Page 151 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
34 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Chest CT will reveal occult pneumothoraces, haemothoraces, pulmonary contusions, thoracic spinal injuries and mediastinal injuries, all of which should be excluded or accurately diagnosed prior to prolonged anaesthesia, transport or positive pressure ventilation.
The presence of an occult pneumothorax or basal pulmonary contusion may often be seen in the uppermost cuts of an abdominal CT.
lndications for Chest CT include:
• Wide mediastinum in a stable patient
• Suspicion of pulmonary contusion
• Suspicion of pneumothorax that is occult to CXR but must be diagnosed prior to transport or positive pressure ventilation
• Suspected thoracic spinal fractures
Brain CT Scanning for Neurotrauma Patients:
CT scanning is the diagnostic test of choice for blunt traumatic brain injury.
All patients with moderate to severe TBI (sustained GCS<14 at any stage) require CT brain. The indications for brain CT scan in patients with mild TBI (GCS>13) are:
• Loss of consciousness >5 minutes
• Persistent neurological signs
• Persistent decrease in level of consciousness
• Unable to clinically assess (anaesthesia, drugs, young children)
• Elderly patient taking anticoagulants
See the Trauma Protocol for the indications and timing of follow up imaging
CT of the Cervical Spine:
In general CT scanning of the cervical spine gives information that is accurate enough to describe all significant injuries and therefore allow definitive clinical decision-making. Scanning of the brain and cervical spine at the same time is rapid and efficient. Returns to the CT scanner for cervical imaging are wasteful of resources and put patients at risk.
Interventional Radiology:
This modality is gaining an increasing important role in trauma management, particularly in early diagnosis and treatment of exsanguination in organ systems where surgical access and haemostasis is challenging and less effective. Angioembolisation can also be used in conjunction with stenting procedures in proximal vascular injuries.
Angioembolisation is both diagnostic and therapeutic, and gives excellent results when applied judiciously. lt is the standard of care for major pelvic exsanguination and is increasingly used for diagnosis and vascular control in many body regions, including:
• Pelvis / retroperitoneum
• Liver/spleen /kidneys
• Chest wall
The technique is usually applied in the context of multiple conflicting priorities and therefore requires expert judgement and careful risk profiling of individual patients around sound clinical principles. The decision-making processes are incorporated into the exsanguinating patient algorithms.