Deviation in the Standard of Perioperative Care Resulting in Hemorrhage (Intra Operative Bleeding)

Evaluate breaches in the standard of care by asking and answering the questions below and analyzing the details of your facts to determine whether or not there has or has not been a Deviation in the Standard of Perioperative Care Resulting in Hemorrhage (Intra Operative Bleeding)

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the clinician obtain a detailed medical history?
    Yes
    No
    Answer unknown
    Why is this important?
    The key to minimizing peri-operative blood loss is identifying patients at significant risk through a thorough history and physical examination.
    (2007) 21 EHOCNA 1 13-24

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Identifying patients at risk for bleeding, needs to occur during the pre-operative screening process.

    (2007) 21 EHOCNA 1 13-24 



  • Did the clinician obtain a detailed drug history? Why is this important?
    Answer this question
    
A drug history and current medication list, including over-the-counter medications, needs to be explored to identify agents that affect the body’s clotting ability.

    (2007) 21 EHOCNA 1 13-24 



  • Was the patient taking Aspirin or anti inflammatory drugs pre-operatively? Why is this important?
    Answer this question
    
Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) inhibit platelet function and may need to be discontinued for a period of time prior to surgery.

    (2010) 24 EBPRCA 1 41-50 



  • Was the patient taking any anti-coagulants pre-operatively? Why is this important?
    Answer this question
    
Patients receiving warfarin therapy require temporary cessation of treatment prior to any surgical or invasive procedures.

    (2003) 17 EBLREV 3 179-185 



  • Was a pre-operative clinical examination performed? Why is this important?
    Answer this question
    
The key to minimizing peri-operative blood loss is identifying patients at significant risk through a thorough history and physical examination.

    (2010) 24 EBPRCA 1 27-40 



  • Were diagnostic laboratory screening evaluations completed pre-operatively? Why is this important?
    Answer this question
    
Diagnostic screening laboratory tests must be ordered pre-operatively.

    (2007) 21 EHOCNA 1 13-24 



  • Was the patient referred to a hematologist? Why is this important?
    Answer this question
    
If the history, clinical examination, or the screening tests are suggestive of a coagulopathy, the patient must be referred to a hematologist for correct diagnosis and pre-operative clearance.

    (2003) 17 EBLREV 3 179-185 



  • Did the patient suffer from massive blood loss intra-operatively? Why is this important?
    Answer this question
    
Massive hemorrhage is defined as blood loss requiring the replacement of the patient’s total blood volume in less than 24 hours. Initial management is aimed at prompt resuscitation and identifying the bleeding source.

    (2003) 17 EBLREV 3 179-185 



  • Were the patient’s vital signs monitored post-operatively? Why is this important?
    Answer this question
    
During the post-operative period, the surgeon must remain alert for signs of ongoing hemorrhage. For the first few hours post-operatively, serial hourly fluid input and output measurements, blood pressure evaluations, heart rate and rhythm assessments and neurological evaluations.

    (2012) 92 ESRCNA 2 235-242 



  • Was the patient’s temperature monitored post-operatively? Why is this important?
    Answer this question
    
A body temperature below 35°C (95°F) may inhibit clotting mechanisms.

    (2005) 85 ESRCNA 6 1191-1213 



  • Was the patient's fluid balance observed and recorded? Why is this important?
    Answer this question
    
The patient’s fluid intake and urine output needs to be monitored every one to two hours post-operatively. Low urinary output is one of the early indications that a patient's condition may be deteriorating.

    (2012) 30 EANESC 3 527-554 



  • Were imaging studies obtained? Why is this important?
    Answer this question
    
Nearly 75-90% of all intra-operative bleeding is technical in nature. The search for technical sources of hemorrhage includes imaging studies such as CT, MRI, MR angiography, and ultrasound.

    (2005) 85 ESRCNA 6 1191-1213 



  • Were laboratory studies performed to ascertain if a post-operative coagulopathy developed? Why is this important?
    Answer this question
    
In post-operative hemorrhage when the exclusion of technical causes of bleeding has been established, the patient is treated as having a coagulopathy.

    (2005) 85 ESRCNA 6 1191-1213 



  • Was the patient diagnosed with coagulopathy? Why is this important?
    Answer this question
    
In the postoperative period setting, test results can change quickly, and serial studies may be required for early detection of a coagulopathy.

    (2005) 85 ESRCNA 6 1191-1213 



  • Was a re-exploration performed? Why is this important?
    Answer this question
    
In the presence of bright red bleeding from any site, urgent re-exploration is indicated.

    (2005) 85 ESRCNA 6 1191-1213 



  • Was the patient instructed to discontinue the use of certain medications? Why is this important?
    Answer this question
    
Medications that affect coagulation or platelet function need to be discontinued before surgery in the majority of cases, preferably at least 5 days before surgery.

    (2003) 17 EBLREV 3 179-185 



  • Were interventions taken to minimize the amount of peri-operative bleeding? Why is this important?
    Answer this question
    
The standard treatment for significant hemorrhage during surgery is the rapid control of the source of bleeding.

    (2006) 38 ESTRPR 3 812-814 



  • Did the patient receive a blood transfusion? Why is this important?
    Answer this question
    
Transfusion management involves the immediate transfusion of packed red cells, platelet concentrates or plasma (fresh frozen plasma and cryo-precipitate).

    (2006) 38 ESTRPR3 812