ABSITE, Oral Boards

Abdominal Compartment Syndrome

Advanced

15-minute rapid review

Dr. Murphy expects rapid recognition of ACS triggers and escalation steps.

High-Yield Pearls

Suspect ACS in any patient with rising ventilator pressures, oliguria, and tense abdomen.
Measure bladder pressure every 4 hours when IAP risk factors accumulate.
Decompress early when intra-abdominal pressure remains > 20 mmHg with new organ dysfunction.

Screen for risk factors: massive resuscitation, burns, pancreatitis, trauma.
Perform focused exam and trend ventilator, UOP, and lactate data.
Obtain baseline bladder pressure and optimize sedation/neuromuscular blockade.
Initiate medical decompression: NG/rectal tubes, prokinetics, diuretics.
Optimize abdominal wall compliance with analgesia and repositioning.
Escalate to percutaneous drainage when tense ascites or hemoperitoneum is present.
Coordinate OR decompressive laparotomy if IAP > 25 mmHg with organ failure.
Pack viscera, place negative pressure dressing, and chart temporary closure plan.
Resuscitate to maintain perfusion: balanced transfusion, avoid over-resuscitation.
Plan staged closure and monitor for recurrent ACS in the ICU.

What threshold defines intra-abdominal hypertension?: >= 12 mmHg of sustained intra-abdominal pressure.
How do you calculate abdominal perfusion pressure?: Mean arterial pressure minus intra-abdominal pressure; goal > 60 mmHg.
Name three temporizing measures before decompressive laparotomy.: Paralysis, nasogastric decompression, and percutaneous drainage of fluid collections.

Abdominal compartments: Understand planes formed by costal margins, iliac crests, and retroperitoneum when planning decompression.
Open abdomen coverage: Review fascia layers and vascular arcades relevant to negative pressure dressing placement.

Use this summary to rehearse the pathophysiology, recognition, and staged management of abdominal compartment syndrome before rounds or call nights.

Watch for fluid creep in massive transfusion patients and titrate balanced resuscitation strategies.
Coordinate with critical care early when bladder pressures begin to climb to 12 mmHg.
After decompression, reassess ventilator mechanics, renal perfusion, and abdominal perfusion pressure every hour.