Surgical Emergency

Surgical Emergency

SURGICAL EMERGENCY GOAL Recognize different. 1 surgical emergencies Learn a correct notion. 2 Decrease delayed. 3 diagnosis Prevent secondary injury. 4 GUIDELINES

Surgical Pediatric surgery Urological ENT Ophthalmic Gynecologic emergencies. emergencies. emergencies. emergencies.

emergencies. emergencies. 1 2 3 4 5 6

PRINCIPLES OF MANAGEMENT Life-saving. 1 a. Identify life-threatening injury

b. Appropriate resuscitation Maintain vital status. 2 a. Detailed physical examination b. Continuous resuscitation Further evaluation and management. 3 a. Laboratory examination b. Consultation TRAUMA The 5th leading causes of death of. 1 Taiwanese

The 1st leading cause of death of. 2 young adults Approximately 8,000 patients died. 3 from trauma annually WOUND CARE Copious irrigation. Remove foreign body. Antiseptic solution. Adequate debridement. Primary / Delayed suture.

1 2 3 4 5 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 Assist airway Oral airway, nasal airway, LMA Endotracheal intubation Oral, nasal Surgical airway

Cricothyroidotomy Tracheostomy LIFE-THREATENING Intracranial hemorrhage HEAD INJURY 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 IICP 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 Airway obstruction. Tension pneumothorax. Open pneumothorax. Massive hemothorax. Pericardiac tamponade. Flail chest combined pulmonary. contusion

1 2 3 4 5 6 BECKS TRIAD Decrease blood. 1 pressure Distended neck vein. 2 Distant or muffled. 3

heart sounds LIFE-THREATENING ABDOMINAL INJURY Liver laceration. Spleen laceration. Large vessel injury. Pelvic fracture. 1

2 3 4 TRAUMATIC SHOCK Hypovolemic Neurogenic Cardiogenic Septic shock.

shock. shock. shock. 1 2 3 4 FLUID RESUSCITATION Access. 1 Two large bore IV catheter

Fluid. 2 Crystalloid, colloid, blood component Amount. 3 a. Bolus: 2 liter for adults ml/ kg for child 20 b. maintain amount based on urine output THREATENING EXTREMITY INJURY Femoral fracture. 1 Multiple fracture. 2

Nerve, vessel, muscle. 3 and soft tissue injury THERMAL INJURY Major burn. 1 High-voltage electric. 2 injury Inhalation injury. 3 Chemical burn. 4

ACUTE ABDOMEN Differential diagnosis Surgical abdomen / medical abdomen Pain history , Onset, location, intensity, duration radiation, quality, associated symptoms Symptoms sequence SEVERE ABDOMINAL PAIN Hollow organ perforation.

Acute pancreatitis. Colic pain. a. Biliary system b. Renal system Ischemia pain. Others. 1 2 3

4 5 COMMON DISEASES Acute cholecystitis. 1 Peptic ulcer) Perforated. (2 Acute appendicitis. 3 Acute pancreatitis. 4 Small bowel obstruction. 5 Colon obstruction. 6 Vascular occlusion. 7

Others. 8 PEDIATRIC SURGERY EMERGENCY Respiratory distress .1 Esophageal atresia * Diaphragmatic hernia * Skin defect. 2 Gastroschisis

* Omplalocele * Menigocele * PEDIATRIC SURGERY EMERGENCY Bowel obstruction. Pyloric stenosis, intussusception , Adhesion, incarcerated hernia

Malroatation Abdominal pain. Acute gastroenteritis* Acute appendicitis Mesenteric lymphadenitis 3 4 * *

ORTHOPEDIC EMERGENCY Fracture Dislocation Rupture (tendon, ligament, ,muscle )nerve, vessel Hemorrhage GYNECOLOGIC EMERGENCY

Vaginal bleeding Dysfunctional uterine bleeding. 1 Uterine myoma. 2 Hypermenorrhea. 3 Abortion. 4 Atony uterus. 5 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 Emergency Painful conditions Bleeding conditions

Trauma conditions Others ENT Emergency Foreign body Epistaxis Deep neck infection Others Ophthalmic Emergencies Red eyes

Foreign body Blurred vision Blindness Others REEVALUATION Time interval Same personnel Vital signs Laboratory examination Early suspicion

Early consultation MEDICAL ETHICS Treat a person not a disease Treat a patient as your family Be patient to a patients complaint Be kind and more smile Careful explanation

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