Wednesday, July 29, 2009

Sick 2

You're making midnight rounds on your surgical ICU patients when you notice one of your patients has a tense abdomen. This is a young guy who was involved in a motor vehicle accident several days ago. He underwent emergent abdominal surgery for splenic laceration, liver laceration, and bowel injury. He was persistently hypotensive but responded with aggressive fluid resuscitation.

Now you note progressive oliguria, increased ventilator requirements (for hypoxia and hypercarbia), hypotension, tachycardia, an elevated JVP, and peripheral edema. You clamp the Foley, instill 25cc sterile saline into the bladder via the aspiration port, and attach an 18-gauge needle with a pressure transducer into the aspiration port. It reads 30mmHg.

Challenge: What's your diagnosis?

Image is in the public domain.

1 comment:

Craig Chen said...

Sick 2

This is abdominal compartment syndrome which is organ dysfunction resulting from intraabdominal hypertension. For most critically ill patients, an intraabdominal pressure 5-7mmHg is normal (higher if obese); intraabdominal hypertension is >12mmHg (sustained). Intraabdominal hypertension can impair cardiac function, reduce venous return, increase peak inspiratory and mean airway pressures, reduce chest wall compliance and spontaneous tidal volumes, impair renal function, increase intracranial pressure, and decrease mesenteric perfusion.

Sources: UpToDate; Wikipedia.