IMAGING OF TRAUMA IN FINLAND 4/25/12 STATISTICS 1999:2009. Seppo Koskinen HUS Röntgen Töölön sairaala VIOLENT CRIMES IN FINLAND
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1 IMAGING OF TRAUMA IN FINLAND Seppo Koskinen HUS Röntgen Töölön sairaala TRAUMA IN FINLAND 2081 people died in in accidents in 2009 (2006;2240) third commonest cause of death in whole population annual estimate of severe trauma (ISS>15) 20-25/100,000 STATISTICS 1999:2009 Taulukko 3. Tapaturmissa kuolleet tapaturman syyn mukaan sekä päihtyneiden osuus kuolleista vuosina 1999 ja 2009 Sukupuolet yhteensä Miehet Naiset Tapaturmiin kuolleet Päihtyneiden osuus 1) Tapaturmiin kuolleet Päihtyneiden osuus 1) Tapaturmiin kuolleet Päihtyneiden osuus 1) Kuljetustapaturmissa kuolleet ,1 24, ,7 28, ,2 12,8 Kaatumis- ja putoamistapaturmissa kuolleet ,5 11, ,4 16, ,9 3,9 Hukkumistapaturmissa kuolleet ,4 56, ,9 55, ,1 63,6 Ruuan aiheuttamaan tukehtumiseen kuolleet ,2 42, ,2 44, ,0 40,0 Saunakuolemat ,1 64, ,5 78, ,0 27,3 Tulipaloissa kuolleet ,8 65, ,1 71, ,0 45,5 Kylmyyteen kuolleet ,2 41, ,7 44, ,0 31,6 Häkämyrkytykseen kuolleet ,5 43, ,6 50, ,0 25,0 Muihin tapaturmiin kuolleet ,6 11, ,3 14, ,0 4,4 Tapaturmissa kuolleet (pl. alkoholi- ja lääkemyrkytykset) 2) ,5 22, ,2 28, ,8 10,1! / ASSAULTS / MANSLAUGHTER MURDER VIOLENT CRIMES IN FINLAND MANSLAUGHTER MURDER ATTEMPTS ASSAULTS RAPE / ASSAULTS / MANSLAUGHTER MURDER VIOLENT CRIMES IN FINLAND MANSLAUGHTER MURDER ATTEMPTS ASSAULTS RAPE TRAFFIC ACCIDENTS IN FINLAND DEATHS / INJURED / DEATHS INJURED
2 ON-CALL RADIOLOGY IN 5 UNIVERSITY HOSPITALS (outside office-hours) HELSINKI: 3 residents 24h, 2 specialists on-demand TURKU: 1 resident, 1 specialist TAMPERE: 1 resident/specialist 24 h KUOPIO: 1 resident/specialist ondemand OULU: 1 resident/specialist 24 h,one specialis 15-22, 22-> on-demand INTERVENTIONAL ON-CALL informal service OFFICE-HOURS: NO DEDICATED EMERGENCY RADIOLGY NO EMERGENCY RADIOLOGY PROGRAM TRAUMA AND IMAGING OF TRAUMA IN FINLAND Blunt trauma common, penetrating trauma uncommon fall, fall from height, MVA Alcohol related Interpersonal violence CT is deliberately used CTA instead of DSA: head, neck CTA or DSA in peripheral trauma CT-SCANNERS IN FINLAND TRAUMA MANUAL # slices / TOTAL WHERE IS RADIOLOGY? 2
3 GETTING READY FOR THE PATIENT PRE-NOTIFICATION PHONE-CALL RADIOLOGIST S ROLE ADMISSION PRIMARY SURVEY ACUTE CARE+SECUNDARY SURVEY (INCL. NEUROS. SURVEY) IMAGING IN ER Thorax Pelvis FAST Damage Control Radiology (DCR) Special CT Reformats Interventions TRAUMALEADER IS INFORMED ABOUT HEMODYNAMICS AND CRANIAL TRAUMA HEMODYNAMICALLY UNSTABLE ACUTE CARE CONT D IMMEDIATE INTERVENTION HEMODYNAMICALLY STABLE CT WBCT NO NEED FOR IMMEDIATE INTERVENTION DAMAGE CONTROL RADIOLOGY Integration of whole-body CT into early trauma care significantly increased the probability of survival in patients with polytrauma. Whole-body CT is recommended as a standard diagnostic method during the early resuscitation phase for patients with polytrauma. Huber-Wagner et al. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 2009;373:
4 INTEPRETATION WBCT Head CC-spine, Thx-Abd-Pelvis Lower extremities Protocols are different in different institutions BRAIN BREATHING BLEEDING BONES BOWEL BLADDER Six B s 4
5 BRAIN Intracranial hemorrhages & Herniations Contusions and ICH SDH EDH SH A B C D Increased intracranial pressure and edema BCVI: Blunt Cerebrovascular Injury Grading scale Grade I intimal irregularity with <25% narrowing Grade II dissection or intramural hematoma with >25%narrowing Grade III pseudoaneurysm Grade IV occlusion Grade V transection with extravasation 5
6 BREATHING BREATHING pneumothx tensionpneumotx Multiple ribfractures flail chest BLEEDING BLEEDING ATAI Mediastinal hemorrhage Pelvic h. Abd. Aorta and its branches (a. celiaca, renal arteries) spleen, liver, kidneys, mesenterium, pancreas Peripheral arteries(incl. neck vessels) 6
7 7
8 BOWEL INJURIES BOWEL Bowel injuries(blunt trauma: small b5-15%, colon 2-5%) transsection free air thickening of bowel wall BONES BONES vertebral fractures and dislocations rib fractures, flail chest pelvic fractures long bones associated soft tissue injuries and bleeding * 8
9 Remember muscle tears and avulsions BLADDER BLADDERRUPTURE INTRAP. 20% EXTRAP. 80% INTRAP. EXTRAP. RADIOLOGIST ROLE DCR; Damage Control Radiology To detect life-threathening injuries and to infor the trauma leader Use AP- and lateral scout for initial (primary) survey Think 6 B s Use shock-window (lung/bone; W2000/L20) for quick overview for big picture Make useful CT-reformations Interventions as needed 9
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