Primary Radiographic Survey in a Trauma Patient

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Primary Radiographic Survey in
a Trauma Patient
Radiological Category
Principal Modality (1) Principal Modality (2)
Emergency
Plain films
CT
Submitted by
Thomas Morgan MS4
Faculty reviewer
Sandra Oldham M.D.
Date accepted
30, August 2007
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Case History

• 25 year old male victim of a high speed, head-on
  MVC w/prolonged extrication
• Restrained driver
• Loss of consciousness
• Intubated en route, transferred to MHH via
  Life-Flight
• Assessment by Trauma team revealed
• Tachycardic, normotensive
• R hemotympanum, L ear laceration, abnormal but
  stable pelvis, no obvious deformity, Glasgow Coma
  Score (GCS) 3

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Radiological Presentations
CXR 2am

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Radiological Presentations
CRX 7am

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AP Pelvis

6

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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ClinicalThe NEXUS criteria state that a
patient with suspected c-spine injury can be
cleared providing the following No posterior
midline cervical spine tenderness is present.
No evidence of intoxication is present. The
patient has a normal level of alertness. No
focal neurologic deficit is present. The
patient does not have a painful distracting
injury.90.7 sensitive for clearing low risk
patients without the need for radiographic
studies.
Clearing a Cervical Spine Injury
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Radiological (plain films)Lateral
View-anterior contour line -posterior contour
line -spinolaminar contour lineEach of these
lines should form a smooth lordotic curve. An
exception occurs in young children who may have a
benign pseudosubluxation in the upper cervical
spine. Check individual vertebrae thoroughly for
obvious fracture or changes in bone density.ADI-
space between dens and atlas lt3mm in adults,
4-5mm in kidsSoft tissue swelling anterior to
vertebral bodiesOdontoid View Important for
visualizing the dens (C2) and looking at the
symmetry between the dens and the lateral masses
of C1. Can also see if the spinous processes are
midline
Clearing a Cervical Spine Injury
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Coronal and Sagittal Views

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CT Neck

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations

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Radiological Presentations
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Hospital Course

• Admitted to STICU
• L chest tube and ventilator support
• Neurosurgery followed traumatic brain injury with
  bolt ICP monitor, but did not operate
• Orthopedics followed but did not operate
• Course complicated by pneumonia and SIADH
• Neurological status improved minimally
• Transferred to Long term care facility

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1. Cervical Spine Injuries. May 11th 2006.
Jorma B. Mueller. Emedicine.com2. American
Academy of Family Physicians. Cervical Fractures
Vol. 52/No. 2 (Jan. 15 1999). Mark. A. Graber
MD, Mary Kathol MD3. Special Thanks to Dr.
Sitton, John Larkin MS4
References