Emergency surgical aid is resorted to when a life-threatening condition occurs, and the time counts literally by hours, and sometimes by minutes. It is easy to imagine that the responsibility on the surgeons who provide emergency care is colossal, and therefore the most competent and at the same time the most skillful specialists work in this specialty. But the salvation of a person depends not only on how qualified the doctor is. It is important that emergency surgical care is provided in a timely manner - as soon as possible after establishing the fact of a threat to life.
Life-threatening conditions
Conditions in which emergency surgical care is required can be divided into two large groups:
- Arising under the influence of exogenous factors, or trauma;
- Arising under the influence of endogenous factors, or acute complications of existing diseases.
Injuries that carry an immediate threat to life include not only those terrible wounds when large blood loss and traumatic shock are obvious. Often, injuries with a blunt object, without violating the integrity of the skin, are no less dangerous, and are also subject to surgical treatment. Examples include blunt abdominal trauma, which ruptures the spleen or other organs, resulting in massive internal bleeding, or brain contusions, in which the destruction of brain tissue can be severe, although the first symptoms may be mild.
In pediatric practice, another type of condition is often found, when urgent surgical intervention is most likely required, this is the presence of a foreign object in the body. Small children, playing with small objects, often stick them in the nose, ear, swallow or inhale. This situation requires immediate medical attention, and if the object cannot be removed by conservative methods, they resort to emergency surgery.
Acute complications of chronic diseases that require urgent surgical care are abscess or empyema (suppuration of an inflamed organ or tissue with the threat of rupture and outpouring of pus into the surrounding space), phlegmon (acute purulent inflammation of tissue), appendicitis, peritonitis, intestinal obstruction, internal bleeding, perforation or perforation of any organ.
How do you know if you need emergency surgery?
Emergency surgical care for injuries is necessary when there is externally visible serious damage to organs or tissues, and not necessarily with bleeding (burns and frostbite, for example). If there are no visible dangerous injuries after the injury, but the person feels worse, turns pale, the pain intensifies, or he loses consciousness, this is a direct indication that urgent surgical care is most likely necessary for him. In this case, it is unacceptable to self-medicate, you must immediately call an ambulance. It is especially undesirable to give any medications, in particular, analgesics. Medicines in this state are unable to solve the problem, and they can completely confuse the symptoms or even cause a deterioration in the patient's condition. All medications, without exception, should be prescribed by a doctor after an initial examination. In a similar state, the patient should also not be allowed to eat or drink until a medical examination has been carried out.
As for the complications of inflammatory diseases, there are also some signs that urgent surgery is required, and it is very important not to miss them, especially when the patient is at home and not in hospital.
How to determine that the disease has entered a dangerous phase? Firstly, it is a prolonged painful attack. It is believed that if a painful attack during biliary or renal colic lasts more than six hours and does not lend itself to relief with analgesics, then this should alert to the appearance of one of the serious complications - either organ perforation or its suppuration with rupture. In such a situation, home treatment is extremely dangerous to continue, immediate assistance is required in an inpatient setting, since there is a very high probability that emergency surgery will be required.
Increasing pallor, worsening of the condition, acute abdominal pain in combination with the tension of the abdominal wall (acute abdominal syndrome), confusion or loss of consciousness, weak voice, forced position of the body - all these are symptoms of probable surgical pathology.
The first thing doctors focus on when detecting a life-threatening condition is dealing with shock. For this purpose, anti-shock therapy is urgently carried out: electrolyte solutions are injected intravenously, designed to replenish the fluid balance of the body, and drugs whose action is aimed at maintaining cardiac activity. When the condition is more or less stabilized, they begin surgical intervention.
If we are talking about an open injury, the stages of emergency surgical care are as follows: anesthesia, revision (examination) of the wound, removal of tissue scraps and bone fragments, layer-by-layer suturing of tissues, establishment of drainage.
Emergency surgical care for closed wounds, as well as for complications of internal diseases, is complicated by the fact that it is not always clear what exactly happened. Therefore, it is necessary to carry out emergency diagnostics. If we are talking about a traumatic brain injury with suspected brain contusion, computed tomography is performed. In the case of diseases of the abdominal organs, the approach consists in diagnostic surgical intervention, as a rule, it is diagnostic laparoscopy. This saves time and, if pathology is detected, immediately begin to provide assistance. Sometimes this happens by means of laparoscopy, which goes from diagnostic to therapeutic, in some cases, laparoscopic intervention is transferred to abdominal surgery. The essence of the actions is similar to those in surgical intervention for trauma: revision, washing the operating area with an aseptic solution to remove pus, blood or other foreign substances (for example, intestinal contents during intestinal perforation), restoration of the integrity of organs with subsequent suturing of tissues, if an abdominal operation was performed ... With laparoscopic surgery, the incision is not made, so this step is omitted. Then the wound is drained.
