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Trauma is defined as:

a sudden, unexpected, dramatic, forceful or violent event. It is the leading cause of death in the U.S. for persons 1-44 years of age, excluding suicide and homicide related deaths.


The term "Trauma Center" signifies:

a specific level of emergency medical care as defined by the American College of Surgeons- Commission on Trauma.


Trauma centers are categorized:

into five levels of care: Level I-V. Level I is the most comprehensive. Level V is the most basic.


If you are severely injured, access to care at a Level I trauma center lowers your risk of death by:



The "Golden Hour":

the idea that trauma patients have significantly better survival rates if they reach a Level I or II Trauma Center within 60 minutes of their injury.


Less than __% of the U.S. population is within one-hour travel distance from a Level I or II Trauma center.



Level I Trauma Center:

usually a university based center, research facility, or large medical center. Complete imaging capabilities 24/7. All types of specialty physicians are available on site 24 hours a day.


Level II Trauma Center:

typically has all of the same specialized care available, but is not a research or teaching hospital; some specialty physicians may not be available on site.


Level III Trauma Center:

usually located in rural, smaller communities. Does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery and intensive care of most trauma pts. Has transfer agreements with Level I and/or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries.


Level IV Trauma Center:

provides the stabilization and treatment of severely injured patients in remote or rural areas where no alternative care is available.


Several types of forces that cause trauma:

blunt, penetrating, explosive and heat.


Blunt trauma:

injury incurred when the human body hits or is hit by a large outside object (as a car); includes MVA's, which includes motorcycle accidents an collision with pedestrians; falls; and aggravated assaults.


Penetrating trauma:

GSW's, stab wounds, impalement, foreign body ingestion.


Explosive trauma:

Causes injury by several mechanisms, including pressure shock waves, and high velocity projectiles.


Burn trauma:

Burns may be caused by a number of agents including fire, steam and hot water, chemicals, electricity and frostbite.


Universal guidelines during trauma:

Standard Precautions
Attention to Detail Attention to department protocol and scope of practice.


Mobile radiography was first used by:

military for treating battlefield injuries during WWI. Small portable units were carried by soldiers and set up in field locations.


If patients cannot be moved into usual routine positions:

major adaptation of CR angles and image receptor placement is required.


Patients requiring mobile radiography are often:

immobile and among the most sick. Pts may be awake and lying-in bed in traction because of a broken limb, or they may be critically ill and unconscious.


Before entering a pt's room with the machine, the radiographer should follow several important steps:

Announce your presence to the nursing staff, and ask for assistance if needed.
Determine that the correct pt is in the room.
Introduce yourself to pt and family: explain the exam.
Remove obstacles from the path of the mobile machine.


Assessing the pt's condition:

Pt's level of alertness and respiration must be assessed and then determine the extent to which the pt is able to cooperate. Pts may have varying degrees of drowsiness because of their medications or medical conditions.


Keep pt's mobility in mind:

Never move a pt or part of the pt's body without assessing the pt's ability to move, or tolerate movement. Gentleness and caution must prevail! If unsure of pt's condition, check with nursing staff or physician.


The radiographer should never move a limb that has been operated on or is broken unless:

the nurse, the physician, or sometimes the pt grants permission. Inappropriate movement of the pt by the radiographer during the exam may harm the pt.


If the pt's trunk or limb must be raised into position for a projection, the radiographer should have:

assistance so the part can be raised safely without causing harm or intense pain.


IR's must be enclosed in an appropriate, impermeable barrier in any situation in which:

it may come in contact with blood, body fluids, and other potentially infectious material. Approved procedures for disposing of used barrier must be followed.


Principle one of Trauma and Mobile radiography:

Two projections 90º to on another, with true CR-part-IR alignment; may result in two oblique views.


Exceptions with CR-part-IR alignment:

Oblique radiograph of trauma cervical spine, the IR is flat not eh table. Results in some distortion of part.


Principle two of Trauma and Mobile radiography:

Include both joints for all long bones on one IR; include entire trauma area. Make sure divergent beam does not project body part off IR.


Important considerations during trauma exams:

-Time is a critical element.
-Radiographs must be taken with minimal patient movement, requiring more manuvering of the tube and IR.
-Images must b e of high-quality on the first attempt.
-Trauma radiographers must be competent in performing mobile radiography on almost any part of the body.


