Emergency Medicine

ACUTE ABDOMEN

256 Surgical Emergencies

MINOR BURNS OF THE FACE

DIAGNOSIS AND MANAGEMENT

1 Leave these alone and exposed to heal in 10 days. A proprietary moisturizing

lotion may be used.

2 Exclude corneal damage by staining with f luorescein.

3 Warn the patient that facial swelling may develop the following day.

BITUMEN BURNS

DIAGNOSIS AND MANAGEMENT

1 Road-laying and roofing accidents are usually responsible.

2 Irrigate the area immediately with cold water.

3 Leave the bitumen alone and cover it with paraffin-impregnated gauze.

4 Await blister formation or re-epithelialization, which will allow the bitumen

to drop off.

5 Assess subsequently for the depth of the burn, which is usually partial-

thickness.

ACUTE ABDOMEN

The aims are to resuscitate critically ill patients; differentiate those requiring

referral to a surgical, gynaecological, urological or medical team; and to deter-

mine who can be allowed home.

SERIOUSLY ILL PATIENT

DIAGNOSIS AND MANAGEMENT

1 Clear the airway, give oxygen, and attach a cardiac monitor and pulse oxi-

meter to the patient. Check the temperature, pulse, blood pressure, respiratory

rate and blood sugar level.

2 Obtain a brief history of the onset, duration, nature and character of the

pain, prior episodes of pain, relevant previous operations and illnesses,

present medication and known drug allergies.

3 Examine the chest and heart, and then lay the patient f lat to examine the

abdomen, including the femoral pulses.

4 Look for a ruptured abdominal aortic aneurysm (AAA), pancreatitis, inferior

myocardial infarction, mesenteric infarction or a ruptured ectopic pregnancy

in any shocked patient presenting with sudden acute abdominal pain.

5 Perform a rectal examination.