abdominal compartment syndrome

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By: shamsun (23 month(s) ago)

this ppt. is great for surgeon

 

By: preeti15 (25 month(s) ago)

hi...i really like this presentation as its very precise. I am a 4th year medical student at a University in the South Pacific. Can I please have permission to download this? thanks.

 

By: vrajgarg (29 month(s) ago)

very good presentation , can i please download it

 

By: masrawy_forever (31 month(s) ago)

very excellent presentation thanks

Presentation Transcript

Slide 1: 

Abdominal Compartment Syndrome

Slide 2: 

Definition APP = MAP - IAP < 60 mm Hg ( Abdominal Perfusion Pressure) WS ACS : 2004

Slide 3: 

WSACS: 2004 Definition 5 mm OF Hg IAH : > 12mm Hg minimum 3 mean 4-6 hly measurements Or APP = < 60 2 standard measurements

Slide 4: 

Grades of IAH Grade I : 12 -- 15 Grade II :16– 20 Grade III:21– 25 Grade IV: > 25 ACS > 20 with MSOD

Slide 5: 

Types Primary 2. Secondary Tertiary

Slide 6: 

Primary ACS Abdomino Pelvic Surgery Or Angiogram After damage control surgery Penetrating Injury Pelvic fracture with bleeding Massive Retroperitoneal Hematoma Liver Transplant

Slide 7: 

Secondary ACS Sepsis Leak Burns

Slide 8: 

Tertiary ACS ACS recurring after Treatment of ACS

Slide 9: 

Effect of ACS Increased Intra abdominal Pressure Decreased Cardiac Output

Slide 10: 

ACS An Independent Risk Factor

Slide 11: 

ACS -- Patho physiology Virtually affects all organs

Slide 12: 

ACS – Respiratory System Increased IAP Increased Diaphragmatic compression Basal Collapse Decreased VO2 Airway Pressure Airway Pressure _ AIP/ 2

Slide 13: 

BP ACS – Cardiao vascular System IVC Pre load CO Aorta Perfusion Pressure Increased Resistance Dual Impact

Slide 14: 

ACS - GIT Vicious Cycle Vicious Cycle ACS ACS

Slide 15: 

ACS - AKI Increased ADH – Stress Response CO – Renal Blood Flow Direct ureteric Compression 1. 3. 2. AKI

Slide 16: 

ACS - CNS Venous Flow from Head ICP Routine IAP in all TBI

Slide 17: 

Diagnosis

Slide 18: 

Gold Standard Transducer as in Laparoscopy

Slide 19: 

Intra abdominal Pressure Trans vesical Pressure Trans Rectal Trans Femoral Trans Vaginal Intra Gastric Trans Esophageal

Slide 20: 

Ideal------- Simultaneous Intra esophageal and Intra gastric pressures

Slide 21: 

High Risk Groups Major Abdominal Injury Blunt / penetrating injury IP/ RP Bleed Massive fluid resuscitation Severe Sepsis- Capillary leak Pancreatitis Burns Liver Disease / Transplantation Ileus Pseudo obstruction

Slide 22: 

Frequency Of measurement--- 4 – 6 Hly Increased : Hourly, Continue following treatment for ACS/ IAH

Slide 23: 

Treatment Medical Minimally Invasive Increasing abdominal compliance Surgical

Slide 24: 

Decompression of Bowel Correct Electrolyte abnormality Promote Motility Neostigmine Endoscopy

Slide 25: 

Reducing intra abdominal Fluid & Edema RRT Lasix + Albumin Limit fluids EGDT- Fluids S Lactate CVP VO2 CT Guided aspiration Slow vs. rapid Avoid Reperfusion injury

Slide 26: 

Increasing abdominal Compliance Muscle Relaxants Negative pressure cuirasses Does not reverse AC , buy time for definitive therapy

Slide 27: 

Surgical Techniques Gold Standard Surgical Decompression Primary or Delayed

Slide 28: 

Primary TAC : Bogota Bag VAC : Fecal Fistula

Slide 29: 

Minimize reperfusion Sequel Aggressive Fluid resuscitation prior to decompression Na HCO3 Mannitol Free radical Scavengers Anti oxidants