Log-roll in the trauma bay

[Krin135 at aol.com]

In a message dated 3/7/2007 10:59:40 PM Central Standard Time,  tch at sun.ac.za 
writes:

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.


My basic attitude on this one is that the surgeon and OR team is going to  
want the dirty clothes out from under the patient in any case...since the  
patient needs to be log rolled to accomplish that, the posterior exam and  
palpation (along with rectal) can be accomplished at that time, without unduly  
delaying the trip to the OR.
 
ck
Charles S. Krin, DO FAAFP
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