Surgical emergencies Flashcards
Case presentations requiring trauma call
- dangerous mechanism of injury : pedestrian v car; ejected from motor vehicle; fall from >1m or 5 stairs
Calling and setting up management for a trauma call
- 2222 - calling trauma call
- move patient to resus
- Assess with ATLS principles
What is the GCS for: eyes opening to voice, localising pain and saying words which don’t make sense
GCS 11/15
E3V3M5
immediate management for GCS 8/15
definitive airway
define definitive airway
Cuffed tube below the level of the vocal cords used to allow airway access
What are the head injury guidelines used in the UK (name it)
NICE guidelines for Head Injury
Indications for CT head in trauma setting - within 1 hr
- GCS <13 on initial assessment (ED)
- GCS <15 at 2hrs after injury on assessment in ED
- suspected open or depressed skull fracture
- signs of basal skill fracture
- posttraumatic seizure
- focal neuro
- 1+ vomiting
Indications for CT head in trauma setting - within 8hrs
- Age >65
- Hx of bleeding/clotting disorders
- dangerous mechanism of injury
- > 30 mins retrograde amnesia of events immediately before the head injury
Indication for emergency decompression with trauma craniotomy
- evidence of (subdural) haemorrhage w/ significant midline shift
- clinical fts of raised ICP
Pancreatitis management
- Dependent on Glasgow score - >3 to ICU
- Supportive, analgesia, correct cause, CT in 5-7 days
Management of pt to control raised ICP
- ICP monitoring
- sedation + phenytoin
- head elevation
- hypersomolar treatment if required
LUQ pain (following trauma) differentials
- perforated viscus
- splenic injurty/rupture
- L kidney injury
- pancreatic injury
- diaphragmatic injury
Differentials frank haematuria in trauma
- renal injury
- ureteral injury
- bladder injury
- urethral injury
What is full trauma series imaging
CT - thorax abdomen, head and neck
Renal injury grades
AAST (american association of surgery in trauma) renal injury scale
Summary:
- I-IV managed conservatively
- V requires surgical intervention
I - contusion/subcapsular perirenal haematoma
II - superficial laceration >1cm/ no urine extravasation
III - laceration >1cm no urine uxtravasation
IV - laceration extends to pelvis or urine extravasation/ contained haemorrhage/ segmental infarctions
V - devasc of kidney due to hilar injury, complete laceration/thrombus of main renal artery or vein
Differentials post-op hemicolectomy end-to-end anastomosis – fever/haemodynamic instability
- anastomotic leak
- intra-abdominal collection
- wound infection
- systemic infections - UTI/HAP
- non-infections = drug induced, pain, atelectasis, physiological stress resonse, thromboembolism
Risk factors for anastomotic leak
- patient: age, smoking, diabetes, corticosteroid use
- pathology: IBD, autoimmune conditions, vascular disease, collagen disorders
- technical factors: quality of ends, blood supply, tension of the anastomosis
Describe ‘surviving sepsis’ campaign
- educational campaign
- identify patients early + provide goal directed therapy
- sepsis bundle (sepsis 6)
- senior help and monitor with NEWS2 score
Define sepsis
- life-threatening
- organ dysfunction
- dysregulated host immune system
Define septic shcok
- sepsis subset
- circulatory and cellular/metabolic dysfunction
- higher rik of mortality
Define shock
- life-threatening
- tissue perfusion is inadequate to meet metabolic demands
investigations AAA
bedside AA if availabe
CT aortogram if haemodynamically stable
AAA dimensions
- > 5.5cm + symptomatic = emergency
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What is NCEPOD classification
National Confidential Enquiry into Patient Outcome and Deaths
government supported scheme = reduce perioperative mortality and morbidity
4 code system to determine level of urgency
NCEPOD code 1
- category
- description
- target time
- examples
- Immediate
- lifesaving (A) or limb/organ saving (B)
- w/in mins of decision to operate
- Ruptured AAA; major trauma abdo/thorax; #with major neurovascular deficit; compartment syndrome
NCEPOD code 2
- category
- description
- target time
- examples
- urgent
- acute onset/derioration; threatens life/limb/organ survival/distressing symptoms
- within hours of decision to operate
- compound #; perf bowel with peritonitis; critical organ or limb ischaemia; acute appendicitis
NCEPOD code 3
- category
- description
- target time
- examples
- Expedited
- Stable pt, early intervention; NOT immediate threat to life/limb/organ
- w/in days of decision to operate
NCEPOD code 4
- category
- description
- target time
- examples
- Elective
- planned/booked in advance
- planned
- all other conditions not classed as above
