Diagnostic Testing in Trauma

Aka: Diagnostic Testing in Trauma, Lab Testing in Trauma, Radiographic Evaluation in Trauma, Trauma Diagnostic Testing

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II. Evaluation: Bedside Monitoring

  1. Ventilatory rate
  2. Arterial Blood Gas
  3. Pulse Oximetry
  4. Capnography (EtCO2)
  5. Heart Rate
    1. Early marker of shock (with caveat of Delayed Tachycardia in some patients)
  6. Blood Pressure
    1. Poor measure of tissue perfusion
  7. Electrocardiogram
    1. See Rhythm monitoring in Trauma

III. Labs

  1. Blood Type and Cross Match
  2. Complete Blood Count
  3. Chemistry Panel
  4. Urine Pregnancy Test
    1. Indicated in all women of childbearing age
  5. Urine Drug Screen
  6. Urinalysis
    1. Indicated for abdominal or pelvic Trauma to evaluate for Hematuria in retroperitoneal injury
  7. Arterial Blood Gas (or Venous Blood Gas)
  8. Coagulation studies (INR, PTT and Platelet Count)
    1. Coagulopathy is present in 30% of severely injured patients
    2. Indicated in known Coagulation Disorder, Massive Transfusion or serious Head Injury

IV. Imaging

  1. FAST Exam
  2. Consider Head CT
  3. Cervical Spine CT (typically replaces Cervical Spine XRay except in children)
  4. Portable AP Chest XRay (or Chest CT)
  5. Portable AP Pelvis XRay (or Pelvis CT)
    1. Consider pelvic xray in unstable blunt Trauma patients, pelvic instability, Hip Dislocation or Hypotension
    2. Otherwise pelvic xray is not needed if CT Pelvis will be performed (CT Pelvis has higher Fracture sensitivity)
    3. Soto (2015) Am J Surg 210(6): 1076-81 [PubMed]
  6. CT spine imaging may be reconstituted from body imaging
    1. CT Thoracic Spine may be reconstituted from CT chest
    2. CT Lumbar Spine may be reconstituted from CT Abdomen and Pelvis

V. References

  1. (2012) ATLS, 9th Ed, American College of Surgeons, Trauma Committee, p. 14-5

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