It’s taken us 10 years, but we might finally have an answer to the Brian Persaud question, and I wasn’t even looking for it.
Story time. Years ago, somebody at work told me about Quora.com as a good place to get answers to just about anything. I went there to read people’s suggestions for alternatives to CAPTCHAs, those squiggly lined letters and numbers that show up on websites that you have to solve to prove you’re not a robot. What did I call them back in the day, fucking blasted son of a bitch goddamn piece of shit graphical word verification thingies? Yes, those things. But I started receiving Quora digests, and for reasons I will never understand, they almost immediately started straying away from the technical, and going into things about interpersonal relationships. Then, they started going into medical issues. I have no idea what I did to cause this, I’m sure it’s something I may have done since the rest of my colleagues at work still receive informative posts about app and web development and the like. I do have to say that the answers on Quora are mostly very well-thought out and free of nasty trolls. Now, I almost always receive ones about doctors and hospitals and the like. I got one asking if MRIs are dangerous right before my MRI. Thanks, Quora, and…you’re creeping me out now.
Then, the other day, this thread showed up in my digest. The question? “Is it true all people involved in trauma get a rectal examination in the ER? If so, why?”
And here was the top answer.
We used to do this routinely in major trauma. ‘A finger and a tube in every orifice’ was the unofficial mantra of trauma evaluation, and a rectal exam was part of the secondary survey (the head-to-toe evaluation of a trauma patient, to look for any and all injuries). We even called rectal exams the “[major trauma center] handshake” and I know that phrase was used at at least 2 other major trauma centers (with the correct name substituted in, of course)
Why a rectal exam? First, as a sign of possible bowel injury — blood on rectal exam can be a finding if there is an intestinal injury. More so in penetrating trauma (shootings/stabbings) than blunt trauma (car accidents, falls). Second, as a way of evaluating the spinal cord — the muscles of the rectum are innervated by the lowest parts of the spinal cord.
From some who have asked, there is some debate about the utility of digital rectal examination in the trauma patient – for example, see
At the academic trauma center where I work, rectal examinations are still done on patients who meet the criteria for calling in the trauma team. They are also often done on other trauma patients who don’t meet full trauma activation criteria. I cannot comment on whether or not this is still done on all trauma patients at all hospitals, but I know plenty of physicians who no longer routinely perform rectal exams on trauma patients.
I am amazed at the number of views/upvotes this answer has gotten. Who knew rectal exams would be such a popular topic?
It still doesn’t explain why they would sedate him to do the test, unless some of those spinal responses they’re looking for are involuntary, but at least it explains why a bonk on the head might lead to a finger up the other end.