Hemorrhagic Shock in Trauma (Solid Organ Injury)

Patients who are victims of violent trauma may require emergency surgery where undiagnosed injuries are revealed or exacerbated after induction of anesthesia. One such example is solid organ injury that may or may not have been diagnosed during primary survey. Damage to solid organs can result in severe intraoperative hemorrhage. Once this occurs, close coordination by the surgical and anesthesia teams to control hemorrhage while maintaining hemodynamics is essential to optimize patient outcomes. 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 discusses diagnosis and management of major intraoperative hemorrhage and steps to optimize patients for safe anesthetic induction in the setting of hemorrhagic shock and reviews massive transfusion protocols. In addition, this chapter contains tools for developing and deploying a prototypical case scenario, including narrative, setup, progression, and criteria for the evaluation of both anesthesiology and surgery trainees on management of intraoperative hemorrhagic shock from solid organ injury.