Abdominal Compartment Syndrome. Jeff Johnson, MD
|
|
- Bethanie Aleesha Dawson
- 5 years ago
- Views:
Transcription
1 Abdominal Compartment Syndrome Jeff Johnson, MD Acute Care Surgeon, Denver Health Associate Professor of Surgery, University of Colorado Denver
2 The Abdomen A Forgotten Closed Compartment
3 Early Animal Models of Intraabdominal Hypertension (IAH) Emerson (1911) Pressures > 27 46cm H 2 O Fatal to small animals Respiratory failure Thorington (1923) Oliguria in dogs with IAP 15-30mm Hg Anuria with pressure > 30
4 Early Observations: Human IAH Gross (1948) Forced closures of large omphaloceles could cause cardiovascular collapse in infants Richards (1982) 4 AAA patients with post-op hemorrhage developed anuria which reversed with reoperation Kron (1984) Described bladder pressure measurement
5 ACS: Cardiovascular Pathophysiology Venous return Cardiac filling Cardiac output PVR Transiently Reversible with volume
6 Pulmonary Pathophysiology Airway pressures (ventilated pts) O 2, CO 2 Compliance P/F Restrictive pulmonary disease Reversible with decompression
7 Renal Pathophysiology Vascular Resistance blood flow GFR Urine flow Renin
8 ACS First Classification System Grade I (10-15): Fluid Responsive Grade II (15-25): Transient response to fluid Grade III (25-35): Urgent Decompression Grade IV (>35): Emergent Decompression Burch, 1996
9 Current IAH Grading Scale IAH is graded as follows: Grade I IAP mmhg Grade II IAP mmhg Grade III IAP mmhg Grade IV IAP > 25mmHg. The IAH grades have been revised downward as the detrimental impact of elevated IAP on endorgan function has been recognized
10 ACS Definition: IAP >20 (Grade III or IV IAH) + Adverse physiological consequences ACS is defined as a sustained IAP > 20mmHg (with or without an APP < 60mmHg) that is associated with new organ dysfunction/ failure.
11 ACS: Primary vs Secondary Primary: Due to Abdominal injury or condition Major hepatic injury Perforated viscus Primary insult likely determines outcome Secondary : Develops during resuscitation Capillary leak Massive transfusion Vigorous crystalloid resuscitation Early recognition and treatment
12 ACS: Who gets it? Trauma Damage Control (packing) Post-op hemorrhage Septic Shock Severe Burns Severe Pancreatitis Portal Hypertension Ligation / thrombosis PV Intrinsic liver disease
13 Pathophysiology -- Summary Increased IAP affects many compartments Extremities: Venous return Thorax Pleural Pericardial Abdominal: kidney, liver and gut Intracranial Multiple Compartment Syndrome
14 ACS: How is it recognized? Appropriate suspicion: At risk patient Oliguria, increased airway pressures, abdominal distension Measurement of IAP Direct measurements: impractical Gastric/Rectal measurements suboptimal Bladder pressures: surrogate for IAP Instill 25 cc into empty bladder/clamp/use manometer May be unreliable in pts with abnormal bladder compliance Elderly Postoperative Pelvic Packing
15 Modern Natural History Data 83 ICU Patients prospectively followed Mixed med/surg population 46% developed IAH (IAP>12) No specific therapies directed at IAH Mortality associated with IAH = 53% Mortality without IAH = 27% Mortality of ACS = 80% Vidal, Crit Care Med, 2008
16 Factors Affecting Intraabdominal Pressure Inciting Event Abdominal Wall Compliance Obesity Air, fluid, blood, bowel edema Level of sedation and analgesia Patient Positioning Geisel, Hop on Pop 1963
17 ICU Management Patient positioning IAP raised by Reverse Trendelenberg Semirecumbant Supine (or <20 deg HOB) appears best Patient comfort No high quality data Deep sedation Good Analgesia Trials of NM blockers appropriate
18 Abdominal Contents ICU Management Good gastric decompression Colonic decompression Enteral feeding acceptable Fluid Management Again, No high quality data Hypertonic crystalloids, colloids have been recommended Diuresis when tolerated (?day 3) Consider CRRT
19 Catheter Drainage Described in small case series Reed (2005) DPL catheter placed in 8 consecutive pts with IAP > 20 Results: IAP fell by mean 6 mm Hg Abdominal perfusion pressure increased by 15 mm Hg Four patients (50%) still required laparotomy DH practice: use bedside ultrasound. Two groups: Ascites: pigtail catheter Bowel edema laparotomy
20
21 Decompressive Laparotomy When other measures fail to alleviate ACS, prompt surgical decompression is mandatory Bedside ICU decompression a good option Bring the OR to the patient Prompt improvement can be expected Subsequent surgical interventions in OR Minimally invasive approaches Endoscopic subcutaneous division of linea alba 50% success described Proceed with caution
