Table 1 Precautionary rule for CT interpretation by emergency physicians in blunt trauma
Caution | #1 Unstable physiological condition |
1> GCS < 10 points | |
2> Systolic pressure < 90 mmHg | |
#2 Suspected injury to multiple regions of the body | |
1> severe pain in more than 2 of the 6 regions (head, face, neck, chest, abdomen, pelvis) | |
2> bleeding, wounds, deformities, or contusions in more than 2 of the 6 regions | |
#3 Injury due to high energy mechanism | |
1> traffic accident: | |
pedestrian, bicycle vs. vehicle, motorcycle crash, highway crash | |
victim thrown from vehicle, death of fellow passenger | |
case involving a difficult rescue, sideslip of the vehicle, etc. | |
2> fall (3 m) | |
3> crushed under heavy object | |
4> other high energy mechanisms | |
#4 Case that requires invasive emergency treatment necessitating movement to other rooms | |
1> case that requires an emergency operation | |
2> case that requires emergency angiography (embolization) | |
3> other invasive treatment required | |
Action | If patient‘s condition agrees to one of above criteria at least, EP should take action as follows |
1) EP should actively employ enhanced CT for chest, abdomen and pelvis if possible. | |
2) EP should re-interpret emergency CT more than twice after a short interval. | |
3) EP should change window level according to organs to interpret. | |
4) EP should evaluate not only in an axial view but also in a sagittal view or coronal view if needed. | |
5) EP should actively evaluate bone injuries using three-dimensional view. | |
6) EP should repeat CT after time has passed if there are unclear points. | |
Additional advice | If there problems as follows, EP should consider real-time consultation with a radiologist |
1) Patient’s physiological condition deteriorates in spite of treatments. | |
2) Data of laboratory findings show development of anemia or metabolic acidosis in spite of treatments. | |
3) Unclear points remain in spite of re-interpretation CT or repetition of CT. |