CV
“A 75-90 percent reduction in time from OR door to
incision has been achieved
by creating opportunities for
parallel processes....
CODE
ruptured abdominal aortic aneurysm
rAAA
registration; and the blood bank.
patient orientated tasks.
The patient’s hemodynamic status update is delivered to
the team 10 minutes prior to arrival. Patients deemed stable
(systolic >80mmHg), per Code Rupture protocol guidelines are admitted through the ED and onward to radiology
where a scanner has been placed on hold to perform a CT
of chest, abdomen and pelvis with contrast (unless outside
films are available).
The C-arm and operating table are staged to enable the
patient to be transferred from the stretcher to the table
without interference of equipment, and allows unhindered
360-degree access to the patient.
Patients deemed unstable (systolic <80 mmHg for 10 minutes or longer) are admitted directly to the OR. The comprehensive communication model has resulted in a more
efficient and standardized team approach in preparation to
receive the patient.
Rapid Registration Process For Direct Admit to
OR;
A rapid registration process in the OR allows the staff
to expedite the procurement of blood products. A book
containing pre-assigned generic patient ID stickers and
armbands labeled “Code Rupture___” is located at the OR
control desk, complete with instructions of how to register
the patient.
Once the OR charge nurse is notified of the direct admit to
the OR, one phone call to patient registration activates a
new account and medical record, with the generic ID, which
is later reconciled. Once the account is active, a massive
transfusion protocol (MTP) is ordered and a runner is
dispatched to courier the blood products to the OR suite
receiving the patient.
OR Staging And Contingency;
Proactively organizing and staging the operating suite to
receive emergencies after hours offers the surgical team a
significant time advantage as well as opportunities to better
prioritize and focus personnel resources to more acute
6
This staging has created opportunities for simultaneous
processes, including: arterial monitoring line placement,
Foley catheter insertion, shaving, prepping, and draping.
Once the patient is draped, the C-arm is positioned over the
patient from the left shoulder, which enables the anesthesia staff to maintain full access to the head of the patient
for induction immediately following insertion of the aortic
occlusion balloon.
Immediately following intubation, a central line may be inserted. Should problems arise obtaining arterial monitoring
access, the surgeon may pass off a line from the side port of
a femoral arterial sheath (intermittent arterial monitoring).
And Anesthesia.
The anesthesia process evolved from a serial process to a
more efficient, simultaneous, multidisciplinary team approach per evidence-based practice and research.
A 75-90 percent reduction in time from OR door to incision
has been achieved by creating opportunities for parallel
processes, with greater emphasis placed on gaining control
of the bleeding before anesthesia induction by practicing
permissive hypotension.
Anesthesia induction may result in loss of sympathetic
nervous system drive and vascular tone, creating a sudden drop in blood pressure. This drop may exacerbate the
bleed, leading to hemodynamic collapse, cardiac arrest, and
increased intraoperative mortality. Preoperative or intraoperative occurrence of cardiac arrest, profuse bleeding,
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