Management of surgical emergencies - GIP

Management of surgical emergencies : 

Management of surgical emergencies David Birks FRACS November 2008 GIPSIE

Types of surgical emergencies- pathophysiology : 

Types of surgical emergencies- pathophysiology hypovolaemia & haemorrhage sepsis respiratory cardiac renal

Surgical emergencies (cont.) : 

Surgical emergencies (cont.) pain nutrition wound & stoma communication !

Objectives : 

Objectives use a plan for sick patients identify at risk patients communicate

Types of surgical patients : 

Types of surgical patients emergency admissions acutely deteriorating ward patients stable patients in HDU/ICU

Types of surgical patients : 

Types of surgical patients Emergency department e.g. ruptured AAA perforated bowel with peritonitis ischaemic gut multiple trauma

Types of surgical patients : 

Types of surgical patients Acutely deteriorating ward patient e.g. post-op hypoxia post-op peritonitis oliguria

Types of surgical patients : 

Types of surgical patients Patient in ICU/HDU e.g. multi-trauma bowel resection & COPD post-op peritonitis and colostomy

Slide 9: 

Immediate Management ABCDE Full Patient Assessment Chart Review History and Examination Available Results Decide and Plan Stable patient Unstable/Unsure Daily Management Plan Diagnosis Required Specific Investigations Definitive Treatment Medical Surgical Radiological

Immediate management : 

Immediate management A Airway B Breathing C Circulation D Disability (neurological) E Exposure/Environment G Glucose

Airway : 

Airway Assessment talk noisy e.g. stridor Examination Look Feel Listen

Airway : 

Airway Maintain airway Chin lift/jaw thrust Suction Oro-pharyngeal airway + Oxygen

Breathing : 

Breathing Look Feel Listen + pulse oximeter

Breathing : 

Breathing If problems Oxygen Sit up Physiotherapy Chest X Ray ABG

Circulation : 

Circulation Pulse Blood pressure Colour & periphery JVP Conscious state ECG

Circulation : 

Circulation stop bleeding IV access take bloods administer IV fluid

Disability of CNS : 

Disability of CNS Conscious state - AVPU - Glasgow Coma Scale Pupils (& lateralising signs) Glucose

Exposure : 

Exposure Overall view of body Prevent cold Preserve dignity

Immediate management : 

Immediate management take necessary life-saving steps establish monitoring call for help transfer to appropriate site e.g. ICU effective management depends on good communication !

Slide 20: 

Immediate Management ABCDE Full Patient Assessment Chart Review History and Examination Available Results Decide and Plan Stable patient Unstable/Unsure Daily Management Plan Diagnosis Required Specific Investigations Definitive Treatment Medical Surgical Radiological