patient management in radiology department i.e., handling patient with trauma , unconscious and amputated limbs in radiography.

2. Table of content
• Introduction
• Radiographer’s Role as Part of the Trauma Team
• Guidelines for Handling the patients who have severe trauma
• Handling in various aspects
• Transferring technique for spine
• Signs and symptoms of unconsciousness
• First Aid Guide for unconscious patients
• Indications of Amputation
• Handling of amputated limbs
• Precautions for Radiography of amputated part
• Conclusion
• Questions

3. Introduction
• Trauma is defined as a severe injury or damage to the body caused by
an accident or violence.
• Victims of trauma require immediate and specialized care, which is
commonly provided in larger hospitals within a specialized unit,
termed the emergency department (ED).
• Golden hours for trauma is first 60 mins
• Golden hours for stroke is 4.5 hr -6 hr (window period)

4. The main steps in early management of
trauma :
• Primary assessment
• Secondary assessment

5. Primary assessment (ABCDE)
• A- Airway with in line cervical spine immobilization
• B- Breathing and ventilation with oxygen supplementation
• C- Circulation with hemorrhage control
• D- Disability- neurological status, as expressed by the patient
• E- Exposure of the entire body, looking for occult injuries and
environmental factors

6. Secondary assessment(AMPLE)
• A- Allergies
• M- Medications(especially anticoagulants, insulin and cardiovascular
medications)
• P- Previous medical/surgical history.
• L- Last meal(time)
• E- Event- details regarding the bio mechanism of injury

7. Radiographer’s Role as Part of the
Trauma Team
• The role of the radiographer within the ED ultimately depends on the department
protocol and staffing and the extent of emergency care provided at the facility.
Regardless of the size of the facility, the primary responsibilities of a radiographer
in an emergency situation include the following:
• Perform quality diagnostic imaging procedures as requested
• Practice ethical radiation protection for self, patient, and others
• Provide competent patient care
Ranking these responsibilities is impossible because they occur simultaneously, and
all are vital to quality care in the ED

8. PATIENT PREPARATION
• Remembering that the patient has endured an emotionally disturbing and
distressing event in addition to the physical injuries he or she may have
sustained is important. If the patient is conscious, speak calmly and look
directly in the patient’s eyes while explaining the procedures that have been
ordered.
• Check the patient thoroughly for items that might cause an artifact on the
images. Explain what you are removing from the patient and why. Place all
removed personal effects, especially valuables, in the proper container used
by the facility (i.e., plastic bag) or in the designated secure area. Each
facility has a procedure regarding proper storage of a patient’s personal
belongings. Know the procedure and follow it carefully.

9. BREATHING INSTRUCTIONS
• Most injured patients have difficulty following the recommended
breathing instructions for routine projections.
• If a breathing technique is desired, this can be explained to a conscious
trauma patient in the usual manner.
• If the patient is unconscious or unresponsive, careful attention should be
paid to the rate and degree of chest wall movement.
• If inspiration is desired on the image, the exposure should be timed to
correspond to the highest point of chest expansion. Conversely, if the
routine projection calls for exposure on expiration, the exposure should
be made when the patient’s chest wall falls to its lowest point.

10. RADIATION PROTECTION
• One of the most essential duties and ethical responsibilities of the trauma radiographer
is radiation protection of the patient, members of the trauma team, and the
radiographer himself or herself. Common practices should minimally include the
following:
• Close collimation to the anatomy of interest to reduce scatter
• Gonadal shielding for patients of childbearing age (when doing so does not interfere
with the anatomy of interest)
• Lead aprons for all persons that remain in the room during the procedure
• Exposure factors that minimize patient dose and scattered radiation
• Announcement of impending exposure to allow unnecessary personnel to exit the
room

11. Transfer
1. In the imaging department we are often faced with the challenge of
difficult patient transfers. Employing proper lifting techniques
prevents back injuries
2. Proper body mechanics and lifting techniques are the key to avoiding
injurie

12. Proper body mechanics and lifting
techniques are the key to avoiding injurie
• Maintain a wide base of support
• Keep your feet apart
• Place one foot slightly a head of the others
• Flex your knees to absorb jolts
• Turn with your feet

