Accident and Emergency Department

Introduction

It is the most vital area of a hospital where energetic and vigilant management is required. The general surgical department manages the following emergency problems commonly:

• Polytrauma
• Acute abdomen
• Acute infections requiring surgical intervention
• Burns
• Gastrointestinal (GI) bleeding

Road traffic accidents, falls, assaults, blast injuries and various other modalities add to the list of problems. Many systems could be involved and a multidisciplinary approach is needed to treat such cases (see the section in orthopedics also).

GUIDELINES

1. Resuscitation, recognition and repair should be the sequence of management
2. Mechanism of injury should be recorded. This gives a lot of information regarding the probable extent and nature of injuries
3. Airway patency should be maintained
4. Start intravenous (IV) line with normal saline preferably
5. Blood should be drawn for grouping and provide transfusion if necessary
6. Splint for long bone fractures.
7. Methodically examine:

a. Head — Scalp injuries — Fracture of skull — Intracranial injuries Glasgow Coma Scale is a convenient parameter to be followed.

b. Cervical spine

c. Facial skeleton

d. Chest

Flail chest

Sucking wounds

Surgical emphysema

Tension pneumothorax

Hemothorax

Cardiac tamponade

Thoracic spine

e. Abdomen

External bruising

Distension

Bowel sounds

Free fluid

Rigidity/guarding

f. Pelvis

Stability

Tenderness

Urinary extravasation

g. long bones

Swelling

Deformity

Neurovascular deficits

Compound fractures

h. Spine

For deformity/cord injury

I. Clavicle

Fracture often overlooked.

MANAGEMENT

• Airway establishment
• Tetanus prophylaxis
• Active/Passive
• Half hourly monitoring of pulse, blood pressure (BP), urine output, general condition of the patient
• If facilities are available, central venous pressure (CVP) measurement and partial pressure of oxygen in arterial blood (PaO2) evaluation should be done