Emergency Medicine Book

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Primary Survey Exposure Evaluation

Aka: Primary Survey Exposure Evaluation, Emergency Exposure Management
  1. See Also
    1. Cardiopulmonary Resuscitation
  2. Evaluation
    1. Undress patient and do complete visual inspection
      1. Cut off clothing that cannot be removed without disrupting spinal precautions or Resuscitation
      2. Mnemonic: Armpits, Back, Butt cheeks and Sac (Assess for easily missed sites of injury)
      3. Mantra of "fingers in every orifice" has caveats in 2014 ATLS guidelines (every Trauma patient does not need a rectal exam)
    2. Keep spine immobilized and Log Roll
      1. See Trauma Primary Survey and Trauma Secondary Survey
      2. Spine longboard is typically removed at time of Log Roll unless patient is combative or uncooperative
  3. Pitfalls: Trauma - Prevent Hypothermia
    1. Apply warm blankets
      1. Consider applying blankets in the form of trap doors over each of 4 compartments (chest, Abdomen, Pelvis and thighs, lower legs)
      2. Trap door method allows access to a single compartment while still keeping other compartments covered and warm
      3. References
        1. Banton (2014) ATLS Course, University of Minnesota
    2. Warm crystalloid in microwave or bath to 39C
      1. Do not microwave Blood, Plasma or Dextrose
    3. Provide a warm room environment
      1. Patient Body Temperature takes priority over healthcare worker comfort
  4. References
    1. (2012) ATLS Manual, American College of Surgeons

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