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Surgical Emergencies: Introduction

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Surgical Emergencies
Acute Appendicitis | Acute Pancreatitis | Acute Diverticulitis
Bowel Obstruction and Perforation | Testicular Torsion | Extradural Haematoma
Acute Limb Ischaemia | Intussusception | Ectopic Pregnancy | Pre-eclampsia and Eclampsia

Two surgeons perform an operation.

There are many medical emergencies that require the urgent attention of medical staff. The way these are treated varies greatly depending upon the problem. Some, however, are usually only treatable by surgery, and require the individual to be looked after by a surgical team. This project looks at some of the common surgical emergencies in detail:

Those not covered above are in themselves numerous, and this Entry will not attempt to talk about broken bones or traumatic blood loss.

Dealing with Emergencies

Various concerning symptoms can hint at the presence of an emergent surgical condition but many of these, such as nausea, vomiting, and abdominal pain, are found in a wide range of conditions. Diagnosis of a disease often combines the precise nature or site of a symptom, the pattern of associated symptoms, the timing of onset and any changes since, examination of the affected part, and relevant blood tests and scans. Thus any individual who has concerns about their wellbeing probably ought to get in touch with a medical professional.

If a General Practitioner or out-of-hours doctor suspects a surgical emergency, they will refer them to the surgical team at the nearest hospital, who will see them in A+E or on a surgical admissions unit. Patients brought in by ambulance or who self-present to A+E are either seen by the emergency medics and referred to the surgeons, or may be seen by the surgeons straight off.

As well as taking a history and examining the patient, the doctors will often tell the patient not to eat or drink anything, insert a cannula (bendy piece of plastic) into a vein, send off blood for testing, start intravenous fluids and medications, and send the patient for x-rays or a scan. This represents a combination of securing a diagnosis and making sure the patient is treated appropriately pending any potential need for surgery. A catheter may be inserted into the bladder to measure urine output, and a tube may need to be inserted through the nose into the stomach (a nasogastric tube) if the bowel is thought to be obstructed or otherwise affected by the underlying problem. The use of anti-clotting drugs to prevent clots in the legs is commonplace in surgical patients, provided there is no underlying bleeding or clotting problem.

Patients requiring theatre should ideally be kept Nil By Mouth for six hours before an anaesthetic, although rapid induction of the anaesthetic and airway tube can be used if there are concerns about reflux of stomach contents up through the gullet. Hospitals will have an emergency theatre, for which emergency operations are listed and performed according to priority – some emergencies have to be operated upon immediately, and will pull rank over cases that can wait for a few hours. Such emergency surgery will take place at day or night, weekday or weekend, though if time allows the patient's resilience to surgery will be maximised with intravenous fluids and drugs before taking them to theatre.

Please Note: h2g2 is not a definitive medical resource. If you have any health concerns, you must always seek advice from your local GP. You can also visit NHS Direct.

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