Log-roll in the trauma bay

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In a message dated 3/10/2007 5:57:43 AM Central Standard Time,  
karim at trauma.org writes:

No log  roll no nothing.  This patient goes straight to a place of  definitive
care.  Examining the back, monitoring physiology,  everything else can be
done in the operating room with before or after  laparotomy, depending on
haemodynamics.

It *may* be that this  patient is in severe neurogenic shock and is not
bleeding at all.  The  odds are against this, by orders of 100:1 or 1000:1.
Worst case, he has a  negative laparotomy - it won't kill him.  A log  roll
might.

Hooray for Sensible Saturdays, and let it be Sensible  Saturday every day of
the week. 

Karim


Then, Karim, I'll expect that your OR supervising nurse will be removing  the 
dirty clothing in the recovery room....and that you have some percentage of  
survivors with skin break down. I strongly suspect that those clothes are 
going  to come off before the patient is on the table....and if you are going to 
do  that, is it that much more time to look for posterior injuries that may 
prove  crucial to the patient's long term survival and recovery? As I pointed out 
 before, parallel processes are good. 
 
Could you bring enough of the ED/EMS/A&E team upstairs to the OR to  manage 
the log roll/posterior clearance/transfer to the OR table? Sure...just  ask, 
we'll be glad to help....
 
I understand that the patient needs to be moved to the OR...and that's fine  
when you, as a surgeon, have a hot OR that is immediately  available.
 
Bottom line: life threatening trauma is a surgical condition that  often 
requires initial management in non surgical ways due to the nature of  human 
endeavor...and the inherent limitations of the trauma system. Reduction of  the 
delay to OR by use of teamwork, parallel processing and appropriate use of  high 
speed transport systems is in the patient's best interests and leads to  
better ultimate outcomes.
 
Chuck
Charles S. Krin, DO FAAFP
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