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Trauma Imaging Protocols

Purpose

Rapid Triage And Accurate Detection Of Life Threatening Injuries | Standardized Imaging Pathways For The Emergency Setting

Scope

Primary Survey Imaging | Secondary Survey Imaging | Focused Assessment With Sonography For Trauma FAST | CT Triage Algorithms

Team

Emergency Physician | Trauma Surgeon | Radiologist | Radiographer | Sonographer | Nursing Staff

AP Supine Chest For Tension Pneumothorax Massive Hemothorax And Large Mediastinal Widening | AP Pelvis For Pelvic Fracture And Hemorrhage Screening

Evaluate Pericardial Effusion And Free Fluid In RUQ LUQ Pelvis And Perisplenic Regions | Perform Extended FAST For Pleural And Lung Sliding Assessment

Hemodynamically Stable Patients With Mechanism Suggesting Multi System Injury Proceed To Whole Body CT | Unstable Patients With Positive FAST Or Ongoing Hemorrhage May Proceed To OR

Noncontrast Head CT For Acute Hemorrhage | Contrast Enhanced CT From Skull Base To Mid Thigh With Arterial And Portal Venous Phases As Indicated | Thin Slice Acquisition For Reformats

Bolus Tracking With Arterial Phase For Active Bleeding Or Vascular Injury | Include Delayed Phase When Evaluating For Urinary Tract Or Bowel Injury

Generate Coronal Sagittal And 3D Volume Rendered Reconstructions For Pelvic And Facial Fractures | Provide Structured Trauma Report Highlighting Life Threatening Findings

Noncontrast Axial CT With Thin Slices | Evaluate For Intracranial Hemorrhage Skull Fracture And Mass Effect | Consider CT Angiography For Vascular Injury Or Suspicion Of Dissection

CT Cervical Spine With Thin Slices And Sagittal Coronal Reformats For Trauma Patients | Use NEXUS Or Canadian C Spine Rules To Guide Imaging In Stable Patients

When Full CT Not Feasible, Use Portable Chest And Pelvis Radiographs And Targeted CT Or Ultrasound As Clinically Indicated

CT Chest With Contrast For Aortic Injury And Mediastinal Hemorrhage | Use Expiratory Or Upright Radiographs For Small Pneumothorax When CT Not Available

Contrast Enhanced CT Portal Venous Phase For Detection Of Lacerations Hematoma Active Extravasation And Vascular Injuries | Consider Delayed Imaging For Urinary Tract Injuries

CT Pelvis To Identify Fracture Pattern And Hematoma | If Ongoing Hemorrhage, Proceed To CT Angiography And Consider IR Embolization

Initial Radiographs For Extremity Trauma | CT For Complex Intra Articular Fractures And Preoperative Planning | 3D Reconstructions For Pelvic And Facial Fractures

CT For Fracture Characterization | MRI For Spinal Cord Compression Ligamentous Injury And Neural Element Assessment

Use Pediatric Dose Protocols Reduce Scan Range And Consider Ultrasound Or Plain Radiographs When Appropriate | Tailor Contrast And Acquisition Parameters To Size

FAST Is Valuable For Rapid Detection Of Free Fluid | Ultrasound Preferred For Solid Organ Assessment When Feasible To Avoid CT

Rapid Communication With IR For Pelvic Or Solid Organ Bleeding | CT Angiography To Localize Bleed Followed By Angiographic Embolization

Provide Surgeons With 3D Reconstructions And Key Measurements | Use Intraoperative Fluoroscopy Or Portable CT As Needed

Establish Clear Pathways For Immediate Communication Of Life Threatening Findings To The Trauma Team | Use Structured Reports And Phone Or Pager Notification

Include Airway Breathing Circulation Findings Head And Spine Chest Abdomen Pelvis Extremities And Vascular Injuries | Highlight Active Bleeding And Need For Immediate Intervention

FAST

Focused Assessment With Sonography For Trauma | Rapid Bedside Ultrasound For Free Fluid And Pericardial Effusion

Pan Scan

Whole Body CT From Head To Mid Thigh Often Used In Major Trauma Evaluation

CT Angiography CTA

Contrast Enhanced CT Focused On Vascular Structures To Detect Active Bleeding Or Vascular Injury

ALARA

As Low As Reasonably Achievable | Apply Especially In Pediatric And Repeat Imaging

IR Embolization

Minimally Invasive Endovascular Procedure To Control Hemorrhage