the role of ct scanning for emergent trauma care rich lehrer, rt, crt, bs ed

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Slide 2 The Role of CT Scanning for Emergent Trauma Care Rich Lehrer, RT, CRT, BS Ed Slide 3 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! Slide 4 Slide 5 Slide 6 Slide 7 Slide 8 Whats 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. Slide 9 Helical CT - The Need for Speed Continuous & Simultaneous Source Rotation Patient Translation Data Acquisition Slide 10 Slide 11 Helical CT Reconstruction Reconstruct raw data into new images Display anatomy from different planes Slide 12 Richs Rules of Trauma Radiography Assume that there is an injury. Spinal precautions Internal bleeding IAI Closed Head Injury CHI Slide 13 Slide 14 Slide 15 The Neurosurgery A-B-Cs Airway Breathing CT Head Scan... Slide 16 Indications for CT Head Major cranial trauma Altered level of consciousness Abnormal neurologic exam Display deterioration under observation Headache - N/V Slide 17 Richs Rules of Trauma Radiography Assume that there is an injury. Be aware of your patients condition and changes in their condition. Slide 18 Slide 19 Slide 20 Slide 21 Slide 22 Slide 23 Slide 24 Slide 25 Slide 26 Slide 27 Slide 28 Slide 29 Basilar Skull Fracture Slide 30 Depressed Skull Fracture Slide 31 Slide 32 Slide 33 Slide 34 Slide 35 Slide 36 Slide 37 C7 T1 C7 Slide 38 Slide 39 Mama told you this was gonna happen! Slide 40 Richs Rules of Trauma Radiography Assume that there is an injury. Be aware of your patients 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? Slide 41 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. Slide 42 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. Slide 43 Slide 44 Slide 45 Slide 46 Slide 47 Slide 48 Slide 49 Slide 50 Slide 51 Slide 52 Slide 53 Slide 54 Slide 55 Slide 56 Richs Rules of Trauma Radiography Assume that there is an injury. Be aware of your patients 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 Slide 57 CT vs. DPL Stable, conscious => observe Stable or unstable, unconscious => DPL Unstable, conscious, abdomen equivocal => CT or DPL Unstable, definite abdomen signs => Laparotomy Slide 58 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. Slide 59 Slide 60 Slide 61 Slide 62 Slide 63 Slide 64 Richs Rules of Trauma Radiography Assume that there is an injury. Be aware of your patients condition and changes in their condition. Know your patient before you meet them. Be Prepared. Dont take it home with you. Slide 65 Slide 66 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.