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ABC of Imaging in Trauma PDF

ABC of Imaging in Trauma PDF

Preface:

Trauma is a leading cause of morbidity and mortality in the developed world, accounting for 39 deaths per 100 000 population in the United States in 2005 and around 800 000 deaths per year in Europe. Deaths resulting from trauma typically follow a tri – modal distribution (Figure 1.1 ). The fi rst peak, which accounts for 50% of all trauma deaths, occurs within the fi rst few minutes after injury. Very few of these victims can be salvaged and thus prevention is the key to signifi cantly decreasing the rate of immediate deaths. The second peak occurs from a few minutes up to several hours after injury, often due to uncontrolled bleeding, and accounts for 30% of trauma – related mortalities. With appropriate medical care many of these patients can be saved by prompt identifi cation and management of correctable injuries. The last peak occurs days to weeks after the injury. Outcome during this period of late deaths depends in part on how cases are managed in the preceding periods. Recognition that trauma care was previously fragmented and disorganized with poor outcomes has helped to stimulate innovations in trauma care including trained paramedics, advanced trauma life support (ATLS) training for surgeons and in – house response teams in many hospitals. These developments, supported by technological advances including imaging techniques, have led to an improvement in the quality of emergency care.
Nevertheless, motor vehicular collisions, domestic and industrial accidents, assaults, gunshot wounds and injuries related to acts of terrorism continue to challenge the management of trauma by medical teams throughout the world. During the hospital phase of resuscitation, modern technology and medical facilities should complement the physician ’ s clinical skills to improve decision making for trauma patients. There are a number of different imaging modalities that can be used to assist in the management of these patients, each with a variety of strengths and weaknesses. Plain radiographs remain a useful tool, particularly for the assessment of limb fractures and dislocations. In recent years, however, there have been signifi cant developments in the imaging of major trauma, particularly with the introduction of multidetector computed tomography (MDCT), which allows rapid acquisition of detailed whole body cross – sectional imaging. Coupled with advances in post – processing techniques, MDCT now also allows the routine application of computer – generated high – quality multiplaner reformat (MPR) and three – dimensional volume – rendered images in addition to the axial plane images (Figure 1.2 ). This new technology has redefi ned the role of plain radiographs, ultrasound and computed tomography in the evaluation of victims of major trauma. At institutions where the full range of diagnostic imaging facilities are readily available, whole body MDCT has become the imaging investigation of choice in stable patients following the initial ATLS recommended trauma series (chest, lateral cervical spine and pelvis). Some trauma centres are also fortunate enough to have CT within the emergency department and are advocating CT for all but the most unstable trauma patients, a policy which is not suitable for many other hospitals where CT facilities are remote from the resuscitation area or may not be immediately available for an unstable trauma patient. In such circumstances and in more austere situations, alternative imaging strategies will need to be employed, including additional plain radiographs, ultrasound, intravenous urography and on – table in – theatre angiography.

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