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Hay, hay…..CTA!!*
*(Warning: bad pun)

Craig Hore
Intensive Care Unit
Liverpool Hospital
For the city slickers…..
MIST
M:
75 yr old male brought to by helicopter after
getting head trapped between tractor hydraulic
mechanism and hay bal...
MIST
S:
Ü  BP= 140/75
Ü  GCS = 15
Ü  RR 25

HR= 63
Sats 96%

T:
Ü  Fentanyl
Ü  Ondansetron
Ü  Sandbags and tap (not ...
Primary Survey
A
Ü 

Patent; no stridor

Ü 

Neck - sandbags and tape in situ

Ü 

Expectorating blood

B
Ü 

SpO2 96%...
Primary Survey
C
Ü 

Well perfused; CRT < 2sec

Ü 

PR 63 bpm BP 140/75

Ü 

Pelvis stable Abdo SNT

D
Ü 

GCS 15 PEAR...
Immediate management
Ü  IV access:

- Bloods taken
Ü  Immobilisation
Ü  O2
Ü  Warming:

- Warmed IV Fluids
- Warming b...
Secondary survey
Ü  HEAD:
- 

Loose teeth, bleeding from mouth

Ü  NECK:
- 

No central C-spine tenderness

- 

Sandbags...
Secondary survey
Ü  ABDO:

- SNT; normal FAST
Ü  PELVIS:

- stable; plain X-ray normal
Ü  LIMBS:

- NAD
Ü  BACK:

- NA...
Where to next?
Radiology department
Ü  CT BRAIN (14:50):

- no acute intracranial abnormality

Approx Injury Time:
Dispatched:
Arrive sc...
Any other images?
Why or why not?
Radiology department
Ü  CT CAROTID ANGIO:

Approx Injury Time:
Dispatched:
Arrive scene:
Depart:
ED:

10.40
10.53
11.40
1...
Radiology department
Ü  C-spine:
-  non-displaced fracture through right C2 lateral mass

traversing the transverse foram...
Radiology department
Ü  CT CAROTID ANGIO:
-  right vertebral artery dissection
Any other images?
Radiology department
Ü  C-spine MRI (17:19):
-  oedema in the posterior spinal soft tissues of the mid

to upper cervical...
Where to next?
Progress
Ü  Admitted to surgical ward
Ü  Vascular surgery and interventional radiology

review:

-  observation
-  not f...
CTA neck - indications?
Screening criteria CTA Neck
(blunt CVI)
Ü  Injury Mechanism:

Severe cervical hyper-extension, rotation or
hyperflexion a...
Screening criteria CTA Neck
(blunt CVI)
Ü  Physical signs:
-  seat belt abrasion
-  other soft injury of anterior neck re...
Questions?
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax
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BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax

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Craig Hore talks us through a case based discussion on trauma and CTA of the neck and thorax; and all in under 15 minutes! This talk was recorded at BCC4.

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Transcript of "BCC4: Craig Hore on Trauma: CTA of the Neck and Thorax"

  1. 1. Hay, hay…..CTA!!* *(Warning: bad pun) Craig Hore Intensive Care Unit Liverpool Hospital
  2. 2. For the city slickers…..
  3. 3. MIST M: 75 yr old male brought to by helicopter after getting head trapped between tractor hydraulic mechanism and hay bale lifting apparatus (approx. 4 inch gap) Previously fit and well I: Ü  Lateral and anterior neck injuries Ü  Head injury Ü  Facial bone injuries Approx Injury Time: Dispatched: Arrive scene: Depart: ED: 10.40 10.53 11.40 12.08 13.04
  4. 4. MIST S: Ü  BP= 140/75 Ü  GCS = 15 Ü  RR 25 HR= 63 Sats 96% T: Ü  Fentanyl Ü  Ondansetron Ü  Sandbags and tap (not tolerating cervical neck collar) Approx Injury Time: Dispatched: Arrive scene: Depart: ED: 10.40 10.53 11.40 12.08 13.04
  5. 5. Primary Survey A Ü  Patent; no stridor Ü  Neck - sandbags and tape in situ Ü  Expectorating blood B Ü  SpO2 96% Ü  RR = 25 Ü  Trachea midline Ü  No chest wall tenderness Ü  Equal breath sounds bilaterally Approx Injury Time: Dispatched: Arrive scene: Depart: ED: 10.40 10.53 11.40 12.08 13.04
  6. 6. Primary Survey C Ü  Well perfused; CRT < 2sec Ü  PR 63 bpm BP 140/75 Ü  Pelvis stable Abdo SNT D Ü  GCS 15 PEARL E Ü  •  Logroll NAD
  7. 7. Immediate management Ü  IV access: - Bloods taken Ü  Immobilisation Ü  O2 Ü  Warming: - Warmed IV Fluids - Warming blanket Ü  ADT given • 
  8. 8. Secondary survey Ü  HEAD: -  Loose teeth, bleeding from mouth Ü  NECK: -  No central C-spine tenderness -  Sandbags and tape -  Bilateral swelling and ecchymoses of the lateral neck Ü  CHEST: NAD • 
  9. 9. Secondary survey Ü  ABDO: - SNT; normal FAST Ü  PELVIS: - stable; plain X-ray normal Ü  LIMBS: - NAD Ü  BACK: - NAD • 
  10. 10. Where to next?
  11. 11. Radiology department Ü  CT BRAIN (14:50): - no acute intracranial abnormality Approx Injury Time: Dispatched: Arrive scene: Depart: ED: 10.40 10.53 11.40 12.08 13.04
  12. 12. Any other images? Why or why not?
  13. 13. Radiology department Ü  CT CAROTID ANGIO: Approx Injury Time: Dispatched: Arrive scene: Depart: ED: 10.40 10.53 11.40 12.08 13.04
  14. 14. Radiology department Ü  C-spine: -  non-displaced fracture through right C2 lateral mass traversing the transverse foramen laterally -  non-displaced fracture of the base of spinous process and a displaced fracture of transverse process of C3 on the right side -  non-displaced fracture of the transverse process of C4 bilaterally traversing the transverse foramina -  fracture through the transverse foramen of C5 on the left
  15. 15. Radiology department Ü  CT CAROTID ANGIO: -  right vertebral artery dissection
  16. 16. Any other images?
  17. 17. Radiology department Ü  C-spine MRI (17:19): -  oedema in the posterior spinal soft tissues of the mid to upper cervical spine -  raises possibility of ligamentous injury
  18. 18. Where to next?
  19. 19. Progress Ü  Admitted to surgical ward Ü  Vascular surgery and interventional radiology review: -  observation -  not for anti-coagulation Ü  PCA fentanyl Ü  Fax / max for mandibular fractures Ü  Neurosurgical review: -  cervical collar for six weeks
  20. 20. CTA neck - indications?
  21. 21. Screening criteria CTA Neck (blunt CVI) Ü  Injury Mechanism: Severe cervical hyper-extension, rotation or hyperflexion associated with: -  displaced midface or complex mandibular fracture -  closed head injury consistent with diffuse axonal injury -  near hanging resulting in hypoxic brain injury
  22. 22. Screening criteria CTA Neck (blunt CVI) Ü  Physical signs: -  seat belt abrasion -  other soft injury of anterior neck resulting in significant swelling or altered mental status -  fracture in proximity to ICA or vertebral artery -  basilar skull fracture involving carotid canal -  cervical vertebral body fracture Ü 
  23. 23. Questions?
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