CXR & PXR. in Poly trauma Primary survey
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This document discusses guidelines for interpreting chest x-rays (CXR) and pelvic x-rays (PXR) in patients with polytrauma. It outlines the ATLS and DRS ABCDE approaches for systematically evaluating CXRs. It then provides guidance for interpreting PXRs by evaluating the adequacy and alignment of the image, bones, cartilages, diameters, and any extras such as soft tissues, tubes, or foreign bodies. Specific bones and structures of the pelvis are identified. Common injuries like contrast extravasation, intra-pelvic bleeding, and bladder rupture are also addressed.
CXR & PXR. in Poly trauma Primary survey
- 1. CXR & PXR A Systematic Approach in Polytrauma • Dr Venu Gopalan P P • Director & Lead consultant • Emergency Medicine • Aster DM Healthcare
- 3. 3 of 41 ATLS way
- 4. 4 of 41 DRS ABCDE
- 6. 6 of 41 DRS ABCDE
- 7. 7 of 41 DRS ABCDE
- 8. 8 of 41 DRS ABCDE
- 9. 9 of 41 DRS ABCDE
- 10. 10 of 41 DRS ABCDE
- 12. 12 of 41
- 13. 13 of 41
- 14. 14 of 41
- 15. 15 of 41 A- Adequacy &Allignment B- Bones C –Cartilages D- Diameters E- Extras –Soft tissue , Tubes ,Dye, FB
- 16. 16 of 41 A- Adequacy & Alignment Data Exposure View
- 17. 17 of 41
- 18. 18 of 41
- 19. 19 of 41
- 20. 20 of 41 Ilioischeal line –Posterior column Iliopectineal line – Anterior column Acetabulum
- 21. 21 of 41 B- Bones
- 22. 22 of 41
- 23. 23 of 41
- 24. 24 of 41
- 25. 25 of 41
- 26. 26 of 41 C- Cartilages & Joints
- 27. 27 of 41
- 28. 28 of 41
- 29. 29 of 41
- 30. 30 of 41
- 31. 31 of 41
- 32. 32 of 41
- 33. 33 of 41 Pelvis
- 34. 34 of 41 Pelvis
- 35. 35 of 41 pelvis
- 36. 36 of 41 Pelvis
- 37. 37 of 41 Pelvis
- 39. 39 of 41 Intra pelvic bleed With pelvic pack Look at bladder shape
- 40. 40 of 41 Contrast outside the bladder Retroperitoneal bladder rupture
- 41. 41 of 41 Contrast Extravasation
- 42. 42 of 41 Thank you so much For patient listening
Editor's Notes
- #6: Normal chest Xray
- #7: This image does not represent the patient in the scenario, but illustrates the potential causes of desaturation. Note there is no chest tube on this film.
- #8: This patient has bilateral chest injuries. He has residual pneumothorax on the right side and a pulmonary contusion on the left. What would you do next? He would need a second chest tube and may have tracheal bronchial injury.
- #9: 69-year-old woman, restrained driver in MVC, with prolonged extrication. Vital signs: GCS 12, low oxygen saturations, and decreased breath sounds. Crepitus and palpable rib fractures. CXR obtained showing subcutaneous air and pneumothorax. Chest tube placed and found to be kinked. Note eFAST may be difficult to perform when there is significant subcutaneous air.
- #10: 44-year-old male driver in high-speed MVC vs tree. Complains of severe chest pain. History of hypotension. In field now with BP 100/70 mm Hg. Widened mediastinum on CXR.
- #14: PXR – 4 types of mechanism
- #20: Complete the examination of the foramina by tracing along its superior border to the inferior surface of the neck of the femur. This is known as Shenton’s line
- #21: The start point of the examination is the pubic symphysis. Then, slowly progress to the right or left side. Focus on the posterior and anterior joint margin, the ilioischial line (posterior column), and the iliopectineal line (anterior column
- #29: Check for either widening or overlapping of bones at the level of the symphysis pubis (A). If you see one of those, disruption in the pelvic brim should be investigated. Sacroiliac joints (B) at the right and left sides must also be checked for widening, defects in the cortical surface, overlapping of bone, and lack of congruity of the joint margin
- #33: Inlet and outlet views should ideally be requested if there is clinical or radiological evidence of a pelvic fracture. An inlet view looks down the lumen of the true pelvis. It is better than the anteroposterior view for showing the orientation of fractures of the pubic rami. Outlet views are used to detect the degree of vertical displacement of the fracture fragments. Oblique (Judet) views are used to define acetabular fracture patterns. If a fracture or abnormality of the acetabulum is suspected computed tomography will usually be necessary once the patient has been adequately resuscitated and stabilized.
- #34: Normal pelvic x-ray of 46-year-old woman status post T-bone MVC with altered level of consciousness
- #35: APC pelvis fracture. 40-year-old woman, unrestrained passenger in MVC rollover. Patient was pinned under the vehicle at her pelvis and complained of severe pelvic pain. She was hypotensive, and 2 units of PRBCs were transfused. Extensive widening of the sacroiliac joints and pelvic diastasis.
- #36: Same patient after pelvic binder placed. Note the significant decrease of pelvic volume.
- #37: LC fracture. 82-year-old fell down 3 stairs and is complaining of pelvic pain. Imaging shows bilateral inferior and superior pelvic rami fractures and osteopenia.
- #38: Vertical shear fracture. 32-year-old jumped from a 4-story roof. Unconscious and hypotensive. Noticed vertical translation of the pelvis and widened pubis. Left acetabular fractures and right superior and inferior rami fractures.
- #39: Urethragram without flow into bladder and extravasation of contrast material
- #40: 40-year-old motorcyclist withTBI; hypotension; obvious unstable pelvis, with gross hematuria; and perineal ecchymosis. Urethrogram negative, cystogram performed. Shape of bladder indicates pelvic hematoma. No extravasation of contrast is seen. Patient has had pelvis packed for bleeding.
- #41: 38-year-old with gross hematuria following MVC. Contrast is seen outside bladder, but confined to pelvis, making it a retroperitoneal bladder rupture. It is treated by bladder decompression with urinary catheter.
- #42: 34-year-old woman involved in frontal impact MVC with lower abdominal pain and gross hematuria. Contrast extravasation is diffuse and not confined to the pelvis. Represents intraperitoneal bladder rupture. These injuries require laparotomy for repair.