Emergency Situation Identification

Guidelines:

• Code (obvious)
• Facility specific policies
• “NOW”
  • Trauma
  • Cold leg
  • hemorrhage
• “Within 24”
  • Incarcerated hernia
  • Perf
  • Complicated fracture
• “Within 48”
  • D/c
  • Acute Chole
• “Routine”
• Life, Limb, Sight, Fertility

Considerations:

• Emergencies:
  • Bump other cases
  • Utilize reserve resources – all needed
  • Skip count(X-ray instead)
  • Order sets best
    • Facility specific, planned
  • Strategically located if possible
  • Sterility “second”
• Pre-made carts are best
• Patient care > cost
  • Infinite budget on test
  • Infinite ability to delay other cases

Nurse’s role:

• Train, advocate for policy before emergencies arise
• Clear interpretation of emergency policies
• Anticipate needs of emergencies to keep as much “normal” as possible
  • Count sheets premade, carts, etc
• Drills
  • “Who’s on first”

Pitfalls:

• Delaying for routine practices
  • Patient in room, table not open
• No training, anticipation
• Unsafe practices
  • Bovie
  • Alcohol prep
  • Radiology
• Failure to recognize developing situation intraop

Examples:

• Laparoscopic chole punctures aorta on entry (emergent open, activate response, Xray after, anticipate needed gear/help, ICU after, etc)

Linchpins (Key Points):

• Emergency situations should follow an expected pathway that preserves as much safety as possible without compromising care of the patient