get MDCT if appropriate, so the need for FAST in these individuals is questionable. In multiple casualty scenarios, information gained by FAST may assist in triage, but FAST must not delay transfer to MDCT because it can add information as a basis for case triage.If MDCT can be done promptly, some or all of the other investigations can be omitted. The decision to use MDCT should be based on the patient's physiologic condition and the mechanism and degree of injury. Other imaging should not delay MDCT or be used alone to determine which patients should be scanned. Even though concerns about delays in treating patients will ensue if MDCT is used, there is no evidence for routinely omitting MDCT in unstable trauma patients. This group will gain the most from MDCT imaging before intervention. One study found that the use of whole-body MDCT is a strong predictor of patient survival, even after adjusting for confounding factors and injury grade. Multidetector computed tomography use before emergency bleeding control was associated with a survival benefit only in the most unstable patients. Hemodynamic instability should be a reason to scan a patient as soon as possible.Although location of MDCT in the emergency department (ED) is advocated, this may be difficult to do in current economic climates and with competing imaging requirements. Trials have found that even when the scanner is in the ED, 36 minutes elapsed between arrival and the start of scanning. Protocols for scanning should focus on immediate stabilization in the ED followed by diagnosis (MDCT) and then targeted treatment. Diagnosis and therapy usually involve transfer from the ED. Protocols should be created and rehearsed to minimize delays with damage control resuscitation continuing during the process. The standardized examination by MDCT should include noncontrast head to assess for intracranial hemorrhage, followed by a dual-phase contrast injection for the neck and trunk to identify injuries needing the most immediate management (eg, site of ongoing bleeding or solid organ laceration). The scan can be extended to the lower legs if necessary. Reporting the MDCT should be structured and consistent.Minimally invasive IR techniques to stop active bleeding include temporary balloon arterial occlusion, embolization to occlude arteries, and stent grafting to repair injured vessels. Multidetector computed tomography can quickly identify the site of ongoing bleeding and will help determine whether hemostasis will be best and most rapidly achieved by embolization or surgery or their combination. Interventional radiology is viewed as an arm of damage control surgery and not as conservative or nonoperative management. Multidetector computed tomography will allow estimation of how long it will take to reach hemostasis by IR techniques. Often the decision-making process between IR and damage control surgery for hemorrhage control will depend on the expertise of the clinicians involved. Anesthetists must be part of the discussions because they will have to manage pat...
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