Conventional Imaging in Trauma Radiography - Essay Example

Trauma Imaging Over the years, trauma has been the primary cause of death resulting from unexpected violent events in the cause of peoples lives. Normally, such events result to serious injuries or uncontrollable emotional responses that may manifest themselves in the form of flashbacks, and some emotions. Blunt, penetrating and explosive events pose as the principle causes of traumatic injuries. In the event of a traumatic occurrence, it is essential for the injured person to receive rapid diagnosis and treatment within the first hour as this ensures the likelihood of survival (Johnson 2009). This hour (period), where diagnosis and treatment are administered to ensure high survival, is defined as the "Golden Hour". The chances of ensuring victims survival are usually totally dependent during this hour. It is the mandate of the health care professionals to ensure that necessary treatment is administered in a timely manner during this period; not only to treat the victim, but to also prevent further complications, such as the risk of disability. The role of ATLS during the "Golden Hour" ATLS primary focus rotates around assessing the condition of the patient/victim, resuscitating or stabilizing them and establishing whether they need further advanced medical treatment. In order to correctly assess the course of action to be taken, the medical team is required rightfully to determine the cause of a traumatic injury. Traumatic injuries may either be less severe or life threatening, and determining whether it is less severe or life threatening is important in dictating the course of measures to be taken. Less severe traumatic injuries usually leave the victim conscious, and he/she is usually able to talk and respond to questions asked by the medical team. This gives the therapeutic team a clear perspective on how the injury occurred, and the diagnosis is achieved in a timely manner. Usually, it involves imaging of the affected regions to determine the severity of the injury and hence administer the correct treatment, saving the victims life. However, severe life-threatening traumatic injuries usually leave the victim unconscious, making diagnosis relatively difficult. It is in such instances that ATLS plays a major role in saving the victims life as the diagnosis remains relatively ambiguous. During this golden hour, after a severe traumatic injury, the therapeutic team hastily and carefully evaluates the victims situation. The vital signs are thoroughly checked and stabilized/normalized, and a head-to-toe assessment is carried out to correctly set diagnosis required for an adequate therapy procedure. If resuscitation seems unimportant at this stage, then ultra-sonography and chest films are carried out. The importance of doing ultra-sonography is to detect abdominal fluids and determine which organs may have ruptured, while a chest film is essential in providing information about the victims cardiopulmonary status. Victims of severe traumatic injuries, due to their unconscious state have to be subjected to these tests. These scans are important in enabling the medical team to get a clear picture of their condition, in order to act fast and accordingly. These scans play a vital role (Drabek et al. 1971). In the recent time, technological advancements have allowed for full body scans to be undertaken within minutes, and modern medical facilities nowadays are equipped with such facilities. Timely diagnosis, therefore, is achieved, and the correct therapy procedures executed, saving the victims life. In less severe traumatic injuries, however, imaging is targeted to the affected organs, and a timely diagnosis and therapy achieved. It is, therefore, important to carry out ALTS in the golden hour effectively, increasing the chances of the victims survival. The concept of trimodal distribution of death Deaths resulting from trauma normally have a trimodal distribution, in that; they may occur within three stages- the first peak, the second peak, and the third peak. Within the first (main) peak, death usually occurs within minutes of injury. This is usually attributed to major injuries in the vascular and neurological organs. In the instance of attending to victims in the first peak, the medical team has little or no control in preventing the death of the victim. Deaths in the second peak usually occur within an hour after the traumatic injury. It is usually attributed to major abdominal or thoracic injuries or intracranial hematoma. The ATLS methodology primarily focuses on preventing deaths at this stage as their intervention and treatment usually result to positive outcomes in saving the victims life. During the final stage, the third peak, deaths usually occur after an indefinite period following the traumatic injury. It is normally attributed to multiple organ failure and sepsis. Role of conventional imaging in trauma radiography Trauma radiology plays an important part in decreasing the number of casualties for victims of a traumatic injury. Rapid transportation to a hospital or medical clinic guarantees the effectiveness of trauma radiology. Once the victim arrives at the hospital, a radiologist has to be present and ready for carrying out the necessary tests. Multiple x-rays are usually the first steps a radiologist undertakes, focusing on the chest and the pelvic and lateral spine. Further radiology tests are only carried out in case additional complications are detected, and the need for carrying out these tests determined. Medical assistants who are carrying out the trauma imaging radiation need to work within the confines of regulations which require them to perform the imaging process in a competent manner, following the procedure and the required referral criteria. This is