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SPRING 2024: Advanced Procedures > UNIT 4: Trauma > Flashcards

UNIT 4: Trauma Flashcards

1
Q

Is trauma more common in men or women

A

Men

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2
Q

Golden hour

A

Recovery rate is best if pt is stabilized within the first hour after the trauma

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3
Q

Trauma centers (Level 1-4)

A

• Level 1: university-based center, research facility, or large medical center, most comprehensive emergency care available
• Level 2: 24 hour specialized care but not a research or university hospital, some specialty physicians are not available 24 hours a day
• Level 3: Ability to resuscitate and stabilize victims for transfer to a larger facility
• Level 4: clinics or outpatient facilities that transfer patients out

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4
Q

Blunt trauma

A

non-penetrating trauma or blunt force by impact
• MVA (Motor Vehicle Accidents)
• Falls
• Assault

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5
Q

Closed Head Injuries

A

most common traumatic brain injury (TBI) in which brain matter is not exposed or penetrated

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6
Q

Coup injury vs Countercoup injury

A

• Coup Injury- the injury occuring on the same side as the site of impact
• Contrecoup injury- damage to the brain on the side opposite the point of impact as a result of the brain hitting the skull

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7
Q

Watch for signs of neurological deficit from coup/countercoup injuries

A

• N/V (Nausea/Vomiting)
• Loss of Consciousness
• Slurred Speech
• Confusion/Agitation
• Seizure

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8
Q

Penetrating trauma

A

when an object pierces the skin and enters a tissue of the body, creating an open wound
• GSW (Gun Shot Wound)
• Stab wounds
• Impalement injuries
• Foreign body ingestion

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9
Q

Explosive trauma

A

aka blast injury: injury resulting from direct or indirect exposure to an explosion
• Pressure shock waves
• High-velocity projectiles
• Burns

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10
Q

Heat trauma

A

Burn injuries are classified 1st-4th degree
•fire
•steam
•chemicals
•electricity
•radiation
•frostbite

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11
Q

First-Fourth degree burns

A
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12
Q

Caring for burn patients

A

• Inhalation of hot gasses may cause pleural effusion or pneumonia
• Chest X-rays are the usual radiography procedure ordered
• Use reverse/ protective isolation technique
• Movement may cause severe pain
• Ensure patient has pain medications prior to X-ray if possible

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13
Q

Trauma Equipment

A

• Mobile x-ray machine
• Ceiling mounted stationary tubes
• Lodox Xmplar Total Body Scanner

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14
Q

What modality has largely replaced diagnostic x-rays for trauma patients but has increased patient dose

A

CT

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15
Q

Role of the Radiographer

A

• Speed
• Accuracy
• Quality
• Positioning
• Immobilization
• Safety
• Anticipation
• Attention to Detail
• Scope of Practice
• Professionalism

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16
Q

Recognize the Signs

A

• Vital Signs:
• HR 70-82 bpm
• BP 100/140 60/90
• Change in mental status or consciousness
• Blood or fluid loss
• Loss of sensation or bowel/urine control or N/V
• Medication side effects

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17
Q

Patient Care in trauma

A

• Never assume a patient can’t hear or understand you!
• Pay attention to verbal and nonverbal signals
• Eye contact if possible
• Watch for changes in patient condition:
• Diaphoresis(Sweating)
• Confusion/Agitation
• N/V (nausea/vomiting)
• LOC (Loss of conscience)
• Increasing abdominal pain and distension
• Know the location of crash cart

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18
Q

T or F: For fractures of the hip, watch for extreme eversion of the foot

A

True

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19
Q

Imaging the hip/pelvis

A

• WATCH FOR SIGNS OF HYPOVOLEMIC SHOCK AND ABDOMINAL DISTENSION (internal bleeding)
• Reassess pt condition repeatedly
• DO NOT INTERNALLY ROTATE LOWER LIMBS
• IMMOBILIZERS MUST NOT BE REMOVED FOR IMAGING unless approved by MD