13. Transferring
Devices
• Transfer Belt
• Transfer Boards
• Draw Sheet
• Hospital Bed Mattress
• Hydraulic Lifts

14. Methods
• There are essentially three ways of transferring patients:
• By Gurney
• By Wheelchair
• By Ambulation.

15. General guidelines
General guidelines to follow when caring for a patient who has traumatic injuries are as follows:
1. Do not remove dressings or splints.
2. Do not move patients who are on a stretcher or backboard until ordered to do so by the physician in
charge of the patient.
3. When performing an initial cross-table lateral cervical spine radiograph, never move the patient’s head or
neck or remove the cervical collar. The physician must interpret the radiograph and “clear” the cervical spine
for injury before removing the collar or moving the patient.
4. Request direction from the emergency room team when planning moves, and assemble adequate assistance
to move the patient safely and as painlessly as possible.
5. Do not disturb impaled objects. Support them so that they do not move as you image the patient.
6. Do not remove pneumatic antishock garments.
7. Have oxygen, suction equipment, and an emesis basin ready for use.
8. Work quickly, efficiently, and accurately to minimize repeat radiographs.
• Include all anatomy of interest

16. THE PATIENT WITH A HEAD INJURY
Radiographer’s Reponses
1. Keep the patient’s head and neck immobilized until the physician
rules out injury to the spinal cord.
2. If possible, elevate the patient’s head 15 to 30 degrees.
3. Do not remove sandbags, collars, or dressings. Take all radiographs
with these in place.
4. Do not flex the patient’s neck or turn it to either side. Rotation of
the head may increase intracranial pressure

17. THE PATIENT WITH A FACIAL INJURY
• Radiographer’s Response
1. Observe for airway obstruction. Watch for noisy labored respiration.
2. Do not remove sandbags, collars, or other supportive devices or move a
patient unless supervised by the physician.
3. Apply a sterile pressure dressing if bleeding is profuse, and call for
assistance.
4. Position the face properly as possible as we can
5. Wear sterile gloves if in contact with open wounds.
6. If you find teeth that have fallen out, place them in a container
moistened with gauze soaked in sterile water.
7. Immobilize with taping

18. THE PATIENT WITH A SPINAL CORD INJURY
• Radiographer’s Response
1. Monitor vital signs.
2. Maintain an open airway. If respirations change, notify the
physician at once and call for assistance. If in respiratory failure, use
jaw downward. Do not tilt the head.
3. Do not allow or request the patient to move when performing
radiographs. Patient must be log rolled with a synchronized move
supervised by the physician.
4. Do not move the patient’s head or neck if position is awkward.

19. Cervical injury
• 10-20% patients with head injury also have a cervical spine injury.
• The majority of patients are imaged while being immobilized in a cervical spine
collar. If the CT is reported as negative, the collar is typically removed (cervical
spine collar clearance). A select few patients nevertheless require further assessment
with MRI.
Precautions for cervical injury
• When cervical collar placed for immobilization ,
• Check for metal implants / history of implants
• Oxygen supply
• Handling and transferring techniques are more important (same time)
• Maintaining consistent motion
• VR IMAGES
“DO NOT ATTEMPT TO STRAIGHTEN THE NECK”

20. HARD COLLAR SOFT COLLAR

21. A LOG ROLL TECHNIQUE
• Method of turning patients following neurosurgical procedures when the
spine must be maintained in alignment. Two persons use a sheet
to turn the patient as a unit; if the patient is unable to support the
head, a third person is necessary.
Steps :
• Enlist 3 or 4 people to help, with a leader positioned at the injured
person’s head, other helpers kneeling to one side, and one in charge of
sliding the stretcher under the person.
• Roll the injured person onto their side, keeping the head and neck
aligned with the body, and place the injured person on the stretcher.

22. Get in your positions to move
the injured person • The other 3-4 helpers should be
kneeling on one side of the
injured person.
• Each helper will be in control of
moving a different portion of the
injured person's body, and the
helpers should be spread out
evenly.
• One helper should be designated
to slide a stretcher under the
injured person as the rest of the
helpers roll them on their side.
• This helper should be kneeling on
the opposite side of the injured
person's body.

23.  On the leaders command, the helpers
will roll the injured person onto their
side.
 Each helper must place one hand
under the injured person's back, and
reach their other arm across the top
of the injured person's body to grab
the side opposite side of them.
 The helpers will then roll the injured
person toward them, so that the
injured person ends up on their side
 As the helpers move the injured
person, the leader must keep the
head and neck aligned with the body.
Roll the injured person onto their side.

24. 😉 Once the injured person
has been rolled onto their
side, the designated helper will
slide the stretcher underneath
them.
😊 The rest of the helpers will
then roll the body back down
onto the stretcher.
Place the injured person on stretcher

26. THE PATIENT WITH ABDOMINAL TRAUMA
Radiographer’s Response
1. Do not remove antishock garments.
2. If the patient has open wounds, wear gloves; sterile gloves are indicated
if in direct contact with the wound.
3. Call for assistance if the patient is too ill to help you move him or her.
4. If the patient is unable to stand for upright exposures or maintain the
position on a tilt table, use other means of obtaining necessary
radiographic images.
5. Transport the patient by gurney.
6. Have an emesis basin and tissues prepared in case the patient vomits.
7. Do not give the patient anything to drink or eat

27. EMESIS BASIN
ANTISHOCK GARMENTS

28. Often, patients will
have some type of
medical equipment,
i.e.:
• Infusion catheters and pumps
• Oxygen: cannula, mask or
tracheal intubation.
• Nasogastric or nasoenteric
• Urinary catheters
• Always check a patient’s O2
tank setting
• Always communicate with your
patient even if they seem
unresponsive!

