While many people have time to prepare for surgery, learning about the procedure and discussing options with their physician, there are other times in which emergency surgery must be performed immediately as a matter of life or death—this could range from a traumatic injury to an appendectomy. Since those undergoing emergency surgery may be unconscious or disoriented upon admittance into the emergency room, here’s a look at what goes on behind the scenes.
6 Steps in Emergency Surgery
1. The Intake Assessment Process
As soon as someone arrives in the ER, the emergency staff gets to work, quickly performing a physical assessment of the patient’s overall condition, checking symptoms, taking vitals, and reviewing medical history, including past and present illnesses, allergies, and current medications or illicit drugs they may be taking. Of course, if the patient is in critical condition, treatment will be started immediately and some of these assessments will occur simultaneously.
Often, emergency room patients need to be stabilized, so a nurse will immediately insert an IV into a vein to allow for quick delivery of medications, transfusions, or intravenous fluids with emergency physician direction.
2. Pre-Surgery Diagnostic Testing
After the patient has been stabilized and the intake assessment is finalized, diagnostic tests may be ordered. Diagnostic tests include:
- Lab work and X-rays
- Computed tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
- Electrocardiograms (ECGs) for heart health
- Electroencephalograms (EEGs) for brain injury
If diagnostic testing confirms emergency surgery is needed, a trauma or general surgeon will be brought in immediately to perform their own assessment.
3. Facilitating an Emergency Transfer
While large hospitals accustomed to high volumes of traffic will have trauma or general surgeons on staff 24 hours a day, small or rural hospitals may not have the staff nor the technical capabilities to perform surgery. In these cases, the smaller facility will stabilize the patient and then coordinate a patient transfer to a larger facility.
Transfers can happen via ambulance or air services, with trained staff onboard to ensure the patient arrives safely. Transfers are generally done in under an hour, and despite this loss of time, the transfer ensures the patient receives the proper treatment and has the necessary specialists available to take care of them.
4. Preparing for Emergency Surgery
Someone undergoing emergency surgery will be fully sedated with general anesthesia, administered through an IV. The anesthesia helps to relax a patient’s muscles, which allows a physician to place an endotracheal tube into the windpipe; this is connected to a ventilator, which takes over the patient’s breathing during the surgical procedure. An anesthesiologist remains present throughout the procedure, ready to administer other medications if needed to keep the patient unconscious and prevent them from moving (which can be very dangerous) during the surgery.
5. Undergoing Surgery
Once the patient is unconscious, staff is properly dressed, and the area of the body being opened up is cleansed and surrounded by sterile drapes to prevent transmittal of germs, surgery begins. The nature and severity of the surgery will dictate who’s in the room, but in general, there is the surgeon, an assistant to the surgeon, a surgical technician, the anesthesiologist, and usually one or two nurses.
During surgery, IV fluids are typically given to offset the loss of blood and other bodily fluids; in addition, transfusions may be deemed necessary to further stabilize the patient. The nature of the surgery (and any complications that may arise) will determine the length of the procedure. When surgery is complete, patients will be stitched or stapled up, or BandGrip—an innovative new wound-closure bandage—can be applied, before stable patients are transported to the post-anesthesia care unit (PACU).
6. Post-Emergency Surgery Recovery
During a patient’s recovery phase, their vital signs will be closely watched and pain medication and any other prescriptions will be administered as needed. Some patients may need to remain on a ventilator, and others may require additional surgeries. But, in general, once anesthesia has completely worn off patients are moved to a hospital room to begin the healing process; those who are unstable or need more close attention will be transported to the intensive care unit (ICU).
BandGrip for Emergency Surgeries
During emergency surgery, every second counts. Unfortunately, emergency medical professionals face many challenges when it comes to delivering effective care promptly and efficiently, especially in a busy ER. BandGrip, which was recently highlighted at the 25th Annual Scientific Assembly of the American Academy of Emergency Medicine (AAEM), is a non-invasive Micro-Anchor Skin Closure 3.5”x1.5” bandage that is designed for speed and ease of use (it can also be tiled for large incisions or lacerations). In emergency situations, it can be applied quickly to stop blood loss, one of the major causes of mortality in the emergency room.