Mod 9a: emergencies Flashcards
How does an emergency differ from urgent situation
Emergency is a threat to life, surgery within 1-2 hrs
Urgent requires surgery within 24 hrs, allows time for optimisation
What is a purple triage colour
time elapsed, needs to be reclassified
What is blue triage colour
elective surgery/surgery withinh 72 hrs/next elective list
What is green triage colour
surgery within 24 hrs
What is yellow triage score
surgery within 6 hrs
What is orange triage colour
surgery within 2 hrs
What is red triage colour
immediate surgery
What are common general surgery emergencies
*Appendicectomy
*Incision and drainage of abscesses
*Laparatomies for bowel obstruction
*Strangulated hernia
*Acute upper or lower gastro-intestinal bleed
What are trauma surgical emergencies
*Blunt
*Penetrating
What are gynae surgical emergencies
*Ruptured ectopic
pregnancy
*Evacuation of retained
products of conception
What are obstetric surgical emergencies
*Caesarean sections with a
variety of indications
*Retained placenta
What are orthopaedic surgical emergencies
*Open fracture
debridement
*Poly-trauma
What are vascular surgical emergencies
*Ruptured abdominal aortic
aneurysm
*Amputations
What are neurosurgery emergencies
*Intracranial haemorrhage
with raised intracranial
pressure or falling Glasgow
coma scale (GCS
What are ENT emergencies
*Epistaxis
*Tonsillar abscess
What situational factors contribute to risk in surgery
- Limited time to assess
and prepare patient - Junior staff
- After hours
- Uncertain diagnoses
- Situational awareness of
staff may vary
What clinical factors contribute to emergency risks
- Full stomach
- Intravascular depletion
- Electrolyte derangements
- Anaemia and
coagulation
abnormalities - Co-morbidity
- Pain
What must be communicated with the surgeons in emergency surgeries
surgical diagnosis
magnitude of surgery
urgency
outstanding work up
method of anaesthesia
post-op requirements
What CVS complications must be anticipated
Ongoing haemorrhage
Hypovolaemia
Hypotension
Coagulopathies
Dysrhythmias
What trauma complications must be anticipated
C spine injuries
Airway injury
What metabolic complications must be anticipated for
Electrolyte abnormalities
Renal dysfunction
What categories of complications must be anticipated
CVS
Trauma
Adverse drug reactions
Metabolic
Hypothermia
Sepsis and septic shock
What must be checked in preoperative evaluation?
History:
- starved
- Current problem list
- Co morbidity
Examination:
- airway assessment
- fluid status
- CVS and resp
Basic investigations:
- renal function
- FBC + X-match
- ABG+lactate
- Serum glucose
- CXR
- ECG
Surgical investigations:
- U/S
- C/T
