Clinical Pearl: August 16.

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    Clinical Pearl: August 16.

    A nursing home patient presents critically ill with respiratory distress, severe abdominal distension, ascites and oliguria.  You are concerned for abdominal compartment syndrome. How will you make the diagnosis?

    Measure intraabdominal pressure:

    1) Two three-way stopcocks are connected serially to a disposable pressure transducer.

    2) A standard IV tubing set is connected to 1,000cc of normal saline and attached to one stopcock.

    3) 60-mL Luer lock syringe is attached to the second stopcock.

    4) An 18-gauge angio-catheter is inserted into the culture aspiration port of the foley urinary drainage tubing using aseptic conditions.

    5) The infusion catheter is attached to the first stopcock via pressure tubing. The system is flushed with saline

    6) Pressure transducer “zeroed” at the level of the symphysis pubis, with patient fully supine.

    7) The urinary drainage tubing is clamped immediately distal to the catheter.

    8) The stopcocks are turned “off” to the patient and to the pressure transducer. Normal saline is aspirated from the IV bag using the 60-mL syringe.

    9) The first stopcock is turned “on” to the patient and the normal saline instilled into the bladder through the urinary catheter.

    10) Stopcocks are then turned “off” to the syringe and IV tubing.

    11) Momentarily release catheter clamp to ensure that all air is flushed from the urinary catheter.

    12) Measure intraabdominal pressure at end-expiration.

     >12mmhg = intraabdominal hypertension (IAH).

    >20mmhg = abdominal compartment syndrome (ACS).

     

    References:

    Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement. J Am Coll Surg. 1998 May;186(5):594-5.

    http://emcrit.org/

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