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20
Q

Judet method views

A

-Oblique views of the acetabulum
•14 X 17 CW IR
•RPO and LPO patient, use sponge if possible
•For UNILATERAL CR enters 2” inferior to ASIS of the affected side
•For Pelvis (when imaging both(BILATERAL) at the same time) CR enters 1”-1.5” from the MSP on the elevated side halfway between PS and ASIS

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21
Q

Judet method Internal Oblique

A

• Internal Obl = affected side up
• Anterior Iliopubic column - ilium and pubis from ASIS to pubic symphysis
• Posterior rim of acetabulum

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22
Q

Judet method External Oblique

A

• External Obl = affected side down
• Posterior Ilioischial column
• Anterior rim of acetabulum

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23
Q

AP AXIAL PELVIS - OUTLET PROJECTION TAYLOR METHOD

A

• IR SIZE: 14 X 17 CW IR with grid
• Supine patient
• flex knees slightly if possible
• CR enters MSP 2” inferior to pubic symphysis
• Women: 30-45 degrees cephalic
• Men: 20-35 degrees cephalic
• Suspend respiration

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24
Q

AP AXIAL PELVIS - OUTLET PROJECTION TAYLOR METHOD Evaluation Criteria

A
  1. Pubic rami without foreshortening
  2. Superimposition of pubic bones over sacrum/coccyx
  3. Obturator foramen symmetric and open
  4. Symmetry of pelvis and hips
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25
Q

AP AXIAL PELVIS - OUTLET PROJECTION TAYLOR METHOD male vs female

A
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26
Q

AP AXIAL PELVIS - INLET PROJECTION BRIDGEMAN METHOD

A

• 14 X 17 CW IR with grid
• Supine patient
• Flex knees slightly if possible
• CR: MSP at level of ASIS, 40 degrees caudal
• Suspend respiration

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27
Q

AP AXIAL PELVIS - INLET PROJECTION BRIDGEMAN METHOD Evaluation Criteria

A
  1. Pelvic ring/inlet
  2. Superimposed superior and inferior pubic rami
  3. Nearly superimposed superior and inferior borders of ischial bones
  4. Symmetry of pelvis and hips
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28
Q

Pelvic trauma images

A
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29
Q

Transthoracic Lateral Humerus (Lawerence method)

A

• 10 X 12 IR LW with grid
• Elevate unaffected arm
• CR perpendicular to MCP at surgical neck
• Full inspiration or breathing technique

If supine, build the patient up off the table with pads

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30
Q

Transthoracic Lateral Humerus Evaluation Criteria

A
  1. Lateral view of shoulder and humerus
  2. Ribs blurred if breathing technique used
  3. Scapula projected over the thoracic spine
31
Q

AP Oblique Y-View (Shoulder)

A

• 10 X 12 IR LW with grid
• CR perpendicular to IR
• Pt. rotated 45° with unaffected shoulder against the IR
• (Reverse PA Y-view)
• Roll patient up due to trauma, usually on a stretcher
• Suspend respiration

32
Q

AP Oblique Y-View (Shoulder) Evaluation Criteria

A

• Humeral head and glenoid superimposed
• Humeral shaft and scapular body superimposed
• No superimposition of the scapular body over the thorax
• Acromion projected laterally
• Coracoid below clavicle
• Scapula in lateral profile

33
Q

Chest Mobile AP

A

• 14 X 17 CW for most adults
• Top of IR 1 1/2 to 2 inches above shoulders
• Consider grid
• Use MAX SID possible
• Mark entrance/exit wounds if applicable
• CR perpendicular 3” below jugular notch
• Shield gonads
• Deep inspiration

34
Q

Chest Mobile AP Evaluation Criteria

A

• Evaluate the image:
1. Lung fields in entirety (apex to costophrenic angle)
2. No rotation
3. Lungs expanded (10 posterior ribs)
4. Proper collimation

