Initial Radiographic Evaluation

The cervical spine must be imaged in all patients with a significant blunt trauma mechanism, particularly if they have an altered mental status. In cases of penetrating trauma, radiographs are evaluated for fractures and retained foreign bodies. Although the path of a missile is never known with certainty, localizing a bullet may determine or suggest a transcervical trajectory. In both blunt and penetrating trauma, the soft tissues should be examined for hematomas, air-column obstruction or deviation, subcutaneous emphysema, or retropharyngeal thickening. A chest radiograph must be obtained to evaluate for the presence of a pneumothorax, hemothorax, or air in the mediastinum.

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