Trauma radiography can be an exciting and challenging environment for the radiographer. However the performing trauma procedure can be intimidating and stressful. The difference depends on how prepared the radiographer is to handle the situation. To reduce the stress associated with trauma radiography, the radiographer must be properly prepared for multitude of responsibilities encountered in the emergency room (ER).
Trauma is defined as a sudden, unexpected, dramatic, forceful, or violent event. Trauma ranks as the leading cause of death. The term trauma center signifies a specific level of a emergency medical care as defined by the American College of Surgeons Commission on Trauma.
Specialized equipment in trauma.
Time is a critical element in the care of a trauma patient. To minimize the time required to acquire diagnostic x-ray images, many emergency rooms have dedicated radiographic equipment located in the department or immediately adjacent to the department. Specialized trauma radiographic systems are available and are designed to provide greater greater flexibility in x-ray tube IR maneuverability. These specialized systems help to minimize the movement of the injured patient while performing imaging procedure.
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Mobile radiography is widely utilized in the emergency room. Many patients will have injuries that prohibit transfer to a radiographic table, or their condition may be too critical to interrupt treatment. Trauma radiographers must be competent in performing mobile radiography on almost any part of the body and be able to utilize accessory devices like a grids, air-gap technique. Its needed to produce quality mobile images.
Positioning aids are necessity in trauma radiography. Sponges, sandbags, and the creative use of tape are often the trauma radiographerâ€™s most useful tools. Most trauma patients are unable to hold the required positions as a result of pain or impaired consciousness. Other patients cannot moved into the proper position because to do so would exacerbate their injury.
Exposure factors in trauma
Patient motion is always a consideration in trauma radiography. The shortest possible exposures time that can be set should be used in every procedure., except when a breathing technique is desired. Unconscious patients are not able to suspend respiration for the exposure. Conscious patients are often in extreme pain and unable to cooperate for the procedure.
Radiographic exposure factors compensation may be required when a making exposures through immobilization devices, like a spine board or backboard. Most trauma patient arrive at the hospital with some type of immobilization devices. Pathologic changes should also be considered when setting technical factors. For instance, internal bleeding in the abdominal cavity would absorb a greater amount of radiation than a bowel obstruction.
Types on trauma injuries.
The some types of trauma injuries is head injuries, spinal injuries, chest injuries, extremity fractures, wounds, burns and also postsurgical complications wound dehiscence.
The head injuries is the patients who have to received a blow to the head may have sustained serious injury, even when there are external signs of trauma. Damage may occur with or without a skull fracture. If have bleeding or swelling occurs inside the skull, a rise in intracranial pressure(ICP) may cause seizures, loss of consciousness, or respiratory arrest. incidentally, similar symptoms may also occurs in patients with increased ICP due to brain tumors.
The patients with spinal injuries, every trauma patient should be considered to have a potential spinal injury and should be evaluated by the ED physician before being moved. even slight movement of a spinal fracture may cause pressure on the spinal cord, resulting in paralysis or death. for this reasons, exposures should be made without moving the patient whenever possible. when a change of position is required, as for a lateral lumbar radiograph, use a â€œlog rollingâ€ approach, which keeps the body in one plane. this two-person procedure avoids twisting or bending the spine. patients with possible cervical spine fractures are immobilized with cervical collars and other radiolucent devices.
About the patient with the chest injuries is the motor vehicle accidents and falls are two of the most common causes of chest injuries seen in the imaging department. Deaths due to crushing or penetrating wounds of the thorax comprise a significant number of the trauma deaths each year. Fractures ribs are painful and can be life threatening if along or blood vessel in punctured.
Extremity fractures is a trauma involving the long bones of the body may classified in two categories, first is compound fractures, in which the splintered ends of bone are forced through the skin, and then the second is closed fractures. Compound fractures are usually partially reduced and dressing applied before radiographic examination. Some common types of fractures are greenstick, spiral, overriding, comminuted, transverse, compression, depressed(skull), and avulsion. Fractures may also be classified according to the nature of the injury. there are many ways of temporarily immobilizing extremity fractures. the two legs may be fastened together for stability during transportation, or a stiff object, such as a board or rolled-up magazine, may serve as a splint. When want to position the patients with fractured extremity that is not supported by a splint, maintain gentle traction while supporting and moving the arm or leg.
The wounds in the type or trauma is patients with open wounds have usually been treated before you see them in radiology suite. Bleeding has been controlled, and dressings have been applied. the radiographer primary responsibility regarding open wounds is to maintain the dressings and the report promptly any significant amount of fresh bleeding. This is usually considered to be the amount of bright red blood sufficient to soak through a fresh dressing. if a laceration or incision opens, causing severe hemorrhaging, apply direct pressure to the side of bleeding while summoning immediate assistance.
While burns in type of trauma is, burn patients may also have traumatic injuries such as fractures. Burns are frequently associated with respiratory complications. Inhalation of hot gases may result in pleural effusion or the development of pneumonia, which must be monitored radiographically. Burns may be categorized by cause of injury, percentage of body surface involved, and depth of tissue destruction. The depth of burns is classified as first, second or third degree. When a burn patient needs a radiograph, coordinate your examination with the nursing staff to ensure that the patient has had pain medication about 30 minute before the procedure.
