1. CORE Case 8 Workshop GI: Trauma

2. Learning Objectives
List the components of a typical radiographic trauma series
Apply a search pattern for interpreting supine trauma chest radiographs
Apply a search pattern for interpreting supine trauma pelvic radiographs

3. Describe what a “FAST” scan is, and when and how it is performed
Describe how results of a FAST scan direct immediate management in trauma
Classify common CT findings of solid organ injuries into:
“needs surgery”
“can be managed non-operatively”
Describe when bladder and urethral injuries should be suspected and further evaluated

4. What questions or difficulties did you have with the case?

5. How do we initially image trauma patients in this setting?
You are working in the emergency department of a
Level 1 Trauma Center
How do we initially image trauma patients in this setting?

6. 23 year old female motorcyclist who crashed

7. Where do you look on a FAST. What do you look for
Where do you look on a FAST? What do you look for? What are possible problems with a FAST exam?

9. How do results of the FAST alter your care?

10. 54 year old woman with MVC trauma FAST is Negative

15. 17 year old female injured in MVC Initially brought to a small community hospital where you are now working No FAST available

18. 22 year old man whose motorcycle collided with a car Brought to the Level 1 Trauma Center FAST positive

21. What is this study?
Where is catheter?
Is it normal?

22. What has been done?
Why?

23. 34 year old man injured in MVC FAST Positive

28. 30 year old man injured in MVC FAST Negative

29. Portal venous phase

30. Late excretory phase

31. 31 year old woman struck by car FAST positive

36. 51 year old man hurt in mine roof fall FAST Positive Obvious pelvic injury

42. Before we get to his images, let’s go through a systematic assessment of a pelvic radiograph:
Trace main pelvic ring (yellow) looking for disruption.
Trace and both obturator rings (purple) looking for disruption.
The red line is the iliopectineal line – disruption indicates fracture of the anterior acetabular column
The blue line is the ilioischial line – disruption indicates fracture of the posterior acetabular column
Dotted green line is Shenton’s line – disruption indicates proximal femur fracture or pelvic fractures
Assess sacroiliac joints and pubic symphysis for abnormal widening
(Slide courtesy of Jennifer Koay, M.D.)

45. A less mangled pelvic Fx

46. A less mangled pelvic Fx

47. 51 year old man hurt in mine roof fall FAST Positive Obvious pelvic injury

51. 31year old man had blunt trauma to perineum (straddle injury) Now has blood at urethral meatus What study is needed?

53. Young man w straddle injury with blood at urethral meatus, perineal bruising

55. 52ym with crush injury on drill rig FAST negative

57. End