1. Multiple Trauma MVA By Riley Timmins

2. Introduction 29 year old male in single car MVA 29 year old male in single car MVA Patient air-lifted to Good Samaritan Regional Medical Center. Patient air-lifted to Good Samaritan Regional Medical Center. Pt. was stable but unconscious on arrival. Pt. was stable but unconscious on arrival. Pt. presented with multiple fractures and abdominal injuries. Pt. presented with multiple fractures and abdominal injuries. ER Dr. ordered a portable CXR and head/neck/chest/abdomen/pelvic CT’s ER Dr. ordered a portable CXR and head/neck/chest/abdomen/pelvic CT’s

3. Portable AP Chest X-ray Film done supine on backboard Film done supine on backboard 14X17 cassette cross-wise 14X17 cassette cross-wise 125 kVp @ 6.4 mAs w/grid @ 50 inches 125 kVp @ 6.4 mAs w/grid @ 50 inches

4. Axial CT Chest Slice This slice is showing the lungs and the heart in the center. This slice is showing the lungs and the heart in the center. The slice also shows atelectasis which is the partial collapse of a lung due to a blockage of the airway. The slice also shows atelectasis which is the partial collapse of a lung due to a blockage of the airway.

5. Axial CT Abdomen Slice This slice shows the liver of the patient and the arrows indicate contusions. This slice shows the liver of the patient and the arrows indicate contusions.

6. Axial CT Abdomen/Chest Slice This is another contusion of the upper portion of the liver. This is another contusion of the upper portion of the liver.

7. Coronal CT Slice This slice shows the liver on the right and the spleen on the left. This slice shows the liver on the right and the spleen on the left. Notice the smooth borders of both the liver and the spleen. Notice the smooth borders of both the liver and the spleen.

8. Coronal CT Slice The lower margin of the spleen in this slide has become disrupted and is rough in appearance. The lower margin of the spleen in this slide has become disrupted and is rough in appearance.

9. Coronal CT Slice This next slide shows this even more so. This next slide shows this even more so.

10. Coronal CT Slice This is indicative of a macerated spleen. This basically means that the tissue has been shredded. This is indicative of a macerated spleen. This basically means that the tissue has been shredded.

11. Axial CT Abdomen Slice This is just another view of that gives a different view of the macerated spleen. This is just another view of that gives a different view of the macerated spleen.

12. Axial CT Abdomen Slice In this slice, the Mesenteric vasculature is visualized and a bleed can be seen. In this slice, the Mesenteric vasculature is visualized and a bleed can be seen.

13. Coronal CT Abdomen Slice This is a few of the same bleed just from another view. This is a few of the same bleed just from another view.

14. Coronal CT Abdomen Slice In this Slice, free blood is demonstrated, indicating a hemoperitoneum. In this Slice, free blood is demonstrated, indicating a hemoperitoneum.

15. Axial CT Pelvic Slice Again, a hemoperitoneum is demonstrated. Again, a hemoperitoneum is demonstrated.

16. Axial CT Pelvic Slice This slice demonstrates a fracture of the right pubic rami. This slice demonstrates a fracture of the right pubic rami.

17. Axial CT Pelvic Slice The pubic rami fracture is demonstrated again here. The pubic rami fracture is demonstrated again here.

18. Axial CT Pelvic Slice The fracture of the left proximal femur is demonstrated here. The fracture of the left proximal femur is demonstrated here.

19. Axial CT Pelvic Slice A fracture of the acetabulum is visible here. A fracture of the acetabulum is visible here.

20. Axial CT Pelvic Slice Another fracture is visible here in the roof of the acetabulum. Another fracture is visible here in the roof of the acetabulum.

21. AP Right Tib/Fib X-ray 14x17 film corner to corner. 14x17 film corner to corner. 65 kVp @ 3.2 mAs, non-grid @ 40 inches. 65 kVp @ 3.2 mAs, non-grid @ 40 inches. Film should include both knee and ankle joints. Lateral and medial malleoli are clipped. Film should include both knee and ankle joints. Lateral and medial malleoli are clipped. Fractures of the fibular head and mid fibula and tibia. Fractures of the fibular head and mid fibula and tibia.

22. Lateral Right Tib/Fib X-ray 14X17 Film corner to corner, cross-table 14X17 Film corner to corner, cross-table 65 kVp @ 3.2 mAs, non-grid @40 inches 65 kVp @ 3.2 mAs, non-grid @40 inches Film should include both joints but proximal tibia is clipped. Film should include both joints but proximal tibia is clipped. Fractures of the fibular head, mid-fibular and tibial shaft, and the calcaneus. Fractures of the fibular head, mid-fibular and tibial shaft, and the calcaneus.

