Skip to main content

Advertisement

SpringerLink
Log in

Radiographic Imaging and Ultrasound in Early Trauma Management: Damage Control Radiology for the Anesthesiologist

  • Anesthesia for Trauma (JW Simmons, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

The role of radiographic imaging and ultrasound (US) in decision-making during the early management of the polytrauma patient has increased significantly in the last decade based on technological advancements and ongoing research. With the introduction of faster and more capable computed tomography scanners as well as portable US machines, individuals responsible for the care of the trauma patient have more information than ever to guide perioperative care and operative decisions. This has led to the implementation of Damage Control Radiology (DCRad) in the early resuscitation and treatment of these patients. In this review, we focus on the current literature surrounding applications of US and other radiographic imaging in the early management of the trauma patient. This includes reviews of the Focused Assessment with Sonography in Trauma (FAST) and Extended-FAST (E-FAST) exams with an emphasis on their applicability, sensitivity, and specificity in the setting of blunt and penetrating trauma as well as their ability to predict the need for an operative intervention. Additionally, we will briefly review the role of US for airway management, and vascular access. Relevant to anesthesiologists managing patients with potential cervical spine injury, we will also review recommendations regarding radiographic clearance of the cervical spine in the obtunded patient. Finally, we will discuss early detection and management of patients with blunt cerebrovascular injury in the early perioperative period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Gay DA, Miles RM. Use of imaging in trauma decision-making. J R Army Med Corps. 2011;157(3 Suppl 1):S289–92. Provides original description of Damage Control Radiology and its application in the management of battlefield casualties.

  2. Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma. 1999;46(3):466–72.

    Article  CAS  PubMed  Google Scholar 

  3. •• Ramsingh D, Rinehart J, Kain Z, Strom S, Canales C, Alexander B et al. Impact assessment of perioperative point-of-care ultrasound training on anesthesiology residents. Anesthesiology. 2015;123(3):670–82. doi:https://doi.org/10.1097/ALN.0000000000000776. Describes the creation and evaluation of a comprehensive training program for residents in anesthesiology including a dedicated rotation providing ultrasound services in the perioperative setting. In this single center study, 76% of exams where felt to impact subsequent planning or care.

  4. Dehqanzada ZA, Meisinger Q, Doucet J, Smith A, Casola G, Coimbra R. Complete ultrasonography of trauma in screening blunt abdominal trauma patients is equivalent to computed tomographic scanning while reducing radiation exposure and cost. J Trauma Acute Care Surg. 2015;79(2):199–205. doi:https://doi.org/10.1097/TA.0000000000000715.

    Article  CAS  PubMed  Google Scholar 

  5. Quinn AC, Sinert R. What is the utility of the Focused Assessment with Sonography in Trauma (FAST) exam in penetrating torso trauma? Injury. 2011;42(5):482–7. doi:https://doi.org/10.1016/j.injury.2010.07.249.

    Article  PubMed  Google Scholar 

  6. Carter JW, Falco MH, Chopko MS, Flynn WJ Jr, Wiles Iii CE, Guo WA. Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury. 2015;46(5):817–21. doi:https://doi.org/10.1016/j.injury.2014.11.023.

    Article  PubMed  Google Scholar 

  7. Cullinane DC, Schiller HJ, Zielinski MD, Bilaniuk JW, Collier BR, Como J, et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. J Trauma. 2011;71(6):1850–68. doi:https://doi.org/10.1097/TA.0b013e31823dca9a.

    PubMed  Google Scholar 

  8. Soto JA, Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012;265(3):678–93. doi:https://doi.org/10.1148/radiol.12120354.

    Article  PubMed  Google Scholar 

  9. Miller MT, Pasquale MD, Bromberg WJ, Wasser TE, Cox J. Not so FAST. J Trauma. 2003;54(1):52–9. doi:https://doi.org/10.1097/01.TA.0000046382.45913.B0discussion 9-60.

    Article  PubMed  Google Scholar 

  10. Sessa B, Trinci M, Ianniello S, Menichini G, Galluzzo M, Miele V. Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT. Radiol Med. 2015;120(2):180–9. doi:https://doi.org/10.1007/s11547-014-0425-9.

