Figuring that no question is a dumb question, what are your guidelines for CT scans in assessing blunt trauma to the abdomen. Our radiologists often want to give oral contrast(along with IV), but I and the trauma department feel that in most cases the oral contrast delays the study, adds, in most cases, little information necessary acutely and carries the risk of aspiration. Help, support, or education would be most appreciated.

We tend to use oral contrast liberally, as the greatest weakness of CT in this setting is picking up bowel injuries--we have not had any adverse consequences of this practice. Even with the contrast, bowel injuries are missed, but contrast provides the best chance of picking them up. IV contrast poses little risk, and is valuable in assessing the GU tract and pancreas.

We routinely ise both IV and oral contrast for Abd CT. We have had some patients vomit but never had any problem with aspiration. We do try to empty the stomach again after the CT. Mostly, we give the contrast through an NG tube and rather fast, usually in about 10-15 minutes while we finish the screening Xrays.

At Middlemore we have dropped oral contrast out of the protocol for abdo trauma.

We had one patient who aspitated and got ARDS, then died (although it turned out he had terminal CA as well as the trauma, so the death was not directly attributable to the contrast)

After this we asked our radiologists to review their reasons for giving oral contrast, which in the past they had said was essential to rule out duodenal or pancreatic injuries. They did a review of the literature and decided that oral contrast was a waste of time.

Do those of you who routinely use oral contrast for your abdominal scans give reglan to speed transit through the GI system? (or cisapride)

I don't. First, I don't care how far past the duodenum it gets. I especially don't like to delay the scan waiting for transit. If it has much value at all, it is to improve sensitivity for duodenal and pancreatic injuries. Even that value has been called into question. Once the scan is done, I'd rather suck it back out the NG. Secondly, I'd hesitate to give any meds that aren't absolutely necessary to the acutely injured victim.

In our center we start to give the oral contrast on the E.R. through the NG Tube. We don't wait with the CT. We start with the head CT and Chest if indicated and then go to the abdominal CT. Most of the time we can see the stomach the duodenum and part of the small bowel. We give IV contrast on the CT table. We do not see a problem with it and I don't recall any complication of aspiration of something like it.