23. AP Left Tib/Fib X-ray Same technique as the right tib/fib. Same technique as the right tib/fib. Comminuted fracture of the tibial plateau, proximal shaft of both the tibia and fibula. Comminuted fracture of the tibial plateau, proximal shaft of both the tibia and fibula. Lateral malleolus is clipped. Lateral malleolus is clipped.

24. Lateral Left Tib/Fib X-ray Same technique as right tib/fib. Same technique as right tib/fib. External fixation apparatus is superimposed over pertinent anatomy. External fixation apparatus is superimposed over pertinent anatomy. Both proximal and distal tib/fib are clipped. Both proximal and distal tib/fib are clipped.

25. Lateral Left Knee X-ray 10X12 film used lengthwise to the part, cross-table 10X12 film used lengthwise to the part, cross-table 65 kVp @ 4 mAs, non- grid @ 40 inches. 65 kVp @ 4 mAs, non- grid @ 40 inches. Knee joint is visualized but rotated. Knee joint is visualized but rotated. Tibial Plateau fracture is demonstrated as is a femoral fracture. Tibial Plateau fracture is demonstrated as is a femoral fracture.

26. AP Left Knee X-ray Same technique as used for the lateral. Same technique as used for the lateral. Tibial plateau fracture is demonstrated as is another fracture on the medial epicondyle of the femur. Tibial plateau fracture is demonstrated as is another fracture on the medial epicondyle of the femur.

27. AP Left Femur X-ray 14X17 film, lengthwise. 14X17 film, lengthwise. 68 kVp @ 5 mAs, non-grid @ 40 inches. 68 kVp @ 5 mAs, non-grid @ 40 inches. Femur film should include knee joint to the acetabulum of the hip joint. Two films must be taken to achieve this. Femur film should include knee joint to the acetabulum of the hip joint. Two films must be taken to achieve this. Dr. only wanted what was necessary. Dr. only wanted what was necessary. Spiral type femoral fracture is demonstrated Spiral type femoral fracture is demonstrated

28. Lateral Left Femur X-ray 14X17 film lengthwise, cross-table. 14X17 film lengthwise, cross-table. Same technique as AP Same technique as AP Dr. deemed this was sufficient and didn’t request upper films. Dr. deemed this was sufficient and didn’t request upper films.

29. Lateral Right Femur X-ray Same film and technique configuration as Left Femur. Same film and technique configuration as Left Femur. No fractures or abnormalities in the femur. No fractures or abnormalities in the femur. Fibular head fracture is demonstrated. Fibular head fracture is demonstrated.

30. AP Right Femur X-ray No fractures of the femur demonstrated. No fractures of the femur demonstrated.

31. AP Left Hip X-ray 14X17 film lengthwise 14X17 film lengthwise GRID? GRID?

32. AP Pelvis X-ray 14X17 film, crosswise 14X17 film, crosswise 80 kVp @ 100 mAs, with a grid @ 50 inches. 80 kVp @ 100 mAs, with a grid @ 50 inches. Pelvis film should include the entire ischial tuberosity. It is clipped in this film. Pelvis film should include the entire ischial tuberosity. It is clipped in this film. There is a right superior pubic ramus fracture demonstrated. There is a right superior pubic ramus fracture demonstrated.

33. AP Left Forearm X-ray 14X17 film, corner to corner. 14X17 film, corner to corner. 62 kVp @ 2.5 mAs, non- grid @ 40 inches. 62 kVp @ 2.5 mAs, non- grid @ 40 inches. Should include both wrist and elbow joints. Should include both wrist and elbow joints. Mid-shaft fracture of the ulna is demonstrated. Mid-shaft fracture of the ulna is demonstrated.

34. Lateral Left Forearm X-ray 14X17 film is used lengthwise. 14X17 film is used lengthwise. Same technique as AP Same technique as AP Ulnar fracture is demonstrated Ulnar fracture is demonstrated

35. Post-Op AP Left Femur X-ray External fixator has not brought fracture into alignment much. External fixator has not brought fracture into alignment much.

36. Post-Op Lateral Right Tib/Fib

37. Post-Op AP Right Tib/Fib External fixators in place External fixators in place

38. Post-Op Lateral Left Tib/Fib External fixators in place External fixators in place

39. Post-Op AP Left Tib/Fib External Fixators External Fixators

40. Post-Op Lateral Right Ankle External Fixators External Fixators

41. Post-Op AP Right Ankle Only external fixators were used probably due to the severity of his abdominal injuries. Only external fixators were used probably due to the severity of his abdominal injuries. I think the priority was just stabilization. I think the priority was just stabilization.