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EMERGENCY AND TRAUMA SURGERY

The branch of surgical medicine that deals with the treatment of injuries that occur due to impact utilizing both operative and non-operative management is known as trauma surgery. In emergency care the patient is resuscitated, stabilized, evaluated before drawing up a treatment management.

The emergency and trauma department manages injuries to the neck, abdomen, chest and extremities.

Emergency Surgery Kochi

Emergency and Trauma surgery at Dr. Jacob’s Hospital

Surgeons at Jacob’s Hospital are familiar with a variety of procedures such as general and thoracic that enables them to take complex decisions in a complicated situation with incomplete information.

Classification of deaths:
  • Fatal injuries to the heart and neurologic system can cause immediate death at the scene of the injury: requires a multi-disciplinary approach
  • Early fatalities are minutes to hours from the injury mostly due to cardiovascular collapse and haemorrhage; failed oxygenation to vital organs
  • Late deaths are spaced out from days to weeks post the injury and occurs due to multiple organ failure and sepsis
  • Initial evaluation protocols :
      • Extremely challenging and critical for the patient; patient is resuscitated
        • Primary observation: comprises of ABCDE
        • Airway: assess the ability to pass air into the lungs without obstruction
        • Breathing: ability of the patient to ventilate and oxygenate; critical if there is absence of spontaneous ventilation
        • Circulation: the neck and veins are inspected for collapse and if heart tones are present
        • Disability: mental status of the patient, movement, head and spinal cord injury; reaction to light
        • Exposure: a physical examination of the patient is conducted
        • Comprehensive assessment :
          • Patient is stabilized
          • A complete diagnosis is obtained
          • Surgical interventions are performed
          • Blood loss is controlled by applying pressure and transfusion administered
          • Vital signs data guidelines are followed
          • After complete resuscitation another survey is done usually a repeat of the primary survey
          • Subsequent physical examination includes :
            • Chest exam : for evaluation of tenderness and auscultation of heart and lungs
            • Abdomen and pelvis exam : for signs of any abdominal bleeding and penetrating injuries
            • Evaluation of extremities : to identify fractures, tenderness or instability through x-rays
            • Neurologic exam : for stability of the head, neck, spine and a detailed survey of any back injuries
        • Imaging and lab studies :
          • AP chest and AP pelvis radiographs: common imaging for initial survey
          • FAST or focused abdominal sonogram for trauma
          • CT scan: for abdomen, pelvis, and chest - sensitive, accurate, non-invasive diagnostic tool
          • Spinal evaluation to examine any trauma to the spine
          • Laboratory studies: are inclusive of blood sampling, haemoglobin, arterial blood gases, evaluate drug abuse, serum electrolytes, cell blood counts; commonly done within 1 – 2 hours of trauma
        • Imaging and lab studies:
          • Burns :
            • Check for chemical burns; a chemical neutralization is conducted
            • Patient’s skin is tested
            • Clinical history and physical examination are conducted for airway burns and inhalation injuries
          • Injuries due to cold :
            • Rewarming is conducted
            • Severe cold injuries require immersion into warm water
            • IV fluids are administered based on patient’s physiologic status
          • Electrical injuries :
            • Skin is normal appearing in electrical injuries
            • Urine output is examined along with cardiac monitoring

    All critical trauma care is handled with great care and speed at Jacob’s Hospital. Experienced surgeons are always on call for any untoward situations. Head and other trauma that need CT are currently referred to a CT unit elsewhere. Therefore only clinically stable patients are handled here. Patients who are stable with head, chest or abdominal or limb trauma are alone taken in, others being referred to tertiary hospitals

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