Acute Emergencies as seen in the AE Department

Acute Emergencies as seen in the A&E Department Assessment & Initial Management

Acute Emergencies may be: n n Surgical(Non-Trauma) Surgical(Trauma) Medical Miscellaneous

Surgical Emergencies(Non-Trauma) n n n -Abdominal/GIT -Bowel Perforations -Vascular Insufficiency -Organ Disorders -Peritonitis

Thoracic Emergencies Pleural Collections n Primary & Metastatic Neoplasms Do X-rays, Blood gases, Thoracentesis, Give oxygen, give sedation, drain chest n

Genitourinary n n n -Urinary outflow tract obstruction -Haematuria -Neoplasms Do PCV, E/U, Renal USS, catheterise, give fluids/blood, IVU.

Gynaecological n n n -Bleeding PV Inflammations -Neoplasms

Neurological n n n -Acute Loss of Consciousness -Convulsions -Neoplasms Assess GCS, full neurological evaluation Do CT of brain, check for metabolic problems, (sugar, electrolytes, drugs), check CSF. Exclude trauma

Musculoskeletal n n n (mostly traumatic, but. . ) -Inflammations, Abscesses(pyomyositis) -Fast growing tumours Do X-rays, check PCV, septic work up, analgesics, antibiotics, drain pus if possible

Skin and Integument n n n -Haemorrhage -Severe Pain -Acute ulcers Arrest haemorrhage, Check PCV & transfuse as necessary, relieve pain with analgesics, debride & dress wound,

SURGICAL TRAUMA n Surgical Trauma constitute the commonest form of emergencies seen in the A&E Department n ‘Big Three’ are: Neurosurgical, Musculoskeletal and Maxillofacial n --in all do Primary Survey (A B C D E)

SURGICAL TRAUMA Stabilise cervical spine, with ‘anything’ but preferrably with hard collar( assume c-spine injury is present in any unconscious trauma patient until disproved with at least a lateral cspine film n Give supplemental oxygen to ALL severely injured patients, especially UNCONSCIOUS patients n

SURGICAL TRAUMA n Restore/Maintain circulation with blood/fluids through central or peripheral lines. Do cut down if necessary!

SURGICAL TRAUMA Establish breathing, endotracheal intubation if necessary! n Relieve/Remove collections in airway/chest. Evacuate tension pneumothorax immediately. Drain acute collections(blood) from chest n

SURGICAL TRAUMA n In Head injuries, assess GCS, pupillary size, muscle tone, power and sensation as soon as quickly as possible

HEAD INJURIES n n n n Maintain Airway Arrest Haemorrhage in scalp lacerations Assess Glasgow Coma Scale Assess Pupillary size Assess muscle tone, power and reflexes Assess sensation Do relevant X-Rays, CT scan

MUSCULOSKELETAL n n n Mainly fractures… Arrest haemorrage if necessary Reduce dislocations asap! Immobilise fractures. . temporary, permanent POP Do Xrays. .

MAXILLOFACIAL n n n Maintain airway Immobilise neck Arrest haemorrhage Do x-rays Types of injuries: zygomatic complex & arch fractures, mandibular & maxillary fractures, Le. Fort fractures, soft tissue injuries

ABDOMINAL TRAUMA 1 n n Blunt Penetrating

ABDOMINAL TRAUMA 2 BLUNT: Usually affects solid organs n -spleen n -liver n -kidneys n -pancreas n

ABDOMINAL TRAUMA 3 Mainstay of management is to maintain circulation with blood transfusions and arrest of haemorrhage usually by surgery Do PCV, give fluids/blood, do USS/FAST, do DPL if no contraindications and USS not available, pass catheter, use PASG if available. . May give uncrossmatched blood!

ABDOMINAL TRAUMA 4 n Penetrating -may affect solid organs especially liver but as well as the intestines n -may be from stab wounds(knives, broken bottles) or from gunshot(worse prognosis) n

ABDOMINAL TRAUMA 5 n Some superficial stab wounds may be managed conservatively, but mandatory to surgically explore gunshot wounds n -wounds through the back/loin may involve kidneys

CHEST INJURIES 1 n Blunt n Penetrating

CHEST INJURIES 2 n n n Blunt Trauma more common: May involve Pleura, lungs, heart, mediastinum Collection may be Blood or air(Tension Pneumothorax!)

CHEST INJURIES 3 n Fractures of ribs or sternum may occur n Maintain breathing & ventilation. Evacuate fluid(blood) & air speedily. Adequate analgesics!

CHEST INJURIES 4 n Penetrating trauma can be rapidly lethal! n Minor forms may lead to haemopericardium(tamponade)

CHEST INJURIES 5 n Do thoracocentesis, chest tube drainage, pericardiocentesis(may be life saving!) n Do ECG, Xrays, Echocardiography

GENITOURINARY INJURIES 1 n Blunt n Penetrating

GENITOURINARY INJURIES 2 n Kidneys most commonly affected n Haematuria most common symptom n Ureters rarely affected n Bladder rupture may occur in blunt trauma if distended Conservative or surgical management. .

GENITOURINARY INJURIES 3 n Testes may suffer blunt trauma in sports n Rarely injuries may be deliberate n Severe pain, swelling, haematocele n USS may show full extent of damage

GENITOURINARY INJURIES 3 n Conservative or surgical management n Ovaries rarely injured(iatrogenic!) n Urethra may be injured accidentally or iatrogenically

MEDICAL EMERGENCIES Common in A&E n Stroke/CVD n Diabetic Ketoacidosis n Severe sepsis/Septicaemia n Convulsions/Meningoencephalitis

n Severe acute asthma/status asthmaticus n HIV Related disorders n Severe Anaemias n Severe chest infections n Occult neoplasms