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.