Abstract
Late one afternoon, a hospital’s code team responds to a “code blue” on a general surgical ward. Upon their arrival, the patient is unconscious; two nurses are performing cardiopulmonary resuscitation (CPR), while several bystanders observe the events in disbelief. The responding ICU physician has the impression that the resuscitation is chaotic and uncoordinated. He announces in a loud voice that he will be running the code and ensures that the nurses are performing effective, well-coordinated CPR. He then delegates specific tasks to other team members. Several minutes later, a surgeon arrives and the intensivist gives her a brief update on the situation. The two physicians initially entertain the diagnosis of massive pulmonary embolism as the cause for the pulseless electrical activity, but soon learn that the patient had just had an uneventful splenectomy. Suspecting hemorrhagic shock, the intensivist orders aggressive fluid resuscitation. During active CPR, a large-bore central venous access is established and after 2000 ml of crystalloid fluids and repeated epinephrine doses, there is return of spontaneous circulation with an adequate blood pressure. The surgeon calls the operating room (OR) to schedule an emergent exploratory laparotomy, requests the emergency release of blood products from the blood bank, and ensures that a cell saver is prepared for the OR. The patient stabilizes and is transported to the OR, where the intensive care physician gives a concise report to the receiving team and answers their questions. The hemoglobin concentration upon arrival is 3.8 g/dl. During the operation, the surgical team identifies a disengaged splenic ligature and controls the bleeding. Intraoperatively, the patient receives 9 units of packed red blood cells, 12 units of fresh frozen plasma, and 2 units of platelets. The postoperative course is complicated by acute renal failure that resolves over several weeks. The patient recovers completely and goes home without any neurological deficits.
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St.Pierre, M., Hofinger, G., Simon, R. (2016). Speech Is Golden: Communication. In: Crisis Management in Acute Care Settings. Springer, Cham. https://doi.org/10.1007/978-3-319-41427-0_12
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