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Surgical Emergencies - Coggle Diagram

- - - - High ALP
      - High direct bilirubin
    - - Fever
      - Jaundice
      - Confusion
    - - IV fluids
      - IV antibiotics
      - ERCP (lifesaving)
      - Cholecystectomy before discharge
  - - - Severe pain
      - Distension
      - Fever
    - - Dilated transverse colon
    - - NPO
      - IV fluids
      - IV antibiotics
      - IV steroids
      - NG decompression
  - - - Atrial fibrillation
    - - Sudden severe pain
      - Bloody diarrhea
    - - Elevated lactate
    - - CT angiography
    - - Heparin
      - Embolectomy
  - - - Cystic duct obstruction
    - - RUQ pain
      - Fever
    - - Thick wall
      - Pericholecystic fluid
    - - HIDA scan
    - - NPO
      - IV fluids
      - IV antibiotics
      - Laparoscopic cholecystectomy
  - - - US first
      - NO CT
    - - Laparoscopic appendectomy
- - - - Sphincter of Oddi dysfunction
      - Microlithiasis
    - - US first
      - ERCP is choice
  - - - No treatment even in pregnancy
    - - Surgery
    - - Best surgery time: second trimester
  - - - Pneumobilia
      - SBO
      - Radiopaque stone
    - - Fluids
      - NG tube
      - Enterolithotomy if failed
  - - - Saline flushing
      - Aspiration
      - Surgery last option
  - - - Hard sexual intercourse
    - - Popping sound
      - Severe pain
    - - Immediate surgery
- - - - Lateralizing signs
      - Midline shift
- - - - IV fluids
      - Antibiotics
    - - Perforation
      - Generalized peritonitis
    - - Drainage
  - - - Anorexia
      - Periumbilical pain
      - RLQ pain
    - - Right iliac fossa tenderness
    - - CT
    - - Laparoscopic appendectomy
    - - Surgery without imaging
  - - - Surgery
      - Spine fracture
      - Hypokalemia
      - Uremia
      - DKA
      - Peritonitis
    - - Distension
      - Vomiting
      - Constipation
      - Silent abdomen
    - - Markedly dilated loops
    - - Treat cause
      - Conservative
  - - - Pain with hip flexion
    - - Most common
      - Painful defecation
      - Diarrhea
    - - Drainage
      - Antibiotics
      - Surgery
  - - - Distension
      - Pain
      - Vomiting
      - Diarrhea or constipation
- - - - Blind clamp
      - Use tourniquet
      - Remove embedded object in ER
    - - Only in OR
      - Under general anesthesia
    - - Exploratory laparotomy
  - - - Oxygen or intubation
    - - Needle thoracotomy first
    - - Intubation first
    - - Chest tube
    - - IV fluids
      - Blood if available
    - - Intubation
      - Chest tube
      - General anesthesia
  - - - Spleen
      - Liver
      - Kidney
    - - Hypotension
      - Tachycardia
      - Abdominal tenderness
      - Abdominal wall ecchymosis
- - - - Hemoperitoneum
      - Pericardial effusion
    - - Diagnostic peritoneal lavage
    - - Exploratory laparotomy
  - - - LUQ pain
      - Left shoulder pain (phrenic nerve)
    - - Unstable: laparotomy
      - Stable + extravasation: embolization
      - Stable no extravasation: conservative
- - - - Abdominal pain
      - Fecal soiling with diarrhea
    - - Full rectum
    - - Colonoscopy
    - - Enema
      - Manual disimpaction
  - - - Elderly male
      - Constipation
    - - Empty rectum
    - - Omega loop
    - - CT
    - - NPO
      - IV fluids
      - Sigmoid: decompression via sigmoidoscopy
      - Cecal: surgery first line
  - - - Colicky pain
      - Screaming
      - Legs drawn up
      - Red currant jelly stool
    - - Sausage shaped mass
    - - Air enema (diagnostic and therapeutic)
  - - - Central
      - No haustra
      - Cause: adhesions
    - - Peripheral
      - Haustra present
      - Cause: colon cancer
- - - - Midline shift
      - Dilated ventricles
    - - Head elevation 45 degrees
      - Hyperventilation
      - Mannitol + furosemide
      - Sedation
      - Hypothermia
  - - - Headache
      - Dizziness
      - Memory problems
    - - No treatment
      - Symptoms resolve with time
  - - - GCS < 8
      - Imaging shows extradural hematoma with midline shift
      - Neurosurgery unavailable in time
    - - GCS > 8
      - No imaging
      - Neurosurgery available
    - - 2 hours away: CT then burr hole
      - < 2 hours: CT then refer
- - - - Flank pain
      - Hematuria
    - - CT with contrast
    - - FAST
      - Laparotomy if positive
  - - - Stomach rupture
    - - Esophagus or aorta rupture
    - - CT with contrast
    - - FAST
      - Laparotomy if positive
  - - - Laparotomy
- - - - Adhesions (most common)
      - Incarcerated hernia
      - Femoral hernia
      - Volvulus
      - Colon cancer
      - Drugs (Parkinson meds)
    - - Colicky pain
      - Vomiting
      - Constipation
      - Distension
    - - Hyperactive bowel sounds
    - - Air fluid levels
    - - NPO
      - NG tube
      - Surgery if no improvement
    - - Fever
      - Tachycardia
      - Leukocytosis
  - - - Iatrogenic post endoscopy
    - - Trauma
    - - Chest pain
      - Dysphagia
      - Subcutaneous emphysema
    - - Small pleural effusion
    - - Gastrografin contrast esophagogram
    - - Low BP: aortic rupture
      - Pleural effusion: esophageal rupture
  - - - Diverticulitis
      - Peptic ulcer
      - Crohn disease
    - - Erect abdominal X ray
      - Free air under diaphragm
    - - NPO
      - IV fluids
      - IV antibiotics
      - Emergency surgery
    - - Free air with severe pain