Preparations in an emergency under time pressure

Time and again situations occur where the patient's life can only be saved by acting immediately and starting to operate without delay, for example massive haemorrhag-ing, circulatory instability or resuscitation. These situations frequently demand improvisation because the normal planned procedure would take too long. Here it is important to weigh up the various risks to obtain the best outcome in each specific situation.

Fundamentally, an operating table prepared with a water mat or electric heating mat should always be at the ready in every operating department. The vital problem of cooling down can be reduced at least by the use of a heating mat or moving mat for operating tables. Recently, disposable covers with circulating hot air have proven effective on the non-operated regions. Similarly, a neutral electrode should also always be ready on the operating table for immediate application. Depending on the expected emergency operation, the possibility of having to re-bed the patient during the operation must be considered. Even under time pressure, a minimum level of perioperative safeguards should always be provided, to prevent the patient from falling off the table, to avoid further damage from pressure sores, etc.

Management is defined by the operating surgeon, who stipulates the scope and sequence of the surgical procedure in consultation with other disciplines (e.g. anaesthetist) even under time pressure. Typical operation preparations are usually carried out parallel to diagnosis, anaesthetic preparations, transport and transfer to the operating table.

Immediately before the operation begins, the operating site is prepared quickly but thoroughly (depilation, washing) while the surgeon disinfects his hands. But it does happen that such measures have to be omitted completely.

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