Hemorrhagic Shock in Trauma (IVC Tear)

Patients who are victims of violent trauma may require emergency surgery where undiagnosed injuries are revealed after induction of anesthesia. One such example is injury to great vessels resulting in severe intraoperative hemorrhage. Once this occurs, close coordination by the surgical and anesthesia teams is essential to optimize outcomes for the patient. Concise, direct, and professional interdisciplinary communication is critical and may be difficult to develop during high-stress situations. Simulation provides a safe teaching environment in which surgery and anesthesia trainees can practice effective communication while modulating the degree of temporal pressure to optimize learning. This chapter identifies the surgical and anesthetic risk factors for laparoscopic surgery, discusses how to diagnose and manage major intraoperative hemorrhage, and reviews classifications for hemorrhagic shock. In addition, this chapter contains tools for developing and deploying a prototypical case scenario, including narrative, setup, progression, and criteria for evaluation for both anesthesiology and surgery trainees on the management of intraoperative hemorrhagic shock from trauma to a great vessel.