Patients diagnosed with these pathologies need to be adequately resuscitated and managed while undergoing further diagnoses and other steps toward

safe surgery. Physiologically, patients may have signs of sepsis or mild to moderate organ dysfunction requiring rapid resuscitation without delaying surgical intervention. In most cases, tissue loss is imminent. Within 6 hours from diagnosis- implies localized peritonitis or soft tissue infection in need of surgery, but not a physiological state that entails spreading or GW786034 in vivo progression of the disease process. These pathologies have the potential to evolve to more serious conditions if surgery is delayed. Antibiotic SHP099 solubility dmso treatment and fluid administration should be initiated immediately upon diagnosis and repeat examination carried out while waiting for surgery. Within 12 hours from diagnosis-

implies a need of surgery, though evidence- based knowledge indicates that postponing surgery while under medical treatment does not lead to clinical deterioration. As an example, delay in treatment of acute appendicitis has been shown to have no deleterious effect on outcomes. Within 24 or 48 hour from diagnosis- Suggests that intervention is indicated and the process may progress and worsen the morbidity of the operation. Examples include cholecystitis and thoracic empyema. The classification also applies to patients who were operated Selleckchem Ro-3306 under emergency, and re-laparotomy was decided upon during the index procedure for peritoneal

cavity rinsing or for assessment of bowel perfusion and viability. These principals need to be adopted, understood and appreciated by all personnel involved in the treatment of patients with surgical emergencies. Timing of surgical intervention Prompt, early, urgent, expeditious, immediate, and emergency are common adjectives used in the medical literature to describe the need for surgery “in a timely manner”. The literature lacks evidence based data on proper timing of emergency surgery. Flavopiridol (Alvocidib) Definitions of Time To Surgery (TTS), Ideal Time To Surgery (iTTS) and Actual Time To Surgery (aTTS) should therefore evolve and be standard for further discussions. Launching a triage system for non- trauma surgical emergencies will ensure that time to surgery (TTS) develops into a quality improvement tool. Actual TTS (aTTS, real time waiting for surgery) can be compared to the time assigned for each pathology by expert opinion, consistent with data from current literature (ideal time to surgery, iTTS). The ratio aTTS/iTTS will reflect efficiency and should be used for quality assessment. A ratio of ≤ 1 indicates compliance with standards for timing of surgery and a ratio >1 indicates that surgery was delayed. Delaying surgery from the time set by the acute surgical care team and determined by the triage system will be a matter for further quality improvement measures.