superior district, csrt 26th symposium something for everyone sept. 8-9, 2001
TRANSCRIPT
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Superior District, CSRT26th Symposium
SOMETHING FOR EVERYONE
Sept. 8-9, 2001
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The Role of CT Scanning For Emergent Trauma Care
Rich Lehrer, RT, CRT, BS Ed
UC Davis Medical Center
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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!
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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.
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Helical CT - The Need for Speed
Continuous & Simultaneous
• Source Rotation
• Patient Translation
• Data Acquisition
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Helical CT Reconstruction
• Reconstruct raw data into new images
• Display anatomy from different planes
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Rich’s Rules of Trauma Radiography
• Assume that there is an injury.– Spinal precautions– Internal bleeding IAI– Closed Head Injury CHI
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The A-B-C’s of Neurosurgery
• Airway
• Breathing
• CT Head Scan ...
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Indications for CT Head
• Major cranial trauma
• Observed loss of conciousness
• Abnormal neurologic exam
• Display deterioration under observation
• Penetrating Injury
• Headache - N/V - other unexplained behavior
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Epidural Hematoma
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Mass effect of the brain
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Basilar Skull Fracture
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Basilar Skull FX
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Depressed Skull Fracture
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S/P Rock to head 2 days ago...
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Rich’s Rules of Trauma Radiography
• Assume that there is an injury.
• Be aware of your patient’s condition and changes in their condition.
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Axial Coronal
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Mandibular Fracture
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C7
T1
C7
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Multi-Planar Reconstruction (MPR)
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Sometimes we see spinal fractures on abdominal scans.
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L Spine 3-D Reconstruction
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T-8 Fx
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Multi-Planar Reconstruction (MPR)
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T-spine FX
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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?
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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.
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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.
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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
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Fractured Sternum
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Dissecting Aneurysm
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M P RSagittal
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CT Angio ~ AAA
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Pulmonary Embolus
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Fractured Ribs sharp and pointy...
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Lacerated Spleen
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Left Flank Pain ~ R/O Kidney Stone
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3-D Model
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Calcaneous
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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.
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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.