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Improving quality of acute trauma care

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Improving quality of acute trauma care In Radiology Dr R. Nyabanda Radiologist Kenyatta National Hospital 19th April 2013 RADIOLOGY DEPARTMENT VISION To be a world ... – PowerPoint PPT presentation

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Title: Improving quality of acute trauma care


1
  • Improving quality of acute trauma care
  • In Radiology
  • Dr R. Nyabanda
  • Radiologist
  • Kenyatta National Hospital
  • 19th April 2013

2
RADIOLOGY DEPARTMENT VISION To be a world class
centre of excellence in the provision of
innovative diagnostic imaging and interventional
radiology services. MISSION To provide
specialized quality diagnostic imaging and
interventional radiology services, facilitate
medical training, research and participate in
national health planning and policy.
3
JOINT COMMISSION INTERNATIONAL (JCI) ACCREDITATION
STANDARDS FOR HOSPITALS Standards Lists Version
4
trauma in radiology in severely injured patients
5
Management of Severely Injured Patients (SIPs)
  • The acute trauma setting is not the place for
    disagreement about the patient. Immediate
    management decisions must be made by the
    designated trauma leader.
  • The trauma team leader is an overall charge in
    acute care.
  • Just as the trauma team leader must be an
    experienced consultant, there must be a
    consultant in Radiology in charge of trauma.
  • Protol driven imaging and intervention must be
    available and delivered by experienced staff!

6
Location and Facilities
  • Just like in AE, triaging of patients is very
    important.
  • Imaging SIPs more accurately delineates the
    extent of injury than clinical examination.
  • Imaging technique of choice is the one which is
    definitive in trauma setting. In SIPs this is
    most often head to thigh CE-MDCT.
  • The MDCT should be adjacent to emergency room.
  • Radiography must also be present in the emergency
    room
  • The imaging environment requires all the life
    support facilities available in the emergency
    room. This will include monitoring and gases.

7
Radiography
  • CXR-Chest radiograph must be obtained to document
    the position of tubes and lines and to evaluate
    for pneumothorax or hemothorax and mediastinal
    abnormalities
  • AXR or pelvic X Ray are usually irrelevant if
    patient is going in for CT.
  • The British Orthopaedic Association and British
    Society of Spine Surgeons do not recommend plain
    films of the C-spine in a SIP and their standard
    of practice is CT.
  • Cervical spinal injury precautions and pelvic
    binders should remain in place until the MDCT has
    been fully assessed

8
C6
9
Focused Abdominal Sonography in Trauma (FAST)
  • FAST is used to demonstrate
  • - intra-abdominal hemorrhage
  • - Solid organ injuries- spleen, liver,
    kidney
  • - Pericardial effusion

10
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11
MDCT
  • Clear of the need for protocols must exist for
    notifying the CT department urgent imaging and
    how the department will respond to ensure that
    the scanner is clear to receive the incoming
    injured patient.
  • IV assess right antecubital assess is preferred
    for contrast adminstration
  • Radiation dose should be considered

12
Polytrauma protocol MDCT is indicated when
  • There is hemodynamic instability
  • The mechanism of injury or representation
    suggests that there may be occult severe injuries
    that cannot be excluded by clinical examination
    or plain films
  • If plain films suggest significant injury, such
    as pneumothorax, pelvic fractures
  • Obvious severe injury on clinical assessment

13
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14
Interventional Radiology(IR)
  • The role of IR in the SIP is to stop hemorrhage
    as quickly as possible
  • The decision on whether a patient with traumatic
    hemorrhage undergoes endovascular treatment, open
    surgery, a combination of the two or
    non-operative management is typically a decision
    made by both the trauma team leader and
    interventional radiologist after consultation.
  • Interventional treatment modalities include
    Balloon occlusion, transarterial embolization to
    stop hemorrhage.

15
MRI
  • MRI is not indicated in the setting of acute
    trauma care. However availability of clear
    protocols for the transfer of SIPs to MRI
    facilities after stabilizing the patient is
    recommended.

16
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17
No Imaging !
  • There may be circumstances where imaging is
    inappropriate for example, where a SIP is
    admitted with profound shock, is not responding
    to intravenous fluids and the site of bleeding is
    clear from the mechanism of injury and rapid
    assessment. Such patients may be best taken
    straight to theatre.

18
Quality Indicator
  • All imaging should be discussed at debriefing
    meetings and errors of protocol or facts
    discussed at discrepancy meetings
  • Radiologists should ensure they participate in
    ongoing audit and morbidity and mortality
    meetings of trauma services

19
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20
Non-accidental injury
Note massive edema minimally hyper- dense
subdural, extreme mass effect and herniation
despite open fontanelle
21
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24
References
  • Standards of practice and guidance for trauma
    radiology in severely injured patients. Operating
    Framework for the NHS in ENGLAND 2011/2012
  • Ann Osborn. Craniocerebral Trauma update 2010
  • Emergency Radiology, Advanced trauma life support
    ABCDE from a radiology point of view.
  • Emerg Radiol. 2007 July 14(3) 135141
  • McGahan J P, Wang L, Richards J R. Focused
    abdominal US for trauma. Radiographics.
    200121S191S199. PubMed
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