Teamwork: Part 3

Teamwork

One of the most intense feeling in the OR world is when STAT is called overhead. I always ran in, a soldier ready for battle. It was easier as a resident, knowing that there were very few things I would be asked to do, if anything. I even messed up the first time I witnessed a code blue, before I knew what was happening my preceptor was yelling for me to call the front desk, but the blood rushing to my ears, the fear of the anesthesia resident’s eyes, I couldn’t hear. I wasn’t there.

But when you’re alone, everyone else is in a case, you have to prioritize and make the best decision at the time for your patient. You can delegate, but there’s no one to delegate to, they’re all doing their own tasks. That fear either paralyzes you, or ignites a fire. After a few situations, the fear usually takes a sidestep and allows you to focus, laser-in on what needs to be done.

That’s when you know you’re ready. But sometimes, you get the summative report before you’re able to formalize your scaffolding. Teacher lingo for – you’ve got to do it, and pat yourself on the back later for knowing what to do.

You do. You do first. You do the second step. You do and prioritize as best you can.

A general STAT is usually the Trauma surgeons searching for the source of an abdominal bleed. The patient is brought to the room by the surgeon and ER RN, and the best way to assist is to assist yourself. Get the slider board on the bed, get the grounding pad in the machine, get the foley and wet prep on the table. Count with your scrub if you can, at least the Trauma Pack and Major Set. Bring up blood if you can, ask what anesthesia needs from you.

Get the patient on the table, ask as many questions as you can, get the consent (probably a paper 2 Doc), and confirm the name, date of birth, and MRN if you can. Comfort the patient as best you can while putting on SCDs. Wear gloves and assist with intubation. Pull their belongings and chart next to your desk and get the ER stretcher out of the room for the ER nurse.

The surgeons will come pull their gloves, get their headlights, pull their step stools, move the lights, ask for rotem, anesthesia will give you the type and screen, you’ll put in the foley and put on the grounding pad, before prepping and gowning the surgeons into the field.

Ask if the Time Out is waived while plugging in two suctions and the bovie, turn on the headlights and ask your scrub what else needs to be opened. Make sure everyone is as happy as they can be, then chart. Then listen. Always listen. Look at the suction, what blood is returning, bright or dark? How much?

Run around like crazy, getting things for anesthesia, gowning more people in, pulling up images, getting more blood, opening staplers and other supplies. Pull a pathology sheet just in case. Get everyone’s names and credentials.

When it’s calm, connect the dots and fill in the blanks.

When it’s done, count again. Inform the surgeons and anesthesia of any issues. Do you need an ICU bed? Any consults for other issues? What can you facilitate prior to closure? Are you even going to close the belly?

Now you’re done. The patient has an Abthera wound vac, the ICU bed is coming, you’ve given report and indicated the planned extubation but possible need for a ventilator. Everyone is happy, the resident is putting in orders and faculty is satisfied with the debrief and leaves.

You go up to ICU and assist anesthesia to set up the patient as well you can. Make sure the nurse is happy and you go back and chart. If you don’t chart it, it wasn’t done. And you’ve done a lot. Be grateful you were able to help this patient return to homeostasis.

Isn’t that why you became a nurse?