CORE Case 8 Workshop GI: Trauma
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
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
What questions or difficulties did you have with the case?
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?
23 year old female motorcyclist who crashed
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?
How do results of the FAST alter your care?
54 year old woman with MVC trauma FAST is Negative
17 year old female injured in MVC Initially brought to a small community hospital where you are now working No FAST available
22 year old man whose motorcycle collided with a car Brought to the Level 1 Trauma Center FAST positive
What is this study? Where is catheter? Is it normal?
What has been done? Why?
34 year old man injured in MVC FAST Positive
30 year old man injured in MVC FAST Negative
Portal venous phase
Late excretory phase
31 year old woman struck by car FAST positive
51 year old man hurt in mine roof fall FAST Positive Obvious pelvic injury
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.)
A less mangled pelvic Fx
A less mangled pelvic Fx
51 year old man hurt in mine roof fall FAST Positive Obvious pelvic injury
31year old man had blunt trauma to perineum (straddle injury) Now has blood at urethral meatus What study is needed?
Young man w straddle injury with blood at urethral meatus, perineal bruising
52ym with crush injury on drill rig FAST negative
End