Ministry of Health

http://newzealand.govt.nz/

    
 ©Copyright
 Published: 28/11/2011

Trauma Views

The resuscitation room x-rays are as follows:

  Chest X-ray 
(The only x-ray justified in an unresuscitated patient).
The obvious clinical pneumothorax should be treated before a CXR.

  Pelvic X-ray   
A pelvic fracture that is not clinically obvious can be the site of unexplained blood loss. A dislocated hip can be missed in a patient with multiple injuries, especially if unconscious.

  Lateral cervical spine X-ray 
Allows early diagnosis of C-spine injury, but does not clear the C-spine.

The C-spine cannot be cleared in the following circumstances:
    a. history of loss of consciousness
    b. abnormal level of consciousness
    c. intoxication
    d. unable to communicate
    e. head or neck injury
    f. neck symptoms or C-spine tenderness
    g. a distracting injury

When not cleared clinically, radiological examination is required. This is an adequate three view series (and a negative clinical examination in the conscious patient). Swimmers views and/or CT may be required to get full imaging of the neck.

An intubated trauma patient who is already having CT scan SHOULD HAVE CT scan of the neck.

Do not delay urgent surgical interventions to get C-spine X-rays, just treat the spine as fractured. Shocked and unstable patients can die if intervention is delayed. Further x-rays and CT scans are wrong in these patients.