22 Now What?
23 Why is closure so important? Chronic open abdomen Spontaneous rupture of organs beginning at 2 weeks
24 The Goal: Fascial Closure How do we go from: To:
25 Temporary Options Bogotá bag closure temporary silo 3L sterile GU irrigation bag sewn to skin contains the edematous bowel no issues with angiography suturing - time consuming
26 Temporary Options 10 x 10 drape & ioban closure temporary covering no issues with angiography less time consuming
27 Early Primary Closure Able to close primarily at repeat exploration
28 Sequential Fascial Closure: DHMC Technique white sponge under the fascia PDS sutures to pull fascia toward midline black sponge covering fascia and subq
29 Sequential Fascial Closure: DHMC Technique interrupted closure of fascia at superior and inferior edges replace white sponge black sponge covering fascia and subq
30 Sequential Fascial Closure: DHMC Technique entire fascial defect closed place JP drains CLOSED!!
31 Skin Grafting Temporary coverage granulation tissue over bowel STSG covers bowel 9 months later loose covering
32 Component Separation removing STSG lateral release midline closure fully healed
33 Modern Outcomes with Protocol-Driven IAH Rx Cheathem Crit Care Med, 2010
34 Current DH Results Primary fascial closure approaches 100% Complications: Occur in 40% patients GI: anastamotic leaks, bilomas, fistulas Low mortality, however, long Length of mechanical ventilation ICU stay
35 ACS: Summary Persistent IAP >12 is abnormal Conservative measures warranted Must be monitored IAP >20 with organ dysfunction = ACS Life threatening condition Demands prompt resolution ACS treatment Continues to improve Has likely decreased mortality
36 ??
37 THANK YOU
Abdominal Compartment Syndrome. Jeff Johnson, MD
Abdominal Compartment Syndrome Jeff Johnson, MD Acute Care Surgeon, Denver Health Associate Professor of Surgery, University of Colorado Denver The Abdomen A Forgotten Closed Compartment Early Animal Models
More informationManagement of the Open Abdomen
Management of the Open Abdomen Clay Cothren Burlew, MD FACS Director, Surgical Intensive Care Unit Associate Professor of Surgery Denver Health Medical Center / University of Colorado The Open Abdomen
More informationDifficult Abdominal Closure. Mark A. Carlson, MD
Difficult Abdominal Closure Mark A. Carlson, MD Illustrative case 14 yo boy with delayed diagnosis of appendicitis POD9 Appendectomy 2 wk after onset of symptoms POD4: return to OR for midline laparotomy
More informationSURGICAL CRITICAL CARE REVIEW TRAUMA K. INABA, MD FACS LAC+USC MEDICAL CENTER
SURGICAL CRITICAL CARE REVIEW TRAUMA K. INABA, MD FACS LAC+USC MEDICAL CENTER None DISCLOSURES OBJECTIVES CPMT SYNDROME ABDOMEN EXTREMITY OBJECTIVES CPMT SYNDROME ABDOMEN EXTREMITY Abdominal Compartment
More informationEmergency Laparotomy. Open vs Closed Abdomen
Emergency Laparotomy Open vs Closed Abdomen Disclosure Dr. McLean is a site primary investigator for XenMatrix AB Tissue Insert for Ventral Hernia repair. Sponsor: Bard Davol Learning Objectives: 1. The
More informationICU treatment of the trauma patient. Intensive Care Training Program Radboud University Medical Centre Nijmegen
ICU treatment of the trauma patient Intensive Care Training Program Radboud University Medical Centre Nijmegen Christian Kleber Surgical Intensive Care Unit - The trauma surgery Perspective Langenbecks
More informationOne hundred percent fascial approximation with sequential abdominal closure of the open abdomen
The American Journal of Surgery 192 (2006) 238 242 HowIdoit One hundred percent fascial approximation with sequential abdominal closure of the open abdomen C. Clay Cothren, M.D. a,b, *, Ernest E. Moore,
More informationAbdominal V.A.C. Therapy in Trauma
Abdominal V.A.C. Therapy in Trauma Stefaan Nijs, M.D., Ph.D. Mathieu D Hondt, M.D. Dept Abdominal Surgery UZ Leuven 1 2 Damage control = naval technique Damage Control in Trauma 3 USS Nevada 4 In extremis
More informationThe Abdominal Compartment Syndrome
The Abdominal Compartment Syndrome Andre R. Campbell, MD, FACS, FACP, FCCM Professor of Surgery, UCSF Endowed Chair of Surgical Education San Francisco General Hospital Outline Case presentations Review
More informationINTRA-ABDOMINAL HYPERTENSION AND SECONDARY ABDOMINAL COMPARTMENT SYNDROME IN MEDICAL PATIENTS COMPLICATION WITH A HIGH MORTALITY
Trakia Journal of Sciences, Vol. 12, Suppl. 1, pp 202-207, 2014 Copyright 2014 Trakia University Available online at: http://www.uni-sz.bg ISSN 1313-7050 (print) ISSN 1313-3551 (online) INTRA-ABDOMINAL
