Final answer:
When troublesome bleeding is encountered during an open appendicectomy, the surgical team should apply direct pressure, identify the source of bleeding, and achieve hemostasis by ligating or cauterizing the vessel. Continuous monitoring and communication with the anesthesia team is crucial, along with ensuring an adequate blood supply.
Step-by-step explanation:
If a 23 year old man undergoing an open appendicectomy suddenly encounters troublesome bleeding when the incision is extended medially, the best course of action is to achieve hemostasis. First, the surgical team should immediately apply direct pressure to the area of bleeding to control the blood loss. Meanwhile, the source of the bleeding should be identified; this often involves careful dissection or the use of suction to provide a clear view. Once identified, the bleeding vessel may be ligated or cauterized to stop the bleeding. If the situation does not improve, it may be necessary to call for additional surgical assistance or implement advanced hemostatic techniques. Throughout the process, it is critical to monitor the patient's vital signs and continue to communicate with the anesthesia team about the patient's status. It is also essential to ensure an adequate blood supply, and preoperative cross-matching should have been done in anticipation of such an event. Postoperative care will involve close monitoring of the patient for signs of hematoma, infection, or other complications.