    Article  PubMed  Google Scholar 

  11. Plummer D, Brunette D, Asinger R, Ruiz E. Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med. 1992;21(6):709–12.

    Article  CAS  PubMed  Google Scholar 

  12. Bustam A, Noor Azhar M, Singh Veriah R, Arumugam K, Loch A. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J. 2014;31(5):369–73. doi:https://doi.org/10.1136/emermed-2012-201789.

    Article  PubMed  Google Scholar 

  13. Tayal VS, Beatty MA, Marx JA, Tomaszewski CA, Thomason MH. FAST (focused assessment with sonography in trauma) accurate for cardiac and intraperitoneal injury in penetrating anterior chest trauma. J Ultrasound Med. 2004;23(4):467–72.

    Article  PubMed  Google Scholar 

  14. Press GM, Miller S. Utility of the cardiac component of FAST in blunt trauma. J Emerg Med. 2013;44(1):9–16. doi:https://doi.org/10.1016/j.jemermed.2012.03.027.

    Article  PubMed  Google Scholar 

  15. Hyacinthe AC, Broux C, Francony G, Genty C, Bouzat P, Jacquot C, et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest. 2012;141(5):1177–83. doi:https://doi.org/10.1378/chest.11-0208.

    Article  PubMed  Google Scholar 

  16. Nagarsheth K, Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg. 2011;77(4):480–4.

    PubMed  Google Scholar 

  17. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17(1):11–7. doi:https://doi.org/10.1111/j.1553-2712.2009.00628.x.

    Article  PubMed  Google Scholar 

  18. Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013;17(5):R208. doi:https://doi.org/10.1186/cc13016.

    Article  PubMed  PubMed Central  Google Scholar 

  19. • Teoh WH, Kristensen MS. Utility of ultrasound in airway management. Trends Anaesth Crit Care. 2014;4(4):84–90. doi:https://doi.org/10.1016/j.tacc.2014.05.004. A thorough review of ultrasound procedures relevant to airway and ventilatory management in all patients but particularly relevant for the trauma patient.

  20. Teoh WH, Kristensen MS. Ultrasonographic identification of the cricothyroid membrane. Anaesthesia. 2014;69(6):649–50. doi:https://doi.org/10.1111/anae.12735.

    Article  CAS  PubMed  Google Scholar 

  21. Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010;113(4):819–24. doi:https://doi.org/10.1097/ALN.0b013e3181ef6757.

    Article  PubMed  Google Scholar 

  22. Chou HC, Chong KM, Sim SS, Ma MH, Liu SH, Chen NC, et al. Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation. 2013;84(12):1708–12. doi:https://doi.org/10.1016/j.resuscitation.2013.06.018.

    Article  PubMed  Google Scholar 

  23. Chou HC, Lien WC, Ma MH. Reply to letter: real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation. 2014;85(1):e11. doi:https://doi.org/10.1016/j.resuscitation.2013.08.279.

    Article  PubMed  Google Scholar 

  24. Ding LW, Wang HC, Wu HD, Chang CJ, Yang PC. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J. 2006;27(2):384–9. doi:https://doi.org/10.1183/09031936.06.00029605.

    Article  PubMed  Google Scholar 

  25. Weiner MM, Geldard P, Mittnacht AJ. Ultrasound-guided vascular access: a comprehensive review. J Cardiothorac Vasc Anesth. 2013;27(2):345–60. doi:https://doi.org/10.1053/j.jvca.2012.07.007.

    Article  PubMed  Google Scholar 

  26. American Society of Anesthesiologists Task Force on Central Venous A, Rupp SM, Apfelbaum JL, Blitt C, Caplan RA, Connis RT, et al. Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology. 2012;116(3):539–73. doi:https://doi.org/10.1097/ALN.0b013e31823c9569.

    Article  Google Scholar 

  27. Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, et al. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2011;24(12):1291–318. doi:https://doi.org/10.1016/j.echo.2011.09.021.

