S4A-07 SESSION 4A: GENERALITIES IN CRANIOSYNOSTOSIS – PART I CATASTROPHIC AND CRITICAL INTRA-OPERATIVE EVENTS DURING PEDIATRIC CRANIOFACIAL SURGERY: A NURSING PERSPECTIVE.
Bibliographic record
Abstract
Introduction: Pediatric craniofacial surgery carried out in tertiary care centres by dedicated teams of surgeons, anaesthetists and nursing staff is associated with a high level of safety with exceptionally low (< 1%) rates of mortality. However, the majority of life-threatening events occurring in patients undergoing major craniomaxillofacial procedures occur in the operating room. The aim of this study was to review the incidence and outcomes following catastrophic and critical events during surgery and review the role of the nursing team. Methods: Over a 10-year period at a tertiary care pediatric centre specializing in pediatric craniofacial surgery with 2 senior surgeons, catastrophic and critical intra-operative events as defined by alerting the alarm button eliciting a code event and team approach to patient management were reviewed. Details of these cases and outcomes were tabulated. The importance of the nursing role was assessed. Results: From January 2009 to January 2019, 4055 procedures were carried out by the 2 senior pediatric craniofacial surgeons with 1109 cases considered to be major craniofacial (intracranial, intra-extracranial or major facial osteotomies). In this time period, 12 events (0.01% of major craniofacial procedures) were recorded: 5 venous air embolisms, 2 profound cardiovagal reflex responses with cardiac standstill, 1 anaphylaxis and 4 major bleeding episodes that required aggressive resuscitation. All patients survived. Surgery was curtailed in 3 cases. Nursing response to intra-operative codes was critical to the outcomes. Awareness and experience of the procedure, communication strategies, initiation of massive transfusion protocols, documentation, protection of sterile resources and tissue, post-event debriefing and discussion at M&M rounds are all crucial roles for nursing involvement in these events. Further case details and a protocol will be presented. Conclusion: The importance of experience and dedicated teams in the management of catastrophic and critical intra-operative events during major pediatric craniofacial procedures cannot be over-stated. Despite operating in a tertiary care pediatric centre with senior experienced surgeons, these events can occur and successful outcomes are dependent on experience, communication and team approach to maintain an excellent safety record. The importance of the nursing team will be emphasized.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.055 | 0.018 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".