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How could you be better prepared for handover?
Consider how you might improve the initial resuscitation of this patient? Use your knowledge of human factors and non-technical skills, in particular, situational awareness to answer this question.
The ED consultant activates the Massive Haemorrhage Protocol (MHP). This results in the arrival of the ITU consultant and SpR, SpRs in surgery and T&O, the theatre coordinator and a porter with 4 units O neg blood.
A quick summary reveals:
A: Clear airway with blood-stained sputum. Shouting ++
B: RR30 SpO2 94%.
C: Four units O neg have been given. FFP is being defrosted. P130 absent radial pulse. BP 90/45. Pelvic belt in situ. FAST 750ml free fluid.
D: Agitated ++
You decide that the patient needs an urgent RSI and a trauma scan.
The ITU consultant wishes to perform the procedure in theatre prior to laparotomy. The surgical SpR is not happy to go to theatre without a trauma scan.
An RSI in an unstable patient is high-risk.
How would you go about gathering information, anticipating and updating the team? How could this help in your decision making?
Thinking about your own department: how do you think you could improve the situational awareness of your own team on the receipt of an alert of a critically ill or injured patient.