    Article  PubMed  Google Scholar 

  28. • Lalu MM, Fayad A, Ahmed O, Bryson GL, Fergusson DA, Barron CC et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis. Crit Care Med. 2015;43(7):1498–507. doi:https://doi.org/10.1097/CCM.0000000000000973. This recent analysis of ultrasound-guided subclavian catheterization recommends the use of ultrasound based on a decrease in complications and increased first pass success.

  29. Troianos CA, Hartman GS, Glas KE, Skubas NJ, Eberhardt RT, Walker JD, et al. Special articles: guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society Of Cardiovascular Anesthesiologists. Anesth Analg. 2012;114(1):46–72. doi:https://doi.org/10.1213/ANE.0b013e3182407cd8.

    Article  PubMed  Google Scholar 

  30. Milby AH, Halpern CH, Guo W, Stein SC. Prevalence of cervical spinal injury in trauma. Neurosurg Focus. 2008;25(5):E10. doi:https://doi.org/10.3171/FOC.2008.25.11.E10.

    Article  PubMed  Google Scholar 

  31. Manoach S, Paladino L. Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions. Ann Emerg Med. 2007;50(3):236–45. doi:https://doi.org/10.1016/j.annemergmed.2007.01.009.

    Article  PubMed  Google Scholar 

  32. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 1992;21(12):1454–60.

    Article  CAS  PubMed  Google Scholar 

  33. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841–8.

    Article  CAS  PubMed  Google Scholar 

  34. Schoenfeld AJ, Bono CM, McGuire KJ, Warholic N, Harris MB. Computed tomography alone versus computed tomography and magnetic resonance imaging in the identification of occult injuries to the cervical spine: a meta-analysis. J Trauma. 2010;68(1):109–13. doi:https://doi.org/10.1097/TA.0b013e3181c0b67adiscussion 13-4.

    Article  PubMed  Google Scholar 

  35. Satahoo SS, Davis JS, Garcia GD, Alsafran S, Pandya RK, Richie CD, et al. Sticking our neck out: is magnetic resonance imaging needed to clear an obtunded patient’s cervical spine? J Surg Res. 2014;187(1):225–9. doi:https://doi.org/10.1016/j.jss.2013.09.022.

    Article  PubMed  Google Scholar 

  36. • Tan LA, Kasliwal MK, Traynelis VC. Comparison of CT and MRI findings for cervical spine clearance in obtunded patients without high impact trauma. Clin Neurol Neurosurg. 2014;120:23–6. doi:https://doi.org/10.1016/j.clineuro.2014.02.006. These guidelines incorporate the most recent evaluations of computed tomography and magnetic resonance imaging for evaluation of cervical spine injuries in the patient with an altered level of consciousness. The authors support the use of computed tomography as the primary means for cervical clearance in these patients.

  37. Patel MB, Humble SS, Cullinane DC, Day MA, Jawa RS, Devin CJ, et al. Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;78(2):430–41. doi:https://doi.org/10.1097/TA.0000000000000503.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Badhiwala JH, Lai CK, Alhazzani W, Farrokhyar F, Nassiri F, Meade M, et al. Cervical spine clearance in obtunded patients after blunt traumatic injury: a systematic review. Ann Intern Med. 2015;162(6):429–37. doi:https://doi.org/10.7326/M14-2351.

    Article  PubMed  Google Scholar 

  39. Kanji HD, Neitzel A, Sekhon M, McCallum J, Griesdale DE. Sixty-four-slice computed tomographic scanner to clear traumatic cervical spine injury: systematic review of the literature. J Crit Care. 2014;29(2):314 e9–13. doi:https://doi.org/10.1016/j.jcrc.2013.10.022.

  40. Plackett TP, Wright F, Baldea AJ, Mosier MJ, Thomas C, Luchette FA, et al. Cervical spine clearance when unable to be cleared clinically: a pooled analysis of combined computed tomography and magnetic resonance imaging. Am J Surg. 2015;. doi:https://doi.org/10.1016/j.amjsurg.2014.12.041.