Exposure factor considerations during trauma/mobile

Use shortest exposure time to minimize motion. Adjust techniques for exposures through immobilization devices and/or pathology.


Positioning considerations during trauma and mobile radiography:

Position stretcher next to upright Bucky.
Enables positioning with minimal pt movement.
Higher ratio grid than portable grids.


Marking radiographs for trauma and mobile radiography:

For penetrating trauma, mark entrance and/or exit wounds with a radiopaque marker. Two exposures at right angles to each other will demonstrate depth, as well as the path, of the projectile.


Sequencing during trauma and mobile radiography:

Perform all laterals first, working top to bottom.
Perform all AP's next, moving bottom to top.


Types of fractures:

dislocation or luxation
fracture (fx)


Dislocation or Luxation:

Displacement of a bone from a joint.
Clinically identified by abnormal shape or alignment of body parts and any movement can be painful.
Must be imaged in two planes 90º ftp each other to demonstrate degree of displacement.


For a dislocated joint, a minimum of 2 projections is required to assess for damage and/or possible avulsion fractures even if:

a bone has relocated itself following the injury.



Partial dislocation of a bone from a joint.


Nursemaid's elbow:

a traumatic partial dislocation of the radial head of a child, caused by a hard pull on the hand and wrist by an adult. Also called "jerked elbow."



A forced wrenching or twisting of a joint, resting in partial rupture or tearing of supporting ligaments without dislocation.


A sprain can result in:

severe damage to blood vessels, tendons, ligaments or nerves.


Severe swelling and discoloration resulting from hemorrhage of ruptured blood vessels often accompany:

a severe sprain.


Radiographs can aid in differentiating sprains from:



Fracture (fx)

a break in the bone


When dealing with a fractured bone, the radiographer must use extreme caution in moving and positioning pt so as not to:

cause further injury or displacement of fracture fragments. NEVER force a limb or body part into position.



Bruising of the bone with a possible avulsion fracture.


And example of a contusion is:

A hip pointer, a football injury involving a contusion of bone at the iliac crest of pelvis.



relationship of the long axes of fracture fragments.


Anatomic apposition:

anatomic alignment of ends of fractured bone fragments, wherein the ends of the bone make end-to-end contact.


Lack of apposition (distraction):

The ends of fragments pulled apart and not making contact (such as may occur from excessive traction.)


Bayonet apposition:

A fracture wherein the fragments overlap and the shafts, but not the fracture ends, make contact.



refers to the loss of alignment


Apex angulation:

describes the direction or angle of the apex of the fracture, such as medial or lateral apex and it is described in degrees.


Varus deformity:

The distal part of the distal fragments angled toward the midline of the body, a lateral apex that points away from the midline.


Valgus deformity:

The apex of the fracture, directed toward the midline (medial apex) and the distal fragment away from the midline.


Simple fracture:

bone does not break through the skin (closed fracture).


Compound fracture:

Bone protrudes through skin (an open fracture).


Incomplete fracture:

Fracture does not traverse through entire bone (examples: torus fx, greenstick fx, plastic fx)


Complete fractures:

(two pieces) transverse fx, oblique fx, spiral fx.


Comminuted fractures:

(two or more fragments) Segmental fx (double type fx), butterfly fx (two fragments) splintered fx (thin, sharp fragments).


Impacted fracture:

One fragment driven into another (ends of bones)


Torus fracture:

incomplete fracture with a buckle of the cortex. Characterized by localized expansion of the cortex. Little or no displacement and no complete break in the cortex. "Soda can" appearance. Most common fx in young children.


Greenstick fracture:

(Hickory or Willow Stick) Fracture is on one side only. Cortex on one side of bone is broken, and other side is bent.


Three major types of complete fractures:

Transverse, oblique, spiral


Transverse fracture:

Fracture is transverse at near right angle to long axis of bone.


Oblique fracture:

fracture passes through bone at an oblique angle.


Spiral fracture:

Bone has twisted apart and the fracture spirals around long axis.


Comminuted fracture:

Bone is splintered or crushed at site of impact resulting in two or more fragments. Three types: Segmental, Butterfly, Splintered.


