Exposure

Written on 10/10/2024
jombuatapp

Exposure and Environmental Control

 

1. Complete Exposure for Thorough Examination

 

    i. Identify All Injuries:

  • Complete exposure is necessary to detect hidden injuries that could be life-threatening if missed.

 

    ii. Carefully Undress the Patient:

  • Remove clothing methodically to avoid aggravating existing injuries. Cutting away garments may be necessary.

 

     iii. Preserve Evidence:

  • In cases of assault or self-harm, handle clothing carefully to maintain forensic evidence

 

    iv. Immediate Re-Covering:

  • Warm Blankets: After examination, promptly cover the patient with warm blankets to conserve body heat.
  • Modesty and Dignity: Use sheets or drapes to cover areas not being examined, respecting the patient's privacy.

 

 

2. Prevention of Hypothermia

Physiological Impact: Hypothermia can lead to coagulopathy (impaired blood clotting), acidosis, and increased susceptibility to infections.

 

    i. Environmental Control:

  • Warm Environment: Ensure the resuscitation area is warm (ideally above 28°C or 82°F).
  • Limit Exposure Time: Only expose the patient when necessary for examination or procedures.

 

    ii. Active Warming:

  • Forced-Air Warming Blankets: Utilize devices like Bair Hugger® to provide consistent warmth.
  • Warmed IV Fluids and Blood Products: Use fluid warmers to prevent core temperature drop.

 

    iii. Minimize Heat Loss:

  • Dry the Patient: Remove wet clothing and dry any moisture on the skin promptly.
  • Cover the Head and Extremities: Significant heat loss occurs through these areas.

 

 

3. Modification of Patient Handling Techniques

A. Avoid Routine Log Roll

i. Reason:

  • Log rolling can cause movement of unstable fractures, particularly pelvic fractures, potentially worsening injuries.
  • Movement may disrupt clots or exacerbate bleeding.

ii. Alternative: Back Sweep Technique

  • Description: Gently slide a hand under the patient's back to palpate for injuries without moving the spine or pelvis.
  • Advantages: Reduces the risk of additional injury and is quicker in critical situations.

 

B. Digital Rectal Examination (DRE)

No more routine DRE.

 

Exceptions:

    i. Paraplegic Patients:

  • Assessment of anal tone to determine the level and completeness of spinal cord injury.

    ii. Patients with Priapism:

  • Priapism indicates potential cervical or high thoracic spinal cord injury.

    iii. Intubated or Unconscious Patients:

  • DRE can reveal occult bleeding or high-riding prostate suggestive of urethral injury.

 

Assessment in DRE:

Anal Tone: Assess sphincter contraction.

Presence of Blood: Indicates potential gastrointestinal injury.

Prostate Position: A high-riding prostate may suggest urethral injury.