List Archives

Fri Mar 9 05:06:03 GMT 2007

Jacob

Given this additional detail my initial support for the surgeon stands - the log-roll would not likely have added anything to the initial care at this stage. The treatment of bleeding - is to stop the bleeding! In the abdomen this means laparotomy and damage control!

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
Cell: +27824681615
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: Thursday, March 08, 2007 9:55 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Log-roll in the trauma bay

Here is some more information:

The patient, a builder, fell from a scaffold (approximately 6-7 m), as he
was climbing a ladder. The ambulance closest to the scene had a neck-collar
but no equipment to immobilise the rest of the spine. The crew did however
consider the possibility of spinal injury. As he arrived to the ER he was in
respiratory distress. A saturation of 99%. Blood pressure of 65/- and a
pulse of 120. All limbs were moving. The pelvis seemed to be stable.

Our trauma team is lead by a surgeon but an orthopedist is also called. The
surgeon (and the anaesthesiologist watching the patients airway) wanted to
go straight to the OR as the patient did not respond to fluid resuscitation.
This decision was announced to the trauma team and then the orthopedist
raised the question if the patient should not be log rolled first. As the
orthopedist was more senior than the surgeon, the surgeon hesitated, but
after a while decided to go to the OR.

I am an emergency physician (who was working with the anaesthesiologist as
the patient arrived) so I can not provide you with the surgical details
but the laparotomy showed a liver and spleen laceration. A left sided
hemo-/pneumothorax was diagnosed and treated in the OR. A follow up CT
showed a stable lumbar spine fracture and pelvic fractures. Plain
radiographs showed bilateral calcaneal fractures and a left tibial fracture
(not dislocated).

Jacob

On 3/8/07, Anthony caruso <medic541 at hotmail.com> wrote:
>
> Was there an event prior to the fall ?
>
> A. Caruso EMT-P
>
> >From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
> >Reply-To: "Trauma & Critical Care mailing list"
> ><trauma-list at trauma.org>
> >To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> >Subject: RE: Log-roll in the trauma bay
> >Date: Thu, 8 Mar 2007 06:58:52 +0200
> >
> >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
> >Cell: +27824681615
> >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
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/index.php?/community/
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/index.php?/community/
>
> _________________________________________________________________
> With tax season right around the corner, make sure to follow these few
> simple tips.
>
> http://articles.moneycentral.msn.com/Taxes/PreparationTips/PreparationTips.aspx?icid=HMFebtagline
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Log-roll in the trauma bay