  41. Raza M, Elkhodair S, Zaheer A, Yousaf S. Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan—a meta-analysis and cohort study. Injury. 2013;44(11):1589–95. doi:https://doi.org/10.1016/j.injury.2013.06.005.

    Article  PubMed  Google Scholar 

  42. Fisher BM, Cowles S, Matulich JR, Evanson BG, Vega D, Dissanaike S. Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients? Am J Surg. 2013;206(6):987–93. doi:https://doi.org/10.1016/j.amjsurg.2013.08.021discussion 93-4.

    Article  PubMed  Google Scholar 

  43. James IA, Moukalled A, Yu E, Tulman DB, Bergese SD, Jones CD, et al. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT. J Emerg Trauma Shock. 2014;7(4):251–5. doi:https://doi.org/10.4103/0974-2700.142611.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bruns BR, Tesoriero R, Kufera J, Sliker C, Laser A, Scalea TM, et al. Blunt cerebrovascular injury screening guidelines: what are we willing to miss? J Trauma Acute Care Surg. 2014;76(3):691–5. doi:https://doi.org/10.1097/TA.0b013e3182ab1b4d.

    Article  PubMed  Google Scholar 

  45. Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE Jr, Johnson JL, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139(5):540–5. doi:https://doi.org/10.1001/archsurg.139.5.540discussion 5-6.

    Article  PubMed  Google Scholar 

  46. Eastman AL, Muraliraj V, Sperry JL, Minei JP. CTA-based screening reduces time to diagnosis and stroke rate in blunt cervical vascular injury. J Trauma. 2009;67(3):551–6. doi:https://doi.org/10.1097/TA.0b013e3181b84408discussion 5-6.

    Article  PubMed  Google Scholar 

  47. Schneidereit NP, Simons R, Nicolaou S, Graeb D, Brown DR, Kirkpatrick A, et al. Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma. 2006;60(1):209–15. doi:https://doi.org/10.1097/01.ta.0000195651.60080.2cdiscussion 15-6.

    Article  PubMed  Google Scholar 

  48. Bromberg WJ, Collier BC, Diebel LN, Dwyer KM, Holevar MR, Jacobs DG, et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma. 2010;68(2):471–7. doi:https://doi.org/10.1097/TA.0b013e3181cb43da.

    PubMed  Google Scholar 

  49. Paulus EM, Fabian TC, Savage SA, Zarzaur BL, Botta V, Dutton W, et al. Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it. J Trauma Acute Care Surg. 2014;76(2):279–83. doi:https://doi.org/10.1097/TA.0000000000000101discussion 84-5.

    Article  PubMed  Google Scholar 

  50. • Laser A, Kufera JA, Bruns BR, Sliker CW, Tesoriero RB, Scalea TM et al. Initial screening test for blunt cerebrovascular injury: Validity assessment of whole-body computed tomography. Surgery. 2015;158(3):627–35. doi:https://doi.org/10.1016/j.surg.2015.03.063. Study suggests that whole-body computed tomography holds promise as a rapid screening test for blunt cerebrovascular injury in the patient with polytrauma to identify injuries in the early stage of the trauma evaluation when they may impact outcome.

  51. Chakraverty S, Zealley I, Kessel D. Damage control radiology in the severely injured patient: what the anaesthetist needs to know. Br J Anaesth. 2014;113(2):250–7. doi:https://doi.org/10.1093/bja/aeu203.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 S. Greene St., T1R77, Baltimore, MD, 21201, USA

    Thomas E. Grissom

  2. Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 804 Jefferson Tower, 619 South 19th Street, Birmingham, AL, 35249-6810, USA

    Bert Pierce

Authors
  1. Thomas E. Grissom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bert Pierce
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas E. Grissom.

Additional information

This article is part of the Topical Collection on Anesthesia for Trauma.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grissom, T.E., Pierce, B. Radiographic Imaging and Ultrasound in Early Trauma Management: Damage Control Radiology for the Anesthesiologist. Curr Anesthesiol Rep 6, 79–88 (2016). https://doi.org/10.1007/s40140-016-0147-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-016-0147-8

Keywords

Search

Navigation