This completes the emergency surgical care, the patient is transferred to the surgical intensive care unit, where he stays until his condition stabilizes.
Emergency operations - operations carried out in cases where there is a threat to the life of the animal.
The time for performing emergency operations is from several minutes to 1-2 hours, these include:
- stopping bleeding;
- wound treatment;
- suturing the defect of the skin and organ;
- operations for asphyxia (edema, neoplasm or foreign body of the respiratory tract);
- surgical interventions for extensive purulent inflammatory diseases (phlegmon, osteomyelitis, suppuration of a neoplasm, pyometra, hematometer, etc.);
- urethrostomy;
The operation for obstruction requires special urgency and attention, when every minute counts and therefore the struggle for life is still in the ambulance, where they are obliged to put a stomach tube to the animal and ensure the decompression of internal organs. Therefore, the competent actions of the mobile team and the correct transportation determine the success of the treatment of these patients.
Most often, emergency operations are associated with polytrauma in dogs in a traffic accident and in cats in a fall from a height . They are carried out after or simultaneously with the recovery of the animal from shock. In these cases, emergency operations involve:
- stopping bleeding;
- wound treatment;
- suturing a defect in case of rupture of an organ (bladder, intestine, spleen, liver).
Limb immobilization, reduction and other interventions can be postponed at a later time after recovery from shock and stabilization of the animal's condition.
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Traumatological operations occupy an intermediate position between urgent and emergency interventions. In case of hematomas, dislocations, closed fractures and other injuries not complicated by depression of consciousness, it is possible to provide assistance immediately upon admission to the clinic after anti-shock therapy (reposition, immobilization with a plaster cast, blockade), or, by the decision of the surgeon, may be delayed for some time.
in the Moscow veterinary clinic SanaVet, equipped with endoscopic equipment, refers to emergency interventions. In cases where a foreign substance is in the pharynx, trachea or in the upper digestive tract, it can be obtained using an endoscope, without surgery (regardless of the size of the animal). If endoscopic extraction is impossible, a large abdominal operation is performed - laparotomy, gastrotomy (or enterotomy), or surgical removal of a foreign body by other methods.
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Surgical department "CM-Clinic" on the street. Yaroslavskaya provides emergency surgical assistance around the clock.
The Department of Emergency Surgery "CM-Clinic" specializes in the treatment of acute surgical diseases of the abdominal cavity, such as:
- acute appendicitis,
- acute cholecystitis,
- strangulated hernia,
- perforated stomach and duodenal ulcers,
- acute pancreatitis,
- acute intestinal obstruction,
- peritonitis
- obstructive jaundice
- renal colic and some other diseases and conditions.
Some diseases of internal organs if not properly treated, can cause serious complications and lead to death. Chronic diseases accompanying the patient for more than one year, in some cases can also turn into an acute form. Such conditions require urgent hospitalization and emergency surgical care.
The concept of emergency surgical care is spreading rapidly around the world. This is due to the desire to provide quality surgical treatment for the growing number of patients admitted to shock wards and trauma centers with life-threatening surgical conditions. Originating from operative traumatology, emergency surgery very soon faced a large shortage of specialists capable of working in this field. The surgical world in Russia is overcrowded with "narrow" specialists and surgeons of venerable age who have ceased their duty in emergency departments. In Germany, on-site emergency surgeons are highly regarded for their availability, expertise and superior performance in the management of emergency surgical conditions.
Modern in name, the concept of emergency surgery, which is based on knowledgeable, well-trained, experienced and ready to provide qualified assistance for a wide range of emergency surgical diseases specialists, is not new in content. In fact, it was the basis of all training and practice in general surgery until the second half of the twentieth century. General surgeons have always been key specialists in emergency departments, ready to treat patients with acute abdomen, limb ischemia, soft tissue infections, trauma and a host of other critical conditions.
Long before intensive care was recognized as a separate specialty, it was surgeons who performed urgent measures for their patients. The Surgical Emergency Concept copies this type of practice, but focuses on all emergencies. Typically, the training program assumes that the emergency surgeon has expertise in trauma, critical care medicine, combustiology, and the vast majority of emergency surgical conditions. In addition, the concept of emergency surgical care has successfully integrated into the system of care, according to which the surgeon is ready and able to resuscitate, diagnose, operate and take part in the treatment of major surgical diseases.
