Trauma Imaging: The role of ATLS during the Golden Hour (Essay Sample)

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Trauma Imaging
Trauma has been the primary cause of death resulting from unexpected violent events in the cause of people’s lives. Normally, such events result to uncontrollable emotional responses that may manifest themselves in form of flashbacks, and sore emotions. Johnson (2009) explains that blunt, penetrating and explosive events pose as the main causes of traumatic injuries. In the event of a traumatic occurrence, it is vital for the injured person to receive rapid diagnosis and treatment within the first hour after the incidence, as this ensures the likelihood of survival. This hour (period), where diagnosis and treatment is administered to ensure high survival, is defined as the “Golden Hour”. The chances of a victim surviving are usually totally dependent during this hour, and it is the mandate of the health care professionals to ensure that necessary treatment is administered; not only to treat the victim, but to also prevent further complications, such as the risk of disability.
The role of ATLS during the “Golden Hour”
ATLS’ primary focus rotates around assessing the condition of the patient/victim, resuscitating or stabilizing them, and establishing whether they need further advanced medical treatment. In order to correctly assess the course of action to be taken, the medical team is required to rightfully determine the cause of the traumatic injury. Traumatic injuries may either be less severe or life threatening, and determining whether it is less severe or life threatening is important in dictating the course of action to be taken. Less severe traumatic injuries usually leave the victim conscious, and he/she is usually able to talk and respond to questions asked by the medical team. This gives the medical team a clear perspective on how the injury occurred and diagnosis is achieved in a timely manner. Usually, it involves imaging of the affected regions to determine the severity of the injury and hence administer the correct treatment, saving the victims life.
However, severe life threatening traumatic injuries usually leave the victim unconscious, making diagnosis relatively difficult. It is in such instances that ATLS plays a major role in saving the victim’s life as the diagnosis remains relatively ambiguous. During this golden hour, after a severe traumatic injury, the medical team hastily and carefully evaluates the victim’s situation. The vital signs are thoroughly checked and stabilized/normalized and a head-to-toe assessment is carried out to correctly set diagnosis required for the adequate therapy procedure.
If resuscitation seems-unimportant at this stage, then ultra-sonography and chest films are carried out. The importance of doing ultra-sonography is to detect abdominal fluids and determine which organs have been ruptured, while a chest film is essential in providing information about the victim’s cardio-pulmonary status. Victims of severe traumatic injuries, due to their unconscious state, have to be subjected to these tests so as to enable the medical team to get a clear picture of their condition, in order to act fast and accordingly; therefore, these scans play a vital role (Drabek et al. 1971)
In the recent time, technological advancements have allowed for full body scans to be done within minutes, and modern medical facilities are usually equipped with such facilities. Timely diagnosis, therefore, is achieved and the correct therapy procedures executed, saving the victim’s life. In less severe traumatic injuries however, imaging is targeted to the affected organs and a timely diagnosis and therapy is achieved. It is therefore important to carry out ALTS in the golden hour effectively, increasing the chances of the victim’s survival.
The concept of trimodal distribution of death
Deaths resulting from trauma normally have a trimodal distribution, in that, they may occur within three stages- the first peak, second peak and third peak. Within the first peak, death usually occurs within minutes of injury. This is usually attributed to major injuries in the vascular and neurological organs. In the instance of attending to victims in the first peak, the medical team has little or no control in preventing the death of the victim. Deaths in the second peak usually occur within the hour after the traumatic injury. It is usually attributed to major abdominal or thoracic injuries or intracranial hematoma. The ATLS methodology primarily focuses on preventing deaths at this stage as their intervention and treatment usually result to positive outcomes in saving the victim’s life. During the final stage, the third peak, deaths usually occur after an indefinite period of time following the traumatic injury. It is normally attributed to multiple organ failure and sepsis.
Role of conventional imaging in trauma radiography
Trauma radiology plays an important role in decreasing the number of casualties for victims of a traumatic injury. Rapid transportation to a hospital or medical clinic ensures the effectiveness of trauma radiology. Once the victim arrives at a hospital, a radiologist needs to be present and ready for carrying out the necessary tests. Multiple x-rays are usually the first steps a radiologist undertakes, focusing on the chest and the pelvic and lateral spine. Further radiology tests are only carried out in case further complications are detected and the need for carrying out these tests determined. Medical employees carrying out the trauma imaging radiation need to work within the confines of regulations which require them to perform the imaging process in a competent manner, following procedure and the required referral criteria. This is because; they are solely responsible for the radiation dosage and the outcomes that arise from the procedure.
Training and responsibility required for a radiographer
The medical perception on how a professional radiographer should perform his tasks plays an important role in dictating the expectation and training required from the medical personnel performing their duties as radiologists. With advancement in technology, it has become very important for radiologists to be adequately trained in performing necessary tasks and responsibilities effectively.
Macgough et al. (2005) explains that an effective radiographer needs to act in a professional and organized manner in order to perform his/her tasks to the expected standards. Formative formal education has been put in place by medical training institutions to ensure that radiologists are at par with new technological equipment used in radiology imaging, thus ensuring proper decision making by radiologists in terms of diagnosis and managing critically unwell patients. In recent times, radiologists have acquired extended roles and advanced practices in their undertakings. Radiologists have assumed the responsibility of referring victims of traumatic injuries to additional imaging in the result of an abnormal outcome from a scan. According to Snaith and Hardy, the decision-making process and expertise practices need to be undertaken by medical staff. Therefore, a radiologist needs to carry out all the necessary imaging procedures in a professional manner and produce accurate scans required for diagnosis.
A major role assumed by radiologists is the sole responsibility of the outcomes of a scan. This ensures that in the event of a misdiagnosis from his scans, he is held responsible for the outcome of the patient’s health. Training a radiologist comprises both medical training, prior to the radiologist title, and continued training in the course of their practice. This ensures that they remain relevant to the ever-changing medical advancements and procedures in the medical sphere. Educational programs equip the radiologist with adequate training and information on how to perform his/her tasks.
Role of Ultrasound and CT imaging in respect to the detection of free abdominal fluid
In the event of abdominal trauma, it is important to carry out examinations focusing on abrasions to the abdominal wall and fractures on the chest ribs. If doctors aim for a favorable outcome, then ultrasound and CT imaging becomes very vital in the treatment procedure. Since the sixties, doctors have been employing the use of CT scans and ultrasound to detect abdominal fluids. These two techniques have been pivotal in diagnosing blunt abdominal trauma allowing for necessary treatment procedures to be applied to the victim. In choosing these methods, it is first important to ascertain the stability of the patient first and the severity of the abdominal injury so as to ascertain if a treatment modality for the diagnosis is available.
Dittrich et al. (2004) explains that ultrasound and CT scans have a relatively high sensitivity, in some cases up to 100% sensitivity in detecting abdominal fluids around the liver and spleen. Detection of this fluid alerts the doctor that the victim of the traumatic injury requires a laparotomy. Despite The finding of free intraperitoneal fluid in a hypertensive patient alerts the treating doctor that the patient may need an urgent laparotomy. However, there are some limitations in the use of these techniques, such as the inability of ultrasound waves to penetrate the patient’s abdomen and this in most cases makes it very difficult to visualize the abdominal structures especially in cases where the victim’s abdomen containssurgicalemphysema.
Ultrasonography also is effective in detecting abdominal fluids but most times lacks the differentiation aspect to clearly distinguish between bile, urine and blood. As a result of this, medical experts have to correlate the findings from sonography with clinical findings to arrive at a suitable diagnosis and treatment course (Branney et al.,...