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Abdominal Hypertension No Photos

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  Intra-Abdominal Hypertension (IAH) Abdominal CompartmentSyndrome (ACS)&  What was their intra-abdominal pressure? ã Have you ever seen a critically ill patient become progressively more swollen and edematous after fluid resuscitation? ã Have any of your ICU patients developed renal failure requiring dialysis? ã Have you ever seen a patient develop multiple organ failure and die?  Case: Septic child 5 y.o. female presenting with septic syndrome ã Treatment: Fluids, antibiotics, vasopressors ã 24 hours into therapy develops worsening hypotension, oliguria, hypoxemia, hypercarbia. PIP rises from 20 to 40 cm ã IAP = 26 mm Hg decompressive laparotomy ã Immediate resolution of renal, pulmonary and hemodynamic compromise ã 7 days later abdomen closed. Alive and well now. DeCou, J Ped Surg 2000  Case: Dyspnea in ER 67 y.o. female presenting to ER with pleurisy, dyspnea ã Hypotensive, agitated, H&P suggest liver dz ã IVF resuscitation, intubation, sedation ã Worsened over next 4-6 hours -Difficult to ventilate, hypoxic/hypercarbic, hypotension, no UOP. ã IAP = 45 mm Hg, abdominal ultrasound showed tense ascites paracentesis of 4500 cc fluid (IAP = 14) ã Immediate resolution of renal, pulmonary and hemodynamic compromise. ã Pathology shows malignant effusion  – pancreatic CA. ã Care withdrawn at later time and allowed to expire. Etzion, Am J EM 2004
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