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Trauma Radiology-- the futurethe future

Unstable Patient = Whole Body CT in 90 sec

Bertil Leidner, MDKarolinska University Hospital Huddinge

Anesth docAnesth nurse

radiologist

Rad tech 1trauma-leader

nurse 1 Surgeon

nurse

nurse

rad-tech 2

EmergencyEmergency roomroom workwork--upupspectators

Orthosurgeon

Patient

nurse

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Radiology in multitraumaCirkulatory UNSTABLE patient» In the Emergency Room (ER)» ATLS First survey –ABC –» ER radiology

– Chest– Pelvis– Ultrasound

Radiology in multitraumaCirkulatory UNSTABLE patient» ATLS First survey –ABC –ER radiology

– Chest– Pelvis– Ultrasound

How long time does the patient spend in the Emergency Room?» M = 29 min (range 18-61 min)

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Trauma Radiology before CTSurgeon´s View

X-ray = X-time

Trauma Radiology WITHWITH CTCTRadiologist´s View

STOPSSTOPSXXXXXXXXXXXXXXXXXX

MSCTMSCTXXXXXXXXXXXXXXXX

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Radiology in multitrauma

Circulatory UNSTABLE patient –Emergency Room equipped with MSCT

MSCT in the primary work-up

CT suite & ER combinedPatient transferred directly to the scanningtable from the prehospital careA (+B ?) securedImmediate scanning – no clinical measures» 90 sec from ambulance trolley until scan

completionCT noncontrast survey» 10 sec from pelvis to head» 5 mm axial slices

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First survey - radiology report

Substitutes – chest, pelvic x-rays + ultrasoundAirways» Injury? Airway threat?» Correctly intubated?

Breathing» Pneumothorax, hemothorax, diaphragm

Circulation – source of bleeding to stop» Thorax, abdomen or in retroperitoneum (pelvic fx)

Disability» Unique information cf standard evaluation» Intracranial hematoma to evacuate» Immense value in the intubated/unconscious patient

Clinical work-up

ATLS – ABCDEFull clinical resuscitation» Circulatory stabilized or not

Still bleeding – unstable» Operating Room or Angio-embolization

Stabilized» Standard trauma CT incl iv contrast» Why? Non-contrast exam does NOT exclude

serious injury; artifacts in primary scan» Head, c-spine, thorax-abd-pelvis

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CT suite & ER combined

CT in the Emergency Room

or

Emergency Room in the CT suite

DiscussionOnly critically injured patients» Don´t tie up the scanner» Don´t waste radiation» Additional radiation (+ 1/3)

Secure the total trauma work-up» Too few critical patients

– ProblemPart of the future» Challenges the traditional ATLS routine» Needs to be implemented with the whole

trauma team

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Summary

64 channel MSCT » offers new possibilities

Work in progress» Emergency room CT resource» Non-contrast fast scan as 1st survey» 90 seconds from trolley to diagnosed bleeding

source

Thank you for your attention !