Trauma positioning for upper extremity
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- Опубликовано: 22 окт 2020
- Radiography students in the lab working on alternate ways to perform upper extremity radiography when the patient is injured and has limited range of motion. Wrist, elbow and forearm positioning are demonstrated with patients having various mobility issues. I don't think that trauma external oblique is in the book, but it can certainly be done. Although for most trauma cases the radial head shot is more commonly used (Coyle method, 45 degree tube angle)
Entertaining lmao. I hope a lot of the students learned and went on to do well :)
This is exactly how patients are in the real world! Now try a pt who has a fractured shoulder and a cast on their wrist going all the way past their forearm and are 88 yrs old AND cant seem to move the body part away from their body! Haha 😛
I wish we were taught to move injured patients especially when you have never been in the medical field. 😔
When you're working in radiography, it's all but impossible to avoid moving the patient somewhat. But you have to be _very careful_ when doing so such that bone and joint alignment is preserved. Obviously, in our lab we're not really injured, but we try to practice as if we were so that when we get to clinic we have some advance notion of what to do and what not to.
hi! I was just wondering why a 45 degree sponge was used to obtain the lateral wrist projection, even though placing the hand on the other sponge (at 12:25) would still provide an adequate lateral wrist image?
There was no particular reason. The students were trying different positioning aides to try and see which was the most comfortable for the patient. The truth is that most of the clinical sites don't have ANY positioning sponges, so you will probably just be using a rolled up towel or sheet. But we have to get the part of interest away from the edge of the IR so that nothing gets cut off. If the patient is able, they can just hold it up but in a trauma situation, they may not be able to help.
ive been trying to find a video on how to do a lateral trauma on a forearm if they cant turn their hand (in a thumbs up position) to get the radius and ulna superimposed. One tech i saw just x-rays it with the hand pronated and said its ok since its trauma. But i dont think thats right
Trauma imaging is a challenge, because a lot of times I will take an initial image of the part "as it lies" and discover that there are one or more breaks. Now what? you can't move the limb or you might damage a blood vessel. The only thing you can do is take two images offset 90 degrees from each other _without_ moving the patient any more than absolutely necessary. I've been doing this for over 20 years, and sometimes my images don't look all that good but they are normally enough for the surgeons to get what they need. The main thing is just do the best you can with what you have to work with and hopefully some of what we show in lab will help.
Thank you for watching and for commenting!
I've been doing trauma radiography for over 10 years. What I'm seeing on this video is absolutely not the right way to do this.
Judging by this video he's got a break between his wrist and elbow. Clearly he has the ability to rotate his shoulder and extend his elbow fully.
Assuming that this is a mid shaft to distill radius and ulnar break you can use the proximal joints to position the arm accurately and quickly. This should not be a 40-minute video.
This should not be angled sponges holding the IR. Proper way to do his exam would be raising the table up to shoulder level and placing his arm in a bent position to do his PA wrist and most likely the doctor would want a two view forearm. Some trauma doctors will want imaging of the elbow as well.
I positioning the patients arm at shoulder height you can easily get images of his or her wrist, PA forearm, and lateral elbow without moving the patient. You can continue by shooting a radio headshot of the elbow if desired by angling 45°, latero - medial.
As far as getting in oblique image of the wrist you would need to drop the table down enough to allow rotation of the arm after it has been extended fully.
If there is excessive pain or instability of the arm distal to the brake you may place something under the hand to help support the weight while taking your oblique image.
Once this is completed you may continue to rotate externally into a lateral position and proceed to take lateral wrist, lateral forearm in the extended position, and externally rotate further for an AP elbow.
I tell my students all the time one of the best things to do is put yourself in that patient's position and understanding where the pain / break is. At that point you can picture what your limitations are as far as adjusting your position to get the images you need.
There are other alternative positions in projections that can help you obtain the views we spoke of above including cross table projections meaning you're propping the patient's arm up on a radiolucent block shaped positioning sponge and angling your tube parallel to the floor.
Not sure what level of experience the techs in the room have had but they'd learn a thing or two working at a level 1 trauma center like the one I'm working for.
Thanks very much for the insights! These aren't techs, they were 1st semester students, just starting to learn basic positioning. But they're getting better every day! I agree, after a few years on the job they'll probably learn a lot more ways to do things.
ive been trying to find a video on how to do a lateral trauma on a forearm if they cant turn their hand (in a thumbs up position) to get the radius and ulna superimposed. One tech i saw just x-rays it with the hand pronated and said its ok since its trauma. But i dont think thats right
@@Samson-dn4eo I'd suggest, if their arm is in a lateral elbow position, but they cannot rotate their wrist to a thumbs up position, I would prop their arm up on a sponge, place the detector upright, parallel to their lateral forearm, and move the tube to a horizontal beam position. I'd then angle slightly up, to get a lateral wrist!! If you don't achieve a lateral elbow (condyles superimposed), then do a lateral elbow view like you would normally, just without wrist rotation. This way, you'll be getting: AP elbow and Lateral wrist in one photo, and Lateral elbow, PA wrist in the other.