Log-roll in the trauma bay

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In a message dated 3/9/2007 9:28:18 AM Central Standard Time,  pbjorn at emh.org 
writes:

I think  the distinction lies in whether the primary exam has ENDED. 
If you  subscribe as I do to the philosophy that the ABC's are sequential
and  absolute (no point moving to Breathing if the Airway isn't open...),
then  one can argue that a damage control laparotomy may the only way  to
stabilize Circulation before checking Disability, Exposing the  patient,
and so on.  In the Trauma Nursing Core Course, we don't get  where you
want to be until the NINTH step ("Inspect the  back").



Pret:
 
While I agree to the step wise situation describe in both the TNCC and ATLS  
courses, the point remains that if you have determined that the patient needs 
to  go to the OR, you still need to take some precautions to reduce the 
possibility  of contamination of same. Also, I don't know about TNCC directly, but I 
do  know that in the ATLS course, they also point out that while the steps 
need to  go in order, more or less, there is no reason why some of them cannot 
be  parallel processes if your team is large enough and you have enough 
equipment. 
 
You can provide manual stabilization of both the pelvis and the Cspine  
during the log roll, and that also gives you a chance to get that draw sheet  under 
them and do a 10 second check of the prostate to see if you can safely  
insert the Foley that will help you judge urine output, which in turn gives you  
another measure of how stable the patient is.
 
Since the hospitals I work at normally stabilize and ship patients, we  don't 
have to worry about taking patients to the OR still in grubby cloths and  on 
a back board. I'd think that there would be enough complications from doing  
that (between direct contamination, infections and tissue damage), that most OR 
 teams will have to stop and do the log roll then...maybe without enough  
experienced people to properly manage all three stabilizations at once (c spine,  
airway and pelvis).
 
ck
Charles S. Krin, DO FAAFP
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