1 / 12

Trauma Patient with Open abdomen

Case History. 52 y.o. male in high speed MVCED / Radiographic findings:Grade III Liver LacerationGrade IV Spleen lacerationOpen book pelvis fracture. Emergent Interventions. External FixatorDamage Control LaparotomySplenectomySuture hepatorrhaphy

jana
Télécharger la présentation

Trauma Patient with Open abdomen

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Trauma Patient with Open abdomen Courtesy of: Michael Cheatham, MD WSACS website

    3. Emergent Interventions External Fixator Damage Control Laparotomy Splenectomy Suture hepatorrhaphy Open Abdomen dressing with vacuum style temporary closure

    4. Initial ICU Evaluation MAP=76 HR=124 T=34.5 C IAP=14 APP=62 (APP=MAP-IAP) Lactate 3.2 Coagulopathic, Low Plts, Anemic Abdominal dressing soft, draining serosanginous fluid

    5. What should be done? Warm the patient Transfuse with appropriate blood products

    6. 6 hour ICU Evaluation MAP=70 HR=114 T=36.5 C IAP=24 APP=46 (APP=MAP-IAP) Lactate 6.5 UOP < 30 cc/ hour, PIP = 60 cm H2O Abdominal dressing firm and bulging

    7. What is wrong? Recurrent Abdominal compartment syndrome Definition: The redevelopment of ACS following previous surgical or medical treatment to prevent or treat ACS. The is no such thing as an open abdomen outside the O.R. just an expanded abdomen with temporary abdominal closure.

    8. Treatment 6 hours into ICU Vacuum pack is removed Dramatic bowel evisceration Replaced with plastic silo dressing

    9. Post-dressing expansion MAP=70 HR=96 T=36.7 C IAP=12 APP=58 (APP=MAP-IAP) UOP >100 cc/ hour PIP = 30 cm H2O

    10. 24 hours into ICU stay Worsened bowel edema However: MAP = 79 IAP = 12 APP = 67 Lactate = 1.9

    11. Remaining ICU course Day 2-4: Visceral edema decreases IAP drops further, VSS remain stable Day 7: Abdomen is closed primarily Day 8: Transfer to floor

    12. Case points Recurrent ACS: There is no such thing as an open abdomen Just an expanded abdomen that is re-dressed Open abdominal management = High risk of capillary leak and recurrent ACS All patients who require open abdomens require mandatory serial abdominal pressures to allow early detection of recurrent ACS.

More Related