Initial investigations
Initial investigations that are essential in the multitrauma patient

* X match
* CXR (supine)
* Lateral Cervical spine Xray indicated if:
Head Injury
Severe faciomaxillary injury
Mechanism of injury eg. sudden deceleration
Cervical spine pain /tenderness
Signs of spinal cord injury
Cervical spine X-ray checklist ­ need to see from C1 to C7/T1 interspace

* Alignment of the anterior & posterior vertebral lines, the spino-laminar line and tips of spinous processes
* Bones ­ compression of vertebral bodies, C1 peg
* Cartilage ­ disc spaces should be equal
* Soft tissue ­ prevertebral space
Chest X-ray - checklist

* Lungs ­ look for evidence of aspiration, contusion
* Pleura ­ look for haemopneumothorax
* Heart shadow ­ if enlarged suspect pericardial tamponade
* Pneumomediastinum / pneumopericardium / subcutaneous emphysema ­ suspect major airway injury
* Ribs ­ if upper ribs fractured then patient at high risk of major intrathoracic trauma