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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.

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SURGICAL EMERGENCY


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surgical emergency
SURGICAL EMERGENCY

Shyr-Chyr Chen, MD

Department of Emergency Medicine

National Taiwan University Hospital

slide2
GOAL
  • 1. Recognize different surgical

emergencies

  • 2. Learn a correct notion
  • 3. Decrease delayed diagnosis
  • 4. Prevent secondary injury
guidelines
GUIDELINES
  • 1. Surgical emergencies
  • 2. Pediatric surgery emergencies
  • 3. Urological emergencies
  • 4. ENT emergencies
  • 5. Ophthalmic emergencies
  • 6. Gynecologic emergencies
principles of management
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
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
WOUND CARE

1. Copious irrigation

2. Remove foreign body

3. Antiseptic solution

4. Adequate debridement

5. Primary / Delayed suture

primary survey
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
SECURE AIRWAY
  • Assist airway

Oral airway, nasal airway, LMA

  • Endotracheal intubation

Oral, nasal

  • Surgical airway

Cricothyroidotomy

Tracheostomy

life threatening head injury
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

i i c p
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

observation of head injury
OBSERVATION OF HEAD INJURY
  • Progressive headache
  • Vomiting
  • Consciousness
  • Dyspnea
  • Extremity weakness
  • Seizure
life threatening chest injury
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
BECK’S TRIAD

1. Decrease blood pressure

2. Distended neck vein

3. Distant or muffled heart

sounds

life threatening abdominal injury
LIFE-THREATENING ABDOMINAL INJURY

1. Liver laceration

2. Spleen laceration

3. Large vessel injury

4. Pelvic fracture

traumatic shock
TRAUMATIC SHOCK

1. Hypovolemic shock

2. Neurogenic shock

3. Cardiogenic shock

4. Septic shock

fluid resuscitation
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
THREATENING EXTREMITY INJURY

1. Femoral fracture

2. Multiple fracture

3. Nerve, vessel, muscle and soft

tissue injury

thermal injury
THERMAL INJURY

1. Major burn

2. High-voltage electric injury

3. Inhalation injury

4. Chemical burn

acute abdomen
ACUTE ABDOMEN
  • Differential diagnosis

Surgical abdomen / medical abdomen

  • Pain history

Onset, location, intensity, duration,

radiation, quality, associated symptoms

  • Symptoms sequence
severe abdominal pain
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
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
PEDIATRIC SURGERY EMERGENCY

1.Respiratory distress

* Esophageal atresia

* Diaphragmatic hernia

2. Skin defect

* Gastroschisis

* Omplalocele

* Menigocele

pediatric surgery emergency23
PEDIATRIC SURGERY EMERGENCY

3. Bowel obstruction

Pyloric stenosis, intussusception

Adhesion, incarcerated hernia,

Malroatation

4. Abdominal pain

*Acute gastroenteritis

*Acute appendicitis

*Mesenteric lymphadenitis

orthopedic emergency
ORTHOPEDIC EMERGENCY
  • Fracture
  • Dislocation
  • Rupture (tendon, ligament, muscle,

nerve, vessel)

  • Hemorrhage
gynecologic emergency
GYNECOLOGICEMERGENCY
  • Vaginal bleeding

1. Dysfunctional uterine bleeding

2. Uterine myoma

3. Hypermenorrhea

4. Abortion

5. Atony uterus

gynecologic emergency26
GYNECOLOGIC EMERGENCY
  • Ectopic pregnancy

* Missed period

* Vaginal spotting

* Abdominal pain

gynecologic emergency27
GYNECOLOGIC EMERGENCY
  • Abdominal pain

* Pelvic inflammatory disease

* Acute appendicitis

* Ovarian cyst (torsion)

* Ileus

* Menstruction

urological emergency
Urological Emergency
  • Painful conditions
  • Bleeding conditions
  • Trauma conditions
  • Others
ent emergency
ENT Emergency
  • Foreign body
  • Epistaxis
  • Deep neck infection
  • Others
ophthalmic emergencies
Ophthalmic Emergencies
  • Red eyes
  • Foreign body
  • Blurred vision
  • Blindness
  • Others
reevaluation
REEVALUATION
  • Time interval
  • Same personnel
  • Vital signs
  • Laboratory examination
  • Early suspicion
  • Early consultation
medical ethics
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