Deviation in the Standard of Surgical Care Resulting in Blood Vessel Injury

Evaluate breaches in the standard of care by using your fact pattern to answer the questions presented below to determine whether or not there was or was not a Deviation in the Standard of Surgical Care Resulting in Blood Vessel Injury

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

  • Was a pre-operative evaluation performed?
    Yes
    No
    Answer unknown
    Why is this important?
    The pre-operative evaluation is used to identify risks to the patient undergoing surgery with the goal of minimizing those risks, optimizing a patient's peri-operative medical condition, and preventing complications.
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  • Was a thorough medical history obtained? Why is this important?
    Answer this question
    
A thorough medical history and physical examination must be performed to assess patient-related risk factors, the status of patient co-morbid conditions, and to evaluate their overall health status.

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  • Was a careful inspection of the surgical wound completed and documented? Why is this important?
    Answer this question
    
Careful inspection of the surgical site before closure is the best method to prevent post-operative hemorrhage.

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  • Was the vascular injury identified and handled emergently? Why is this important?
    Answer this question
    
A vascular injury, if unmanaged could lead to life threatening complications.

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  • What type of bleeding did the patient experience? Why is this important?
    Answer this question
    
Vascular injury is an unexpected complication during any surgical procedure.

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  • Was the minor bleeding managed by direct pressure or cautery? Why is this important?
    Answer this question
    
Direct pressure is the safest and most effective way of controlling external bleeding.

    (2007) 25 ESURGO 8 329-334 



  • Was follow-up examination performed? Why is this important?
    Answer this question
    
Follow-up in all patients after corrective surgery is required. Patients must receive thorough discharge instructions reflecting the treatment they have received, the new medications they have been prescribed, and the necessary follow up evaluations required after discharge to minimize the likelihood of relapse and re-admission to the healthcare facility.

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  • Which of the following treatments were initiated for major bleeding? Why is this important?
    Answer this question
    
In cases of injury to major blood vessel(s) the adoption of the following principles is recommended: (1) Asking the immediate advise of a senior vascular surgeon; (2) Applying pressure to lacerated blood vessel(s) in order to stop the bleeding; (3) Stabilizing the patient hemodynamically; (4) Repairing the damaged blood vessel(s); (6) Taking into consideration the possibility of development of consumption coagulopathy.

    (1998) 79 EJOBGY 1 91-93 



  • Was a vascular surgeon consulted emergently? Why is this important?
    Answer this question
    
Repair of major blood vessels in cases of injury requires the immediate advice of a senior vascular surgeon.

    (1998) 79 EJOBGY 1 91-93 



  • Was the procedure converted to an open laparotomy? Why is this important?
    Answer this question
    
In cases of injury to major blood vessel associated with laparoscopy, an explorative laparotomy through a median incision must be performed.

    (1998) 79 EJOBGY 1 91-93 



  • Were the patient’s vital signs monitored post-operatively? Why is this important?
    Answer this question
    
Patients with obviously unstable vital signs are often bleeding from major vascular sources. Vital signs and urine output should be monitored closely in patients who have any evidence of hemodynamic instability.

    (2005) 34 EGASCN 4 581-588 



  • Was the patient evaluated for signs of hemorrhage post-operatively? Why is this important?
    Answer this question
    
Vascular injury can produce systemic symptoms of hypotension, tachycardia, and altered mental status because of hypovolemic shock produced by hemorrhage. As a result, vascular injury can be life-threatening.

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  • Which of the following symptoms did the patient exhibit post-operatively? Why is this important?
    Answer this question
    
Common signs of vascular injury include swelling, loss of pulsation or weak pulses, pain in the involved area or numbness and hematoma formation.

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  • Were imaging studies performed to identify the patient’s blood vessel injury? Why is this important?
    Answer this question
    
Imaging studies need to be performed in all patients suspected to have vascular injury to diagnose the location of the vascular injury and to assess the extent of the injury.

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  • Did the clinician obtain a vascular surgeon consultation? Why is this important?
    Answer this question
    
Once a patient is diagnosed with vascular injury the patient needs to be referred to a vascular surgeon for immediate surgical management of the injured vessel. 

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  • Was an emergency re-exploration surgery performed? Why is this important?
    Answer this question
    
Urgent re-exploration to stop the hemorrhage is required in a patient who has been returned to the ICU and suddenly hemorrhages from a vessel that was not identified at the initial operation.

    (2004) 35 ESINJR 7 712-721