Tech in Surgery Prep / Unit 29 TSC 704 review, 2 to 3 minutes
Case Three: An Emergency Laparotomy
The idea
A worked example, constructed for this course, follows an emergency laparotomy for internal bleeding, where speed and safety have to work together.
In practice
A patient with abdominal bleeding is coming to the operating room immediately. Riley, the scrub person, opens the laparotomy set and the large sponges, and prepares suction, extra clamps and the energy device. Riley and the circulating nurse count aloud as quickly as they can while the patient is moved and anesthesia begins. The team still completes the time out, briefly, and the anesthesia provider names the expected blood loss as the critical concern. On incision, the surgeon finds a large amount of blood. Riley passes laparotomy sponges for packing, and keeps two suction lines ready. The surgeon finds the bleeding vessel; Riley passes a clamp and then a tie. Riley watches the field and listens to anesthesia, and tells the circulating nurse each time sponges come off the field so the count stays current. The bowel is found to be injured, and the wound class becomes contaminated; the team changes instruments and gloves as policy directs. Before closing, the count is one large sponge short. Riley says so aloud, the surgeon stops, and the team searches. The sponge is found folded behind the liver. The count is repeated and is correct, and the abdomen is closed.
Where people slip
In an emergency, the safety steps are done faster, not dropped. A brief time out still named the critical concern, the sponge count was still kept, and a missing sponge was still said aloud. When the room is busiest, the count is what keeps track of everything that entered the patient.
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