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
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
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
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
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 