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SURGICAL EMERGENCY

SURGICAL EMERGENCY. 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

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SURGICAL EMERGENCY

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  1. SURGICAL EMERGENCY

  2. GOAL • 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 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. GYNECOLOGICEMERGENCY • 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

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