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Emergency Treatment Center's new on-site CT scanner
benefits patients with traumatic injuries
It was a terrible accident. Jason Grams, a 26-year-old
automotive mechanic from Anamosa, Iowa, was working
underneath a truck supported on a hydraulic bed when the bed
tilted down and the weight of the truck crushed Grams'
skull.
Grams was rushed to a hospital in Cedar Rapids.
Physicians there decided he needed treatment at University
of Iowa Hospital and Clinics, so he was flown by AirCare
helicopter to the Emergency
Treatment Center (ETC). There, physicians evaluated his
head injuries using a new, highly advanced multi-slice
computed tomography (CT) scanner.
The scanner, which was installed in the ETC in early
2000, uses X-rays and sophisticated software to produce
images of the inside of the body. A doughnut-shaped device
rotates around the patient capturing image "slices." It
works so quickly that it can image the entire body in 17
seconds.
The incredible speed of this machine means patients with
traumatic injuries receive rapid, high resolution,
diagnostic imaging. Images, acquired in seconds, often
provide all the information physicians need to plan a
treatment course for trauma patients.
Matthew A. Howard, M.D., was the lead neurosurgeon
treating Grams.
"The CT scans were available quickly, which is crucial in
these situations," Howard said. "And, importantly, the image
quality was sufficiently good that we were able to identify
and locate a blood clot, which we treated, and plan the
surgery we would use to reconstruct the patient's skull."
Grams also required attention from surgeons specialized
in treating eye and nose injuries.
Nancy Bauman, M.D., led a team of otolaryngologists who
used CT scans to assess the damage to Grams' facial bones.
"We looked at the scans and determined where the
fractures were," Bauman said. "The scans helped us decide
where to make our incisions and what approach to use to
reassemble the facial and sinus bones, which were severely
displaced."
Repair of Grams' fractures was particularly important as
his brain tissue was exposed to the frontal and ethmoid
sinuses. Sinuses contain bacteria, so any contact with the
brain is very dangerous.
Howard performed a craniotomy to repair the skull
fractures, and Bauman and her team reconstructed the
forehead, orbit, and nasal bones using titanium metal plates
to secure the mobile bone fragments.
Jeffrey A. Nerad, M.D., ophthalmologist, and his
colleague, Rodrigo J. Poblete, M.D., repaired the lacerated
eye and collaborated with Bauman's team to reconstruct the
orbit.
"Clinical examination showed that the left eye was
ruptured, and this diagnosis was confirmed by the CT scan,"
Nerad said.
To prevent the fluid from being squeezed out of Grams'
eye during the neurosurgical procedures, the eye surgery was
performed immediately. Grams subsequently had additional
surgery, performed by ophthalmologist Stephen R. Russell,
M.D., to clear the blood from his eye.
Information from the CT scans provided the greatest
benefit to Howard's team, which repaired Grams' skull and
rescued his brain. However, both Nerad and Bauman found
value in the ETC-based scanner as well.
"It's nice to have a CT scanner dedicated to emergency
cases," Nerad said. "Trauma cases can be given immediate
access to the CT scanner and patients don't have to be
transported from the ETC to a scanner located elsewhere and
then back."
Bauman added that being able to perform diagnostic
imaging in the ETC means that emergency staff members are on
hand if a patient's condition suddenly deteriorates.
As for Jason Grams, he is happy with how things are
going. His vision has been restored and about two months
after the accident he was well enough to go back to work.
"I would say my recovery has been really good," Grams
said. "The hospital staff were really well-trained and
friendly. They were helpful with any questions we asked."
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Three-dimensional
reconstruction of 
CT
scan shows bridge of Grams' nose 