Cardiac arrest - Stanford University



• Below are guidelines that you may find helpful. Individual practices and preferences may vary or change.

• In general, identify the surgeons who have operated on the patient in the past.

Ward surgical service

• The ward surgical service (also known as the East/West Surgical Service and listed in the on call paging directory as the General Surgical Service) performs general (e.g., colectomy, pancreatectomy), vascular (e.g. AAA, carotid, acute arterial insufficiency), and thoracic (e.g., chest tube placement, tracheostomy, lung biopsy or resection) surgery.

• There are three teams: Red, White, and Blue. Each team consists of a senior resident and an intern, and the Surgical Chief Resident is the attending for all three. Note that the senior discusses all consults with the Surgical Chief Resident (who is a Staff Surgeon with full operative privileges in general, thoracic, and vascular surgery). At the discretion of the Chief, private attendings may serve as consultants for complex ward cases.

• When you need a consult or if there is a surgical emergency, page the senior resident on call for the ward surgery service that day. He or she will see the patient as soon as possible. Thereafter, the patient will be followed by that team and daily progress notes will be left on active patients. For new issues, page the team that has seen the patient.

Private patients

• The private surgeons are grouped into six teams: Teams 1, 2, 5, and 6 are general surgery/oncology. Although the following numbers are seldom used, Team 3 is Private Vascular, and Team 4 is Private Thoracic.

• When you need a surgical consult for a private patient, call the requested attending’s office with the consult. (In general, for private surgeons, calling the office/answering service is higher-yield than the page operator.) After hours, a message can be left for non-urgent matters.

• For private thoracic and vascular surgery issues, if no attending is specified, you can page the resident on-call for private thoracic or vascular; for general surgical issues a specific attending (or their coverage) must be selected and contacted.

• Residents on call are listed under Baker in the on call paging directory.

Emergency Department

• All surgical patients and consultations in the ED are the ultimate responsibility of the PGY 3 surgical resident (a.k.a., the “pit” senior), although they may be seen by the pit junior (PGY 2), minor surgeon (intern), or various emergency medicine residents who are part of the surgical team.

• The ED surgical team is formally part of the ward team and presents all ward and trauma admissions and consults on ward rounds at 6 a.m.

Miscellaneous

• Cardiac, for urgent issues, call cardiac senior.

• Routine “orbit” issues are managed by nurse practitioners (including Susan Capanno, N.P.).

• Transplant: for cardiac transplant surgical issues, call cardiac senior; for lung transplant issues, call thoracic resident; for other solid organs, call transplant resident on call.

• Burns: call the MGH burns senior resident

• Hand surgery: for private, call the attending office; for ward patients, call the page operator for resident on call for hand (alternates between plastics and orthopedics)

• Plastics: for private, call attending; for ward, call the ward plastics resident.

• Orthopedics, urology, neurosurgery: call the page operator for consult resident.

How to reach a surgeon

• Please note that overhead pages, stat or otherwise, are not heard in many places including the OR, many call rooms, and ED.

• For the ward service, it is perfectly appropriate to call into the OR to: 1. let surgeons know of an emergency, or 2. to leave a brief message with the nurse regarding a new consult, question, etc.

– Routine conversations may or may not be possible; lengthy conversations are usually impossible.

– When operating, surgical residents should be signed out to the appropriate OR.

– Either call the number the resident is signed out to or call the OR Main (Gray) Desk (6-8910) and ask to be transferred to that OR.

• Private surgeons are best reached through their office (at night that telephone number goes to an answering service). Routine consults can be left with the office staff. Urgent calls during the day will be transmitted by the office staff to the surgeon (or his or her covering resident).

• For overnight emergencies for private surgery attendings, the MGH page operators know which residents are in-house covering which private surgical attendings.

• In general, when calling a surgeon it is a good idea to know: the patient’s current condition, vital signs, exam, and relevant PMH.

• Any patient who may require immediate surgery needs to be NPO, have IV access, and almost certainly fluid resuscitation. Consider nasogastric tube, Foley, blood bank sample, and type and cross as indicated and as time permits.

ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery (2002)

|Cardiac risk* stratification for noncardiac surgical procedures |

|High cardiac risk |Reported cardiac risk often >5% |

| |Emergent major operations, particularly in the elderly |

| |Aortic and other major vascular |

| |Peripheral vascular |

| |Anticipated prolonged surgical procedures associated with large fluid shifts and/or |

| |blood loss |

|Intermediate |Reported cardiac risk generally ................
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