วันอาทิตย์ที่ 15 กรกฎาคม พ.ศ. 2555

Imaging interpretation in trauma

CXR (ABCDEF)

Identify : ผู้ป่วยชื่อ => exposure, quick look

Airway :  Trachea, bronchi: deviate?

Breathing :  Pleural space; ลม-น้ำ? subcutaneous emphysema
                     Lung parenchyma: infiltration (pulmonary contusion, hematoma, aspiration)

Circulation : Heart size, mediastinum

[Signs of aortic rupture: wide mediastinum > 8 cm at T4, mediastinum chest width ratio > 0.38, fx 1st-2nd ribs, obliteration of aortic knob contour, tracheal shift to right, pleural cap, Rt bronchus ยก + shift ขวา, Lt bronchus โดนกด > 140 degree จาก trachea, obliterate space pulmonary artery & aorta, NG shift to Rt at T4, loss of paravertebral pleural stripe, massive Lt hemothorax etc.]

Diaphragm:  Sharpe?: ยก > 4th rib, disrupt -> stomach & bowel in lung, มองไม่เห็น -> มี fluid or soft tissue บัง

Exposure:  Bony & soft tissue -> clavicle (vv.), scapular (vv., lung contusion)
                   Rib 1st -3rd: airway, vv.
                   Rib 4th- 9th: lung contusion, pneumo-hemothorax
                   Rib 10th -12th : spleen, liver, kidney

F Tube & line: ETT, ICD, central line, NG, monitoring

C-spine lateral cross table (ABCDE)

Adequacy & Alingment : เห็น base of skull -> C7 ต่อ T1; kyphosis, loss of lordosis, Ant vertebral line, Post vertebral line, facet joint line, spinous process line

Bone : Vertebral body, spinous process

Cartilage : Facet joint

Disc : ไม่แคบ ไม่กว้าง

E : Prevertebral soft tissue ( C1 < 7mm, C7 < 14 mm)

CT brain

ผู้ป่วยชื่อ……..film CT brain axial with/without contrast

Focus ตาม clinical finding ก่อนแล้วอ่านจากนอก ->ใน

Scalp : Contusion, swelling

Skull : Depress skull fx, open fx, suture line

Sulci/gyri : Symmetry?, Asymmetry (acute subdural: crescent shape; acute epidural: lens shape)

Cerebral/cerebellar : เปรียบเทียบ density & symmetry: ICH, contusion(punctuate area, high density), diffuse axonal inj(scattering area of contusion & low density)

Ventricle : Size & symmetry (esp. Lat ventricle), IVH, decrease size -> intracranial hypertension

Shift : วัดระหว่าง Lat ventricle จาก cista galli Ant -> tent-like projection posterior (inion) if > 5mm: mass lesion need Sx

Maxillofacial : Facial bone, sinus, mastoid air cell, air fluid level -> fx base of skull, cribiform plate fx

*****Increase density “4C” : contrast, clot, cellularity (tumor), calcification

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