A case study from Groote Schuur Hospital, Cape Town, South Africa.
A patient with multiple gunshot wounds presents many challenges for the attending physician. Though resuscitation and definitive management must happen rapidly, the traditional imaging methods required to inform treatment are often slow, cumbersome and located outside of resuscitation areas. The advantage of the Lodox machine is that it facilitates a fast, low-dose, full-body X-ray within the resuscitation area while patient care can continue.
A 20 year-old female patient presents to the Trauma Unit with multiple gunshot wounds. On arrival she had a systolic blood pressure of 109 mmHg, pulse of 99 bpm, respiratory rate of 18 and O2 sats of 97%. The patient maintained a GCS of 15/15 throughout. Gunshot wounds to the right eye, right axilla, right forearm and left hand were visible. The number of entry and exit wounds were, however, inconsistent.
Imaging, Diagnosis and Treatment
On arrival the patient underwent a full body AP X-ray on the Lodox scanner to look for retained bullets. The scan revealed a bullet in-situ anterior to the right clavicle with an underlying mid-shaft fracture. The scan also showed a bullet lodged in the right frontal sinus, as well as bullet fragments in the right forearm. The patient was resuscitated as per unit protocol and booked for more detailed imaging.
The use of the Lodox machine in the primary survey of this patient proved invaluable because it quickly indicated the location of retained foreign objects and fractures, thereby guiding further imaging, diagnosis and treatment. A head CT indicated a comminuted fracture of the posterior table of the frontal sinus with a sliver of Pneumocranium. This informed further neurological and ophthalmic interventions. Formal X-rays also confirmed a minimally displaced right distal ulna fracture where the Lodox machine had detected bullet fragments.
In this case a patient presented with multiple gunshot wounds including penetrating facial injuries and suspected retained bullets. Traditional imaging techniques for the entire body are not feasible within the resuscitation environment. The Lodox machine fills this gap by providing a fast and effective view of the entire body, thereby guiding definitive management and care.
“Lodox is a crucial tool in the modern trauma department.”
SAYED M. DHANSAY, Medical Student,
UCT Medical SChool/Groote Schuur Hospital