Discuss utility of CT vs US in trauma
EFAST
Adv
- Done at bedside, suitable in unstable pt
- Immediate results
- Repeatable easily
- Good for quantification of intraperitoneal blood loss i.e. need for laparotomy
Disadv
- Difficult in obese pt, not fasted, bowel gas may obscure
- Fluid not always blood e.g. ascites, physiological, urine from bladder rupture
- No info on solid and non-solid viscera as CT
- Operator dependent, needs experience, expertise
- Less sensitive for less severe injuries/small haemoperitoneum than CT
CT abdo/pelvis + IV contrast
Adv
- Reliably excludes intra-abdo haemorrhage that requires surgery
- Provides anatomical info to grade injuries to determine OT mx
- Determines if intra-abdo fluid is blood, by active blush (post contrast)
- Visualises retroperitoneal structures and bony structures i.e. pelvis (not seen on DPL or US)
- Low false negative rate for significant injury
- Lower complications than DPL
Disadv
- False negatives for bowel injury – only 80% sensitive for small bowel injury
- Only 60% sensitive for pancreatic injury, lower for pancreatic duct
- Limited sensitivity for diaphragmatic injuries
- May not be suitable in very unstable patients
- Radiation – women/children
- Contrast and risks
Contraindications to thrombolysis
bleeding diasthesis
previous ICH
Intracranial malignancy
GI bleeding
aortic dissection
ischaemic stroke within 3 months
significant facial/head trauma within 3 months
NEXUS
Neuro deficit
Spinal midline tenderness
Altered GCS
Intoxication
Distracting injury
Hypoglycaemia treatment RCH
2mL/kg D10W
IO G
IM glucagon
Atropine
10 mcg/kg
Tox risk assessment
ADDICT Treatment
Agent exposed
Dose IR vs SR, liquid vs tablet
Diseases PMHx
Ingestion time/exposure
Clinical status eg toxidrome, well/unwell
Toxic effects
Treatment so far, how have they responded ?