With the expansion of the area of responsibility of surgeons in trauma and critical care medicine to include emergency surgery, as well as the use of the principles of evidence-based medicine, continuous analysis and improvement in order to achieve optimal results, a new surgical specialty has arisen. However, many clinical centers report highly beneficial experiences, improved clinical outcomes, increased patient satisfaction, and cost-effectiveness.
Within the framework of emergency surgery, assistance is provided in the following areas:
- - Acute appendicitis
- - Restrained hernia
- - Acute intestinal obstruction
- - Acute cholecystitis
- - Perforated stomach and duodenal ulcer
- - Acute pancreatitis
- - Gastroduodenal bleeding of ulcerative etiology
- - Acute violation of mesenteric circulation
- - Peritonitis
- - Abdominal trauma
- - Acute gynecological diseases
- - Acute urological diseases
There are conditions called surgical diseases. This means that only surgery can save a person in this condition. It also means that procrastination is extremely dangerous. How to recognize problems when emergency surgery is needed? The general rule is this: you see that a person is very bad, call an ambulance, let the professionals figure it out. If the situation is very critical, then calling the surgeon at home can be a decisive factor.
Still, it is helpful to know the signs that surgery is needed. So, if a person falls or is just badly hurt, and his condition does not improve in the next half hour, but rather worsens, then most likely we are talking about internal bleeding. Pay attention to symptoms such as dizziness, weakness, increasing pallor, dry mouth, especially after bruises in the chest or abdomen, and, of course, the head.
All types of internal bleeding are dangerous and are a reason for urgent medical attention, even if there was no previous injury. Perhaps there was a complication of any chronic disease, and emergency, and in some cases, planned surgical care is needed. But what kind of operation is needed, it will be determined by the doctor, and your task is to notice the bleeding. So, sputum with blood, urine with blood or unusual rusty color, feces with blood, or tarry appearance, bloody discharge from the vagina, not associated with menstruation - all these are signs of internal bleeding.
Chronic diseases of internal organs, sluggishly current for years, under some circumstances can worsen and cause a serious complication. Diseases such as calculous cholecystitis (cholelithiasis), pancreatitis, enterocolitis, stomach and duodenal ulcers, salpingo-oophoritis, appendicitis, tumors and some others can be complicated by peritonitis. Peritonitis is inflammation of the peritoneum that, if left untreated, is fatal.
Another deadly condition is intestinal obstruction. Symptoms caused by these conditions are called "acute abdomen" and require immediate surgical attention. The main symptom is prolonged (more than 6 hours) intense abdominal pain, diarrhea and vomiting are also possible, which do not bring relief. Self-medication is unacceptable here, you can not even give anesthetic, you need an urgent appeal for surgical help.
Well, and one more category, these are superficial injuries and burns, but everything is in plain sight, so it is difficult to make a mistake. Deep cuts, burns, frostbite, fractures - for all these conditions, surgical care should also be urgently provided
At the EMC Surgical Clinic, patients with surgical emergencies are assisted around the clock.
What do we treat:
acute cholecystitis (biliary colic), obstructive jaundice;
perforated stomach and duodenal ulcer;
acute intestinal obstruction, intestinal intussusception;
acute pancreatitis, pancreatic necrosis;
peritonitis;
acute paraproctitis;
gastrointestinal bleeding, rectal bleeding;
trauma to the abdominal and thoracic organs;
abscess, phlegmon, boil, carbuncle, felon, infected wounds.
A qualified surgical team specializing in emergency and urgent surgical care is on duty at EMC around the clock. EMC diagnostic services also operate around the clock. This allows at any time to carry out both laboratory and instrumental diagnostics, including performing, if necessary, any types of ultrasound, X-ray, endoscopic examinations, as well as computed and magnetic resonance imaging. The presence of diagnostic departments, equipped with the latest technology and working around the clock, allows you to make an accurate diagnosis, determine the amount of required surgical intervention and prepare for the operation as soon as possible.
All emergency surgeons have many years of experience and are proficient in the entire range of techniques for performing urgent and emergency operations, including minimally invasive and laparoscopic, which makes surgical treatment less traumatic, minimizes postoperative pain, reduces blood loss and the likelihood of postoperative complications, and shortens the period patient recovery and length of hospital stay.
In the postoperative period, the medical staff of the clinic provides a high level of medical care and service, professional care, care and attention to each patient both during hospital stay and during subsequent outpatient observation.
If you need emergency surgical care, you can always contact EMC clinics directly, call our multi-channel phone or use the round-the-clock ambulance service. If you need hospitalization and an emergency operation, the ambulance team will take you to the EMC Surgical Clinic. The emergency doctor transfers the patient to the emergency and emergency department doctor, and then to the surgeon, thereby ensuring the continuity of medical supervision and maximum safety at all stages of support and treatment.
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