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Key Injury: Abdomen

BC imaging guidelines for major trauma
a) Abdominal Radiograph (AXR) (AP supine)
  • Generally not necessary if CT ordered
b) Standard Trauma Imaging CT Protocol
  • Basic set of CT imaging that will most often be used and should be considered the
  • starting point for CT imaging of the severely injured patient
  • Includes abdomen with IV contrast
  • Non-contrast CT examinations of the abdomen is considered inadequate unless there is a history of allergy to iodinated contrast and other imaging modalities are not available
  • Criteria for the ordering of this standard CT Protocol can be found in Appendix C
c) Extended Focused Assessment with Sonography for Trauma (E-FAST)
  • E-FAST is not necessary in primary or secondary surveys but if CT not readily available, clinicians should consider E-FAST even in stable patients. (E-FAST is low-cost and clinicians can benefit from maintaining their skill with this modality.)
  • If CT is readily available, however, clinicians should forego E-FAST as the latter does not contribute to decision-making.
  • Standard E-FAST (see Appendix F) to visualize free fluid in the pleural, pericardial, perihepatic, perisplenic, and pelvic locations or pneumothorax in the anterior pleura.
  • Also useful in triage of multiple severely injured patients simultaneously.
d) Delayed Phase CT Imaging of Abdomen
  • Generally not necessary
  • Consider if patient is hemodynamically unstable and abdomen is suspected to be source of active bleeding
  • Delay: 2-5 min. after injection
e) CT Urography/Intravenous Pyelogram (IVP)
  • Generally not necessary
  • Consider if patient has hematuria from a suspected urinary collecting system injury
  • Antegrade with delays through entire urinary collecting system (15-20 min.)
f) Rectal Contrast
  • Generally not necessary on initial imaging
  • Consider in penetrating wound to the flank, especially when requesting follow-up CT
  • CT Imaging not to be delayed if patient unstable
  • Requires rectal tube
g) Oral Contrast
  • Generally not necessary
  • Consider in anterior penetrating wounds in the epigastric region to assess for gastric injury
  • CT imaging not to be delayed if patient unstable
  • Consider danger of aspiration if patient has a decreased level of consciousness or nasogastric tube to be used if patient unable to take voluntarily


SOURCE: Key Injury: Abdomen ( )
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