Surgery - Exposure

Patient Exposure

The patient should be fully exposed from head to toe so that injuries anywhere on the body can be identified. Clothing may need to be removed using shears when necessary.

Full exposure is important because visual clues may reveal otherwise unsuspected injuries. For example, seatbelt marks may indicate significant underlying chest or abdominal trauma, including possible sternal injury.

Log-Roll

Following exposure, a log-roll should be performed when indicated. The patient is rolled onto their side while maintaining spinal alignment and immobilisation throughout the manoeuvre.

A coordinated team is required to perform the log-roll safely, traditionally involving up to five people, particularly when spinal injury is suspected.

Assessment During Log-Roll

During the log-roll, the back, buttocks, posterior thighs, posterior legs, and spine should be carefully examined.

The spine should be assessed for deformity, focal tenderness, bruising or ecchymosis, wounds, and other evidence of injury.

A digital rectal examination (DRE) may be performed when clinically indicated, particularly when pelvic, rectal, urethral, or spinal injury is suspected.

Digital Rectal Examination

Anal tone may be assessed during DRE. Reduced anal tone can occur with spinal cord or neurological injury.

The examination should assess for blood, which may indicate anorectal or pelvic trauma.

The prostate may be assessed in male patients. A high-riding or non-palpable prostate has traditionally been associated with urethral injury.

Palpable bony fragments or spicules may suggest an associated pelvic fracture.

Prevention of Hypothermia

Hypothermia must be avoided once the patient has been exposed.

Following examination and log-roll, the patient should be covered and appropriately insulated as soon as possible while still allowing access for continued assessment and treatment.

Core Body Temperature

Core body temperature should be monitored using an appropriate core-temperature measurement method. Rectal temperature is one method of assessing core temperature, although other core sites may be used depending on the clinical situation.

Raising Core Temperature in Hypothermia

In mild hypothermia, external warming can be provided using forced-air warming devices such as Bair Hugger® systems, together with blankets and appropriate covering.

Warmed intravenous fluids may be administered to prevent further heat loss and assist rewarming when fluid resuscitation is required.

In more significant hypothermia, active internal rewarming techniques may be considered depending on severity and available expertise.

These techniques can include warmed lavage or irrigation through appropriate routes, such as gastric, bladder, peritoneal, or other body cavities, although their use depends on the clinical circumstances and current trauma protocols.