More informationMIST. Minimally invasive Infusion & Suction Therapy Device. Effective treatment for deadly abdominal trauma and sepsis
MIST Minimally invasive Infusion & Suction Therapy Device Effective treatment for deadly abdominal trauma and sepsis Summary Medical device for treating condition that annually kills ~156k intensive care
More informationDamage Control in Abdominal and Pelvic Injuries
Damage Control in Abdominal and Pelvic Injuries Raul Coimbra, MD, PhD, FACS The Monroe E. Trout Professor of Surgery Surgeon-in Chief UCSD Medical Center Hillcrest Campus Executive Vice-Chairman Department
More informationIntra-abdominal Hypertension and Abdominal Compartment Syndrome: A Potentially Fatal Mix. Daria C. Ruffolo
Intra-abdominal Hypertension and Abdominal Compartment Syndrome: A Potentially Fatal Mix Daria C. Ruffolo No Conflict of Interest druffol@lumc.edu 708.216.4541 Objectives Differentiate between intra-abdominal
More informationBogota-VAC A Newly Modified Temporary Abdominal Closure Technique
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2008 Bogota-VAC A Newly Modified Temporary Abdominal Closure Technique von
More informationFluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE
Fluids in Sepsis: How much and what type? John Fowler, MD, FACEP Kent Hospital, İzmir Eisenhower Medical Center, USA American Hospital Dubai, UAE In critically ill patients: too little fluid Low preload,
More informationTrauma Scenario. Abdominal Compartment Syndrome. Disclosure Statement of Financial Interest 8/17/2015
Abdominal Compartment Syndrome Diane Cobble M.D., FACS Professor, ETSU Dept. of Surgery 7 th Annual Rural Trauma Symposium August 27, 2015 Disclosure Statement of Financial Interest I DO NOT have a financial
More informationReverse (fluid) resuscitation Should we be doing it? NAHLA IRTIZA ISMAIL
Reverse (fluid) resuscitation Should we be doing it? NAHLA IRTIZA ISMAIL 65 Male, 60 kg D1 in ICU Admitted from OT intubated Diagnosis : septic shock secondary to necrotising fasciitis of the R lower limb
More informationPresented by: Indah Dwi Pratiwi
Presented by: Indah Dwi Pratiwi Normal Fluid Requirements Resuscitation Fluids Goals of Resuscitation Maintain normal body temperature In most cases, elevate the feet and legs above the level of the heart
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal compartment syndrome, as complication of fluid resuscitation, 331 338 abdominal perfusion pressure, 332 fluid restriction practice
More information25. Fluid Management and Renal Function During a Laparoscopic Case Done Under CO 2 Pneumoperitoneum
25. Fluid Management and Renal Function During a Laparoscopic Case Done Under CO 2 Pneumoperitoneum Gamal Mostafa, M.D. Frederick L. Greene, M.D. Minimally invasive surgery aims to attenuate the stress
More informationVolume 16 - Issue 3, Cover Story
Volume 16 - Issue 3, 2016 - Cover Story Update on Intra-Abdominal Hypertension Prof. Manu Malbrain, MD, PhD ******@***uzbrussel.be ICU Director - Intensive Care Unit, University Hospital Brussels (UZB)
More informationPRACTICE GUIDELINES: INTRA-ABDOMINAL HYPERTENSION/ABDOMINAL COMPARTMENT SYNDROME
PRACTICE GUIDELINES: INTRA-ABDOMINAL HYPERTENSION/ABDOMINAL COMPARTMENT SYNDROME OBJECTIVE: Provide guidelines describing the appropriate monitoring for adult and pediatric patients who are at risk for
More informationOpen abdomen in trauma. Ari Leppäniemi Abdominal Center Meilahti hospital University of Helsinki Finland
Open abdomen in trauma Ari Leppäniemi Abdominal Center Meilahti hospital University of Helsinki Finland Frequency and causes of open abdomen - in 23% (344/1531) after trauma laparotomies - damage control
More informationConflicts of Interest
Anesthesia for Major Abdominal Cancer Resection John E. Ellis MD Adjunct Professor University of Pennsylvania johnellis1700@gmail.com Conflicts of Interest 1 Upper Abdominal Surgery Focus on oncologic
More informationIn the early 1980s, Kron et al. 1 showed in an. Surgical management of abdominal compartment syndrome
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this
More informationCanadian Trauma Trials Collaborative. Occult Pneumothorax in Critical Care (OPTICC): Standardized Data Collection Sheet
Canadian Trauma Trials Collaborative STUDY CENTRE: Institution: City / Province: / Occult Pneumothorax in Critical Care (OPTICC): Standardized Sheet PATIENT DEMOGRAPHICS: First Name: Health record number
More informationClinical Evidence Summary ACCURYN ADVANCED CRITICAL CARE MONITORING
