Log-roll in the trauma bay

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Jacob

The short answer is A before B before C BEFORE D: Log-roll in the context you state is to examine for tenderness over the spines and do a PR for anal tone. These can wait in this situation. The incidence of neurogenic shock is low after lower back fractures - it is classically associated with C3 - T5 injuries and so I would be inclined to go with the surgeon and make sure he has a vascular set open as there may well be an IVC or Aortic injury. If the patient is moving arms and has minimal neck pain go to the OR. Neurogenic shock also usually gives a (relative) bradycardia - you did not provide a pulse-rate???

Some more info would be nice.

Let us also have some outcome feedback.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
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Office: +27219389281 or 4911 pager 0302



-----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 8:13 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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