Trauma imagaing:
Question 1:
A patient is brought to the hospital following an ATLS assessment after a horse riding incident.
a) Discuss the role of ATLS during the “golden hour”, its impact on the patient care pathway, and the concept of trimodal distribution of death.
b) When the patient arrives in the emergency department they are imaged in the resuscitation room using conventional radiography of the chest and abdomen. The images are “hot reported” by an advanced practitioner radiographer.
i) In relation to current guidelines critically evaluate the role of conventional imaging in trauma radiography for the scenario
ii) Discuss the additional level of training and responsibility required for a radiographer undertaking an advanced practitioner role in conventional reporting
c) Conventional imaging proves inconclusive in the detection of free abdominal fluid. Critically evaluate the roles of Ultrasound and CT imaging in this respect
Question 2:
Scenario: It is early Saturday evening on a foggy winter’s day. There is a radiographer working with you however they are currently on ICU completing 3 mobile chest examinations and you are the Band 5 radiographer working single-handed in the A&E X-ray dept. Your hospital is a major trauma centre within the Major Trauma Network and you receive a Major Incident alert. There has been a multi- vehicle pile-up on the motorway, about 6 miles away from your hospital. Many of the vehicles involved belong to fans who were returning home to Leeds after a Premier League football match. At the time the incident is declared, there are thought to be up to 15 people dead or seriously wounded, approximately 20 severely injured casualties; plus many others who have sustained minor injuries. A major incident was declared by the senior officer on site. Your hospital is one of the first hospitals to be notified.
Section A:
With reference to relevant legislation and guidelines,
a. discuss two relevant issues, related your/your department’s role in communications during the preparations for the arrival of the patients from the Major Incident;
b. discuss two relevant issues, dilemmas or challenges related to the prioritisation of patients which may be encountered by yourself and the imaging department in the activity during this major incident and how these may be addressed;
c. discuss two relevant ethical challenges which you may encounter at any point before stand-down is declared and consider how you might address these;
d. discuss two requirements of your role/the imaging department’s role following this major incident.
Section B:
Discuss how the service provision (i.e. before, during and after the incident) might differ if this incident occurred during normal working hours
Question 3:
Radiology Imaging Request Form Please complete all sections. Incomplete forms will be returned
Patient Details
Name: Louise Smith
Address: 35 Brown Street
Manchester
Postcode: M20 3TN
DOB: 19/09/1935 Hospital Number XR1234567
Ward/Dept A&E
Consultant Mr Jones
Male/Female Female
LMP (if applicable)
Mobility Trolley
Examination Requested: CT Head and C/Spine
Clinical Information:
Fell downstairs at nursing home. Large haematoma on forehead and confusion. ? SDH. R/O cervical spine injury,
Referrer Dr K Jones Date 10/01/15
You receive the above request for Louise Smith following an accident in the nursing home where she resides.
Section A:
a. With reference to current imaging guidance, explain the justification for performing a CT head and cervical spine in relation to this request and the expectation of the radiology department.
b. The CT scan reveals a left-sided sub-dural haematoma. With the aid of diagrams, explain the radiographic appearance of a typical, acute sub-dural haematoma and the pathophysiology involved.
Section B:
When the examination has finished, Mrs Smith becomes agitated and starts to cry. She tells you that she is frightened to go back to the nursing home. With reference to relevant legislation and guidelines, discuss your responsibilities as a radiographer in this situation.