4. Radiological Presentations CRX: 7am

  5. AP Pelvis

  6. Radiological Presentations

  7. Radiological Presentations

  8. Radiological Presentations

  9. 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

  10. 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

  11. Coronal and Sagittal Views

  12. CT Neck

  13. Radiological Presentations

  14. Radiological Presentations

  15. Radiological Presentations

  16. Radiological Presentations

  17. Radiological Presentations \

  18. 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

  19. 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