SURGICAL EMERGENCY ShyrChyr Chen MD Department of Emergency
- Slides: 32
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 1. Surgical emergencies 2. Pediatric surgery emergencies 3. Urological emergencies 4. ENT emergencies 5. Ophthalmic emergencies 6. Gynecologic emergencies
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 1. The 5 th leading causes of death of Taiwanese 2. The 1 st leading cause of death of young adults 3. Approximately 8, 000 patients died from trauma annually
WOUND CARE 1. Copious irrigation 2. Remove foreign body 3. Antiseptic solution 4. Adequate debridement 5. Primary / Delayed suture
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 u u u Assist airway Oral airway, nasal airway, LMA Endotracheal intubation Oral, nasal Surgical airway Cricothyroidotomy Tracheostomy
LIFE-THREATENING HEAD INJURY u Intracranial hemorrhage Epidural hematoma, subdural hematoma, intracerebral hematoma, subarachnoid hematoma u u Diffuse axonal injury Management a. Evacuation of hematoma b. Decrease IICP and mass effect c. Maintain cerebral perfusion
IICP u u u 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 u u u Progressive headache Vomiting Consciousness Dyspnea Extremity weakness Seizure
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 1. Decrease blood pressure 2. Distended neck vein 3. Distant or muffled heart sounds
LIFE-THREATENING ABDOMINAL INJURY 1. Liver laceration 2. Spleen laceration 3. Large vessel injury 4. Pelvic fracture
TRAUMATIC SHOCK 1. Hypovolemic shock 2. Neurogenic shock 3. Cardiogenic shock 4. Septic shock
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 1. Femoral fracture 2. Multiple fracture 3. Nerve, vessel, muscle and soft tissue injury
THERMAL INJURY 1. Major burn 2. High-voltage electric injury 3. Inhalation injury 4. Chemical burn
ACUTE ABDOMEN u u u Differential diagnosis Surgical abdomen / medical abdomen Pain history Onset, location, intensity, duration, radiation, quality, associated symptoms Symptoms sequence
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 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 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 u u Fracture Dislocation Rupture (tendon, ligament, muscle, nerve, vessel) Hemorrhage
GYNECOLOGIC EMERGENCY Vaginal bleeding 1. Dysfunctional uterine bleeding 2. Uterine myoma 3. Hypermenorrhea 4. Abortion 5. Atony uterus u
GYNECOLOGIC EMERGENCY u Ectopic pregnancy * Missed period * Vaginal spotting * Abdominal pain
GYNECOLOGIC EMERGENCY Abdominal pain * Pelvic inflammatory disease * Acute appendicitis * Ovarian cyst (torsion) * Ileus * Menstruction u
Urological Emergency u Painful conditions u Bleeding conditions u Trauma conditions u Others
ENT Emergency ☢ Foreign body ☢ Epistaxis ☢ Deep neck infection ☢ Others
Ophthalmic Emergencies A A A Red eyes Foreign body Blurred vision Blindness Others
REEVALUATION u Time interval u Same personnel u Vital signs u Laboratory examination u Early suspicion u Early consultation
MEDICAL ETHICS u u u 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
- Chen chen berlin
- Northwick park emergency department
- Sfgh emergency department
- New nurses orientation
- Ambulatory care whittington
- Tatum surgical
- Qrc surgical
- Surgical phase periodontal therapy
- Color coding of sutures
- Parts of a diathermy machine
- Chapter 22 surgical asepsis
- Joint hospital surgical grand round
- Care of critically ill surgical patient
- Surgical planning laboratory
- Which parts of the surgical gown are considered sterile
- Surgical bandage types
- Voluntary surgical contraception
- Surgical metabolism
- Surgical hand scrub products
- A nurse floats to a busy surgical unit
- Surgical sieve vitamin d
- Conclusion of oral medication
- Surgical conscience
- Clasis a suffix denoting break, fracture
- There are dangling modifiers in this descriptor
- Suture cutting scissors uses ppt
- Medical asepsis definition
- Surgical neck
- Absorbtion
- Surgical audit cycle
- Managing surgical smoke
- Hibiclense
- Surgical metabolism