Hemorrhagic Shock after Elective Spine Surgery: Failure to Rescue after Limited Response to Nursing Concerns. Scott Zakaluzny, MD, FACS | July 10, 2024

https://psnet.ahrq.gov/web-mm/hemorrhagic-shock-after-elective-spine-surgery-failure-rescue-after-limited-response-nursing Hemorrhagic Shock after Elective Spine Surgery: Failure to Rescue after Limited Response to Nursing Concerns In this WebM&M Spotlight Case with CE/MOC, a 67-year-old man with severe low back pain was admitted to the hospital for anterior lumbar interbody fusion (ALIF) with bone autograft from the iliac crest. The surgical team had difficulty achieving intraoperative hemostasis and the patient left the operating room (OR) with the bone graft donor site open and oozing blood. He was still bleeding in the postanesthesia care unit (PACU), where the nurse called the attending physician three times to report hypotension and oozing blood. Each time, the surgeon ordered hetastarch for volume expansion. Over the next 14 hours, the patient’s blood pressure remained at or below 90/60 with a weak and thready pulse and continued complaints of back and pelvic pain. The next morning, the patient was unresponsive and in hypovolemic shock. Electrocardiography confirmed a non-ST segment elevation myocardial infarction (NSTEMI). The patient was transferred to an intensive care unit and resuscitative efforts were initiated, but the patient expired from multiorgan failure resulting from hypovolemic shock.