• fractures
• interstitial air
• pneumothorax/hemothorax
• line placement

35
Q

Rib fracture

A
36
Q

Cervical Spine

A

• When Cervical spine imaging is requested, ALWAYS perform the cross-table lateral (dorsal decubitus) first
• 72’ SID when possible
• DO NOT MOVE THE PATIENT’S HEAD OR NECK
• DO NOT REMOVE CERVICAL COLLAR OR TAKE OFF THE BACKBOARD
• CR horizontal and perpendicular to C4
• Shield when possible
• Suspend respiration at end of expiration when possible

37
Q

Cervical Spine Evaluation Criteria

A

• Sella Turcica to top of T1
• No rotation/tilt
• Intervertebral Discs
• Z joints

38
Q

Subluxation of C6

A
39
Q

Hangman’s fracture

A
40
Q

Clay Shovelers Fracture

A
41
Q

Skull Cross-Table Lateral

A

• Cross table lateral skull with a horizontal beam (dorsal decubitus)
1. Elevate head on sponge
2. 10 X 12 IR with grid
3. IPL perpendicular to IR
4. Horizontal CR 2 inches above EAM

42
Q

Skull Cross-Table Lateral Evaluation Criteria

A

a. Profile image of the skull
b. Air fluid levels
c. Sphenoid sinus

43
Q

Skull AP

A
  1. 10 X 12 IR with grid
  2. OML and MSP perpendicular to IR
  3. CR perpendicular to the nasion
44
Q

Skull AP Evaluation Criteria

A

a. Anterior cranium
b. Petrous ridges fill the orbits
c. Orbits magnified

45
Q

Skull AP Axial Reverse Caldwell

A
  1. 10 X 12 IR with grid
  2. CR: 15 degrees cephalic entering MSP at the nasion
  3. OML and MSP perpendicular to IR
46
Q

Skull AP Axial Reverse Caldwell Evaluation Criteria

A

a. Anterior cranium
b. Petrous ridges lower third of orbits
c. Orbits magnified

47
Q

AP vs PA Caldwell

A
48
Q

Skull AP Axial Towne

A
  1. 10 X 12 IR with grid
  2. CR: 30 degrees caudal to OML or 37 to IOML
  3. OML or IOML and MSP perpendicular to IR

*CR Passes through EAM

49
Q

Skull AP Axial Towne Evaluation Criteria

A

a. Posterior cranium
b. Foramen Magnum

50
Q

Cross-Table Lateral Hip - Danelius-Miller Method

A

• Elevate patient off bed if possible
• 10 X 12 GRID LW to the patient
• Top of IR at crest; IR placed parallel to the femoral neck
• Elevate unaffected leg to the vertical position
• DO NOT ROTATE AFFECTED LEG
• CR horizontal and perpendicular to the long axis of the femoral neck
• CR enters the groin midway between the anterior and posterior surfaces of the thigh

51
Q

Cross-Table Lateral Hip - Danelius-Miller Method Evaluation Criteria

A
  1. Hip joint and acetabulum
  2. Femoral neck without superimposition from greater trochanter
  3. Small amount of lesser trochanter
  4. Small amount of greater trochanter
  5. Trochanter Ischial tuberosity
52
Q

Trauma Hip - Clements/Nakayama

A

• Bilateral Hip fractures
• 10 X 12 IR with Grid LW to patient
• DO NOT INTERNALLY ROTATE LOWER LIMBS
• IR parallel to femoral neck, tilted back 15 degrees
• CR 15 degrees posteriorly to enter the femoral neck of interest

53
Q

Trauma Hip - Clements/Nakayama Evaluation Criteria

A
  1. Acetabulum and proximal femur in profile
  2. Greater and lesser trochanters in profile
  3. Compare to Dani-Miller
54
Q