Clinical Evidence Summary ACCURYN ADVANCED CRITICAL CARE MONITORING Table of Contents Introduction: Urine Output 3 Intensive monitoring of urine output is associated with increased detection 4 of acute
More informationDESCRIPTIONS FOR MED 3 ROTATIONS Critical Care A2 ICU
Critical Care A2 ICU A. Neurological 1. Delirium Discuss the differential diagnosis and appropriate investigation for delirium. Provide non-pharmological and pharmological treatment options for delirium.
More informationIntraabdominal Pressure in Abdominoplasty Patients
Aesth. Plast. Surg. 30:655 658, 2006 DOI: 10.1007/s00266-004-5026-x Intraabdominal Pressure in Abdominoplasty Patients Lincoln Grac a Neto, M.D., M.Sc., Luiz Roberto Arau jo, M.D., M.Sc., Marcelo Roberto
More informationIV Fluids. I.V. Fluid Osmolarity Composition 0.9% NaCL (Normal Saline Solution, NSS) Uses/Clinical Considerations
IV Fluids When administering IV fluids, the type and amount of fluid may influence patient outcomes. Make sure to understand the differences between fluid products and their effects. Crystalloids Crystalloid
More informationCase Presentation. Joseph M Brandel, MD Kings County Hospital Center Department of Surgery Friday, November 12, 2004
Case Presentation Joseph M Brandel, MD Kings County Hospital Center Department of Surgery Friday, November 12, 2004 The Abdominal Compartment Syndrome Definition A syndrome of intra-abdominal hypertension
More informationDISCHARGE DIAGNOSES: End stage renal disease secondary to rapidly progressive glomerulonephritis.
DISCHARGE SUMMARY DISCHARGE DIAGNOSES: End stage renal disease secondary to rapidly progressive glomerulonephritis. OPERATIONS/PROCEDURES: Living related renal transplantation. HISTORY: For full details
More informationThe FAST Exam! Dr. David Easton MD FRCPC Critical Care and Emergency Medicine University of Manitoba Canada
The FAST Exam! Dr. David Easton MD FRCPC Critical Care and Emergency Medicine University of Manitoba Canada Dr. David Easton MD FRCPC Assistant Professor Section of Critical Care and Emergency Medicine
More informationPEDIATRIC TRAUMA: Implications for Respiratory Care
PEDIATRIC TRAUMA: Implications for Respiratory Care 17 th Annual Rainbow Respiratory Conference - September 4, 2015 Mike Dingeldein, MD Pediatric Surgeon Pediatric Trauma Medical Director Disclosures none
More informationDiagnosis & Management of Kidney Trauma. LAU - Urology Residency Program LOP Urology Residents Meeting
Diagnosis & Management of Kidney Trauma LAU - Urology Residency Program LOP Urology Residents Meeting Outline Introduction Investigation Staging Treatment Introduction The kidneys are the most common genitourinary
More informationMESH REPAIR VERSUS PLANNED VENTRAL HERNIA STAGED REPAIR IN THE MANAGEMENT OF TRAUMA PATIENTS WITH ACUTE ABDOMINAL COMPARTMENT SYNDROME
TOFIQ Journal of Medical Sciences, TJMS, Vol. 1, Issue 1, (2014), 47-61 ISSN: 2377-2808 MESH REPAIR VERSUS PLANNED VENTRAL HERNIA STAGED REPAIR IN THE MANAGEMENT OF TRAUMA PATIENTS WITH ACUTE ABDOMINAL
More informationTransplant Surgery. Patient Education Guide to Your Kidney/Pancreas Transplant Page 9-1. For a kidney/pancreas transplant. Before Your Surgery
Patient Education Page 9-1 Transplant Surgery For a kidney/pancreas transplant By the time you have your transplant surgery, you may have been waiting for some time. Reading this chapter before surgery
More informationUnderstanding Intra-Abdominal Pressures
Understanding Intra-Abdominal Pressures 1 Contact Hour Course Expires: May 31, 2018 Course Updated: October 14, 2014 First Published: October 14, 2011 Copyright 2011 by RN.com All Rights Reserved Reproduction
More informationExtracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure
Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure Introduction This pediatric respiratory failure guideline is a supplement to ELSO s General Guidelines for all
More informationManagement of Bleeding Pelvic Fractures
Management of Bleeding Pelvic Fractures Clay Cothren Burlew, MD FACS Professor of Surgery Program Director, SCC and TACS Fellowships Director, Surgical Intensive Care Unit Denver Health Medical Center/University
More informationEffects of mechanical ventilation on organ function. Masterclass ICU nurses
Effects of mechanical ventilation on organ function Masterclass ICU nurses Case Male, 60 - No PMH - L 1.74 m and W 85 kg Pneumococcal pneumonia Stable hemodynamics - No AKI MV in prone position (PEEP 16
More informationSHOCK and the Trauma Victim. JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital.
