SURGICAL EMERGENCY SURGICAL EMERGENCY Shyr-Chyr Chen, MD Department of Emergency Medici ne National Taiwan University Hos pital
Dec 26, 2015
SURGICAL EMERGENCYSURGICAL EMERGENCY
Shyr-Chyr Chen, MD
Department of Emergency Medicine
National Taiwan University Hospital
GOALGOAL
1. Recognize different surgical
emergencies 2. Learn a correct notion 3. Decrease delayed diagnosis 4. Prevent secondary injury
GUIDELINESGUIDELINES
1. Surgical emergencies 2. Pediatric surgery emergencies 3. Urological emergencies 4. ENT emergencies 5. Ophthalmic emergencies 6. Gynecologic emergencies
PRINCIPLES OF PRINCIPLES OF MANAGEMENT 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
TRAUMATRAUMA
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 CAREWOUND CARE
1. Copious irrigation
2. Remove foreign body
3. Antiseptic solution
4. Adequate debridement
5. Primary / Delayed suture
PRIMARY SURVEYPRIMARY SURVEY
A. Airway and C-spine control
B. Breathing and ventilation
C. Circulation and hemorrhage control
D. Disability
E. Exposure
M. Monitor
SECURE AIRWAYSECURE AIRWAY
Assist airway
Oral airway, nasal airway, LMA Endotracheal intubation
Oral, nasal Surgical airway
Cricothyroidotomy
Tracheostomy
LIFE-THREATENINGLIFE-THREATENING HEAD INJURY 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 PI 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 OFOBSERVATION OF HEAD INJURY HEAD INJURY
Progressive headache Vomiting Consciousness Dyspnea Extremity weakness Seizure
LIFE-THREATENING LIFE-THREATENING CHEST INJURY 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 TRIADBECK’S TRIAD
1. Decrease blood pressure
2. Distended neck vein
3. Distant or muffled heart
sounds
LIFE-THREATENING LIFE-THREATENING ABDOMINAL INJURY ABDOMINAL INJURY
1. Liver laceration
2. Spleen laceration
3. Large vessel injury
4. Pelvic fracture
TRAUMATIC SHOCKTRAUMATIC SHOCK
1. Hypovolemic shock
2. Neurogenic shock
3. Cardiogenic shock
4. Septic shock
FLUID RESUSCITATIONFLUID 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 THREATENING EXTREMITY INJURY EXTREMITY INJURY
1. Femoral fracture
2. Multiple fracture
3. Nerve, vessel, muscle and soft
tissue injury
THERMAL INJURYTHERMAL INJURY
1. Major burn
2. High-voltage electric injury
3. Inhalation injury
4. Chemical burn
ACUTE ABDOMENACUTE ABDOMEN
Differential diagnosis
Surgical abdomen / medical abdomen Pain history
Onset, location, intensity, duration,
radiation, quality, associated symptoms Symptoms sequence
SEVERE ABDOMINAL PAINSEVERE ABDOMINAL PAIN
1. Hollow organ perforation
2. Acute pancreatitis
3. Colic pain
a. Biliary system
b. Renal system
4. Ischemia pain
5. Others
COMMON DISEASESCOMMON 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 SURGERYPEDIATRIC SURGERY EMERGENCY EMERGENCY
1. Respiratory distress
* Esophageal atresia
* Diaphragmatic hernia
2. Skin defect
* Gastroschisis
* Omplalocele
* Menigocele
PEDIATRIC SURGERYPEDIATRIC SURGERY EMERGENCY EMERGENCY
3. Bowel obstruction
Pyloric stenosis, intussusception
Adhesion, incarcerated hernia,
Malroatation
4. Abdominal pain
*Acute gastroenteritis
*Acute appendicitis
*Mesenteric lymphadenitis
ORTHOPEDIC EMERGENCYORTHOPEDIC EMERGENCY
Fracture Dislocation Rupture (tendon, ligament, muscle,
nerve, vessel) Hemorrhage
GYNECOLOGICGYNECOLOGICEMERGENCYEMERGENCY
Vaginal bleeding
1. Dysfunctional uterine bleeding
2. Uterine myoma
3. Hypermenorrhea
4. Abortion
5. Atony uterus
GYNECOLOGICGYNECOLOGIC EMERGENCY EMERGENCY
Ectopic pregnancy
* Missed period
* Vaginal spotting
* Abdominal pain
GYNECOLOGICGYNECOLOGIC EMERGENCY EMERGENCY
Abdominal pain
* Pelvic inflammatory disease
* Acute appendicitis
* Ovarian cyst (torsion)
* Ileus
* Menstruction
Urological EmergencyUrological Emergency
Painful conditions Bleeding conditions Trauma conditions Others
ENT EmergencyENT Emergency
☢Foreign body☢Epistaxis☢Deep neck infection☢Others
Ophthalmic EmergenciesOphthalmic Emergencies
Red eyes Foreign body Blurred vision Blindness Others
REEVALUATIONREEVALUATION
Time interval Same personnel Vital signs Laboratory examination Early suspicion Early consultation
MEDICAL ETHICSMEDICAL 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