explained by the fact that they are solely responsible for the radiation dosage and the outcomes that arise from the procedure. Training and responsibility required for a radiographer Medical perception on how a professional radiographer should perform his tasks plays an important role in the expectation and training from the medical personnel performing their duties as radiologists. With the advancement in technology, it has become very important for radiologists to be adequately trained in performing vital tasks and responsibilities effectively. An effective radiographer needs to move in a professional and organized manner in order to perform his/her tasks to the expected standards (Macgough et al. 2005). Formative formal education has been put in place by medical training institutions so as to ensure that radiologists are at par with new technological equipment. These new equipment are being widely used in radiology imaging, thus ensuring proper decision making by radiologists in terms of diagnosis and managing critically unwell patients. In recent times, radiologists have acquired extended roles and advanced practices in their undertakings. Radiologists have assumed the responsibility of referring victims of traumatic injuries to additional imaging in the result of an abnormal outcome from a scan. According to Snaith and Hardy, the decision-making process and expertise practices need to be undertaken by medical staff. Therefore, the radiologist needs to carry out all the necessary imaging procedures in a professional manner and produce accurate scans required for diagnosis. A major role assumed by radiologists is the sole responsibility of the outcomes of a scan. This ensures that in the event of a misdiagnosis from his scans; he is held responsible for the outcome of the patients health. Training a radiologist comprises both medical trainings, prior to the radiologist title, and continued training in the course of their practice. This ensures that they remain relevant to the ever changing medical advancements and procedures in the medical sphere. Educational programs equip the radiologist with adequate training and information on how to perform his/her tasks. Role of Ultrasound and CT imaging in respect to the detection of free abdominal fluid In the event of abdominal trauma, it is important to carry out examinations focusing on abrasions to the abdominal wall and fractures on the chest ribs. If doctors aim for a favorable outcome, then ultrasound and CT imaging becomes very vital in the treatment procedure. Since the sixties, doctors have been employing the use of CT scans and ultrasound to detect abdominal fluids. These two techniques have been pivotal in diagnosing blunt abdominal trauma allowing for necessary treatment procedures to be applied to the victim. In choosing these methods, it is first important to ascertain the stability of the patient first and the severity of the abdominal injury so as to ascertain if a treatment modality for the diagnosis is available. Ultrasound and CT scans have a relatively high sensitivity, in some cases up to 100% sensitivity in detecting abdominal fluids around the liver and spleen (Dittrich et al. 2004). Detection of this fluid alerts the doctor that the victim of a traumatic injury requires a laparotomy. However, there are some limitations in the use of these techniques, such as the inability of ultrasound waves to penetrate the patients abdomen. This in most cases makes it very difficult to visualize the abdominal structures especially in cases where the victims abdomen contains surgical emphysema. Ultrasonography also is effective in detecting abdominal fluids but most times lacks the differentiation aspect to distinguish clearly between bile, urine, and blood. As a result of this, medical experts have to correlate the findings from sonography with clinical findings to arrive at a suitable diagnosis and treatment course (Branney et al., 2007). The effectiveness and wide use of Ultrasound and CT scans relate to the fact that they are carried out within a short time. A highly trained radiologist must be present to perform these tests. In the recent times, advanced CT scan and ultrasound equipment that have advanced resolution and gain have been designed. This equipment has been able to provide more accurate results, and they have proved very useful in attending to patients who need timely scans and treatment. Relevant issues in communications during the preparations for the arrival of the patients from the Major Incident In the event of a medical call to the hospital, it is important that the hospital respondent get as much information as possible about the victim (Deamu et al. 2009). The information would include; the number of victims, cause of injury, and estimated time of arrival. This information allows the medical staff at the hospital to prepare adequately for receiving patients and to knowing the steps to be taken the necessary cause of action in treating the victims. In case notification about the victims comes from a person who is not in the medical team; then a callback needs to be done so as to enquire further about the victim. Challenges related to the prioritization of patients Urgency in giving care to patients with traumatic injury is paramount. However, the case of overcrowding in medical facilities cannot be overlooked; hence, this causes major dilemmas when prioritizing which patients are to be attended to first. Overcrowding is a common scenario across the globe in medical facilities, whereby resources, such as staff, space and equipment are usually limited (Mooscop et al. p.53). Overcrowding would inevitably limit the urgency in provision of medical care. Mostly, the number of patients overwhelms the number of medical staff; thus, a delay in administering the necessary