SHOCK and the Trauma Victim JP Pretorius Department of Surgery & SICU Steve Biko Academic Hospital. Classification of Shock Cardiogenic - Myopathic Arrythmic Mechanical Hypovolaemic - Haemorrhagic Non-haemorrhagic
More informationAbdominal Wound Dehiscence. Presenter: T Mohammed Moderator: Dr H Pienaar
Abdominal Wound Dehiscence Presenter: T Mohammed Moderator: Dr H Pienaar Introduction Wound Dehiscence is the premature "bursting" open of a wound along surgical suture. It is a surgical complication that
More informationIndex. Crit Care Clin 19 (2003)
Crit Care Clin 19 (2003) 331 335 Index A ACVECC. See American College of Veterinary Emergency and Critical Care (ACVECC). Aging. See also Elderly; Geriatric critical care. respiratory function effects
More informationAlbumina nel paziente critico. Savona 18 aprile 2007
Albumina nel paziente critico Savona 18 aprile 2007 What Is Unique About Critical Care RCTs patients eligibility is primarily defined by location of care in the ICU rather than by the presence of a specific
More informationSurgery for Complications of Peptic Ulcer Disease (Definitive Treatment)
Surgery for Complications of Peptic Ulcer Disease (Definitive Treatment) Amid Keshavarzi, MD UCHSC Grand Round 3/20/2006 Department of Surgery Introduction Epidemiology Pathophysiology Clinical manifestation
More informationIs the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival?*
Continuing Medical Education Article Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival?* Michael L. Cheatham, MD, FCCM; Karen Safcsak, RN
More informationIVC. Fig. ACS. 84/60mmHg. CT Fig. 2 AAA. 30 declamp. declamp. Tel:
12 633 637 2003 IVC 3 4 5 3 12 633 637 2003 1 ACS ACS 1 6 3 ACS 3 Tel: 0566-75-2111 446-8602 28 2003 7 18 2003 10 15 Fig. 1 4 5 1 71 12 5 COPD 14 10 30 60 CT AAA 84/60mmHg 8.2g/dl6.6g/dl2.5mg/dl CT Fig.
More informationCompartment Syndrome
Compartment Syndrome Chapter 34 Compartment Syndrome Introduction Compartment syndrome may occur with an injury to any fascial compartment. The fascial defect caused by the injury may not be adequate to
More informationShock. Shao Mian Emergency Department,Zhongshan Hospital
Shock Shao Mian Emergency Department,Zhongshan Hospital What is shock THE BEGINNINGS OF UNDERSTANDING: THE LATE 19TH CENTURY THE AGE OF REASON: 1890 1925 THE MODERN ERA: BLALOCK S EPIPHANY POSTMODERNISM:
More informationSevere necrotizing pancreatitis. ICU Fellowship Training Radboudumc
Severe necrotizing pancreatitis ICU Fellowship Training Radboudumc Acute pancreatitis Patients with acute pancreatitis van Dijk SM. Gut 2017;66:2024-2032 Diagnosis Revised Atlanta classification Abdominal
More informationDecision-Making in the Acute Management of Blunt and Penetrating Wounds Mary Somerville, DVM, DACVS
Decision-Making in the Acute Management of Blunt and Penetrating Wounds Mary Somerville, DVM, DACVS Providing the best quality care and service for the patient, the client, and the referring veterinarian.
