Wednesday, May 25, 2016

Abdominal Compartment Syndrome

emDocs - May 24, 2016 - Author: Simon E - Edited by: Koyfman A and Long B
"The diagnosis of IAH and ACS begins with clinical suspicion. By maintaining a broad differential, to include ACS in the appropriate setting, the ED physician can take steps to address the morbidity and mortality associated with this condition.
How does IAH/ACS result in systemic end organ dysfunction? Through direct transmission of intra-abdominal pressure (A figure from Rizoli et al.’s work includes the effects):
Screen Shot 2016-05-22 at 12.41.56 AM
Let’s Recap a Few ACS Take-Aways
  • IAH is prolonged IAP >12mmHg; ACS is IAP >20mmHg with end organ dysfunction. 
  • ACS has significant morbidity and mortality.
  • IAH and ACS should be on your differential for common ED presentations.
  • Trauma, shock, severe burns, pancreatitis, sepsis => anything requiring massive resuscitation.
  • Remember: ACS can occur s/p abdominal procedures, and can also occur in children.
  • Perform your H&P, send appropriate studies, and if you suspect IAH or ACS => check a bladder pressure.
  • ACS = Consult a surgeon
  • Temporize by evacuating intraluminal contents, improving abdominal wall compliance, optimizing fluid administration, optimizing tissue perfusion, and evaluating for undiagnosed etiologies in atraumatic ACS."