treatment for an accident victim becomes difficult. To tackle this limitation, an increase in funding to medical facilities will ensure sufficient resources to cater for the large number of accident victims arriving at the hospital; thus facilitating for the necessary prioritization of all patients. Ethical challenges In the case of an accident, the medical team encounters an ethical dilemma of choosing which patients to be transported to and treated first. It is the responsibility of a medical practitioner to act irrationally when they justifiably assert that their actions would significantly increase the probability a saving the victims life. Adequate assistance however is very vital in order to ensure all lives are saved. In the case of a medical emergency with limited transportation, the medical team just has to make irrational decisions in choosing who best has the chances of survival and picking them. Another ethical dilemma comes in the form of benevolent deception that results in the medical staff withholding information from the patient for their own good. Even though the medical team has the best interest of the patient at heart by withholding this information, it is ethically wrong. The medical code of conduct clearly stipulates that all information concerning the patient must be openly given to the patient (Egol et al. 1999). Requirements of your role in the imaging department The role in the imaging department requires one to assist patients in different levels, such as preparing for procedures of imaging and producing film images. This helps prepare the patient for treatment, ensuring the imaging department has a good working environment that is clean and hygienic, recognizing equipment faults and addressing issues of increase in equipment necessities, and finally undertaking basic maintenance of the imaging equipments. As a radiologist, one is expected to be ready to perform CT scans on patients. These scan and provide the efficient results necessary for deciding what cause of action need to be taken to treat the patient. Justification for performing a CT scan Undertaking a CT scan on the head and cervical spine is very important since it reveals critical information relating to the facial bones and cervical spine and assist in making healthy decisions or actions that would help the patient. Upon completion of the CT scan, the medical team will be able to identify the causes of hematoma and confusion that the patient is experiencing that would otherwise result to severe brain injury. Also, the information arrived at from the CT scan will assist in planning for the next cause of action which may involve a surgery or the need to perform further detailed CT scans. Radiographic appearance of a typical, acute sub-duralhaematoma and the pathophysiology involved. Figure 1: Acute subdural hematoma. (Richard Meagher 2003) Figure 2: Left-sided acute subdural hematoma (SDH). (Richard Meagher2003) Acute subdural hematoma results from a rapid force to the skull, which causes brain tissue to speed up or slow down relative to the permanent dural formations, tearing blood vessels (Richard et al. 2013). Brain hematomas and hemorrhage may be experienced from this head trauma. Brain physiological investigations carried out on trauma victims have suggested that secondary injuries to the brain are prevalent in the event of this degree of injury. Action to be taken in case patient refuses CT scans As a radiologist, my first step would be to and reason with the patient. I would explain the importance of carrying out the CT scan and how it would be beneficial to improving her health. In case she refuses, that would be a call to evaluate her judgment. At this point, it will be my legal obligation to put her on medical hold since she poses a danger to herself. I could also involve a psychiatrist to investigate whether she has adequate decision-making capacity so as to ascertain whether she is in her right senses. In case she is persistent in her refusal, I may medically sedate her to run more CT scan tests. This is a legal obligation of the radiologist as it puts the interest of the medical team in front of the interests of the patient. This will ensure she gets treated and continues with her life healthier with no complications. References Barnett J, Dennis, M & Martinez, V 2009, ‘Wild disaster leads to facilities evacuation’, Orthopaedic Nursing.28(1):17 Branney, SW, Moore EE & Cantrill SV, 1997, ‘Ultrasound based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma’, J Trauma, 42 : 1086–1090. Dittrich, K & AbuZidan, FM 2004, ‘Role of Ultrasound in Mass-Casualty Situations’, International Journal of Disaster Medicine; 2:18–23. Drabek, TE & Stephenson JS 1971, ‘When disaster strikes,’ Journal of Applied Social Psychology, 1(2):187-203. Duanmu, J & Chowdhury M 2009, Minimizing patient transport times during mass population evacuations. Technical report, Department of Industrial Engineering, Clemson University, Clemson, SC Egol, A, Fromm, R, Guntupalli, KK, Fitzpatrick, M, Kaufman, DS, Ryon, D, & Zimmerman, J 1999, ‘Guidelines for intensive care unit admission, discharge, and triage’, Critical Care Medicine, 27(3):633-638. McGough LJ, Reynolds SJ, Quinn TC, Zenilman JM 2005, ‘Which patients first? Setting priorities for antiretroviral therapy where resources are limited’, Am J Public Health.. 95(7):1173-80.    Moskop, JC, Sklar, DP, Geiderman, JM, Schears, RM & Bookman, KJ 2009, ‘Emergency department crowding concept, causes, and moral consequences’, An Emergency Medical. 53(5):605-11. Richard, JM & William, FY, 2013 Subdural Hematoma. Available from: http://emedicine.medscape.com/article/1137207-overview Richard, JM, 2013, digital image, Subdural Hematoma, viewed 12 December 2014, http://emedicine.medscape.com/article/1137207-overview Read More