Surgical emergency is a medical emergency for which immediate surgical intervention is the only way to solve the problem successfully.
(1) Acute Pancreatitis
(2) Biliary Colic & Cholecystitis
(3) Massive Upper GI Haemorrhage
(4) Small Bowel Obstruction
(5) Perforated Abdominal Viscus
(6) Acute Appendicitis
(8) Rectal Bleeding
An emergency surgery is a procedure that must be performed immediately, and without which a
patient could be permanently harmed or die. Examples of emergency surgeries include less
serious surgeries like an appendectomy or a fixation of a broken bone. More serious surgeries
include attempting to stop massive bleeding after a gunshot wound or repairing a brain aneurysm,
which is causing the brain to fill with blood.
In some cases the patient will go to the Emergency Department with a complaint of pain or feeling “not quite right” and not realize they are very ill. For the obviously injured, an ambulance may be called to transport a patient who is badly injured or not breathing. A patient who is transported by an ambulance will be assessed and care will be started immediately by paramedics or other trained emergency medical personnel.
Upon presenting to the Emergency Department, the staff will begin to assess the patient’s condition. This will include taking vital signs, taking a history of past and present illnesses, a discussion of symptoms and a physical examination by nursing staff and the physician. If the patient is critically ill upon arrival and needs to be stabilized with medications, transfusions, intravenous fluids or other types of interventions, care will begin immediately upon arrival, and the assessment done simultaneously. In most cases, the nursing staff will start an IV, or initiate IV access, in case it is needed for giving medications.
Once the physical assessment is complete and the patient is as stable as possible, diagnostic tests
may be ordered. These tests include x-rays, CT and MRI scans and lab work. Tests are performed
to help the doctors determine the nature and severity of the illness.
If these tests show a clear need for surgery, a surgeon will be consulted to participate in the care of the patient. In larger hospitals, a trauma or general surgeon is available twenty four hours a day, and will perform their own assessment of the patient within the Emergency Department.
Depending on the type of Emergency Department the patient is taken to, a transfer to another facility may be necessary. Once a diagnosis is made, it will be clear if the facility is capable of providing the necessary care. Small or rural hospitals may not provide surgical services or have specialists available for the needed surgery, requiring the patient to be transferred to a larger facility. The facility will begin stabilizing the patient as quickly as possible, and the transfer of the patient will be arranged, typically within an hour or less. Transportation of critical patients is typically done by ambulance or by helicopter, with trained staff caring for the patient during the transfer.
General anaesthesia is the anaesthesia of choice during emergency surgeries; this type of anaesthesia paralyzes the entire body, including the lungs, and causes the patient to become unconscious. First, an IV medication is given to relax the patient while the physician places an endotracheal, or breathing, tube. This tube is connected to a ventilator, which will provide breaths for the patient during surgery. Once the ventilator is breathing for the patient, the rest of the medications are given to prevent any movement of the patient during the surgery and to make sure the patient sleeps through the procedure. The anaesthesia provider will continuously monitor the patient’s vital signs and heart activity throughout the surgery.
Once the anaesthesia has taken full effect, the emergency surgery will begin. The area of the body that will be operated upon will be cleansed thoroughly and then surrounded by sterile drapes to isolate the area with a germ-free barrier. The nature of the surgery and severity of the illness will dictate how many surgeons are participating and how long the surgery will take. For less serious surgeries, such as a routine appendectomy, one surgeon can perform the surgery in approximately an hour, for serious trauma or brain surgeries, the surgery can take much longer. If necessary, transfusions and medications can be provided to stabilize the patient during surgery. Typically, IV fluids will be given during the surgery, to compensate for any blood and fluid loss during the procedure.
When the surgery is over, the patient will be transported to the Post-Anaesthesia Care Unit if they are stable. The patient will be groggy until the anaesthesia wears off completely. During this recovery phase, vital signs will be closely monitored and pain medication will be given as needed. Once the patient is alert and the anaesthesia has worn off, they will be transported to their hospital room to begin healing. If the patient is unstable, or needs constant monitoring, they will be taken to the Intensive Care Unit. If necessary, the patient will remain on the ventilator until they are strong enough to breath on their own. In some cases, the patient will still be in critical condition after surgery and may need additional surgeries or procedures.
After emergency surgery, antibiotics will be given to prevent infection, along with medication to control pain. For severely injured or very ill patients, recovery may take days or weeks, and often includes rehabilitation therapy. Patients who require a ventilator to breathe will typically remain in Intensive Care until they are able to breathe without assistance. For patients too sick to eat, nutrition can be given by IV or through a tube that goes up the nose and down the oesophagus into the stomach. Once strong enough, the patient will begin eating by sipping small amounts of clear liquids and progress to a normal diet as food is tolerated. For patients who are cured by surgery, recovery will begin with sitting on the edge of the bed or walking to the bathroom with assistance. The staff will provide incision care during this time, and teach the patient how to care for the surgical incision when they go home. Once the patient is well enough, and able to care for their own basic needs, including eating, drinking and using the bathroom, they are typically discharged to continue healing at home.