The patient was then followed up successfully by the Emergency Team of the Civil Hospital: the Emergency Room, directed by Dr. Geminian FlagAnesthesia and Resuscitation and Intensive Care, directed by the doctor Elizabeth Bertellinithe General Surgery, Emergency and New Technologies, directed by the doctor Michaela Smallthe Vascular Surgery, directed by prof. Roberto SilingardiRadiology, directed by Dr Antonio Zagnoli and Emergency Internal Medicine (MIDU), directed by Dr John Pinelli. The support of the nursing staff of the Operating Block and of the departments involved is essential.
(In the group photo a representation of the emergency team involved: doctors, surgeons and nursing staff)
“This case – complimented the General Managers of AUSL and AOU, Anna Maria Petrini e Claudius Vagnini – it is really a great example of managing a critical patient in a multidisciplinary way; an orchestra of professionals with a single score, respecting times and roles with the sole objective: to save the patient’s life in danger. We want to congratulate all the healthcare personnel for the excellent work.”
“The added value in this type of emergency – explains the doctor Geminian FlagDirector of the Emergency Department of the Civil Hospital and of the Intercompany Emergency-Urgency Department – it is represented by the multi-specialist teamwork that has always characterized our work in emergencies, starting from the intervention of the 118 which understood the problem and led the patient to the appropriate place. To this now consolidated approach is added the acquisition of new technical skills such as the use of the aortic balloon and strategies such as, in this case, damage control surgery. The presence at the Baggiovara Hospital of equipment such as the Hybrid Room, the Tromboelastograph, the application of the Protocol for Massive Transfusions, the multi-specialist coordination for interventions, interventional radiology, resuscitation management according to damage control. This multidisciplinary approach and the teamwork of everyone has made it possible to recover a situation that, in other contexts, would have had a poor prognosis”.
“That day a call came to the Operations Center 118 Emilia Est for an illness in a workplace – says Dr. Marcello BaraldiMedical Director of the 118 of Modena – The Central sent an ambulance with a nurse on board who, after detecting a serious clinical and instrumental picture of shock characterized by alarming low pressure values, promptly started maneuvers to stabilize the patient and at the same time requested support the intervention of the air ambulance. The Bologna helicopter arrived on site in a short time, whose team continued the maneuvers together with the nursing team and then transported the patient to the Baggiovara Emergency Department in a code of maximum gravity. In this situation with a happy ending, it can be seen that the synergistic teamwork, starting from the territory with the resuscitation and stabilization maneuvers of the patient and then continuing in the hospital, which sees the great professionalism of all the medical, nursing and techniques involved represents the trump card to achieve the result”.
“The resuscitator – added the doctor Elizabeth BertelliniDirector of Intensive Care at the Civil Hospital – he intervened in the Emergency Department on a severe picture of internal bleeding caused by a rare vascular pathology. The clinical condition, immediately extremely critical and refractory to resuscitation treatments, rapidly deteriorated up to cardiac arrest. Therefore, a life-saving maneuver was implemented in the Emergency Department to stop the bleeding, through the insertion of a particular device in the thoracic aorta. This procedure allowed the resumption of cardio-circulatory activity and consequently the possibility of taking the patient to the operating room where the work of the anesthesiologist, through a complex and careful management of the vital functions with specific instruments, was fundamental for the survival of the patient and the success of the delicate vessel repair procedure. After the operation, the patient was admitted to the Intensive Care Unit, in critical condition, where he required advanced and complex intensive treatments, pharmacological support of the circulation, respiratory support, replacement of the renal function, which progressively led to the stabilization of the clinical picture and to the recovery of compromised organ functions”.
“Like Radiology – concluded the doctor Antonio Zagnolipro-tempore Director of Radiology at the Baggiovara Hospital – we participated in the diagnostic process by CT identifying the site of the internal bleeding, ready to intervene with the interventional radiology team on the patient’s arrival and we were ready to intervene to correct the internal bleeding. When the patient went into cardiac arrest, however, he had to be taken to the operating room at which point he was taken over by fellow vascular surgeons. This ability to adapt the intervention to the clinical condition is an important feature of the team”.
“The patient, who arrived in the emergency room for abdominal pain – explains the prof. Roberto SilingardiDirector of Vascular Surgery – immediately presented a very serious clinical picture, on which we intervened in full collaboration with the team of the Anesthesia and Intensive Care Service”. From the Emergency Department, the patient was immediately transferred to the Hybrid Operating Room. “The traditional surgical treatment for this rare and dangerous pathology is very invasive and burdened by a high rate of complications, including the possibility of intra-operative death of the patient – explains Dr. Stefano GennaiVascular Surgeon who personally conducted the surgery. “In these cases, with massive bleeding in progress and highly unstable vital parameters, the minimally invasive endovascular technique allows very complex operations to be performed quickly and minimizing the risks, already very high in emergency conditions, for the patient ”. The Vascular Surgery of the Civil Hospital of Baggiovara represents the reference center for the province of Modena, and beyond, for the treatment of complex aortic pathologies and for the technique of endovascular surgery. “The case just mentioned was an example of an excellent and efficient collaboration between professionals – continues Silingardi – fundamental in the management of emergencies and complex cases and essential to ensure maximum patient care. From the point of view of an increasingly specialized Medicine and Surgery, the integration of different skills is essential and precious”.
“In this case the convergence of all the professionals already in the Emergency Department was fundamental, upon arrival of the patient whose conditions immediately appeared critical without the possibility of an accurate medical history given the language barrier – reports Dr Fouzia Mecherisurgeon of the UOC of Emergency Surgery and New Technologies (directed by Dr Michaela Small) who was consulted together with the vascular surgeon and the anesthesiologist. Like an orchestra, the various professionals followed one another on the patient: first the vascular surgeon to control the bleeding via the endovascular route. “Once the patient was stabilized in intensive care, after a few hours Dr. Mecheri always subjected the patient to a real abdominal surgical exploration to evaluate the presence of an intestinal ischemia (infarction), which is inevitable after the vascular treatment which provided for the necessary closure of a vessel responsible for the vascularization of a large part of the intestine” continues Dr Little ones. “An ileal resection (about 1 meter) and the removal of part of the colon with the placement beforehand of a dressing capable of providing temporary abdominal closure, designed to remove fluid from the abdominal cavity and allow a second operation after a few days which was performed by Dr. Giancarlo Abbatito verify the good vascularization of the rest of the ileum, the creation of a temporary ileostomy and the closure of the abdomen”. In a few months the patient can be recanalized by closing the Stoma. “A story with a happy ending, the kind that make us proud to do our job”. Micaela concluded Little ones.