Log-roll

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A method of examining a patient while their spine remains immobilised - ie if there is a risk of unstable vertebrae. This is part of D (and some of E), so ABC should be completed first.

LogoWarningBox4.pngIt is possible to paralyse patients through damage to the spinal cord. Don't log roll unless you've been shown how by an expert, don't log roll without 4 assistants, and don't log roll unless in a controlled environment!
  1. Explain what is going to happen, to the patient (if conscious) and to those assisting.
  2. People are at:
    • the head (anaesthetist or most experienced assistant)
    • the thorax (tallest)
    • the pelvis
    • the legs (shortest)
    • the examiner is on the other side of the patient
  3. on 3 (or go) called by the head person, the patient is rolled towards the assistants.
  4. pull the back board out from under the patient
    • along with any cut off clothing, twigs, glass and other extraneous material - be careful!
  5. inspect the back for obvious wounds/deformity
  6. palpate down the spine to localise any spinal injury
  7. percuss/auscultate the lungs
  8. digital rectal examination for perianal sensation and anal tone
  9. down on 3 (or down) called by the head person
  10. keeping the head immobilised, undo the cervical collar and examine the cervical spine (see also clearing the cervical spine)
  11. consider imaging based on clinical findings AND mechanism of injury
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