Network Trauma CT Protocol (Adults)

Transcription

1 SOUTH YORKSHIRE MAJOR TRAUMA OPERATIONAL DELIVERY NETWORK Network Trauma CT Protocol (Adults) This Guideline is in accordance with the National Trauma Peer Review Measures - ODN T16-1C-107 TU T16-2B-311 Adult MTC T16-2B-216 SYMT ODN Trauma CT Protocol (Adults) V1.0 Page 1 of 6

2 Purpose of Document Required Action Action Required by/audience Circulation Authors Date agreed by SY MT ODN CAAG Date Signed off by ODNs Board This document has been developed in response to the National Major Trauma Quality Indicators 2016 which require all Major Trauma ODNs, Adult MTCs and TUs to develop, agree and put in place a Network Trauma CT protocol (Adults). The guidelines set out good practice for EDs to follow when managing and imaging adult trauma patients. All relevant staff should ensure they are fully aware of, and operate in line with this guideline. Sheffield Teaching Hospitals NHSFT Adult MTC Trauma Lead TU Trauma Leads (Barnsley, Chesterfield, Doncaster, Rotherham) Trusts Chief Executives Trusts Medical Directors Trusts Directors of Operations Trusts General Managers responsible for Trauma Services Operational Delivery Networks Strategy Board South Yorkshire Clinical Audit and Advisory Group (Pre-hospital/RESUS/Acute) Mark Regi Consultant Interventional Radiologist, STH Version Number Version 1.0 Approved for implementation 12 Apr 2017 Policy Review Date Apr 2018 Please note that from Jun 2017 all ODN Clinical Guidelines, Protocols and Policies will be available on the ODN website for downloading. SYMT ODN Trauma CT Protocol (Adults) V1.0 Page 2 of 6

3 Trauma CT Protocol ALL MAJOR TRAUMA PATIENTS PRESENTING TO THE SHEFFIELD ADULT MAJOR TRAUMA CENTRE REQUIRING IMAING UNDERGO FULL BODY CE CT AS DESCRIBED IN THE BASTION CT PROTOCOL. THIS PROTOCOL WILL UNIFY THE REGIONS IMAGING FOR THE BENEFIT OF PATIENTS. Principles: The general principles that the Trauma Units (TUs) will follow are that 1) Imaging should never delay a transfer if that is required 2) If trauma units are planning on scanning a patient in trauma then they should also follow the Bastion protocol see below 3) The decision to image trauma patients in TUs should be made after discussion between the trauma team leader and the Consultant Radiologist on call 4) Trauma patients should be not re scanned if transfer the adult major trauma centre (MTC) unless there is this a pressing clinical reason. 5) All trauma scans will be reported locally and both images and reports transferred to the MTC as soon as technically possible. For patients at the Trauma Units presenting with poly-trauma a full Bastion protocol is indicated (see below. Patients presenting with single region trauma should be considered for focused imaging however a chest / abdomen / pelvis Bastion should be considered as there is evidence that unexpected injuries can occur in trauma and injuries to one region can affect adjacent regions. STH currently utilises a stable single phase Bastion and an unstable duel phase Bastion protocol. At the TUs the single phase (one combined arterial and venous phase scan) is sufficient for all trauma patients. Measure T16-1C-105 Teleradiology Facilities There should be radiology facilities between the MTC and all the TUs in the network allowing immediate image transfer 24/7. MTC targets There should be a 'hot' report protocol for Trauma CT available in 5 minutes There should be radiological report available within 1 hour Trauma CT scans should be reported by a consultant radiologist with 24 hours TU targets There should be radiological report available within 1 hour Trauma CT scans should be reported by a consultant radiologist with 24 hours SYMT ODN Trauma CT Protocol (Adults) V1.0 Page 3 of 6

4 1. Implementing the CT protocol 1.1. Protocol to be available in all CT scan rooms 1.2. Training of all CT radiographers in the protocol prior to implementation is vital 1.3. Training and support, including site visits is available from the Radiology department at STH. Please contact the superintendent radiographers in CT (Judith Sugden or Phil Heath) SYMT ODN Trauma CT Protocol (Adults) V1.0 Page 4 of 6

5 MAJOR TRAUMA Stable Chest/abdo/pelvis - 70 second set delay CHNTPC 1. This should be performed after the trauma brain and C. spine scans as part of the major trauma protocol. Position supine, head to gantry. Centre to sternal notch in the isocentre. 2. Scout range to include apices to lower border of symphysis pubis (anal verge) and axillae/soft tissue border laterally. AP and lateral scout. Pelvis injuries may require a longer scan range to image hip joint injuries. Check with Radiologist. 3. Plan chest to pelvis to include all bony pelvis. 4. Select correct contrast icon & check ma table. 5. Check reconstructions there is one to demonstrate bone. 6. Start scan delay countdown and contrast injection. 7. Scan at 70 second delay Points to note Ensure that any wires are limited as much as possible in the regions to be scanned to reduce artefact. If clinicians allow, raise arms above head and secure with strapping if possible. A retro reconstruction of spine may be required SYMT ODN Trauma CT Protocol (Adults) V1.0 Page 5 of 6

6 Bastion protocol: 75 Kg Patient 150ml contrast Kg Patient 140ml contrast Kg Patient 20ml contrast Kg Patient 40ml contrast Kg Patient 120ml contrast Kg Patient 100ml contrast Kg Patient 80ml contrast Kg Patient 60ml contrast SYMT ODN Trauma CT Protocol (Adults) V1.0 Page 6 of 6