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KEY POINTS
Imaging is a critical adjunct to the comprehensive evaluation of the trauma patient.
Imaging protocols specific to blunt and penetrating trauma victims should be clearly defined and operationalized to enhance rapid imaging and patient throughput.
Modern computed tomography (CT) technology and imaging protocols allow for high-resolution imaging of any body part.
Advanced imaging exams, such as extremity and neck CT angiography, can now be integrated as a part of the initial imaging evaluation of the trauma patient.
Multiphase CT can provide important information regarding the presence and character of vascular lesions, including active bleeding and solid organ pseudoaneurysms.
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Obtaining reliable clinical history and a physical examination may be challenging in the acute trauma patient. Thus imaging can provide timely and helpful information about these patients and identify injuries that otherwise may not be readily recognized. Imaging can be used to assist in injury prioritization and patient triage, as well as guiding the trauma surgeon toward any number of management choices. Despite the advanced imaging technology available in a 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 an experienced integration of their clinical assessment and diagnostic images.
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Practical variables that affect imaging strategies include the proximity of available imaging technology to the resuscitation area, the technical capabilities of the imaging equipment, the experience and availability of radiology technologists performing these imaging procedures, and timely access to expert interpretation and reporting.
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Imaging is typically initiated in the trauma bay and integrated as a part of the clinical survey. However, it should reflect the needs of each individual patient. Hemodynamically unstable patients should be resuscitated prior to imaging according to accepted guidelines and recommendations, with some exceptions for image-guided endovascular hemostasis techniques in select scenarios (eg, resuscitative endovascular balloon occlusion of the aorta [REBOA]). To enhance efficiency, imaging should be obtained 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 and provide superior patient care.
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A single chapter alone cannot reasonably teach interpretation of diagnostic images. Instead, a general overview of trauma imaging strategies is provided. In addition, reflecting current trends in the modern trauma center, an emphasis on advanced computed tomography (CT) technology and capabilities, focusing on select high-yield and common clinical scenarios, is presented.
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INITIAL IMAGING FOR THE ASSESSMENT OF BLUNT TRAUMA
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Imaging of the trauma patient is integrated as a part of the secondary clinical survey in the resuscitation suite. The goal of the initial imaging studies ...