More informationPneumothorax. Defined as air in the pleural space which can occur through a number of mechanisms
Pneumothorax Defined as air in the pleural space which can occur through a number of mechanisms Traumatic pneumothorax Penetrating chest trauma Common secondary to bullet or knife penetration Chest tube
More informationGastro-intestinal failure. ICU Fellowship Training Radboudumc
Gastro-intestinal failure ICU Fellowship Training Radboudumc Case history (1) Male, 47 No previous medical history Mechanical ventilation for severe CAP Stable HD on NE 0.04 μg/kg/min Early enteral nutrition
More informationThe Septic Patient. Dr Arunraj Navaratnarajah. Renal SpR Imperial College NHS Healthcare Trust
The Septic Patient Dr Arunraj Navaratnarajah Renal SpR Imperial College NHS Healthcare Trust Objectives of this session Define SIRS / sepsis / severe sepsis / septic shock Early recognition of Sepsis The
More informationAbdominal Compartment Syndrome in Surgical Patients
CASE SERIES Abdominal Compartment Syndrome in Surgical Patients Alex Muturi 1 Daniel Ojuka 1 Peter Ndaguatha 1, Andrew Kibet 2 1. The University Of Nairobi 2. Kenyatta National Hospital Correspondence
More informationPenetrating abdominal trauma clinical view. Ari Leppäniemi, MD Department of Abdominal Surgery Meilahti hospital University of Helsinki Finland
Penetrating abdominal trauma clinical view Ari Leppäniemi, MD Department of Abdominal Surgery Meilahti hospital University of Helsinki Finland Meilahti hospital - one of Helsinki University hospitals -
More informationDiscussion of Complex Clinical Scenarios and Variable Review ACS NSQIP Clinical Support Team
Discussion of Complex Clinical Scenarios and Variable Review CS NSQIP Clinical Support Team SCR Open Q& Calls The CS NSQIP Clinical Team is trialing Open format Q& calls for NSQIP SCRs Participation in
More informationWhich Blunt Trauma Patients Should Be Studied by Abdominal CT?
MDCT of Bowel and Mesenteric Injury: How Findings Influence Management 4 th Nordic Trauma Radiology Course 2006 4 th Nordic Trauma Radiology Course 2006 Stuart E. Mirvis, M.D., FACR Department of Radiology
More informationImaging abdominal vascular emergencies. V.Stoynova
Imaging abdominal vascular emergencies V.Stoynova Abdominal vessels V. Stoynova 2 Acute liver bleeding trauma anticoagulant therapy liver disease : HCC, adenoma, meta, FNH, Hemangioma Diagnosis :CT angiography
More informationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 Mitchell M. Levy MD, MCCM Professor of Medicine Chief, Division of Pulmonary, Sleep, and Critical Care
More informationProceedings of the 34th World Small Animal Veterinary Congress WSAVA 2009
www.ivis.org Proceedings of the 34th World Small Animal Veterinary Congress WSAVA 2009 São Paulo, Brazil - 2009 Next WSAVA Congress : Reprinted in IVIS with the permission of the Congress Organizers DIFFUSE
More informationReview Article Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective
Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2016, Article ID 5251806, 6 pages http://dx.doi.org/10.1155/2016/5251806 Review Article Interventional Treatment of Abdominal
More informationThe Emergency Hernia or The call you don t want at 2:00 a.m.*
or The call you don t want at 2:00 a.m.* *Or even at 8:00 a.m. Michael G. Sarr, MD Professor of Surgery Mayo Clinic South Canada WEST CANADA EAST CANADA Clinical talk Hernias Inguinal Umbilical Incisional
More informationObjectives. ER & ICU Pot Pourri. Why is this important? Brady et al: Objective. Discuss published information. Take away new information
ER & ICU Pot Pourri Karl E. Jandrey, DVM, DACVECC Asst. Professor of Clinical Emergency and Critical Care Veterinary Medical Teaching Hospital University of California-Davis Objectives Discuss published
More informationSHOCK. Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital
SHOCK Emergency pediatric PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital 1 Definition Shock is an acute, complex state of circulatory dysfunction
More informationCase Scenario 3: Shock and Sepsis
Name: Molly Boyle 1. Define the term shock (Lewis textbook): Shock is a syndrome characterized by decreased perfusion and impaired metabolism. Shock can have a number of causes that result in damage to
More informationChapter 2 Damage Control
Chapter 2 Damage Control Rona E. Altaras, Firas G. Madbak and Dale A. Dangleben History Originally a naval term, damage control (DC) is a simple and useful idea referring to the ability of a battleship
More informationAcute Liver Failure: Supporting Other Organs
Acute Liver Failure: Supporting Other Organs Michael A. Gropper, MD, PhD Professor of Anesthesia and Physiology Director, Critical Care Medicine University of California San Francisco Acute Liver Failure
More informationBladder Trauma Data Collection Sheet