Segmental fx:

Double fracture with two fracture lines isolating a distinct segment of bone.


Butterfly fx:

Fracture with 2 fragments on each side of a main, wedge-shaped separate fragment. Has some resemblance to wings of butterfly.


Splintered fx:

A comminuted fx where bone is splintered into thin, sharp fragments.


Impacted fx:

One fragment is firmly driven into the other. Most commonly occurs at distal or proximal ends of femur, humerus, or radius.


Barton's fracture:

A dislocation fracture of the radio carpal joint. A fracture at the distal end of the radius and often the ulnar styloid.


Mallet (Baseball) fracture:

fracture of the distal phalanx caused by a ball striking the end of an extended finger. DIP joint is partially flexed, and an avulsion fx is frequently present at the posterior base of the distal phalanx.


Bennett Fracture:

Longitudinal fracture at base of 1st metacarpal.
Extends to carpometacarpal joint.
Generally includes posterior subluxation; significantly displaced; highly unstable fx.
Common football, baskeball fracture.


Boxer's fracture:

A fracture resulting from punching someone or something.
Most commonly involves the distal 5th metacarpal with an apex posterior angulation.
Best demonstrated with a lateral projection.


Colles' fracture:

A fracture of the distal radius of the wrist. Distal fragment is displaced posteriorly. Usually results from falling on an outstretched hand. Most common wrist fracture.


Hangman's fx:

Frature of the arch of c-2 usually accompanied by anterior subluxation of c2 on c3.
Sometimes called "traumatic spondylosis"
Results from acute hyperextension of head.


Hutchinson's fx (Chauffer's fracture):

Name originates from the time when hand-cranked cars would backfire, with the crank striking the lateral side of the distal forearm.
An intraarticuar fracture of the radial styloid process.


Monteggia's fx:

Is a fracture of the proximal 3rd of the ulnar shaft, with anterior dislocation of the radial head.
Proximal and distal injuries to the forearm.
Important to ensure both joints are included on the radiograph.
Results from defending against blows with the raised forearm.


Pott's fracture:

In ankle, the most common injuries are to the malleoli.
Pott's fracture involves both malleoli, with dislocation of the ankle joint.


Smith's (reverse Colles') fracture:

This is a fracture of the distal radius with anterior displacement.


Avulsion fx:

Occurs when a fragment of bone is pulled away from the shaft.
Results from severe stress to a tendon or ligament in a joint region.


Compression fx:

Caused by compression-type injury.
Vertebral body collapses or is compressed.
Evidenced by a decreased vertical dimension of the anterior vertebral body.


Depressed Fracture (ping-pong fx):

Fracture of skull where a fragment is depressed.
Appearance similar to ping-pong ball that has been pressed in by finger.


Epiphyseal fx

Fracture is through the epiphyseal plate, the point of union of the epiphysis and shaft of bone.
One of the most easily fractured sites in long bones of children.


Salter-Harris classification:

commonly used by radiologists to describe epiphyseal fractures.


Pathologic fx:

fractures due to disease process within the bone.
Commonly osteoporosis, neoplasia, or other bone disease.


Stellate fx:

The fracture lines radiate from a central point of injury with a star-like patter.
Most common example of the type of fx is at patella, often caused by knees hitting the dashboard in MVA.


Stress fx:

Result of an abnormal degree of repetitive trauma.
Generally found at point of muscular attachments.
May not be clearly visible on plain radiographs.
NM bone scan or MRI


Fatigue fx:

Occur at sites of maximal strain on a bone.
Most frequently found in metatarsals, particularly the 2nd.
Other names for fatigue fx include "stretch" or "insufficiency" fx.


Trimalleolar fx:

Fracture involving both the media and lateral malleoli and the posterior tip to the distal tibia.


Tuft fx:

Comminuted fx of the distal phalanx.


Realignment of fractures:

Closed reduction and open reduction.


Closed reduction:

Realigned by manipulation and immobilized by a cast or splint; non-surgical procedure.


Open reduction:

severe fractures with significant displacement or fragmentation; surgical procedure is required.


Most trauma pt's must be radiographed in the supine position. If it's necessary to see air-fluid levels, a _____ can be performed.

