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Update: The Rectal Exam In Trauma Continues to “Pass”?
This topic continues to come up from time to time. I still see trauma programs that perform the good, old-fashioned digital rectal exam on nearly every trauma patient. But is it really necessary?
In the not so distant past, it was standard operating procedure to perform a digital rectal exam in all major trauma patients. The belief had always been that valuable information about blood in the GI tract, the status of the urethra, and the neuro exam (rectal tone) could be gleaned from this exam.
Unfortunately, a finger in the bum also serves to antagonize or even further traumatize some patients, especially those who may be intoxicated to some degree. On a number of occasions I have seen calm patients become so agitated by the rectal exam that they required intubation for control.
So is it really necessary? A study in 2001 conducted over a 6 month period (1) showed that the rectal exam influenced management in only 1.2% of cases. The authors felt that there was some utility in 3 special cases:
- Spinal cord injury – looking for sacral sparing
- Pelvic fracture – looking for bone shards protruding into the rectum
- Penetrating abdominal trauma – looking for gross blood
A more recent 2005 study (2) was also critical of the rectal exam and found that using “other clinical indicators” (physical exam and other diagnostic study information) was at least equivalent, changing management only 4% of the time. They concurred with the first two indications above as well.
And what is the best patient position for the exam? I continue to see people try to do it when the patient is in the logroll position! This is substandard for two reasons:
- It is not a stable position, and no one likes a finger in their butt. Awake patients will squirm and withdraw, defeating any attempt at spinal precautions.
- It’s not ideal for the examiner, either. Access to the male prostate is subpar because the examiner’s finger is generally pointed posteriorly, away from this organ. In order to rotate anteriorly, the examiner must spin around, putting “reverse English” (billiards reference) on their arm.
To do a proper rectal exam when indicated, make sure the patient is supine, warn them that you are going to do it, and use the same hand as the side of the patient you are standing on. Right side, right hand to avoid the “reverse English” thing again.
Bottom line: For most major trauma patients, the rectal exam is not worth the patient aggravation it causes. I still recommend it for the 3 special cases listed above, however, as there are no equivalent and effective exams for these potentially serious patient problems. And remember, DON’T do it while the patient is in the logroll position.
References:
1. Porter, Urcic. Am Surg. 2001 May;67(5):438-41.
2. Esposito et al. J Trauma. 2005 Dec;59(6):1314-9.
well that’s progress i guess
Handmade Heaven
read it on the AO3 at http://bit.ly/2FzoOdY
by Medea_Nunc_Sum, ssironstrange
Step 1: attempt to write a/c smut
Step 2: immediately fail by making it s o f t
Step 3: recruit your bff and the most poetic writer in the history of ever to collab
Step 4: turn it into the most beautiful rendition of backseat car sex the world has ever seen
Step 5: profit????
Words: 1170, Chapters: 1/1, Language: English
- Fandoms: Good Omens - Neil Gaiman & Terry Pratchett, Ineffable husbands - Fandom
- Rating: Mature
- Warnings: No Archive Warnings Apply
- Categories: M/M
- Characters: Aziraphale (Good Omens), Crowley (Good Omens)
- Relationships: Aziraphale/Crowley (Good Omens), Ineffable Husbands - Relationship
- Additional Tags: poetic smut, Car Sex, getting it on in the back of the bently, soft, like really soft, i’m never gonna be able to write horny stuff for them, they’re too soft
read it on the AO3 at http://bit.ly/2FzoOdY
A city wall and a trampoline
read it on the AO3 at http://bit.ly/2KCkJJT
by FayJay
In their cottage in the South Downs, when Crowley eventually succeeds in getting Aziraphale to use a laptop, it takes Aziraphale literal hours to get past the default Windows screensavers of picturesque locations because ‘oh, look, isn’t it lovely, Crowley!’
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5 times Crowley knows he’s in love with Aziraphale + 1 time he knows the reverse.
Words: 10, Chapters: 1/1, Language: English
- Fandoms: Good Omens
- Rating: Teen And Up Audiences
- Warnings: No Archive Warnings Apply
- Categories: M/M
- Characters: Aziraphale, Crowley, Anathema Device, Newton Pulsifer
- Relationships: Aziraphale/Crowley
- Additional Tags: Fluff, First Kiss, Podfic, Podfic Length: 20-30 Minutes, Audio Format: MP3
read it on the AO3 at http://bit.ly/2KCkJJT
Fun fact! According to folklorists, all myths, fairy tales and nursery rhymes that are about some dude named Jack are talking about the same guy
What this means is, that ever single one of the following
- Jack Be Nimble (who jumped over burning candles for fun)
- Jack the Giant Killer (who sold his cows for magic beans then robbed and killed a giant)
- Stingy Jack (who tricked the devil so many times he was banned from both afterlives)
- Jack of Jack and Jill (who splattered his head open falling down a hill)
- Jack o’ Lantern (the headless horseman spirit of halloween)
- Jack Frost (the spirit who heralds the end of autumn and the start of winter)
Are literally the same jackass who made so many bad life choices he ended up an immortal ice dullahan with a pumpkin serving as both his head and flashlight
but what an incredible journey he had getting there
He’s Ye Olde Florida Man
‘ye olde florida man’ is actually way closer then it has any right to be and that scares me
i just had the weirdest moment, i was feeling my front teeth with my tongue because they’re the tiniest bit crooked, and then i had the thought “i’ll check if they’re also crooked in my other mouth” and then i realized to my shock and confusion that i have only one mouth, leading me to believe that in a past life i was a terrible monster with two mouths
A few months ago, I thought to myself “Mmm I’m so tired… how much longer in this one again?” and I knew instinctively what I meant by ‘this one’ was this body and this life. I then spend a few wide-eyed moments having an identity/existential crisis like how many times have I been on this earth to have such an instinctive response to being bone-weary to my soul? No one can really answer, especially not me.
In July 2017, one night I woke up around 2 a.m and blurted out in a quasi professorial voice “the Equinox Bird has infinite beaks, all in the wrong direction, and infinite eyes” and I don’t know what the fuck I was dreaming about but it still haunts me. It seemed like a very important information for a few seconds.
i really appreciate the last commenter giving us an exact date and time like that information needs to be preserved
McDonald’s introduced a new item called the Ketchup Smear© where they would dump ketchup in your bag and shake it up. The tag line was: “Ketchup on everything in the bag. Guaranteed.”
pommywhirl