Superior District, CSRT 26th Symposium SOMETHING FOR EVERYONE Sept. 8-9, 2001

The Role of CT Scanning For Emergent Trauma Care Rich Lehrer, RT, CRT, BS Ed UC Davis Medical Center

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 A-B-C’s of Neurosurgery Airway Breathing CT Head Scan...

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

Epidural Hematoma

Mass effect of the brain

Basilar Skull Fracture

Basilar Skull FX

Depressed Skull Fracture

S/P Rock to head 2 days ago...

Rich’s Rules of Trauma Radiography Assume that there is an injury. Be aware of your patient’s condition and changes in their condition.

AxialCoronal

Mandibular Fracture

C7 T1 C7

Multi-Planar Reconstruction (MPR)

Sometimes we see spinal fractures on abdominal scans.

L Spine 3-D Reconstruction

T-8 Fx

Multi-Planar Reconstruction (MPR)

T-spine FX

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 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 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

Fractured Sternum

Dissecting Aneurysm

M P R Sagittal

CT Angio ~ AAA

Pulmonary Embolus

Fractured Ribs sharp and pointy...

Lacerated Spleen

Left Flank Pain ~ R/O Kidney Stone

3-D Model

Calcaneous

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.