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Trauma Tidbits

INTRA-ABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME

Abdominal Compartment Syndrome is a potentially life threatening condition if left untreated. Any event that causes intra-abdominal hypertension can lead to ACS. The most common cause is blunt abdominal trauma. The most common cause is bleeding from splenic, hepatic or mesenteric injuries. Packing after a surgical procedure may also increase pressure in the peritoneal space. “Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include the release of cytokines, formation of oxygen free radicals, and decreased cellular production of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome.” (American Journal of Critical Care.2003; 12: 367-373)

Procedure for Measuring Abdominal Pressures
A. Supplies Needed
1. 500 ml Normal Saline
2. Transducer/pressure tubing
3. 60 ml syringe
4. 18 gauge needle
5. Providone-iodine swab
6. Alcohol Swab
7. Kelly
8. 4 x 4 gauze
GUIDELINES
1. Place patient in supine position
2. Clamp tubing of the indwelling urinary catheter distal to sampling
port with Kelly clamp, using 4 x 4 gauze to protect tubing.
3. Clean sampling port with providone-iodine/alcohol
4. Attach IAP monitoring device to foley
5. Insert 18-gauge needle into sampling port of bladder drainage
system.
6. Attach 60-ml syringe to 3-way stopcock and withdraw 60 ml of
normal saline from the flush system.
7. Instill 60 ml of normal saline into the bladder
8. Using the proximal stopcock, level and zero the transducer at the
symphysis pubis. Please mark position if you are going to be
doing more intra-abdominal pressure measurements.
9. Measure abdominal pressure at end expiration (please note that
the intra-abdominal pressure waveform is a relatively flat line with
excursion that corresponds to respiratory cycle.
10. Record reading on flow sheet
11. Subtract NS instilled into the bladder from urine output
12. Label and date flush bag/transducer used for intra-abdominal
pressure readings if repeated measurements are ordered. Please
ensure that the flush bag/transducer is labeled for intra-abdominal
pressure readings only.

 2009 TRAUMA PROTOCOL MANUAL

Signs and Symptoms of ACS
Decreased lung compliance                   
Increased PIP
Resp. acidosis secondary to decreased ventilation
Increased CVP, PWP, PAP (falsely)
Increased HR
Decreased BP
Decreased UOP
Increased ICP
Decreased CPP

IF YOU THINK YOUR PATIENT IS AT RISK FOR ACS:
MONITOR FOR
ABDOMINAL DISTENTION,
TIGHTNESS, TENDERNESS AND ANY OF THE ABOVE SIGNS OR SYMPTOMS. IF PRESENT NOTIFY YOUR PHYSICIAN.