Spoon Feed Ultralow-dose chest CT (ULCT) had perfect diagnostic accuracy for minor traumatic injury to the chest. It was superior to plain CXR and delivered the same, or in several cases, a lower radiation dose.
Why does this matter? We often obtain a CXR in patients with blunt thoracic trauma as a screening tool. But as CT technology improves, lower-dose techniques may more accurately detect injuries with the same or lower radiation dose than an x-ray. Is that the case here?
CT vs. x-ray = same radiation dose? Yup… This was a comparison of patients with chest trauma that were hemodynamically stable and had traditional CXR +/- rib series and ULCT. CT was done with a 64 slice scanner without contrast, with iterative reconstruction (which reduces the “noise” from a lower dose scan). A reference CT, with a 1-2 mSv dose, was also done and read by the radiologists in real time as the gold standard. ULCT performed perfectly, with sensitivity 100%, specificity 100% for detecting all patients with at least one finding on reference CT, with no false positives. Plain x-ray had sensitivity 79%, specificity 89%. The radiation dose of ULCT was the same or lower than plain x-ray. ULCT is more expensive than x-ray. It also may or may not change management to find a small pneumothorax, hemothorax, or a couple rib fractures, but it depends. Might it be best to use ULCT instead of CXR in patients for whom we want to screen but not do a full trauma CT chest?
Here are two example images from the supplemental material.
Spoon FeedNewer CT scanners led to faster head CT by about 10 seconds, and this decreased the number of pediatric patients who required sedation. SourceImpact of a Faster Computed Tomography Scanner on Sedation for Pediatric Head Computed Tomography Scans in 2 Large Emergency Departments-A Retrospective Study. Pediatr Emerg Care. 2022 Aug 5. doi: 10.1097/PEC.0000000000002816. Online ahead of print.
Spoon FeedThe EZ-IO may be considered as a temporizing measure for trepanation of an epidural hematoma (EDH) in rural ED settings. This should be considered only under the guidance of a skilled neurosurgeon when immediate transportation to a higher level of care is not possible.
Spoon FeedHaving an array of techniques for digital nerve blocks in your back pocket can only serve to improve your patient care. Let’s review some approaches. SourceDigital Nerve Blocks: A Comprehensive Review of Techniques. J Emerg Med. 2022 Oct 10;S0736-4679(22)00428-0. doi: 10.1016/j.jemermed.2022.07.002. Online ahead of print.