A) Introduction to Surgical Emergencies

Emergency Unit: When on call, you will be examining patients in the Emergency Unit.  Examine the patient fully and request all the needed investigations before actually transferring the patient to the surgical ward.  Never hesitate to call your senior for help.  The nursing staff in the Emergency Unit are busy, but they will help if asked.  Always make sure there is a bed for the patient in the ward and book the patient with the duty sister in the surgical ward before transfer.  If the patient needs resuscitation, it is better done in resus area of the Emergency Unit.   

NEVER refuse to see a patient who has been referred to you by a colleague. If you are expecting to be delayed for long in theatre, make alternative plans if at all possible (send an intern, the student or clearly inform the casualty staff of this). The time spent in casualty waiting for your assessment is the most vulnerable time.

Your job as a surgical doctor is to sort problems out! Do not avoid, delay or hinder patient management in any way.

In the emergency setting use adequate analgesia to relieve pain even if a final diagnosis has not been made.  If the patient has a surgical problem, transfer the case to the ward as soon as possible- lengthy delays in the EU are DANGEROUS, and most unpleasant for the patient. Correct active management within the first 12 hours of an emergency is critical for a good outcome. EU is typically overcrowded and poorly supervised. Get the patient out of there.

When a patient is transferred from Emergency Unit to the ward, make sure there is a fluid chart with fluid administration prescribed, a prescription chart with all the necessary medication and other management orders (nil by mouth, Hb monitoring, oxygen by face mask etc.) written on it.  Patients should not be lying in the ward without any active management by the nursing staff. Communicate EXPLICITLY to the nurses in the ward about the condition of the patient, what you expect them to do, and how to contact you in case of problems.

All units will insist on a presentation and formal hand over of cases admitted after a night on call. Prepare for this thoroughly. Be on time. Re-examine the cases before the morning ward round, ensure that all results, radiology images and other information are available and documented in the notes. Write up fluids and all meds for the day ahead. 

Be particularly meticulous about patients who are still in the Emergency Unit, or who are outliers in other wards. Inform clearly what further test are outstanding and ensure that the colleague taking over is aware of what to look for. Book urgent investigations/ interventions (e.g. theatre or endoscopy) early and pro-actively. 

COMMUNICATE WELL. If decisions are made by a consultant on ward round, document this and any other further plans.

Some of the commonly seen conditions in the emergency department and their relevant investigations are listed within these guidelines.