What the radiologist should know about the different medical internal and external devices used to treat critically injured patients in the acute trauma setting

Congress:

ECR 2018

Poster Number:

C-1875

Type:

Educational Exhibit

Keywords:

Computer Applications-Detection, diagnosis, Computer Applications-3D, Instrumentation, Conventional radiography, CT, Abdomen, Trauma, Emergency, Acute, Foreign bodies

Authors:

M. De La Hoz Polo, L. M. Meacock, D. A. Elias, E. Kashef, D. Bew, E. A. Dick; London/UK

DOI:

10.1594/ecr2018/C-1875

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-1875

Fig. 1: .

Fig. 2: .

Fig. 3: Fig. A) Example of an endotracheal tube (ET) with a distal balloon to fix it in...

Fig. 4: Fig A,B) Coronal CT image and 3D reconstruction respectively showing ET almost...

Learning objectives

To review the indications for the different medical devices most commonly used to manage acutely injured patients in the trauma setting To illustrate with examples the radiological appearance of these medical devices To illustrate common complications and pitfalls of these devices Fig 1

Background

In the trauma setting a number of internal and external medical devices are used to maintain life support and manage severe injuries of unstable patients. Common devices such as endotracheal tube, nasopharyngeal tube, nasogastric tubes, and chest and abdominal drains are well known to most radiologists. Nevertheless, radiologists with limited trauma experience might not be familiar with the appearance of otherdevices such as tracheostomy, laryngeal airway mask, pneumothorax needle decompression, pelvic binder, tourniquet, intraosseous line, different types of packing material for damage control surgery, inferior...

Findings and procedure details

We have classified the following devices according to location in the body. AIRWAY DEVICES 1. Endotracheal Tube Indications: Definitive airway (a cuffed tube in the trachea). In paediatrics an uncuffed tube is used. Position: The tip of the tube should be situated approximately 5cm above the tracheal carina, so excursions of 2cm upward or downward (with neck extension or flexion) can be safely accommodated. Fig 2, 3,4,5 2. Nasopharyngeal Airway Tube Indications: The Nasopharyngeal airway (NPA) is a flexible endotracheal tube that is designed to...

Conclusion

Familiarity with the different medical devices used in the trauma setting will allow the radiologist to help the Trauma Team rapidly identify correctly and incorrectly positioned devices.

Personal information

References

Hunter et al. Medical Devices of the Chest. Radiographics 2004; 24:1725-1746 Hunter et al. Medical Devices of the Abdomen and Pelvis. Radiographics 2005; 25:503-523 Roldan C et al. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction. West J Emerg Med. 2015 Sep; 16(5): 658–664 Brian Clemency et al. Intravenous vs. intraosseous access and return of spontaneous circulation during out of hospital cardiac arrest. Am J Emerg Med.2017; 35(2):222-226 Day M. Intraosseous Devices for Intravascular Access in Adult Trauma Patients. Crit Care Nurse 2011;...