Treatment of surgical emergencies with and without an algorithm

J. A. Hopkins, W. C. Shoemaker, S. Greenfield, P. C. Chang, T. McAuliffe and R. W. Sproat

A patient care algorithm was developed for resuscitation of patients entering the surgical emergency department with hypotension. The diagnostic workup, monitoring, and therapy were progressively excalated according to admission blood pressure and responses to therapeutic interventions. The branching-chain logic is ideally suited for rapid decision making in emergency conditions where the need is most urgent, the time constraints are most severe, and the potential improvements in terms of patient salvage are greatest. Preliminary results from these ongoing clinical trials indicate that (1) physicians can and will use an algorithm for emergency medical service resuscitation; (2) in a university hospital with a large emergency service and a commitment to emergency care, the physicians using the aigorithm performed as well as and in some instances better than those not using the algorithm; and (3) the use of the algorithm may prevent delays in resuscitation and lead to less morbidity and mortality. Thus, we conclude that the algorithm helps to organize emergency care, establish standards, and improve care.