Emergency Radiology

Emergency Department clinical Labaratory Radiology

Patient presenting either: Trauma Acute diseases

Clinical At Trauma setting TensionPneumothorax Skull base fracture Flail chest Hematuria

Penetrating Trauma Stab wound Bullets Impalement Eviseration

Acute Setting Tenderness at Mecburnys point Clinical Murphys sign Crepitations in congestive heart failure Unequal pulse in aortic dissection

Labarotry In Trauma setting 1-CBC ,HB& blood typing. 2- ABG. 3-urine analysis (microhematuria) 4-Renal Functions (creatinine). 4-Liver enzymes(elevated in liver injury). 6-Pancreatic Amylase (elevated in pancreatic injury).

At The Acute Setting 1-CBC(total leucocytic count). 2-ABG. 3-urine analysis(cyrstals,microhematuria&pus cells). 4-Liver Enzymes. 5-Pancreatic Amylase. 6-Blood Electrolytes. 7-ECG & Cardiac enzymes in chest pain.

What About Radiology Dudes!??

Radiography

In Trauma Setting (protocol of x-ray in Trauma Patient) (Trauma Series) Cervical spine ( (AP,Lat,Open mouth) CXR(AP) Pelvic Xray(AP)

X-rays of the Trauma Patient For the trauma patient, “x-ray everything that hurts.”   The only caution is that unimportant x-rays not take precedence over treatment of life-threatening problems. For example, don’t delay operating on an epidural hematoma to take hand x-rays. If x-rays must be deferred, the reason for the delay should be written on the chart, along with a clear list of the x-rays desired. The films can be obtained later. Splint any extremity with a possible fracture if x-ray will be delayed.  Almost every patient with severe trauma should have a cross- table C-spine x-ray, chest x-ray, and pelvis x-ray. The rationale: Neck pain may be missed in a massively-injured patient, and the cost of missing a cervical fracture is great. The chest may have significant internal injury without external tenderness. Pelvic fractures are often present in patients with trunk trauma, and are often missed. Order these important x-rays before the patient leaves the emergency department for other care.

Extremity Contrast Enhanced

At The Acute Setting CXR Abdominal Xray (Erect,supine&lateral decubitus) Extremity

Ultrasound

Types of Probes

At The Trauma setting FAST Examination At The Acute setting discussed later

CT

At the trauma setting Brain chest Abd&pelvis bones Orbit

At The Acute Setting CT orbit in ophalmitis CT brain in Hge or infarction or tumors CT orbit in ophalmitis Abd &pelvis CT CHEST (e.g. dissection)

1-TRAUMA Blunt Trauma Penetrating Trauma

BLUNT TRAUMA (Causes) MVA Fall from height Fight

Shearing (Acceleration/Deceleration) Mechanism of Injury Compression Crushing Shearing (Acceleration/Deceleration)

Penetrating Injuries Stab Gun shot injury

(so it’s more dangerous) Mechanism of injury Low-velocity projectiles A knife or projectile, for example, produces tissue damage by stretching and crushing; injury is usually confined to tissues in the path of penetration The severity of the internal injury depends on the organ penetrated and on how vital the organ is. High Velocity Projectiles GSI leads to injury along its path + by shock waves to the adjacent structures. (so it’s more dangerous) The degree of injury also depends on the biomechanics of the penetrating projectile . velocity, size of impact face, and deformability, and the density of the body tissues penetrated

you can continue emergency radiology for each specialty;