Surgical / Soft-Tissue Emergencies

1. Necrotising Fasciitis

• Rapidly spreading infection causing necrosis of subcutaneous tissues and overlying skin; caused by beta-haemolytic streptococci, S. aureus, or polymicrobial (Bacteroides, Clostridium, Pseudomonas, Klebsiella)
• Presentations: dusky blue/black skin, severe pain out of proportion, bullae, fever, septic shock; mortality approaches 70% without aggressive treatment
• Management: ICU admission, IV high-dose penicillin G + broad-spectrum antibiotics (cephalosporins + metronidazole), emergency surgical debridement - the cornerstone; daily wound revision; hyperbaric oxygen as adjunct
• Special forms: Fournier's gangrene (perineum), Meleney's gangrene (abdominal wall)
• Bailey and Love's Short Practice of Surgery 28th Edition

Cardiovascular Emergencies

2. Acute Myocardial Infarction (STEMI)

• Full-thickness myocardial ischemia from coronary artery occlusion; ST elevation on ECG
• Time is myocardium: door-to-balloon time target <90 minutes
• Management: aspirin + P2Y12 inhibitor, anticoagulation, primary PCI (preferred) or thrombolysis

3. Aortic Dissection

• Tear in the intima of the aorta; Stanford Type A (ascending) requires emergency surgery; Type B may be managed medically
• Classic presentation: tearing/ripping chest/back pain, unequal BP/pulses, widened mediastinum on CXR
• Immediate BP control with IV beta-blockers (target SBP 100-120 mmHg)

4. Cardiac Tamponade

• Fluid accumulation in pericardial sac compresses cardiac chambers; Beck's triad: hypotension, JVD, muffled heart sounds
• ECG: electrical alternans; Echo is diagnostic
• Treatment: immediate pericardiocentesis (needle drainage)

5. Hypertensive Emergency

• Severe hypertension (usually >180/120) with acute end-organ damage (encephalopathy, AKI, ACLE, aortic dissection)
• Controlled BP reduction by 20-25% in first hour with IV labetalol or nicardipine; not a rapid drop
• ROSEN's Emergency medicine

Respiratory Emergencies

6. Tension Pneumothorax

• Lung collapse with mediastinal shift; air trapped under pressure compresses great vessels
• Presents with hypoxia, hypotension, absent breath sounds, tracheal deviation (late sign), raised JVP
• Do not wait for CXR - immediate needle decompression (2nd ICS, mid-clavicular line) followed by chest drain
• Bailey and Love's; Roberts and Hedges' Clinical Procedures in Emergency Medicine

7. Pulmonary Embolism (Massive)

• Haemodynamically significant PE causes right heart failure and circulatory collapse
• Presentations: hypoxia, pleuritic chest pain, tachycardia, syncope; ECG shows S1Q3T3 (classic but non-specific)
• CT pulmonary angiography is diagnostic gold standard; treatment: systemic thrombolysis or catheter-directed therapy for massive PE

8. Acute Severe Asthma (Near-Fatal)

• Status asthmaticus: bronchospasm unresponsive to initial bronchodilators
• Silent chest is an ominous sign (no air movement)
• Management: continuous nebulized salbutamol, IV magnesium sulfate, IV corticosteroids; intubation as last resort (high risk)

9. Acute Respiratory Distress Syndrome (ARDS)

• Diffuse alveolar damage from direct/indirect lung injury; bilateral infiltrates, hypoxia (PaO2/FiO2 <200)
• Management: lung-protective ventilation (low tidal volume 6 mL/kg, PEEP titration), prone positioning

Neurological Emergencies

10. Status Epilepticus

• Continuous seizure activity >5 minutes or recurrent seizures without recovery of consciousness
• Management: benzodiazepines first-line (lorazepam/diazepam), then second-line agents (levetiracetam, valproate, phenytoin); refractory SE requires anaesthetic agents (propofol, midazolam, thiopental)
• Tintinalli's Emergency Medicine; ROSEN's Emergency Medicine

11. Acute Ischaemic Stroke

• "Time is brain" - 1.9 million neurons die per minute during occlusion
• IV alteplase (tPA) within 4.5 hours of symptom onset; mechanical thrombectomy for large vessel occlusion up to 24 hours in selected patients
• Rule out haemorrhage with CT before giving thrombolytics

12. Subarachnoid Haemorrhage (SAH)

• "Worst headache of my life" (thunderclap headache); caused by ruptured aneurysm in ~85% of cases
• CT head non-contrast first; if negative, LP for xanthochromia
• Neurosurgical consultation urgently; nimodipine for vasospasm prevention

13. Raised Intracranial Pressure (ICP) / Brain Herniation

• Cushing's triad: bradycardia, hypertension, irregular breathing
• Immediate: head elevation 30°, hyperventilation (transient), IV mannitol or hypertonic saline, neurosurgery

Abdominal / GI Emergencies

14. Ruptured Abdominal Aortic Aneurysm (rAAA)

• Classic triad: hypotension, pulsatile abdominal mass, back/flank pain
• Mortality >80% without surgery; bedside FAST ultrasound confirms; immediate theatre
• No time for CT if haemodynamically unstable

15. Acute Mesenteric Ischaemia

• Occlusion of superior mesenteric artery causes bowel infarction; "pain out of proportion to examination"
• Causes: arterial embolism (50%), arterial thrombosis, venous thrombosis, non-occlusive
• CT angiography diagnostic; surgical/endovascular revascularization; bowel resection if infarcted
• Schwartz's Principles of Surgery