Bladder Trauma Data Collection Sheet If there was no traumatic injury with PENETRATION of the bladder DO NOT proceed Date of injury: / / Time of injury: Date of hospital arrival: / / Time of hospital arrival:
More informationCURRICULUM FOR FELLOWSHIP IN CRITICAL CARE MEDICINE
CURRICULUM FOR FELLOWSHIP IN CRITICAL CARE MEDICINE AIM: The course has been designed to train candidates by the anesthesiologists in the principles and practice of intensive care & artificial ventilation
More informationReview Abdominal compartment syndrome Jeffrey Bailey and Marc J Shapiro
http://ccforum.com/content/4/1/023 Review Abdominal compartment syndrome Jeffrey Bailey and Marc J Shapiro Saint Louis University, St Louis, Missouri, USA Received: 4 January 2000 Accepted: 5 January 2000
More informationMasatoku Arai 1*, Shiei Kim 1, Hiromoto Ishii 1, Jun Hagiwara 1, Shigeki Kushimoto 2 and Hiroyuki Yokota 1
Arai et al. World Journal of Emergency Surgery (2018) 1:9 https://doi.org/10.118/s1017-018-0200-7 RESEARCH ARTICLE Open Access The long-term outcomes of early abdominal wall reconstruction by bilateral
More informationManagement of Acute Pancreatitis and its Complications Aspirus Grand Rounds June 6, 2017 Eric A. Johnson MD
Management of Acute Pancreatitis and its Complications Aspirus Grand Rounds June 6, 2017 Eric A. Johnson MD Disclosure: None In accordance with the Standards of the Wisconsin Medical Society, all those
More informationRESUSCITATION IN TRAUMA. Important things I have learnt
RESUSCITATION IN TRAUMA Important things I have learnt Trauma resuscitation through the decades What was hot and now is not 1970s 1980s 1990s 2000s Now 1977 Fluids Summary Dogs subjected to arterial hemorrhage
More informationClinical Questions. Clinical Questions. Clinical Questions. Health-Process-Evidencebased Clinical Practice Guidelines Acute Abdomen
Health-Process-Evidencebased Clinical Practice Guidelines Acute Abdomen 1. What is an operational concept of acute abdomen? any abdominal condition of acute onset from various causes involving the intraabdominal
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 3, Issue 1 2013 Article 9 ISSUE 1 Perforation Of The Caecum Owing To Benign Rectal Obstruction: A Paradigm Of Damage Control In Emergency Colorectal Surgery DIMITRIOS
More informationSTORMY DENGUE with bloody problems. Anand M.Patil PICU MED/SURG TEAM Apollo Childrens Hospitals Chennai
STORMY DENGUE with bloody problems Anand M.Patil PICU MED/SURG TEAM Apollo Childrens Hospitals Chennai 1 HISTORY 4 ½ years girl Day 1: Fever, Lethargy, Low urine output Hypotension, high PCV,low platelets
More informationSurgery. Patient Education Transplant Services. For a kidney/pancreas transplant
Patient Education Surgery For a kidney/pancreas transplant By the time you have surgery, you may have been waiting for some time. It will help to read this section before surgery so you will know what
More informationThe Surgical Patient. Objectives:
The Surgical Patient Objectives: 1. Discuss the effect of surgery on the body systems. 2. Explain the etiological factors, nursing assessment, and management of potential problems during the postoperative
More informationDAMAGE CONTROL. Outline. Definition 5/29/2014. No Disclosures
DAMAGE CONTROL No Disclosures Rochelle A. Dicker, MD Associate Professor of Surgery and Anesthesia University of California, San Francisco Definition Term used in the Merchant Marines and in Navies for
More informationR2R: Severe sepsis/septic shock. Surat Tongyoo Critical care medicine Siriraj Hospital
R2R: Severe sepsis/septic shock Surat Tongyoo Critical care medicine Siriraj Hospital Diagnostic criteria ACCP/SCCM consensus conference 1991 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
More informationPulmonary Embolectomy:
Pulmonary Embolectomy: Recommendation for early surgical intervention Tomas A. Salerno, M.D. Professor of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital Epidemiology
More informationAcute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? Modalities of Dialysis
Acute Kidney Injury (AKI) How Wise is Early Dialysis in Critically Ill Patients? A common condition in ICU patients Associated with high mortality and morbidity Renal Replacement Therapy (RRT) is the cornerstone
More informationResuscitating neonatal and infant organs and preserving function. GI Tract and Kidneys
Resuscitating neonatal and infant organs and preserving function GI Tract and Kidneys Australian and New Zealand Resuscitation Council Joint Guidelines Outline Emphasis on the infant - PICU Kidney Gastrointestinal
More informationColostomy & Ileostomy
Colostomy & Ileostomy Indications, problems and preference By Waleed Omar Professor of Colorectal surgery, Mansoura University. Disclosure I have no disclosures. Presentation outline Stoma: Definition
More informationfollowing the last documented transfusion; thereafter, evaluate the residual impairment(s).
