chbare Posted November 24, 2008 Author Share Posted November 24, 2008 ARDS is always a consideration in these types of patients. The problem is in fact compartment syndrome. Abdominal compartment syndrome to be exact. What could have caused abdominal compartment syndrome? Take care, chbare. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted November 24, 2008 Share Posted November 24, 2008 Abdominal compartment syndrome would be caused by intrabdominal bleeding placing pressure on the pleural space and on venous return which will decrease perfusion of the abdominal organs. I know there's some other pathophysiological steps in there in the middle but I can't seem to think them through. I'm making an educated guess/logical leap here. Link to comment Share on other sites More sharing options...
chbare Posted November 25, 2008 Author Share Posted November 25, 2008 Consider the event that caused this entire mess. Somebody mentioned the problem earlier. What underlying pathophysiology is at work here? Take care, chbare. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted November 25, 2008 Share Posted November 25, 2008 Neurogenic shock resulting in loss of vascular tone below the site of the injury increasing any intrabdominal bleeding? I'm reaching now. Might need to hit the books on this one. Link to comment Share on other sites More sharing options...
chbare Posted November 25, 2008 Author Share Posted November 25, 2008 Start at the beginning. Young guy falls at a construction site and is found in cardiac arrest. AED is attached and advises, "shock advised." Patient is shocked into a perfusing rhythm. (Not exactly characteristic of a "traumatic" arrest.) XII lead is performed and indicating massive MI. Pt also has "unstable" vital signs and runs of ventricular tachycardia. The only signs of "trauma" are obvious arm deformity and red marks on a hand and a foot. During his stay at the hospital he develops rhabdo, compartment syndrome of his extremities, and abdominal compartment syndrome. Assuming he is healthy otherwise and there is more to the story than a simple fall, what the heck is going on, what could be causing all of these problems? Take care, chbare. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted November 25, 2008 Share Posted November 25, 2008 Okay I'll admit I did a bit of quick reading in my patho book and a dive online for abdominal compartment syndrome to grab a handle on what the condition is. I also reread the posts to get a better handle on the timeline. So my thinking at this point is that the pressor therapy and the fluid resucitation is what resulted in fluid shift and tissue edema in the abdominal cavity and abdominal hypertension which progressed into abdominal compartment syndrome. I still don't feel like I've got a handle on it at this point, but am I getting closer? Link to comment Share on other sites More sharing options...
chbare Posted November 25, 2008 Author Share Posted November 25, 2008 What about all of the other findings? Take care, chbare. Link to comment Share on other sites More sharing options...
WolfmanHarris Posted November 25, 2008 Share Posted November 25, 2008 Are the red marks indicative of a systemic inflammatory response? He was in a shockable rhythm, so did he have V-tach or V-fib secondary to an MI? Was the arrhythmia caused by an electrolyte imbalance? Do we have any information about how he was acting prior to the fall? How hot is it out and how long has he been working? Did he sweat himself to hypokalemia? Am I getting closer at all? I feel like I'm losing my grasp on this one a bit. Link to comment Share on other sites More sharing options...
chbare Posted November 25, 2008 Author Share Posted November 25, 2008 He was working at a power plant near high tension power lines when he fell and was found in arrest. Young guy, healthy, no known history. Take care, chbare. Link to comment Share on other sites More sharing options...
Fignewt345 Posted November 25, 2008 Share Posted November 25, 2008 Thermal energy from the electrical burn destroyed large amounts of internal tissue. This heralds coagulation necrosis and tissue edema, allowing the build-up of fluids in possibly multiple areas, causing compartment syndrome. Since the path of the circuit appears to pass from upper extremity to lower, any and all tissues within the abdominal and thoracic cavities , and of course the extremities, should be suspected to have received thermal damage. http://www.emedicine.com/med/TOPIC2810.HTM Link to comment Share on other sites More sharing options...
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