Can E-FAST Reduce the Role of Chest X-Ray in Trauma Patients?

Background : The first case of COVID-19 in Indonesia was recorded in March 2020. Limitation of reverse-transcription polymerase chain reaction (RT-PCR) has put chest CT as an essential complementary tool in the diagnosis and follow up treatment for COVID-19. Literatures strongly suggested that High-Resolution Computed Tomography (HRCT) is essential in diagnosing typical symptoms of COVID-19 at the early phase of disease due to its superior sensitivity (97%) compared to chest x-ray (CXR).The two cases presented in this case study showed the crucial role of chest CT with HRCT to establish the working diagnosis and follow up COVID-19 patients as a complement to RT-PCR, currently deemed a gold standard.

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08. Missed Diagnosis of Pneumothorax During Aeromedical Transport

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00045829 ◽

1996 ◽

Vol 11 (S2) ◽

pp. S38-S38

Author(s):

SH Thomas ◽

P DeVellis ◽

T Harrison ◽

SK Wedel

Keyword(s):

Trauma Center ◽

Air Transport ◽

Trauma Patients ◽

X Ray ◽

Chest X Ray ◽

Missed Diagnosis ◽

Level I ◽

Aeromedical Transport ◽

One Year ◽

Needle Decompression

Purpose: Difficulties with physical assessment inherent to the helicopter environment have led to suggestion that aeromedical crews may be unable to identify hemo- or pneumothorax (HTX/PTX) while in-flight. This study was conducted to determine the frequency of missed HTX/PTX in trauma patients undergoing air transport.Methods: One year (1994) of an air medical service's trauma transports to a Level I trauma center were analyzed to identify patients undergoing tube thoracostomy (TT) within 2 hours of trauma center arrival. Patients who had received intra-transport needle thoracostomy were excluded. Records were reviewed to determine how HTX/PTX was diagnosed at the trauma center.Results: Only 11 patients who had not received aeromedical needle decompression underwent TT at the receiving center. Two of the 11 were trauma arrests and received TT as part of thoracotomy, without air or blood return on TT. None of the remaining 9 patients had TT on clinical suspicion alone. Four had normal physical examination and underwent TT after chest X-ray (CXR). Remaining patients had no HTX/PTX clues on exam or CXR; one had a small HTX identified on chest computed tomography and the other four received intra-operative TT because of rib fractures in the setting of multisystem trauma.

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Weather the Cytokine Storm: A Report of Successful Management of a Colon Cancer Survivor and a Critically Ill Patient with COVID-19

Case Reports in Oncology ◽

10.1159/000509507 ◽

2020 ◽

Vol 13 (2) ◽

pp. 754-759

Author(s):

Mansoor Khalid ◽

Tarek Dernaika ◽

Lirin Jacob ◽

Pavan Annamaraju ◽

Achuta K. Guddati

Keyword(s):

Critically Ill ◽

Cancer Survivor ◽

Critically Ill Patient ◽

Cytokine Storm ◽

Ventilator Support ◽

X Ray ◽

Chest X Ray ◽

Underlying Mechanisms ◽

Poor Outcomes

Patients with novel corona virus infection (COVID-19) can develop acute respiratory failure secondary to acute respiratory distress syndrome. Cytokine storm is suggested as one of underlying mechanisms for the rapid clinical decline. Immunocompromised patients and cancer patients are at particular risk for poor outcomes due to COVID-19 infection. This case report describes the presentation and clinical course of a cancer survivor who became critically ill and required mechanical ventilation. The patient was treated with hydroxychloroquine, azithromycin, and ceftriaxone; however, he remained febrile, hypoxemic, continued to require full mechanical ventilator support and his chest X-ray showed increased bilateral infiltrates. The patient was treated with tocilizumab, after which he improved and was successfully extubated. This report illustrates a possible role of tocilizumab in management of cytokine storm in critically ill patients with COVID-19 infection.