Extremity Imaging

A

• Support injured limbs at both joints AND at fracture site
• If extremity must be lifted to place the IR underneath, do so slowly and with patient permission
• If the limb is severely deformed, do not attempt to position for true AP and lateral images
• Expose two projections, 90 degrees apart, moving limb as little as possible
• Long bone images MUST include both joints above and below the injury
• Shoulder images should be initially imaged in neutral rotation
• Assess patient condition for signs of shock throughout examination

55
Q

Elbow - Partial flexion AP (2 views)

A

• 10 X 12 IR LW
a. CR perpendicular to humerus entering elbow joint
• closed joint, distortion of the forearm
b. CR perpendicular to forearm entering elbow joint
• partially open elbow joint

56
Q

Elbow - Partial flexion AP (2 views) Evaluation Criteria

A

a. Distal Humerus:
1. Closed elbow joint
2. Distortion of forearm

b. Proximal Forearm:
1. Partially open elbow joint
2. Distortion of humerus

57
Q

Avulsion Fractures

A

Medial and Lateral epicondyles

58
Q

Proximal Ulna Fracture

A
59
Q

Lateral Epicondyle fracture and Dislocation

A
60
Q

Elbow - Coyle method

A

• 10 X 12 IR LW
• Elbow flexed 90 degrees *RADIAL HEAD
-CR 45 degrees towards shoulder
• Elbow flexed 80 degrees *CORONOID PROCESS
-CR 45 degrees away from shoulder

61
Q

Elbow - Coyle method Evaluation Criteria

A

a. Radial head: open joint space between head and capitulum; head and tuberosity free of superimposition
b. Coronoid process: open joint space between coronoid and trochlea; coronoid process in profile
• fractures
• subluxation
• dislocation

62
Q

Elbow Dislocation

A
63
Q

Lower Extremity

A
64
Q

Mobile Radiography

A

Many patients are too ill or unable to come to the department, mobile x-rays take the machine to them

  1. Set manual techniques
  2. Radiation safety is important, due to high occupational exposure
  3. Shielding considerations for patients
  4. SSD cannot be less than 12 inches

Common Mobile Procedures:
• Chest
• Abdomen
• Pelvis
• C-spine
• Extremities
• Infant Chest/Abd

65
Q

Mobile Radiography - preliminary steps

A
  1. Announce presence and ask for assistance based on pt condition
  2. Check orders, patient room number, correct patient in the room
  3. Introduce yourself to the patient and family, explain procedure
  4. Maneuver around medical equipment in the room and connected to the patient, move if necessary
  5. Ask family to step out

-Shield patient and work carefully; work as a team; put things back in their place; Thank your patient

66
Q

T or F: Falls and MVA are the most common

A

True

67
Q

T or F: firearms as a cause of injury are the least common but have the highest fatality rate

A

True

68
Q

the primary responsibilities of a radiographer in an emergency situation include the following:

A

• Perform quality diagnostic imaging procedures as requested.
• Practice ethical radiation protection for self, patient, and other personnel.
• Provide competent patient care.

69
Q

If patient on stretcher is less than ___ ft away from the x-ray tube, appropriate shielding should be provided

A

6ft (72 inches)

70
Q

Some of the greatest exposures to patients and medical personnel comes from

A

Fluoroscopic procedures

71
Q

Symptoms and Causes

A
72
Q

Hypovolemic or hemorrhagic shock

A

Most common type of shock in trauma patients. Symptoms include diaphoresis(excessive sweating), cool and clammy skin, decrease in venous pressure, decrease in urine output, thirst, and altered state of consciousness.

73
Q

Vasovagal reaction

A

-Also called a vasovagal attack, situational syncope, and vasovagal syncope
-Patients may complain of nausea, feeling flushed (warm), and feeling lightheaded. They may appear pale before they lose consciousness for several seconds.

74
Q

Cerebrovascular accident

A

commonly called a stroke and may be caused by thrombosis, embolism, or hemorrhage in the vessels of the brain

SPRING 2024: Advanced Procedures (25 decks)

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