Log-roll in the trauma bay

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It's hard to fairly convey the entirety of this situation in a paragraph.
No matter what our responses, we weren't there.  Plus, your first sentence
is incomplete: may we assume you meant to say "FALL from a building?"

Ideally, yes, you should get a look at the patient's back as soon as
possible, and if you're in a facility able to instantly produce a trauma OR,
one wonders why you can't collect up a few people to help in the ten-second
process of looking over your whole patient.  It's surprising what can be
hidden behind one's back.

All that said, if you have a qualified surgeon who can't see getting beyond
"C" in the ABC's without a damage control laparotomy, then let's relegate
(E)xposure to the secondary survey and give credit for an aggressive
surgical mindset.  If it's truly blunt/decelerating trauma (there's no small
arms holes in the patient's unexamined flanks), then you can argue for
either turning him as part of his transfer to the OR table, or after his
abdomen is packed twenty minutes from now.  It's just harder to find free
hands for the job in the operating room.

I'm guessing there's more to this case, including a reason you ask...

Pret Bjorn, RN
Bangor, ME USA



-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Jacob Scholtz
Sent: Wednesday, March 07, 2007 1:13 PM
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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