Crisis Containment: Tools for Harm Mitigation in Surgery

Gogălniceanu, Petruţ; Kessaris, Nicos; Karydis, Nikolaos; Loukopoulos, Ioannis; Sevdalis, Nick; Mamode, Nizam

doi:10.1016/j.jamcollsurg.2021.08.676

Cited by 10 publications

(12 citation statements)

References 43 publications

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“…It is possible that negative reactions such as the startle reaction might respond to simulation training. Simulation as well as other training measures have been helpful for pilots in controlling the startle reaction 12,13…”

Section: Discussionmentioning

confidence: 99%

“…17,20 How a surgeon responds in situation management goes beyond the actionsit includes demeanor and leadership. [12][13][14]21 Three indicators are enough to actdo not wait for more information. 15 The hematocrit can be normal initially in hemorrhagic shock.…”

Section: Discussionmentioning

confidence: 99%

“…4 An expectant approach or waiting for the anesthesiologist or others to control the situation is unsafe, leads to a poor outcome, and is poor leadership. 2,4,13,23,25 Approximately 90% of vascular injuries that are identified and treated intraoperatively during total hip replacement end with a good outcome. 23,25 The steps a surgeon takes during and following the emergency will have lasting effects on the surgeon, the assistants, the patient's family, and all operating room staff.…”

Section: Discussionmentioning

confidence: 99%

“…Openness and transparency are more effective in establishing a healing connection with the family and operating room staff. 12,13 There are reasons why the surgeon can contribute to an intraoperative death from hemorrhage. It is possible the surgeon was not well prepared by training, experience, or temperament.…”

mentioning

confidence: 99%

“…In any emergency, an effective response requires surgeons to use their knowledge and training to control the hemorrhage well enough to create stability while additional help is summoned. [12][13][14] Death cases are discussed later at morbidity and mortality conferences. Some explanation, however, will need to be provided to the family and operating room staff immediately.…”

mentioning

confidence: 99%

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Unexpected operative death from hemorrhage: a review of six cases and recommendations

Pritchett¹

2022

Current Orthopaedic Practice

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All busy surgeons will eventually face a severe intraoperative hemorrhage and about one-third will have an intraoperative death. Situational awareness is the key to good operating room leadership and clinical performance. Technical, emotional, and professional skills are equally necessary. When hemorrhage occurs, some surgeons are affected by a "startle" response and freeze. An immediate surgical plan to stop the hemorrhage by pressure or direct vascular control is required. A stable patient presents other options such as waiting for additional surgical or interventional help; an unstable patient does not. The operating room team and family look to the surgeon as the threat-and-error manager. The surgeon must fill this role with a skilled, open, and compassionate approach rather than a hesitant, protective, or defensive approach. The urgent needs of the patient can require a surgeon to perform an unfamiliar or unpracticed exposure when there is no safe alternative. The emotional and professional cost of a fatal intraoperative hemorrhage is significant. With preparation, a better path for the surgeon, operating room staff and patient is possible. This review presents six actual scenarios of managing hemorrhage in orthopaedic surgery.

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Section: Discussionmentioning

confidence: 99%