Operating Room Team

A.

A physician team includes the trauma surgeon, the resident or assistant surgeons, and the anesthesiologist and residents. Continuous communication between the physician members of the team is essential. In a persistently unstable patient, a second trauma surgeon may be valuable to participate in resuscitative and technical aspects of the patient's care.

B.

An OR scrub nurse, a circulating nurse, a nurse anesthetist, an emergency department nurse, and a critical care nurse are essential participants in a major OR resuscitation. OR technicians, perfusionists, laboratory technicians, and respiratory therapists should have assigned vital responsibilities as part of the OR resuscitation.

III. Operating Room Communication

A.

The OR should be notified of all Level I trauma patients arriving to the hospital. This occurs whether or not the need for immediate operative intervention is known. The OR personnel should be notified and on standby when the trauma team is activated. The OR personnel should communicate with the trauma team to determine the need for operative intervention.

B.

A system should be in place for the operating team to be able to provide periodic updates to family members.

C.

Direct communication between the OR and the blood bank/laboratory should be available.

IV. Priorities for Multiple Procedures

A.

The decisions as to prioritization of operative procedures can be challenging. Following are some general guidelines:

• After airway and ventilatory control, major hemorrhage either external or body cavity鈥攖akes priority.
• External hemorrhage from the face, scalp, and extremities can be controlled by pressure, packing, or temporary suture closure until major body cavity hemorrhage is controlled.
• In general, uncontrolled thoracic hemorrhage takes priority over uncontrolled abdominal hemorrhage.
• Damage-control techniques with hemorrhage control, stapling of intestine, and packing should be seriously considered in the massively injured patient who is coagulopathic, acidotic, and hypothermic (Chapter 28).
• Craniotomy without a preceding imaging study in the OR is rarely required, especially in the absence of lateralizing signs.
• Body cavity hemorrhage (chest, abdomen, pelvis) takes priority over head injury.
• A patient with a wide mediastinum and active intraabdominal hemorrhage should undergo exploratory laparotomy and simultaneous evaluation of the mediastinum with transesophageal echocardiography.