Most people don't like rectal exams - especially after a traumatic injury. We know this because if you do one without giving them a heads up you can sprain your finger. Kenji and Mel discuss why foleys and tubes aren't always necessary and which trauma patients still need the old anal probe routine.
Paul T. MBChB - March 5, 2014 12:27 AM
I hate doing rectals in trauma patients.
Funny story....In my residency....obese female polytrauma patient...I drew the short straw....log roll...rectal...patient lets out a loud scream and shouts "wrong hole". D'oh. Years later...they still talk about it!
I'm scared for llfe!
Ron R. - March 8, 2014 4:27 AM
Funny story, Paul T. That's why I always get visual confirmation for female rectals, especially when the patient is obese. Of course, that almost blew up in my face once - literally. I could feel the pressure building around my finger, so in Matrix like fashion, I bent my body and head backwards just as the feces flew by me and landed on the wall 6 feet away.
Michael U. - March 12, 2014 9:50 AM
I don't see many trauma patients in my ED. However, rectal exams are most useful to me when I'm pushing ahead the soft admission of an ill-appearing debilitated elderly patient with ever-so-slight hypotension. The addition of my heme positive DRE seems to 'seal-the-deal' with the disgruntled hospitalist who's moaning about the meaningless admission of Great Aunt Sally who's family just left her at the ED and will "sue" the hospital if we discharge her!
That: "........and she is heme positive and needs GI consult" silences the hospitalist every time!