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

GOAL emergencies 2. Learn a correct notion 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 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 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 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 obstruction 2. Tension pneumothorax 3. Open pneumothorax 4. Massive hemothorax 5. Pericardiac tamponade 6. Flail chest combined pulmonary contusion

BECK’S TRIAD 2. Distended neck vein 3. Distant or muffled heart sounds 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 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 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

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 patient’s complaint Be kind and more smile Careful explanation