Ministry of Health

http://newzealand.govt.nz/

    
 ©Copyright
 Published: 28/11/2011

Abdominal CT for Trauma

Abdominal CT for trauma is an adequate and reliable study only when performed in a dedicated and specific fashion. Patients must be able to lie still by virtue of either being co-operative or being paralysed and sedated. A "double contrast" technique should be employed. The patient must be given, either by mouth or via gastric tube, a radio-opaque contrast material. Currently this is "Gastroview" a water-soluble compound. This is available in the ED and the Radiology Department. 
Ten mls should be mixed with 300mls of water and given as soon as you make a decision to perform a CT, preferably at least 30 minutes prior to the scan. However, CT scanning should not be delayed merely to allow time for the passage of oral contrast. The scan itself should be performed with intravenous contrast material, begin at the top of the diaphragm and go down to the symphysis pubis. 
As all radiopaque markers produce a scatter artefact it is desirable to have none in the scanned field. If a nasogastric tube has been inserted it should be drawn back to the oesophagogastric junction. The pelvis is better evaluated with the bladder filled. Thus, if the patient has been catheterised, the catheter should be clamped at the beginning to allow the bladder to fill while the scan is being performed.

 The general surgical registrar should evaluate the scan in conjunction with the radiologist. If there is any doubt about the interpretation of the findings or if there is still a possibility of intra-abdominal injury, consider performing a DPL.

Last updated on 28/11/2011