XTL (dorsal decubitus position)


Mobile chest: Check for signs of ______ or _______ during radiographic exams and report any changes to the attending physician immediately.

respiratory distress/changes in level of consciousness


Mobile chest: Use _______ if wounds and/or bleeding are present and protect IR with ________.

Universal precautions/plastic covering.


Mobile chest: Mark ___________ with radiopaque indicators if evaluating a penetrating injury.

entrance and/or exit wounds


Mobile chest: Use of a _____ improves image contrast.



Mobile chest: Internally rotate arms to prevent:

scapular superimposition in lung fields, if not contraindicated.


Mobile chest: CR is perpendicular to long axis of _____. This prevents clavicles from obscuring apices of lungs.



Mobile chest: R or L lateral decub: Pt placed in ______ poistion. Flexing pt's _____ provides stabilization.

lateral rebumbent. knee.


Mobile chest: R or L lateral decub: Firm support under pt to _______ and prevent pt from sinking into the mattress.

elevate body 2-3 inches.


Mobile chest: R or L lateral decub: Raise both of pt's arms up and away from chest region, preferably above the head. An arm lying on the pt's side can imitate:

a region of free air.


Mobile chest: R or L lateral decub: Position pt for the ____ projection whenever possible. It is much easier to position an ill pt (particularly the arms) for an ____.



Mobile chest: R or L lateral decub: Place IR _____ the pt and below the _____ so the lower margin of the chest can be visualized.



Mobile Abdomen: Place IR in ________ for easier placement under patient, if bedside.

pillowcase or cover


Mobile Abdomen: If a trauma case, ask _____ to assist in transferring pt to radiographic table if possible.

ER personel


Mobile Abdomen: If transfer is unadvisable, obtain assistance to:

carefully lift the pt to position the grid IR under the pt.


Mobile Abdomen: Position grid under pt to demonstrate the abdominal anatomy from _______ to _______.

the pubic symphysis/ the upper abdomen region.


Mobile Abdomen: Keep the grid from tipping by:

placing it in the center of the bed and stabilizing as necessary.


Mobile Abdomen: Use pt's draw sheet to ____; this makes it easier to shift the pt from side to side during positioning of the IR, and it provides a barrier between the pt's skin and the grid.

roll the pt.


Mobile Abdomen: Hypersthenic pt's may require:

two separate projections using a crosswise grid. One grid is positioned for the upper abdomen and the other for the lower abdomen.


Mobile Abdomen: Use of a radiographic table and a Bucky provides optimum image quality. Before moving the pt:

verify transfer to table with attending physician.


Mobile Abdomen: If transfer to radiographic table is not possible:

Use of a grid IR is required.


Mobile Abdomen: Determine the possibility of fluid accumulation within the abdominal cavity to:

determine appropriate exposure factors.


Mobile Abdomen: For pt's with blunt force or projectile injuries, check for signs of:

internal bleeding during radiographic examination and report any changes to the attending physician immediately.


Mobile Abdomen: R or L decubitus projection: Grid should be supported in position and not leaned against pt to prevent:



Mobile Abdomen: R or L decubitus projection: Grid is positioned so that its center is 1-2 inches above the iliac crests to ensure diaphragm is included. Pubic symphysis and lower abdomen:

do not have to be included.


Mobile Abdomen: Dorsal decubitus, lateral position not a common bedside projection…useful for:

demonstrating a possible abdominal aortic aneurysm or as an alternative to the lateral decubitus position if the yet cannot be moved.


Trauma & Mobile Cervical spine: Always perform the ________ projection first.

horizontal beam lateral


Trauma & Mobile Cervical spine: The attending physician or radiologist must:

review this image before performing other projections.


Trauma & Mobile Cervical spine: Swimmer's poistion: Do not move the pt's arms without permission from:

the attending physician and review of the lateral projection.


Trauma & Mobile Cervical spine: Swimmer's Lateral: Position: Start:

Supine, usually on backboard and in a c-collar. Have pt depress shoulder closest to tube as much as possible. Do not push on pt's shoulder.


Trauma & Mobile Cervical spine: Swimmer's: Instruct pt to raise arm opposite:

the tube over his/her head. Assist pt as needed, but do not force or move the limb too quickly. Ensure pt is looking straight ahead without any rotation of head or neck.