Postsurgical complications(wound dehiscence) is the patient who had a major surgery may require radiographic examination. Wound dehiscence occurs when a suture line parts and the underlying tissues or organs protrude through the opening. While this rare, it may happen, particularly in obese patients who had extensive abdominal surgery. It is possible for evisceration its means loss of organs from a body cavity, it to result when extensive suture lines spread apart or split.
Positioning of the patient trauma
The primary challenge of the trauma radiographer is to obtain a high quality, diagnostic image on the first attempt when the patient is unable to move into the desired position. To minimize risk of exacerbating the patients condition, the x-ray tube and IR should be positioned, rather than the patient or the part. For examples, position the stretcher adjacent to the vertical Bucky or upright table as often as the patients condition allows. To increases the efficiency, while minimizing patient movement, is to take all of the AP projections of the requested examinations, moving superiorly to inferiorly. Then perform all of the lateral projections of the requested examinations, moving inferiorly to superiorly. This method moves the x-ray tube in the most expeditious manner.
Radiographers Role as Part of the Trauma Team
The role of the radiographer within the emergency rooms ultimately depends on the department protocol and staffing, as well as 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 , the first is perform quality diagnostic imaging procedures as requested. Then to practice ethical radiation protection , and also provide competent care. It is impossible to rank these responsibilities because they occurs simultaneously, and all are vital to quality care in the emergency rooms.
Diagnostic imaging procedures
producing a high quality, diagnostic image is one of the more obvious roles of any radiographer. A radiographer in the trauma environment has the added responsibility to perform that task efficiently. Efficiency and productivity are commo0n and practical goals for the radiology department. In the emergency room, efficiency is often crucial to saving the patients life. Diagnostic imaging in the emergency room is paramount to an accurate, timely and often life saving diagnosis.
One of the most essential duties and ethical responsibilities of the trauma radiographer is radiation protection of the patient, the members of the trauma team, and self. In highly critical care situations, members of the trauma team cannot leave the patient while imaging procedure are being performed. The trauma radiographer must ensure the others team members are protected from unnecessary radiation exposures. Common practices should minimally included the following close the collimation to the anatomy of interest to reduce scatter, gonadal shielding for the patients of child bearing age, lead aprons for all personnel that remain in the room, during the procedure, exposure factors that minimize patient dose and scattered radiation and also announcement of impending exposure to allow unnecessary personnel to exit the room.
As with all imaging procedures, trauma procedures required a patient history. the patient may provide this, if he or she is conscious, or the attending physician may inform you of the injury and the patients status. if the patient is conscious, explain what you are doing in detain in terms the patient can understand. listen to the patient rate and manner of speech, which may provide insight into his or her mental or emotional status. Make eye contact with the patient to provide comfort and reassurance. Keep in mind that a trip to the emergency room is an emotionally stressful event, regardless of the severity of the injuries illness.
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Radiographers are often responsible for the total care of the trauma patient while performing diagnostic imaging procedures. Therefore it is critical that radiographers constantly assess the patient condition, recognize any signs of decline or distress, and report any change in the status of the patient condition to the attending physician. The trauma radiographer must be well versed in taking vital signs and knowing normal ranges, competent in cardiopulmonary resuscitation (CPR), administration of oxygen, and dealing with all types of medical emergencies. the radiographer must be prepared to perform these procedures when covered by a standing physicians order or as departmental policy allows. Additionally, the radiographer should be familiar with the location and contests of the adult and pediatric crash carts, and understand hoe to use the suctioning devices.
It is important to remember that the patient has endured an emotionally disturbing and distressing event in addition to the physical injuries he or she may have sustained. If the patient conscious, speak calmly and look directly in the patient eyes while explaining that procedures that have been ordered. Do not assume that the patient cannot hear you even if he or she cannot or will not respond.
Check the patient thoroughly for items that might cause an artifact on the images. Explain what are you removing from the patient and why. Be sure to place all removed personal effects, especially valuables, in the proper container uses by the facility example like a plastic bags, or in the designated secure area. every facility has a procedure regarding proper storage of a patients personal belongings. Be sure to know the procedure and follow it carefully.
A wide variety of immobilization devices are uses to stabilize injured patients. Standard protocol is to perform radiographic images without removing immobilization devices. Once injuries have been diagnosed or rules out, the attending physician gives the order for immobilization to be removed, changed, or continued. Many procedures necessitate the use of some sort of immobilization to prevent in voluntary and voluntary motion. Prudent use of such is discussed in many patient care textbooks. The key issue in the use of immobilization in trauma is not to exacerbate the patient injury nor increase his or her discomfort.
Ideally, trauma radiographs should be of optimum quality to ensure prompt and accurate diagnosis of the patients injuries. Evaluate images for proper positioning and technique as indicated in the routine projections. Allowance can be made when true right angle projections (AP/PA and also lateral) must be altered as a result of patient condition.
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