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Ultrasound Detection of Pneumothorax Compared with Chest X-Ray and Computed Tomography Scan

The American Surgeon ◽

10.1177/000313481107700427 ◽

2011 ◽

Vol 77 (4) ◽

pp. 480-483 ◽

Cited By ~ 29

Author(s):

Khanjan Nagarsheth ◽

Stanley Kurek

Keyword(s):

Ct Scan ◽

Negative Predictive Value ◽

Predictive Value ◽

Chest Ct ◽

Trauma Patients ◽

X Rays ◽

Thoracic Ultrasound ◽

X Ray ◽

Chest X Ray ◽

Chest Ct Scan

Pneumothorax after trauma can be a life threatening injury and its care requires expeditious and accurate diagnosis and possible intervention. We performed a prospective, single blinded study with convenience sampling at a Level I trauma center comparing thoracic ultrasound with chest X-ray and CT scan in the detection of traumatic pneumothorax. Trauma patients that received a thoracic ultrasound, chest X-ray, and chest CT scan were included in the study. The chest X-rays were read by a radiologist who was blinded to the thoracic ultrasound results. Then both were compared with CT scan results. One hundred and twenty-five patients had a thoracic ultrasound performed in the 24-month period. Forty-six patients were excluded from the study due to lack of either a chest X-ray or chest CT scan. Of the remaining 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) were found on ultrasound and 7 (32%) were found on chest X-ray. The sensitivity of thoracic ultrasound was found to be 81.8 per cent and the specificity was found to be 100 per cent. The sensitivity of chest X-ray was found to be 31.8 per cent and again the specificity was found to be 100 per cent. The negative predictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.

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Cross-sectional imaging of the torso reveals occult injuries in asymptomatic blunt trauma patients

World Journal of Emergency Surgery ◽

10.1186/s13017-019-0287-5 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Gregory J. Roberts ◽

Lewis E. Jacobson ◽

Michelle M. Amaral ◽

Courtney D. Jensen ◽

Louis Cooke ◽

...

Keyword(s):

Blunt Trauma ◽

Chest Ct ◽

Physical Exam ◽

Trauma Patients ◽

Cross Sectional ◽

X Ray ◽

Cross Sectional Imaging ◽

Normal Chest ◽

Chest X Ray ◽

Sectional Imaging

Abstract Background High morbidity and mortality rates of trauma injuries make early detection and correct diagnosis crucial for increasing patient’s survival and quality of life after an injury. Improvements in technology have facilitated the rapid detection of injuries, especially with the use of computed tomography (CT). However, the increased use of CT imaging is not universally advocated for. Some advocate for the use of selective CT imaging, especially in cases where the severity of the injury is low. The purpose of this study is to review the CT indications, findings, and complications in patients with low Injury Severity Scores (ISS) to determine the utility of torso CT in this patient cohort. Methods A retrospective review of non-intubated, adult blunt trauma patients with an initial GCS of 14 or 15 evaluated in an ACS verified level 1 trauma center from July 2012 to June 2015 was performed. Data was obtained from the hospital’s trauma registry and chart review, with the following data included: age, sex, injury type, ISS, physical exam findings, all injuries recorded, injuries detected by torso CT, missed injuries, and complications. The statistical tests conducted in the analysis of the collected data were chi-squared, Fischer exact test, and ANOVA analysis. Results There were 2306 patients included in this study, with a mean ISS of 8. For patients with a normal chest exam that had a chest CT, 15% were found to have an occult chest injury. In patients with a negative chest exam and negative chest X-ray, 35% had occult injuries detected on chest CT. For patients with a negative abdominal exam and CT abdomen and pelvis, 16% were found to have an occult injury on CT. Lastly, 25% of patients with normal chest, abdomen, and pelvis exams with chest, abdomen, and pelvis CT scans demonstrated occult injuries. Asymptomatic patients with a negative CT had a length of stay 1 day less than patients without a corresponding CT. No incidents of contrast-induced complications were recorded. Conclusions A negative physical exam combined with a normal chest X-ray does not rule out the presence of occult injuries and the need for torso imaging. In blunt trauma patients with normal sensorium, physical exam and chest X-ray, the practice of obtaining cross-sectional imaging appears beneficial by increasing the accuracy of total injury burden and decreasing the length of stay.

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