Chest

a) Chest XR (AP supine)

  • Needed after placement of intrinsic tubes, such as endotracheal or chest tubes
  • To rule out critical diagnoses contributing to hypotension, including major pneumothorax and major hemothorax
  • If tension pneumothorax is suspected because of hypotension in the setting of absent/diminished breath sounds, respiratory distress, possible tracheal shift and/or hypoxia, then chest decompression should precede CXR
  • Other important findings include stigmata of blunt aortic injury, diaphragm disruption, thoracic spine injury, major rib fractures
b) Standard trauma imaging CT protocol

  • The 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 CT angiogram (CTA) of the thoracic aorta with IV contrast
  • Non-contrast CT examinations of the chest 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) Delayed CT imaging of chest

  • Generally not necessary
  • Consider if patient is hemodynamically unstable and chest is suspected to be source of active bleeding
  • Delay: 2-5 minutes after injection
d) Volume rendered reconstructions

  • For flail chest
  • Can use data already obtained from initial CT