29. Unconsciousness
• Unconsciousness is a state in which a patient is totally
unaware of both self and external surroundings, and
unable to respond meaningfully to external stimuli
• Unconsciousness is an abnormal state in which a person is not
alert and not fully responsive to his/her surroundings. Levels of
unconsciousness range from drowsiness to collapse and may
range in severity from fainting to coma

30. Signs and Symptoms
A person who is unconscious may be:
• Drowsy or disoriented; he/she may come in and out of consciousness.
• Confused and incoherent.
• In a coma; he/she may be completely motionless.

31. First Aid Guide
If you find an unconscious person, try to determine what caused the loss of
consciousness.
Check the person's airway, breathing, and circulation.
If you do not think there is a spinal injury, put the person in the recovery position:
1. Kneel beside them. Make sure they are face up and straighten their arms and
legs.
2. Take the arm closest to you and fold it over their chest.
3. Take the arm farthest from you and extend it away from the body.
4. Bend the leg closest to you at the knee.
5. Support the patient's head and neck with one hand. Hold the bent knee, and
roll the person away from you.
6. Tilt the patient's head back to keep the airway clear and open.

32. LEFT LATERAL RECUMBENT POSITION.

33. Who Should Not Be Put in the Recovery Position
• The recovery position is widely used in first aid
situations, but there are some situations when it is
not appropriate. In some cases, moving a patient on
their side or moving them at all could make their
injury worse.
• Do not use the recovery position if the patient has a
head, neck, or spinal cord injury.
• For children under age 1, Place the baby face down
across your forearm. Make sure to support the
baby's head with your hand.

34. Amputation
• The term amputation refers to the disconnection of all or part of
a limb from the body. Specifically, amputation is defined as the
removal of the structure through a bone. This is in contrast
to disarticulation, which is the removal of the structure through a
joint.
• Whereas surgical amputation is a controlled procedure that
allows reconstruction of the stump (for function or use with
prostheses thereafter). Amputations can also be congenital and
autoamputation can also occur in the diabetic foot

35. Indications of Amputation
• Trauma - RTA, Gun shot
• Malignant tumors
• Nerve injuries & infection
• Extreme heat & cold - burn, gangrene
• Peripheral vascular insufficiency
• Congenital absence of limbs or malformation
• Severe infection

36. Handling of amputated limbs
Pain management
• The pain is made worse by movement of the limb, pressure in the area of
the wound, swelling (edema).
• Pain in the postsurgical period can be controlled with medications and
through the use of physical modalities
• Physical interventions can also provide significant pain control.
• The limb should be elevated for one or two hours, two or three times each
day to reduce local edema or swelling .
• Elevation should be used to control swelling and limit pain.
• Compressive elastic bandages can be worn on the stump to control
swelling.

37. Handling of amputated limbs
• Gentle handling of the amputated part.
• All unnecessary movements should be avoided
• If visible dirty, clean with normal saline.
• The stump should be covered with a saline.
• Moistened sterile dressing to prevent further
contamination.
• Place the part in dry plastic bag.
• Ice should be avoided as it can lead to frostbite
and freezing.
• Radiographs of the amputated part and proximal
stump should be obtained.

38. Precautions for Radiography of amputated part
• Immobilization of amputated part.
• Removal of prosthetics
ANGIO
• During angio appropriate FOV covered
• Immobilization
• Using sorbitrate.
During pre surgery of amputee, there is a
necessary to place clipping of vessels and
undergoes contrast, otherwise it leads to
extravasation of contrast.

39. Conclusion
The primary responsibilities of a radiographer in an emergency situation
include the following:
• Perform quality diagnostic imaging procedures as requested
• Practice ethical radiation protection for self, patient, and other personnel
• Provide competent patient care
• Unconscious: Recovery Position
• Immobilization of amputated part.
• Removal of prosthetics
• Pain management

40. Questions ?
• A log roll technique used for ?
• Sorbitrate ?
• Antishock garments?
• Responsibilities of a radiographer in an emergency situation?

41. References
• Care of the patient in diagnostic radiography. by: Chesney,
D. Noreen; Chesney, Muriel O., joint author. Publication date:
1978.
• Patient Care in Imaging Technology Seventh Edition BY LILLIAN S.
TORRES, ANDREA GUILLEN DUTTON,
• https://www.verywellhealth.com