16. Perforated Viscus (Perforated Peptic Ulcer)

• Free air under diaphragm on erect CXR; peritonitis on examination
• Surgical emergency: IV resuscitation, broad-spectrum antibiotics, urgent laparotomy/laparoscopy

17. Bowel Obstruction with Strangulation / Sigmoid Volvulus

• Closed-loop obstruction causes rapid bowel ischemia and gangrene
• CT abdomen is diagnostic; emergency surgery when strangulation suspected

Infectious / Sepsis Emergencies

18. Septic Shock

• Life-threatening organ dysfunction from infection; MAP <65 mmHg despite fluid resuscitation
• Hour-1 bundle: blood cultures, broad-spectrum antibiotics, IV fluid bolus (30 mL/kg crystalloid), vasopressors (norepinephrine), measure lactate
• ROSEN's Emergency Medicine

19. Toxic Shock Syndrome (TSS)

• Staphylococcal or streptococcal superantigen-mediated multi-organ failure
• Diffuse macular erythroderma ("sunburn rash"), desquamation, fever, hypotension
• Management: source control, clindamycin (toxin suppression), IV fluids, IVIG in severe cases

20. Bacterial Meningitis

• Triad: fever, neck stiffness, altered consciousness; do not delay antibiotics for CT
• Immediate: IV dexamethasone + ceftriaxone + vancomycin; add ampicillin if Listeria risk
• Lumbar puncture after antibiotics if CT required

21. Ludwig's Angina

• Rapidly spreading cellulitis of the floor of the mouth causing airway compromise
• Immediate airway management (awake fibreoptic intubation preferred - avoid blind intubation); surgical drainage; IV antibiotics

Endocrine / Metabolic Emergencies

22. Diabetic Ketoacidosis (DKA) / Hyperosmolar Hyperglycaemic State (HHS)

• DKA: anion gap metabolic acidosis, ketones, hyperglycaemia; HHS: extreme hyperglycaemia (>600 mg/dL), hyperosmolarity, no ketosis
• Management: IV fluids, insulin infusion, electrolyte replacement (especially K+); HHS needs very slow correction

23. Adrenal Crisis (Addisonian Crisis)

• Profound hyponatraemia, hyperkalaemia, hypoglycaemia, hypotension in adrenal insufficiency
• Immediate: IV hydrocortisone 100 mg bolus, aggressive IV saline, glucose; do not wait for cortisol results

24. Thyroid Storm

• Extreme hyperthyroidism; fever, tachycardia, heart failure, altered consciousness
• Management: propylthiouracil (blocks synthesis), Lugol's iodine (blocks release), beta-blockers, dexamethasone, cooling

Obstetric Emergencies

25. Ruptured Ectopic Pregnancy

• Intraperitoneal haemorrhage from fallopian tube rupture; hypovolaemic shock; positive urine hCG
• FAST ultrasound shows free fluid; resuscitate and take to theatre immediately - surgical emergency

26. Eclampsia

• Seizures in pregnancy/postpartum + hypertension; can cause stroke, placental abruption, multi-organ failure
• Immediate: IV magnesium sulfate (4 g loading dose), antihypertensives (hydralazine/labetalol), urgent delivery

27. Amniotic Fluid Embolism

• Catastrophic obstetric collapse: hypoxia, cardiac arrest, DIC
• Resuscitation per ACLS protocols; manage DIC aggressively

Toxicological Emergencies

28. Organophosphate / Nerve Agent Poisoning

• SLUDGE syndrome (salivation, lacrimation, urination, defecation, GI distress, emesis) + bronchospasm, miosis, seizures
• Atropine (in large doses), pralidoxime (oxime reactivator), benzodiazepines for seizures

29. Tricyclic Antidepressant (TCA) Overdose

• QRS widening (>100 ms), arrhythmia, seizures, hypotension
• IV sodium bicarbonate is the treatment (alkalinizes plasma to reduce drug binding to Na channels)

30. Carbon Monoxide Poisoning

• Cherry-red skin (unreliable sign); headache, confusion, coma; SpO2 is falsely normal
• 100% O2 via non-rebreather mask; hyperbaric oxygen for severe cases (COHb >25%, neurological signs, cardiac involvement)

ENT / Head and Neck Emergencies

31. Epiglottitis

• Rapidly progressive supraglottic inflammation; "tripod position," drooling, stridor, muffled voice
• Do not examine the throat in children - can precipitate complete obstruction
• Immediate anaesthetic/ENT team; controlled intubation in theatre; IV ceftriaxone

32. Retropharyngeal Abscess

• Deep neck space infection extending to mediastinum (descending mediastinitis); high mortality
• CT neck + chest; surgical drainage + IV antibiotics

Orthopaedic / Vascular Emergencies

33. Compartment Syndrome

• Raised pressure in a closed fascial compartment causing tissue ischaemia; the 6 P's: Pain (especially with passive stretch), Pressure, Paresthesia, Pallor, Paralysis, Pulselessness (late)
• Emergency fasciotomy - do not delay

34. Acute Limb Ischaemia

• Sudden arterial occlusion; the 6 P's again: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia (cold)
• Embolectomy or bypass within 6 hours to prevent irreversible muscle/nerve damage

Key Principle: "Time-Critical" Emergencies