Log-roll in the trauma bay

[Bjorn, Pret]

Well stated.

It must be Mutual Agreement Friday on the Trauma-List.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com
Sent: Friday, March 09, 2007 10:37 AM
To: trauma-list at trauma.org
Subject: Re: Log-roll in the trauma bay

 
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
<BR><BR><BR>**************************************<BR> AOL now offers
free 
email to everyone.  Find out more about what's free from AOL at 
http://www.aol.com.
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/