Adult Listings 5.01 Category of Impairments, Digestive System 5.02 Gastrointestinal hemorrhaging from any cause, requiring blood transfusion (with or without hospitalization) of at least 2 units of blood
More informationPENETRATING COLON TRAUMA: THE CURRENT EVIDENCE
PENETRATING COLON TRAUMA: THE CURRENT EVIDENCE Samuel Hawkins MD CASE PRESENTATION 22M BIBEMS s/p multiple GSW ABCs intact Normotensive, non-tachycardic Secondary Survey: 4 truncal bullet holes L superior
More informationNurse Driven Fluid Optimization Using Dynamic Assessments
Nurse Driven Fluid Optimization Using Dynamic Assessments 2016 1 WHAT WE BELIEVE We believe that clinicians make vital fluid and drug decisions every day with limited and inconclusive information Cheetah
More informationEndoscopic Treatment of Luminal Perforations and Leaks
Endoscopic Treatment of Luminal Perforations and Leaks Ali A. Siddiqui, MD Professor of Medicine Director of Interventional Endoscopy Jefferson Medical College Philadelphia, PA When Do You Suspect a Luminal
More informationAnaesthetic considerations for laparoscopic surgery in canines
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Anaesthetic considerations for laparoscopic surgery in canines Author : Chris Miller Categories : Canine, Companion animal,
More informationAbdominal Ultrasonography
Abdominal Ultrasonography David A. Masneri, DO, FACEP, FAAEM Assistant Professor of Emergency Medicine Assistant Director, Emergency Medicine Residency Medical Director, Operational Medicine Division Center
More informationMANAGEMENT OF SOLID ORGAN INJURIES
MANAGEMENT OF SOLID ORGAN INJURIES Joseph Cuschieri, MD FACS Professor of Surgery, University of Washington Director of Surgical Critical Care, Harborview Medical Center Introduction Solid organ injury
More informationINTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2
2 Effects of CPAP INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 ). The effect on CO 2 is only secondary to the primary process of improvement in lung volume and
More informationCritical Care Treatment Guidelines
Critical Care Treatment Guidelines West Virginia Office of Emergency Medical Services CCT Guidelines CCT Guidelines TABLE OF CONTENTS Preface Acknowledgments Using the Guidelines INITIAL TREATMENT / UNIVERSAL
More information2. Blunt abdominal Trauma
Abdominal Trauma 1. Evaluation and management depends on: a. Mechanism (Blunt versus Penetrating) b. Injury complex in addition to abdomen c. Haemodynamic stability assessment: i. Classically patient s
More informationSepsis Wave II Webinar Series. Sepsis Reassessment
Sepsis Wave II Webinar Series Sepsis Reassessment Presenters Nova Panebianco, MD Todd Slesinger, MD Fluid Reassessment in Sepsis Todd L. Slesinger, MD, FACEP, FCCM, FCCP, FAAEM Residency Program Director
More informationFluid Balance in an Enhanced Recovery Pathway. Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017
Fluid Balance in an Enhanced Recovery Pathway Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017 No Disclosures 2 Introduction The optimal intravenous fluid regimen
More informationFrank Sebat, MD - June 29, 2006
Types of Shock Hypovolemic Shock Low blood volume decreasing cardiac output. AN INTEGRATED SYSTEM OF CARE FOR PATIENTS AT RISK SHOCK TEAM and RAPID RESPONSE TEAM Septic or Distributive Shock Decrease in
More informationRelax and Learn At the Farm 2012
Relax and Learn At the Farm Session 9: Invasive Hemodynamic Assessment and What to Do with the Data Carol Jacobson RN, MN Cardiovascular Nursing Education Associates Function of CV system is to deliver
More information