(4)dr.Nur hidayat MAJOR_TRAUMA_RADIOLOGY_for_web.pdf

8/11/2019 (4)dr.Nur hidayat MAJOR_TRAUMA_RADIOLOGY_for_web.pdf

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Imaging in major trauma

Dr Paul Middleton

Medical Adviser Chair, Clinical Advisory Committee

Ambulance Service of NSW


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Dr Paul Middleton

Senior Lecturer inEmergency MedicinePrince of Wales Hospital / UNSW


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Dr Paul Middleton

Retrieval SpecialistCareFlight


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Primary survey - ATLS /EMST

A Airway with cervical spine controlB Breathing and ventilation

C Circulation and haemorrhage controlD DisabilityE Exposure, environment and

everything elseRadiology comes at E trauma seriesRadiology also comes in the Secondary

survey

Imaging in major trauma - perspective


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Trauma series of X-rays

Chest X rayPelvis X rayLateral cervical spine X ray

Additional views AP cervical spine X rayOpen mouth odontoid peg X rayOblique views of cervical spineCTFAST


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Trauma series of X-rays

Chest X rayPelvis X rayLateral cervical spine X ray

Additional views AP cervical spine X rayOpen mouth odontoid peg X rayOblique views of cervical spineOblique views of cervical spineOblique views of cervical spineCTCTCTFASTFASTFAST


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Spinal immobilisation is a priority in multiple

trauma, spinal clearance is not.The spine should be assessed and clearedwhen appropriate, given the injury and

physiological state.Imaging the spine does not take precedenceover life-saving diagnostic and therapeuticprocedures.


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Chest X ray



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How do we examine a CXR?

Imaging in major trauma - interpretation


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How do we examine an XR?

AABCs


A AdequacyA - AlignmentB - BonesC - CartilageS Soft tissues


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Normal CXR


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SomeB*****dPinchedMyToyDinosaur



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Soft tissues

B*****dPinchedMyToyDinosaur


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Soft tissues

BonesPinchedMyToyDinosaur


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Soft tissues

BonesPleura / ParenchymaMyToyDinosaur


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Soft tissues

BonesPleura / ParenchymaMediastinumToyDinosaur


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Soft tissues

BonesPleura / ParenchymaMediastinumTracheaDinosaur


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Soft tissues

BonesPleura / ParenchymaMediastinumTracheaDiaphragms



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NormalCXR

Softtissues


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Normal CXR

Bones


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Normal CXR

Pleura


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Normal CXR

Parenchyma


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Normal CXR

Mediastinum


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Normal CXR

Trachea


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Normal CXR

Diaphragms


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Imaging in major traumaPathology


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Imaging in major trauma - pathology

Subcutaneous

emphysema


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Multiple rib

#s


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Flail chest


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Simple

pneumothorax


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Simple

pneumothorax- detail


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Simple

pneumothorax- detail


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L tension

pneumothorax



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Erect

haemothorax


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Supine

haemothorax


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Massive

haemothorax


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Pulmonary

contusion


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Widened

mediastinum


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Oesophageal

rupture


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Pelvis X ray



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How do we examine a PXR?



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How do we examine a PXR?

AABCs

A AdequacyA - Alignment

B - BonesC - CartilageS Soft tissues



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Normal AP

pelvis


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Normal AP

pelvis


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Normal AP

pelvis


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Normal AP

pelvis


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Normal AP

pelvis


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Imaging in major trauma - interpretationDont forget!


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Imaging in major traumaPathology


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Imaging in major trauma Open book

pelvic #


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Imaging in major trauma Malgaigne

pelvic #


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Imaging in major trauma - pathologyLateral

compressionpelvic #


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compressionpelvic # -CTR


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compressionpelvic # -CTR


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Imaging in major traumaCentral

dislocationof hip


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Imaging in major trauma Vertical

shear #

I i i j


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Anterior +

posterior hipdislocations

I i i j


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Shear# +

centraldislocation

I i i j t


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Sacral #

I gi g i j t


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Widened SI

joint

Imaging in major trauma interpretation


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Cervical spine X ray




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Cervical spine why is it a problem?




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Pathology

Serious head and neck injuries

35mph2001 Daytona 500 fatal accident - change invelocity ~ 43 mph

Resultant load in neck (tension + shearloading) exceeds injury threshold.

Also leads to base of the skull (basilar)

fractures - most common cause of death inracing drivers (and lots of other drivers!)




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Pathology

Severe flexion, extension, and rotationalforces Atlanto-occipital disarticulations occur in

high-energy impacts and collisions Associated with

aortic laceration in 25%

basilar skull fracture in 21%

WHY DOES THIS ALL HAPPEN?




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Anatomy

7 vertebral bodies connect head to torsoC1 (atlas) & C2 (axis) - special shape

Supports the head

Permits head turningPermits upward and downward tilting

Lower 5 vertebrae similar in appearance &function

Permit flexion / extension / rotation, lateralbending

g g j



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g g j


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g g j



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FORCES ACTING ON CERVICAL SPINE

Tensionloading

g g j



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Tensionloading

Compressiveloading



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Tensionloading

Compressiveloading

Shearforces



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Tensionloading

Shearforces

Torsionalforces

Compressiveloading


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How do we examine a lateral cervicalspine XR?

AABCs

A AdequacyA - AlignmentB - BonesC - Cartilage

S Soft tissues



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A - Adequacy

Inadequatelateral cervicalspine view



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A - Adequacy

Adequate(just!) lateralcervical spine



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A - Alignment



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B - Bones



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B - Bones



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B - Bones



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C - Cartilage


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Additional views



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How do we examine an AP cervical spineXR?



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Normal APcervical spine



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How do we examine an AP cervical spineXR?

AABCs




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A - Adequacy

Adequate APcervical spine



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A - Alignment



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B - Bones



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B Bones

SpaceInvader Sign



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C Cartilage



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How do we examine an odontoid peg XR?



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Normalodontoid pegview



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Normalodontoid pegview



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How do we examine an odontoid peg XR?

AABCs




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A - Adequacy

Adequate pegview



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A - Alignment



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B - Bones



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C Cartilage



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Pathology



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Odontoid peg#s

Type I

Type II

Type III



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Odontoid peg#



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Odontoid peg#



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Occipito -atlantaldislocation



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Jefferson(burst) #



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Jefferson(burst) #



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Jefferson(burst) #


A l i l


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Atlanto-axialdislocation


C2 di l #


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C2 pedicle #


H g


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Hangmans#

Teardrop #



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Teardrop #C4


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Unilateral



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Unilateralfacet joint

dislocationC5/6

Bilateral



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Bilateralfacet joint

dislocationC5/6

# dislocation



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# dislocationC5/6


important new imaging techniques


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important new imaging techniques

Imaging in major trauma extra stuff


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Any questions?


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y q ?


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(4)dr.Nur hidayat MAJOR_TRAUMA_RADIOLOGY_for_web.pdf

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