Anesthesiologists

The anesthesiology group in our hospital maintains first-call and second-call schedules that provide an experienced anesthesiologist for at least two microsurgical cases at all times. Coverage for a third emergency case must be recruited from anesthesiologists not on call, but no referral has ever been turned down because of lack of volunteers.

Emergency Room Staff

All members of the emergency staff are trained in the details of transmission of incoming calls regarding emergency referrals to the staff surgeon on call. They also relay patient and amputated part care instruction to outlying hospitals and coordinate air and ground transportation. When the patient arrives, the emergency room staff, in conjunction with the staff surgeon, obtains laboratory and x ray studies, undertakes necessary resuscitation, and oversees transport of the patient and amputated parts to the operating room.

The emergency room staff and the admissions staff meet any family members who accompany the patient and give them preliminary insurance counseling as well as advice on food, shelter, and waiting areas. Guest accommodations are provided by the hospital when necessary. Family members are usually permitted to stay in the patient's room once the patient arrives on the ward. Cots are provided at minimal cost. This arrangement is particularly helpful when the patients are young.

Recovery Room and Intensive Care Unit Nursing

The nursing personnel of the recovery room and intensive care units (where all microsurgical patients spend at least the first postoperative night) are specially trained in the positioning of limbs following replantation, room temperature and heating pad adjustments, and monitoring of the replanted part. Monitoring is usually based on quantitative fluorimetry when the part has intact skin.2 Clinical inspection and surface Doppler monitoring are also performed. With experience, the nursing staff has become adept in the assessment of the vascular status of a replanted part, and any nursing call to the replant physician team gets a prompt response.

After injury and prolonged microsurgical procedures, most patients require significant fluid replacement during the first 24 postoperative hours. Additionally, many require sophisticated care for associated injuries (e.g., pulmonary contusion) or medical complications (e.g., delirium tremens).3 Our nursing staff has integrated the special requirements of microsurgical patients into their sophisticated critical care skills to provide optimum management for these patients.

Ward Nursing

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