Alex Gehring

Kristen Howe

Kelly Foster

* http://www.mtv.com/photos/rob-dyrdeks-fantasy-factory-season-4-ep-3-the-bleeding-frogs/1662172/6045825/photo.jhtml

*

*March 17th at 1834

hours

*Patient received by

Emergency Department

*TRAUMA ALERT:

shrapnel wound to

lower leg. Transport

by air. ETA 10 mins

http://www.rwjuh.edu/news/trauma-center-06-26-09.html

*

*Always prepare for the worst

*Trauma team geared up..

*Shoe covers

*Gowns

*Gloves

*Begin setting up for protocol trauma xrays

*Chest, Pelvis

*Prepare for additional exams

*

*Pilots bring patient to trauma exam room

*Nurses transfer patient to trauma table

*2nd pilot states medical history

*Nurses begin cutting off clothes and gather vitals

*Sedatives and analgesics administered

*

*Pilot informed the nurse of patients medical history

*23 year old male

*Victim of bomb explosion

*Received shrapnel wound to lower left leg

*2 large lacerations – lateral and posterior leg

*No visible shrapnel still in leg, large piece appearing to go completely through found at site

*Possible Tib/Fib fracture

*Not on any medications

*Moderate blood loss

http://www.cleveland.com/healthfit/index.ssf/2010/10/post_45.html

*

*Emergency room physician

ordered…

*Chest, Pelvis and Tib/Fib

Xrays

http://www.hollywoodmemorabilia.com/authentic-memorabilia/george-clooney-autographed-8x10-photo-er-doctor-actor.html

*

* 14x17 in cassette

* Crosswise

* 72 inches

* Top of IR placed just above shoulders

* 120 KVP @ 4 mAs

http://www.med-ed.virginia.edu/courses/rad/cxr/technique3chest.html

*http://www.radpod.org/2007/01/06/trauma-chest-xray/

*

*14x17 in cassette

*Crosswise

*Top of IR placed 1” above illiac crest

*80 KVP @ 60 mAs

http://www.radiology-equipment.com/prod-info.CFM?LineItemID=1509

*

*

*AP and Cross Table Lateral

*14x17 in cassettes used

*Placed in plastic bag

*Lengthwise

*Centered to tib/fib and to image plate

*Collimated to sides of the legs

*75 KVP @ 4 Mas

*

*

*Multiple pieces of shrapnel in lower

left leg

*Fractured Tibia and Fibula

*Requested CT images be taken

*Bilateral Tib/Fib

*Better look at bone, tissue, and vein

damage

http://completeinjurymanagementlasvegas.com/what-conditions-can-a-chiropractor-help-me-with/hip-pain

*

*The origin of the word "tomography" is from the Greek word "tomos" meaning "slice" or "section" and "graphe" meaning "drawing

*A CT imaging system produces cross-sectional images or "slices" of anatomy

*Based on the variable absorption of x rays by different tissues

*

*Motorized table moves

the patient through a

circular opening in the

CT imaging system

*Source of x rays rotates

around the inside of the

circular opening

http://harryallen.info/?p=2826

*Source of x rays rotates around

the inside of the circular opening

*The x-ray source produces a

narrow, fan-shaped beam of x

rays used to irradiate a section of

the patient's body

*In typical examinations there are

several phases; each made up of

10 to 50 rotations of the x-ray

tube around the patient

http://wn.com/progressive_metal

http://www.youtube.com/watch?v=M-4o0DxBgZk

*Founded in 1970

*Godrey Hounsfield

*Allan Cormack- devolved algorithms

*1972 First EMI CT scanner

*Wimbleton, England

http://www.impactscan.org/background.htm

**Patient brought to CT suite

*Radiologist positioned him on the table

*Straps are utilized to prevent movement

*Patients feet facing gantry

*

*Patient is placed on CT table

*Scout film (scanogram) is

obtained

*

*Technologist then sets the parameters

and begins scans

*1cm above the patella to mid foot

*2 mm slices

*2mm per second table speed

http://www.orthobullets.com/pediatrics/4045/leg-length-discrepancy-lld

**Technologist used..

*Multiplanar reconstruction

* Cornal and Sagital planes

*Window Settings

* Soft Tissue

* Bone

http://www.offenburger.com/copingwithcancer.asp?link=20100713

*

**Patient is brought into surgery suite

*Prepped by nurses

*Sedated by anesthesiologist

*Technologist brings in C-arm

*Tech positions C-arm

*Plugs arm into machine and monitors

http://www.medwow.com/articles/c-arm/tips-for-buying-mobile-c-arm-parts/

*

*C-arm brought into surgery suite

* Image intensifier above patient

*Xray source located underneath patient

* .5 to 5 mAs used

*Low mAs used because of long exposure times

*Scout image obtained

http://www.hgmhospital.org/departments.htm

*

*Metal fragments identified and removed

*Open reduction internal fixation

*http://www.youtube.com/watch?v=qKeJd0j2J4E

http://www.zimbio.com/pictures/cxxAnEFqAMW/Frontline+Hospital+Deals+Afghan+Combat+Casualties/z2CXdBxObG7

*

*

*Doctor removed a 10mm x

15mm piece of skin from

anterior left thigh

*Wound was sutured closed

*Skin was then placed over

exposed area and stapled

http://www.flickr.com/photos/soldiersmediacenter/542492085

http://www.nlm.nih.gov/medlineplus/ency/imagepages/19083.htm

*

*

*Wheelchair 4 months

*Crutches 2 weeks

*Physical Therapy 6 months

http://www.usmagazine.com/celebrity-news/news/charlie-sheen-enters-rehab-2011281

*

*http://www.fda.gov/radiation-

emittingproducts/radiationemittingproductsan

dprocedures/medicalimaging/medicalx-

rays/ucm115318.htm