- not easily available - long duration - costly - contraindicated with metal implants

- radiation - allergic reactions

- eye opening - verbal response - motor response

CT Application 5 Trauma Flashcards by Ethan Wong

FAST

Focused Assessment with Sonography for Trauma

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why CT is the undisputed gold standard

immediate access
high spatial res, specificity, sensitivity
low scan time

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FAST rapidly identifies free fluid in ___

abdomen / pericardium / pleural space

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hemopericardium

blood in heart

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hemoperitoneum

blood in peritoneal cavity

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what is the initial assessment of trauma patients

FAST

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advantages of FAST US

BANG
- beside imaging
- available
- no radiation
- guides insertion tubes & catheters

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disadvantages of FAST US

LOL
- Limited visualization in big patients or GI gas accumulation
- Operator dependent
- Low reproducibility

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advantages of x-ray

ABC
- available
- beside imaging
- cheap

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disadvantages of x-ray

RPL
- radiation
- patient must hold still
- limited specificity & sensitivity

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advantages of MRI

SHN
- SST visualization
- high sensitivity & specificity
- no radiation

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disadvantages of MRI

not easily available
long duration
costly
contraindicated with metal implants

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advantages of CT

EVC
- Evaluates multiple organs
- Visualizes pathologies beyond XR & US
- Contrast medium enhances evaluation

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disadvantages of CT

radiation
allergic reactions

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types of errors in trauma imaging

input, intention, execution

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causes of errors made in trauma imaging

TIMU
- time critical decisions with concurrent tasks
- incomplete history
- mass causalities
- unstable patients

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GCS

glasgow coma score

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what is GCS used for

summary to determine impaired consciousness extent of patients but less detailed

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what does GCS assess

eye opening
verbal response
motor response

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CT trauma preparation

triage > transfer > ct scan

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what is the IV access for trauma patients

18G & 22G cannula

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what is checked at triage phase of patient prep

FAST Scan
IV access
creatinine & eGFR

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c4 injury leads to

complete paralysis below neck

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c6 injury leads to

partial paralysis of upper & lower limbs

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t4 injury leads to

paralysis below chest

L1 injury leads to

paralysis below waist

what injuries lead to paraplegia

T4 & L1

what injuries lead to tetraplegia

C4 & c6

complete lesion defined as

no sensation / motor injury in lowest part of spinal cord S4/5 and no motor function at least 3 levels below spinal cord injury

incomplete lesion defined as

some sensation or voluntary movements below level of spinal cord injury

CT head indication

assess for traumatic brain injury

CT C-Spine indication

CXR AP & Lateral C-spine inconclusive

CT thorax & abdomen pelvis indication

patient hemodynamically stable & need to find active bleeding source

scan region for CT head

base of skull > vertex

scan region for CT cervical spine

craniocervical junction > T1

scan region for CT thorax abdomen

thorax and/or abdomen

algorithm for CT head

brain SST & skull

algorithm for CT cervical spine

bone

algorithm for CT thorax abdomen

SST, Lung, Bone

CTA

CT angiography

how does CTA work

CT + IV contrast to visualize blood vessels anatomy & flow to diagnose vascular diseases

purpose of CTA

- detailed visualization - diagnosis - pre & post operative use - non-invasive alternative

aneurysms

outward bulge of blood vessel wall

stenosis

narrowed blood vessels = lower blood flow

occlusions

blood vessel blockage

embolisms

blood vessel blocked by blood clot

conventional diagnostic angiography is used for

interventional procedures unless tiny vessels to be studied due to invasiveness

magnetic resonance angiography provides excellent diagnostic quality for patients with ___

adverse reactions to CT contrast

disadvantage of magnetic resonance angiography is ___

poor resolution on vascular studies and subject image artifacts from metal / blood flow studies

which cannula used for CT angiography

18G

methods to optimize timing of CM injection to enhance images

fixed delay, bolus tracking, test bolus

fixed delay is __

predetermined delay between CM injection & start scan

bolus tracking is __

scanner continuously monitors ROI till desired enhancement reached from arrival of contrast bolus

test bolus is ___

small CM injection followed by series of low-dose scans to determine optimal timing for full contrast injection & scans

peak enhancement time of pulmonary artery

10 - 15s

peak enhancement time of arterial phase

25 - 40s

peak enhancement time of portavenous phase

80 - 90s

essentials for CTA

- large cannula access (18G/20G) - thin slices to reformat MIP images - high table speed

To ensure proper circulation timing, scanners use either ____ or ___

mini test bolus; automatic bolus tracking software

data acquisition of CTA

1. scout / topogram 2. arterial contrast IV injection 3. CM timing 4. data acquisition 5. post processing

scan range of CT brain & carotid angiogram

aortic arch > vertex

pre-monitoring slice ROI of CT brain & carotid angiogram

aortic arch

scan range of CT aortogram

aortic arch > R & L iliac arteries

pre-monitoring slice ROI of CT aortogram

ascending aorta

aortic dissections

tear in internal face of aorta causes dissection through laminas & new lumen formation

what separates true & false lumina

dissection flaps

stanford type A aortic dissection

flap involves ascending aorta or great vessels

problems of stanford type A aortic dissection

urgent surgery due to occlusion risk & aortic valve regurgitation / rupture into pericardium

stanford type B aortic dissection

flap involves descending aorta

scan range of CT pulmonary angiogram

lung apex > lung base

ROI of CT pulmonary angiogram

pulmonary trunk

scan range of CT coronary arteries angiogram

carina > cardiac apex

ROI of CT coronary arteries angiogram

ascending aorta

pre monitoring slice of CT coronary arteries angiogram

mid chest near carina

problems with CT heart imaging

- max temporal resolution at 125ms - ECG trigger/gating - prospective trigger - retrospective scans

prospective sequential ECG trigger

ECG signal used to trigger CT scan at selected heart phase which turns on & off during selected phases

retrospective ECG spiral

acquisition continuous as table moves forward with constant pitch but higher dose

prospective triggering

step & shoot which starts at preset in R-R internal period

pre-monitoring slice of CT angio lower limbs

upper abdomen

ROI of CT angio lower limbs

descending aorta below kidneys

___ slices used for MPR & MIP reconstruction

thin

dual energy techniques

- twin spiral - twin beam - dual source

energy spectra used for dual energy imaging

high (150 kV) & low (90 kV)

advantage of dual energy compared to conventional CT

materials with different elemental compositions can be differentiated and quantified by comparing their CT numbers at two different energy levels

what is gout

monosodium urate crystals deposited commonly at 1st MTP joint

applications of image guided CT imaging

biopsies, drainage, radiofrequency, facet joint corticosteroid injection

commonly biopsied areas

bone, lungs, liver, kidneys, lymph nodes

purpose of CT nerve root block

pain management

why is CT nerve root block performed compared to spinal surgery

minimal invasiveness & lower risk

nerve root block involves injection of ___ anesthetic

steroid & local

complications of image guided CT

- pneumothorax - bleeding - hemoptysis

hemoptysis

airway bleeding

CT Application 5 Trauma Flashcards

(92 cards)