Trauma & Mobile Cervical spine: Swimmer's: CR

horizontal and perpendicular centered to C7-T1. A 5 degree caudal angle may be required if pt cannot depress shoulder opposite IR.


Trauma & Mobile Cervical spine: AP Axial

DO NOT perform this projection until the attending physician has reviewed the lateral projection. If pt is on a backboard, either on a stretcher or an X-ray table, gently and slowly lift the backboard and place the IR in position under the pt's head.


Optional AP Axial C1-C2 region when open mouth projection not possible.

Fuch's. Angle CR cephalad 35-40 degrees or as needed to align CR parallel to a line from symphysis of mandible to base of skull.


Trauma & Mobile Cervical spine: AP axial oblique:

Do not use grid IR because the compound CR angle results in grid cut-off.


Trauma & Mobile Cervical spine: AP axial oblique: IR position:

under the immobilization device, centered at level of C4 and the adjacent mastoid process. CR is directed 45 degrees lateromedially. When a double angle is used, angle 15-20 degrees cephalic.


Trauma & Mobile Cervical spine: Where does the CR enter on an AP axial oblique?

slightly lateral to MSP at the level of the thyroid cartilage and passing through C4.


Trauma & Mobile Cervical spine: Oblique method 2:

Angle CR 45 degrees medial and 15 degrees cephalad and center to C4. Place IR at a 45 degree angle just below table height on an adjustable stand or stool.


Trauma and Moble AP Pelvis: grid placement

Ensure the grid is horizontal and parallel to the pt's MCP to minimize distortion and rotation.


Trauma and Moble AP Pelvis: What is often performed following a diagnosis of a pelvic fracture?

An emergency cystogram. Have the necessary equipment and contrast media readily available.


Trauma and Moble AP Pelvis: Up to 50% of pelvic fractures are:

fatal as a result of vascular damage and shock. The mortality risk increases with the energy of the force and the health of the victim.


Pelvic fractures have a high incidence of:

internal hemorrhage. Alert the attending physician immediately if abdomen becomes distended and firm.


Hemorrhagic shock is common with:

pelvic and abdominal injuries. Reassess pt's level of consciousness repeatedly while performing radiographic examinations. Do no attempt to internally rotate limbs for true AP projection of proximal femurs on this projection.


Venipuncture defined as:

the percutaneous puncture of a vein for withdraw of blood or injection of a solute such as contrast media for urographic procedures.


Bolus injection:

provides a rapid introduction of the contrast agent int o the vascular system.


The rate of bolus injection is controlled by:

Gauge of the needle or connecting tubing.
Amount of contrast being injected.
Viscosity of contrast agent.
Stability of the vein.
Force applied by the individual performing the injection.


Drip infusion:

Permits a larger amount of contrast agent to be introduced over a a longer period of time.


Universal precautions are in line to:

protect you from wide variety of pathogens that could cause disease.


Universal precautions are mandated by:

law (OSHA) to report any exposure. If exposed when to using universal precautions, insurance does not cover.


Best defenses against exposure:

Know your pathogens
Hand washing


Hand washing is the most important precaution but most often:



Hand hygiene refers to:

decontamination of the hands using soap and water (for a minimum of 30-60 seconds) an antiseptic hand wash, or an alcohol-based hand rub (about 15 seconds)


Latex gloves do have some:



Nitryl and vinyl gloves are:

not as flexible and pliable, tend to rip


Remember to bandage any open wounds you have have to prevent:

entrance of bacteria and that GLOVES TO NOT PREVENT NEEDLE STICKS!


Sharps container:

Immediately place sharps in container. Make sure not too full. Never put hand in container.


Never recap:



Immediately following an exposure to blood, you should:

Wash needle stick s and cuts with soap and water.
Flush splashes to the nose, mouth, or skin with water.
Irrigate eyes with clean water, saline, or sterile irrigants.
Report the exposure to the department responsible for managing exposures.
Post exposure treatment may e recommended and it should be started ASAP.


Blood borne pathogens

Hep B
Hep C



Acquire Immunodeficiency Virus. Affects about .6% of the population.


The average risk of HIV infection after a needlestick or cut exposure to HIV-infected blood is

.3% (or about 1 in 300).


HIV has a ___ minute life span in spill