SURGICAL EMERGENCY

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SURGICAL EMERGENCY
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GOAL

• 1. Recognize different surgical
• emergencies
• 2. Learn a correct notion
• 3. Decrease delayed diagnosis
• 4. Prevent secondary injury

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GUIDELINES

• 1. Surgical emergencies
• 2. Pediatric surgery emergencies
• 3. Urological emergencies
• 4. ENT emergencies
• 5. Ophthalmic emergencies
• 6. Gynecologic emergencies

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PRINCIPLES OF MANAGEMENT

• 1. Life-saving
• a. Identify life-threatening injury
• b. Appropriate resuscitation
• 2. Maintain vital status
• a. Detailed physical examination
• b. Continuous resuscitation
• 3. Further evaluation and management
• a. Laboratory examination
• b. Consultation

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TRAUMA

• 1. The 5th leading causes of death of
• Taiwanese
• 2. The 1st leading cause of death of
• young adults
• 3. Approximately 8,000 patients died
• from trauma annually

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WOUND CARE

• 1. Copious irrigation
• 2. Remove foreign body
• 3. Antiseptic solution
• 4. Adequate debridement
• 5. Primary / Delayed suture

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PRIMARY SURVEY

• A. Airway and C-spine control
• B. Breathing and ventilation
• C. Circulation and hemorrhage control
• D. Disability
• E. Exposure
• M. Monitor

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SECURE AIRWAY

• Assist airway
• Oral airway, nasal airway, LMA
• Endotracheal intubation
• Oral, nasal
• Surgical airway
• Cricothyroidotomy
• Tracheostomy

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LIFE-THREATENING HEAD INJURY

• Intracranial hemorrhage
• Epidural hematoma, subdural hematoma,
• intracerebral hematoma, subarachnoid
• hematoma
• Diffuse axonal injury
• Management
• a. Evacuation of hematoma
• b. Decrease IICP and mass effect
• c. Maintain cerebral perfusion

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I I C P

• Symptoms
• Headache, vomiting, consciousness
• change
• Signs
• Increase BP, decrease HR PR
• papilledema
• Neurological findings
• Focal sign, pupil size and light reflex

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OBSERVATION OF HEAD INJURY

• Progressive headache
• Vomiting
• Consciousness
• Dyspnea
• Extremity weakness
• Seizure

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LIFE-THREATENING CHEST INJURY

• 1. Airway obstruction
• 2. Tension pneumothorax
• 3. Open pneumothorax
• 4. Massive hemothorax
• 5. Pericardiac tamponade
• 6. Flail chest combined pulmonary
• contusion

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BECKS TRIAD

• 1. Decrease blood pressure
• 2. Distended neck vein
• 3. Distant or muffled heart
• sounds

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LIFE-THREATENING ABDOMINAL INJURY

• 1. Liver laceration
• 2. Spleen laceration
• 3. Large vessel injury
• 4. Pelvic fracture

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TRAUMATIC SHOCK

• 1. Hypovolemic shock
• 2. Neurogenic shock
• 3. Cardiogenic shock
• 4. Septic shock

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FLUID RESUSCITATION

• 1. Access
• Two large bore IV catheter
• 2. Fluid
• Crystalloid, colloid, blood component
• 3. Amount
• a. Bolus 2 liter for adults
• 20 ml/ kg for child
• b. maintain amount based on urine output

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THREATENING EXTREMITY INJURY

• 1. Femoral fracture
• 2. Multiple fracture
• 3. Nerve, vessel, muscle and soft
• tissue injury

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THERMAL INJURY

• 1. Major burn
• 2. High-voltage electric injury
• 3. Inhalation injury
• 4. Chemical burn

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ACUTE ABDOMEN

• Differential diagnosis
• Surgical abdomen / medical abdomen
• Pain history
• Onset, location, intensity, duration,
• radiation, quality, associated symptoms
• Symptoms sequence

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SEVERE ABDOMINAL PAIN

• 1. Hollow organ perforation
• 2. Acute pancreatitis
• 3. Colic pain
• a. Biliary system
• b. Renal system
• 4. Ischemia pain
• 5. Others

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COMMON DISEASES

• 1. Acute cholecystitis
• 2. (Perforated) Peptic ulcer
• 3. Acute appendicitis
• 4. Acute pancreatitis
• 5. Small bowel obstruction
• 6. Colon obstruction
• 7. Vascular occlusion
• 8. Others

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PEDIATRIC SURGERY EMERGENCY

• 1. Respiratory distress
• Esophageal atresia
• Diaphragmatic hernia
• 2. Skin defect
• Gastroschisis
• Omplalocele
• Menigocele

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PEDIATRIC SURGERY EMERGENCY

• 3. Bowel obstruction
• Pyloric stenosis, intussusception
• Adhesion, incarcerated hernia,
• Malroatation
• 4. Abdominal pain
• Acute gastroenteritis
• Acute appendicitis
• Mesenteric lymphadenitis

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ORTHOPEDIC EMERGENCY

• Fracture
• Dislocation
• Rupture (tendon, ligament, muscle,
• nerve, vessel)
• Hemorrhage

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GYNECOLOGICEMERGENCY

• Vaginal bleeding
• 1. Dysfunctional uterine bleeding
• 2. Uterine myoma
• 3. Hypermenorrhea
• 4. Abortion
• 5. Atony uterus

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GYNECOLOGIC EMERGENCY

• Ectopic pregnancy
• Missed period
• Vaginal spotting
• Abdominal pain

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GYNECOLOGIC EMERGENCY

• Abdominal pain
• Pelvic inflammatory disease
• Acute appendicitis
• Ovarian cyst (torsion)
• Ileus
• Menstruction

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Urological Emergency

• Painful conditions
• Bleeding conditions
• Trauma conditions
• Others

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ENT Emergency

• Foreign body
• Epistaxis
• Deep neck infection
• Others

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Ophthalmic Emergencies

• Red eyes
• Foreign body
• Blurred vision
• Blindness
• Others

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REEVALUATION

• Time interval
• Same personnel
• Vital signs
• Laboratory examination
• Early suspicion
• Early consultation

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MEDICAL ETHICS

• Treat a person not a disease
• Treat a patient as your family
• Be patient to a patients complaint
• Be kind and more smile
• Careful explanation