Superior District, CSRT 26th Symposium SOMETHING FOR EVERYONE Sept. 8-9, 2001.
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Transcript of Superior District, CSRT 26th Symposium SOMETHING FOR EVERYONE Sept. 8-9, 2001.
Superior District, CSRT26th 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.
Axial Coronal
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 7 - 25 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
• 0.7 - 1.5 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 RSagittal
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.