1. SURGICAL EMERGENCY

2. 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

3. GUIDELINES 1. Surgical emergencies 2. Pediatric surgery emergencies
3. Urological emergencies
4. ENT emergencies
5. Ophthalmic emergencies
6. Gynecologic emergencies

4. 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

5. 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

6. WOUND CARE
1. Copious irrigation 2. Remove foreign body 3. Antiseptic solution 4. Adequate debridement 5. Primary / Delayed suture

7. PRIMARY SURVEY
A. Airway and C-spine control B. Breathing and ventilation C. Circulation and hemorrhage control D. Disability E. Exposure M. Monitor

8. SECURE AIRWAY Assist airway Oral airway, nasal airway, LMA
Endotracheal intubation
Oral, nasal
Surgical airway
Cricothyroidotomy
Tracheostomy

9. 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

10. 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

11. OBSERVATION OF HEAD INJURY
Progressive headache
Vomiting
Consciousness
Dyspnea
Extremity weakness
Seizure

12. 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

13. 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

14. LIFE-THREATENING ABDOMINAL INJURY
1. Liver laceration 2. Spleen laceration 3. Large vessel injury 4. Pelvic fracture

15. TRAUMATIC SHOCK
1. Hypovolemic shock 2. Neurogenic shock 3. Cardiogenic shock 4. Septic shock

16. 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

17. THREATENING EXTREMITY INJURY
1. Femoral fracture 2. Multiple fracture 3. Nerve, vessel, muscle and soft tissue injury

18. THERMAL INJURY
1. Major burn 2. High-voltage electric injury 3. Inhalation injury 4. Chemical burn

19. ACUTE ABDOMEN Differential diagnosis
Surgical abdomen / medical abdomen
Pain history
Onset, location, intensity, duration,
radiation, quality, associated symptoms
Symptoms sequence

20. SEVERE ABDOMINAL PAIN 1. Hollow organ perforation
2. Acute pancreatitis
3. Colic pain
a. Biliary system
b. Renal system
4. Ischemia pain
5. Others

21. 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

22. PEDIATRIC SURGERY EMERGENCY
1. Respiratory distress * Esophageal atresia * Diaphragmatic hernia 2. Skin defect * Gastroschisis * Omplalocele * Menigocele

23. PEDIATRIC SURGERY EMERGENCY
3. Bowel obstruction Pyloric stenosis, intussusception Adhesion, incarcerated hernia, Malroatation 4. Abdominal pain *Acute gastroenteritis *Acute appendicitis *Mesenteric lymphadenitis

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

25. GYNECOLOGIC EMERGENCY
Vaginal bleeding
1. Dysfunctional uterine bleeding
2. Uterine myoma
3. Hypermenorrhea
4. Abortion
5. Atony uterus

26. GYNECOLOGIC EMERGENCY
Ectopic pregnancy
* Missed period
* Vaginal spotting
* Abdominal pain

27. GYNECOLOGIC EMERGENCY
Abdominal pain
* Pelvic inflammatory disease
* Acute appendicitis
* Ovarian cyst (torsion)
* Ileus
* Menstruction

28. Urological Emergency Painful conditions Bleeding conditions
Trauma conditions
Others

29. ENT Emergency
Foreign body
Epistaxis
Deep neck infection
Others

30. Ophthalmic Emergencies
Red eyes
Foreign body
Blurred vision
Blindness
Others

31. REEVALUATION Time interval Same personnel Vital signs
Laboratory examination
Early suspicion
Early consultation

32. 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