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Fri Mar 9 16:30:55 GMT 2007

Yep, its another MAF entry,

The possibility of spinal injury was raised by the team member
representing that body system but the 'team' determined that finding
source of blood loss took priority (their decision upon which they may
later reflect). The fact that no further spinal or spinal cord
impairment occurred pre- , peri, or post-operatively illustrates modern
OR team ability to transfer and process 'actual spinal injury' and
'potential SCI' patients appropriately during essential life-saving
surgery. But..what happened to the dirty clothes in the OR and if he
didn't come back to the ward with them still in situ, then there must
have been a log-=-roll within the OR prep room, so did they make the
most of the opportunity?

Paul  

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr
<tch at sun.ac.za>
Sent: 09 March 2007 05:06
To: Trauma &amp; Critical Care mailing list
Subject: RE: Log-roll in the trauma bay

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
> >--
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Log-roll in the trauma bay