Imaging of the acute trauma patient is an important adjunct to clinical history and the physical examination, which may be challenging to obtain. Trauma imaging, when appropriately obtained and executed, can provide timely and helpful information about these patients and identify injuries that otherwise may not be immediately apparent. Imaging can be used to assist in patient triage and guide the trauma surgeon to any number of management choices. Despite the advanced imaging technology that is available in the modern trauma center, it is important to recognize that imaging alone cannot be used to make management decisions in isolation; that is, the surgeon must treat the patient based on all of the information obtained as a part of the assessment and not merely treat the images.
Imaging strategies are affected by the proximity of available imaging technology to the resuscitation area, the capabilities of the imaging equipment, the experience and availability of radiology technologists performing emergent imaging procedures, and timely access to expert interpretation and reporting.
The timing of diagnostic imaging should reflect the needs of individual patients and the local system, with imaging initiated in the trauma bay and integrated as a part of the clinical survey. Hemodynamically unstable patients should be resuscitated prior to imaging according to accepted guidelines and recommendations, with some exceptions for image-guided endovascular hemostasis in select scenarios. In order to enhance efficiency, triage priorities for imaging should be based on the acute needs for accurate information that can be used to direct treatment of the patient. Close cooperation and open communication between all major stakeholders, including emergency medicine physicians, traumatologists, consultants, nurses, imaging technologists, and radiologists, are essential to optimize any imaging assessment.
A single chapter alone cannot reasonably teach interpretation of diagnostic images. Instead, a general overview of imaging strategies will be presented, with an emphasis on advanced computed tomography (CT) technology and capabilities, focusing on select high-yield and common clinical scenarios.
INITIAL IMAGING FOR THE ASSESSMENT OF BLUNT TRAUMA
Imaging of the trauma patient is integrated as a part of the secondary clinical survey in the resuscitation suite. Anteroposterior (AP) supine chest and AP supine pelvis radiographs are routinely performed as a part of this initial assessment, if clinical evaluation alone is deemed insufficient (Fig. 15-1). A single view cross table, horizontal beam cervical spine radiograph can be obtained to evaluate for gross malalignment, but should not be used to exclude all fractures of the cervical spine. The goals of these initial imaging studies are to identify life-threatening, but clinically occult, findings that require emergent intervention prior to any further imaging, such as an unstable pelvic fracture, hemopneumothorax, or malpositioned/misplaced support lines and tubes.1
Trauma series. This 27-year-old unrestrained left rear seat passenger sustained multiple injuries, superfluous in a high-speed side-impact crash. ...