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Wed Mar 7 19:03:30 GMT 2007

Unless your on-the-spot assessment is to agree that he needs to get to
the OR stat. Then if no trauma x-ray screening of the affcted area has
been has been done to exclude gross injury and there is sufficient time
to collect the required number of staff to perform the logroll, then
with an experienced ER team, take the time to logroll and add whatever
you can to the clinical picture. Does he go to OR as a 'potential' but
unexamined spinal/SCI, as a 'possible' spinal injury on the basis of
definitive spinal pain on palpation with suggestion of early onset
changes in lower limb neurology from an enhanced primary survey, or as a
definitive spinal injury with spinal deformity noticed on cursory
clinical examination and possible developing sensory-motor impairment
which may be associated with traumatic bleeding from a thoraco-lumbar
site rather than an abdominal organ. The surgeon gives you and your team
2 minutes before you have to leave for the OR - what you do with that 2
minutes may influence what happens to him , how, and in what sequence
after he goes through the OR doors. 65 systolic is low even for an
apparent tetraplegic so trying to argue for spinal shock is
inappropriate but as we always say its not the number that is cause for
concern, but the trend, or in the case of the non-paralysed, the
response to fluid challenge. Thoraco-lumbar bleeding can be big volumes,
I can recall large volume fluid replacements and multiple returns to
theatre.

Paul

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Jacob Scholtz
Sent: 07 March 2007 18:13
To: trauma-list at trauma.org
Subject: Log-roll in the trauma bay

A patient is brought into your trauma-bay after a from a building. He
has a neck-collar, but the rest of his spine has not been immobilised.
He is in respiratory distress. The airway is clear. Breath-sounds are
present bilaterally. Saturation 99% with 10 L O2. Blood pressure 65/-.
His abdomen is tender. He has no obvious open injuries to the thorax,
abdomen or extremities. Fluids are given, but the blood pressure does
not improve significantly. The surgeon wants the patient brought to the
OR for a laparotomy. The patient is complaining of pain from the lower
back, the abdomen and his legs bilaterally. Would you log-roll the
patient before bringing him to the OR?

Jacob
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Log-roll in the trauma bay