Transcript SURGICAL EMERGENCY

SURGICAL EMERGENCY
Shyr-Chyr Chen, MD
Department of Emergency Medicine
National Taiwan University Hospital
GOAL
1. Recognize different surgical
emergencies
2. Learn a correct notion
3. Decrease delayed diagnosis
4. Prevent secondary injury
GUIDELINES
1. Surgical emergencies
2. Pediatric surgery emergencies
3. Urological emergencies
4. ENT emergencies
5. Ophthalmic emergencies
6. Gynecologic emergencies
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
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
WOUND CARE
1. Copious irrigation
2. Remove foreign body
3. Antiseptic solution
4. Adequate debridement
5. Primary / Delayed suture
PRIMARY SURVEY
A. Airway and C-spine control
B. Breathing and ventilation
C. Circulation and hemorrhage control
D. Disability
E. Exposure
M. Monitor
SECURE AIRWAY



Assist airway
Oral airway, nasal airway, LMA
Endotracheal intubation
Oral, nasal
Surgical airway
Cricothyroidotomy
Tracheostomy
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
IICP



Symptoms
Headache, vomiting, consciousness
change
Signs
Increase BP, decrease HR & PR
papilledema
Neurological findings
Focal sign, pupil size and light reflex
OBSERVATION OF
HEAD INJURY






Progressive headache
Vomiting
Consciousness
Dyspnea
Extremity weakness
Seizure
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
BECK’S TRIAD
1. Decrease blood pressure
2. Distended neck vein
3. Distant or muffled heart
sounds
LIFE-THREATENING
ABDOMINAL INJURY
1. Liver laceration
2. Spleen laceration
3. Large vessel injury
4. Pelvic fracture
TRAUMATIC SHOCK
1. Hypovolemic shock
2. Neurogenic shock
3. Cardiogenic shock
4. Septic shock
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
THREATENING
EXTREMITY INJURY
1. Femoral fracture
2. Multiple fracture
3. Nerve, vessel, muscle and soft
tissue injury
THERMAL INJURY
1. Major burn
2. High-voltage electric injury
3. Inhalation injury
4. Chemical burn
ACUTE ABDOMEN



Differential diagnosis
Surgical abdomen / medical abdomen
Pain history
Onset, location, intensity, duration,
radiation, quality, associated symptoms
Symptoms sequence
SEVERE ABDOMINAL PAIN
1. Hollow organ perforation
2. Acute pancreatitis
3. Colic pain
a. Biliary system
b. Renal system
4. Ischemia pain
5. Others
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
PEDIATRIC SURGERY
EMERGENCY
1. Respiratory distress
* Esophageal atresia
* Diaphragmatic hernia
2. Skin defect
* Gastroschisis
* Omplalocele
* Menigocele
PEDIATRIC SURGERY
EMERGENCY
3. Bowel obstruction
Pyloric stenosis, intussusception
Adhesion, incarcerated hernia,
Malroatation
4. Abdominal pain
*Acute gastroenteritis
*Acute appendicitis
*Mesenteric lymphadenitis
ORTHOPEDIC EMERGENCY




Fracture
Dislocation
Rupture (tendon, ligament, muscle,
nerve, vessel)
Hemorrhage
GYNECOLOGIC
EMERGENCY
Vaginal bleeding
1. Dysfunctional uterine bleeding
2. Uterine myoma
3. Hypermenorrhea
4. Abortion
5. Atony uterus

GYNECOLOGIC
EMERGENCY

Ectopic pregnancy
* Missed period
* Vaginal spotting
* Abdominal pain
GYNECOLOGIC
EMERGENCY
Abdominal pain
* Pelvic inflammatory disease
* Acute appendicitis
* Ovarian cyst (torsion)
* Ileus
* Menstruction

Urological Emergency
 Painful
conditions
 Bleeding conditions
 Trauma conditions
 Others
ENT Emergency
☢
Foreign body
☢ Epistaxis
☢ Deep neck infection
☢ Others
Ophthalmic Emergencies





Red eyes
Foreign body
Blurred vision
Blindness
Others
REEVALUATION
 Time
interval
 Same personnel
 Vital signs
 Laboratory examination
 Early suspicion
 Early consultation
MEDICAL ETHICS





Treat a person not a disease
Treat a patient as your family
Be patient to a patient’s complaint
Be kind and more smile
Careful explanation