SURGICAL EMERGENCY Shyr-Chyr Chen, MD Department of Emergency Medicine National Taiwan University...

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