Pitfalls in surgical resuscitation

Timing of diagnosis and intervention, together with understanding of physiology and knowledge of anatomy, are essential for success in the practice of surgery in general, and emergency surgery in particular. Either excess of treatment, for example fluid overload in tamponated haemorrhage such as a ruptured retroperitoneal Abdominal Aortic Aneurysm, or defect of treatment such as delayed arrest of life threatening bleeding from a transected Superficial Femoral Artery above the knee, can both lead to disastrous outcome or death. Proximal control of damaged arteries is an obligatory step before repair and in emergency situations must be effected rapidly: the femoral artery can be easily aggressed at the groin under local anaesthesia; the abdominal aorta can be rapidly controlled with digital compression at the hiatus through the avascular area of the gastrohepatic ligament.