Tech in Surgery Prep / Unit 23 TSC 572 review, 2 to 3 minutes
Bleeding You Can't See
The idea
A worked example, constructed for this course, shows a team responding to concealed bleeding during a laparoscopic case.
In practice
During a laparoscopic procedure, the view on the monitor is clear and the surgeon is working steadily. The anesthesia provider reports that the patient's blood pressure is falling and the heart rate is rising, and asks whether there is bleeding. The surgeon sees nothing obvious on the screen. The scrub person, Pat, remembers that the risk of bleeding was discussed at the time out and that hemostatic supplies were set up, and quietly prepares an open set, laparotomy pads and suction. The surgeon moves the camera and finds blood collecting in a part of the abdomen out of the earlier view. The surgeon decides to convert to an open operation. Because Pat had prepared, the open instruments, pads and suction are ready in moments. The circulating nurse calls for more help and blood products, as the anesthesia provider requests. The surgeon packs the area with laparotomy pads, which Pat counts in aloud, then controls the bleeding vessel with clamps and ties. The patient stabilizes. At the closing count, every pad packed into the abdomen is accounted for.
Where people slip
Concealed bleeding was first noticed by anesthesia, not by the surgeon looking at the screen. The scrub person's contribution was listening to that report, remembering the plan from the time out, and preparing for conversion before it was announced. Counting each pad aloud during a crisis kept the count correct when it mattered most. The conversion was fast because the decision had been anticipated, and safe because no one let urgency replace the routine of counting.
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