A standard protocol (non-contrast head and cervical spine, arterial chest, portal venous abdomen-pelvis or split-bolus) and a fixed review order — primary survey for the life-threatening findings in minutes, then the tertiary read — so nothing is missed under pressure.
Orient first
- Primary review (hot report): tension pneumothorax, massive haemothorax, aortic injury, active haemorrhage, pneumoperitoneum, unstable spine, extra-axial haematoma with mass effect.
- Split-bolus protocols reduce dose but can mimic or hide extravasation — know the local protocol.
- A secondary full report follows within hours; fractures of the extremities are often completed later.
Acquire the study
- Non-contrast CT head and cervical spine; contrast-enhanced chest (arterial) and abdomen-pelvis (portal venous) or a split-bolus single pass; thin reconstructions with multiplanar and bone/lung windows; delayed phase for the urinary tract when indicated.
The manoeuvre
- Head, non-contrast series: extra-axial haematoma thickness in mm and midline shift.
- Chest on lung window: pneumothorax, haemothorax; mediastinum on the arterial phase: aortic injury.
- Abdomen on the portal venous phase: solid organ injury, active extravasation, free fluid and gas.
- Spine on sagittal bone-window reformats: unstable fractures.
- Pelvis on bone window: ring disruption and associated vascular injury.
- Communicate the critical findings verbally; then complete the tertiary read.
What confirms it
- A structured primary survey with critical findings communicated.
What licenses you to exclude it
- A negative whole-body CT does not exclude hollow viscus or diaphragm injury — re-image if the patient deteriorates.
The classic misread
- Satisfaction of search after the first major injury.