The Role of CT Scanning for Emergent Trauma Care

Rich Lehrer, RT, CRT, BS Ed

The Old Days...

• Plain films - skull, chest, ribs, abdomen, pelvis and additional studies like IVP and/or angiography for suspicious findings.

• Then came CT - 6 minutes per slice!

What’s the Big Deal?

• Now we can acquire a scan of head/chest/abdomen/pelvis in minutes.

• Shorter time frame than plain films.

• Considerably more information making CT scan a good initial survey of injuries and condition.

Helical CT - The Need for Speed

Continuous & Simultaneous

• Source Rotation

• Patient Translation

• Data Acquisition

Helical CT Reconstruction

• Reconstruct raw data into new images

• Display anatomy from different planes

Rich’s Rules of Trauma Radiography

• Assume that there is an injury.– Spinal precautions– Internal bleeding IAI– Closed Head Injury CHI

The Neurosurgery A-B-C’s

• Airway

• Breathing

• CT Head Scan ...

Indications for CT Head

• Major cranial trauma

• Altered level of consciousness

• Abnormal neurologic exam

• Display deterioration under observation

• Headache - N/V

Rich’s Rules of Trauma Radiography

• Assume that there is an injury.

• Be aware of your patient’s condition and changes in their condition.

Basilar Skull Fracture

Depressed Skull Fracture

C7

T1

C7

Mama told you this was gonna’ happen!

Rich’s Rules of Trauma Radiography

• Assume that there is an injury.

• Be aware of your patient’s condition and changes in their condition.

• Know your patient before you meet them.– Current lab values?– History of allergies, heart disease,

kidney disease, diabetes, asthma.– Speaks English or is translator necessary?– IV already established?

BUN

• Range 7 - 25 mg/dl

• Blood urea nitrogen (BUN): waste product of metabolism - level indicates if kidney is excreting sufficiently.

• BUN can rise with dehydration, injury, exercise, or even body size.

Creatinine

• 0.7 - 1.5 mg/dl

• Normal metabolic product of creatine & phosphocreatine which are constituents of skeletal muscle.

• The level of creatinine correlates with overall kidney function. The higher the level, the more abnormal the kidney function.

Rich’s Rules of Trauma Radiography

• Assume that there is an injury.• Be aware of your patient’s condition and changes

in their condition.• Know your patient before you meet them.

• Be Prepared.– Contrast drawn up

– Crash cart or first responder kit available

– Suction available

CT vs. DPL

• Stable, conscious => observe

• Stable or unstable, unconscious => DPL

• Unstable, conscious, abdomen equivocal => CT or DPL

• Unstable, definite abdomen signs => Laparotomy

CT vs. DPL

• DPL -ve, patient stable => observe

• DPL -ve, patient unstable => look elsewhere ie; CT retroperitoneum

• DPL +ve, patient stable => no Laparotomy, CT to see what we're sitting on

• DPL +ve, patient unstable => Laparotomy.

Rich’s Rules of Trauma Radiography

• Assume that there is an injury.

• Be aware of your patient’s condition and changes in their condition.

• Know your patient before you meet them.

• Be Prepared.

• Don’t take it home with you.

Thank You Very Much...

• Denny Belisile, CRT

• Tom Cullivan, CRT

• Russ McFall, MD

• Tony Seibert, Ph D

and all the trauma residents, faculty, and staff at UCDMC.