SURGICAL EMERGENCY

GOAL 1 .Recognize different

surgical emergencies

2 .Learn a correct notion3 .Decrease delayed

diagnosis4 .Prevent secondary injury

GUIDELINES1 .Surgical emergencies2 .Pediatric surgery emergencies3 .Urological emergencies4 .ENT emergencies5 .Ophthalmic emergencies6 .Gynecologic emergencies

PRINCIPLES OF MANAGEMENT 1 .Life-saving

a. Identify life-threatening injury b. Appropriate resuscitation2 .Maintain vital status

a. Detailed physical examination b. Continuous resuscitation3 .Further evaluation and

management a. Laboratory examination b. Consultation

TRAUMA1 .The 5th leading causes of death of

Taiwanese2 .The 1st leading cause of death of

young adults3 .Approximately 8,000 patients died

from trauma annually

WOUND CARE1 .Copious irrigation 2 .Remove foreign body3 .Antiseptic solution4 .Adequate debridement5 .Primary / Delayed suture

PRIMARY SURVEYA. Airway and C-spine controlB. Breathing and ventilation

C. Circulation and hemorrhage control

D. DisabilityE. ExposureM. 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

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

Progressive headache Vomiting Consciousness Dyspnea Extremity weakness Seizure

LIFE-THREATENING CHEST INJURY

1 .Airway obstruction2 .Tension pneumothorax3 .Open pneumothorax4 .Massive hemothorax5 .Pericardiac tamponade6 .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 laceration2 .Spleen laceration3 .Large vessel injury4 .Pelvic fracture

TRAUMATIC SHOCK1 .Hypovolemic shock2 .Neurogenic shock3 .Cardiogenic shock4 .Septic shock

FLUID RESUSCITATION1 .Access

Two large bore IV catheter2 .Fluid

Crystalloid, colloid, blood component3 .Amount

a. Bolus: 2 liter for adults 20 ml/ kg for child

b. maintain amount based on urine output

THREATENING EXTREMITY INJURY

1 .Femoral fracture2 .Multiple fracture3 .Nerve, vessel, muscle

and soft tissue injury

THERMAL INJURY1 .Major burn2 .High-voltage electric

injury3 .Inhalation injury4 .Chemical burn

ACUTE ABDOMEN Differential diagnosis

Surgical abdomen / medical abdomen Pain history

Onset, location, intensity, duration , radiation, quality, associated

symptoms Symptoms sequence

SEVERE ABDOMINAL PAIN1 .Hollow organ perforation2 .Acute pancreatitis3 .Colic pain

a. Biliary system b. Renal system

4 .Ischemia pain5 .Others

COMMON DISEASES1 .Acute cholecystitis2( .Perforated )Peptic ulcer3 .Acute appendicitis4 .Acute pancreatitis5 .Small bowel obstruction6 .Colon obstruction7 .Vascular occlusion8 .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

GYNECOLOGICEMERGENCY

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 EmergencyPainful conditionsBleeding conditionsTrauma conditionsOthers

ENT Emergency☢Foreign body☢Epistaxis☢Deep neck infection☢Others

Ophthalmic EmergenciesRed eyesForeign bodyBlurred vision Blindness Others

REEVALUATIONTime intervalSame personnelVital signs Laboratory examinationEarly suspicionEarly 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