Straight TalkA weekly update from management on the issues that matter most. May 31, 2018 Successful medical events are always the best; this one shared by Dr. Tom Cook, a senior anesthesiologist, confirms teamwork saves lives (lightly edited for brevity and HIPAA compliance): “An amazing story of system teamwork appeared recently. A patient came in with intense abdominal pain to the North ER. A workup ensued with a CT scan and other diagnostic tests. During an ultrasound study the patient stopped breathing but was quickly resuscitated. A surgical team at North with Dr. David Lamon noticed declining blood pressure and hemoglobin counts. Dr. Lamon then consulted Dr. Santiago Chahwan who was downtown at Baker Hospital and together reviewed the studies and diagnosed splenic artery aneurysm with retroperitoneal leakage. Dr. Chahwan recommended a procedure to place a catheter into the patient’s groin to stop the hemorrhage. Previous abdominal surgeries made traditional surgery risky. However, Dr. Chahwan and the sophisticated radiology equipment for this procedure were downtown. With blood transfusions, the patient was rapidly transferred by EMS downtown where the nurses and operating room techs had readied the room. Dr. Chahwan and Assistant Director John Rogers prepared to identify, isolate, and treat the splenic artery aneurysm. The patient was evaluated in the operating room and noted to be in hypovolemic, hemodynamic shock with no peripheral pulses palpable, in extreme pain, and still conscious—basically bleeding to death. Using a Glidescope (an instrument to see the entrance to the lungs), the patient was placed on a ventilator. There was no blood pressure by cuff and no palpable pulse. All extremities were cold, and pulse oximetry further failed to detect a pulse. Cold redpack cells were transfusing through large-bore multiple IVs. The pulse returned slowly at a rate of sixty per minute despite vascular volume shock. The anesthesia team immediately gave several ampules of Sodium Bicarbonate IV which resulted in even more improvement. Meanwhile, the surgical team had prepped the surgical site, and Dr. Chahwan began to utilize fluoroscopy to find the splenic artery. The operating room nurses and radiology helped Dr. Chahwan locate and treat the splenic artery bleeding. The patient had to remain perfectly still and relaxed on the operating room table so that Dr. Chahwan could focus on the splenic artery and stop the bleeding. The anesthesia team was then able to catch up and treat the low blood volume vascular system with blood products and then place monitoring equipment to facilitate post-op care. The case was finished, and the patient was then transferred to the surgical intensive care unit where Dr. Howard Cohen and his colleagues took over and continued to manage the patient with excellent care by the Surgical Intensive Care Unit RNs.” The complex workup and treatment of the hemodynamic blood loss shock involved both hospitals, diagnostic personnel, EMS, operating room personnel, and SICU personnel, all combined with nursing and medical teams of anesthesia, radiology, ED physicians, surgeons, and intensivists. Together, everyone helped this patient not only survive but also live a longer, happier and healthier life. P.S. DO YOU HAVE A COLLEAGUE OR FRIEND WHO WOULD BE INTERESTED IN UPDATES? Please enter their email address at nchmd.org/straighttalk, and we will add them to our complimentary mailing list.