Watch for intra-abdominal hypertension with trauma
Watch for intra-abdominal hypertension with trauma
Do you know the signs of intra-abdominal hypertension? This condition can develop in patients who have had intra-abdominal surgery because of a traumatic injury such as a liver laceration or repair of a ruptured aortic aneurysm, says Reneé Semonin Holleran, RN, PhD, nurse manager for the adult transport service at Intermountain Health Care LifeFlight in Salt Lake City and former clinical manager for the ED at University of Utah Hospital and Clinics.
"Certain infections or excessive fluid resuscitation may cause an increase in abdominal pressure," she explains. Abdominal pressure can be measured with special urinary catheters or by adapting a regular catheter, adds Holleran.
Intraabdominal pressure greater than 10 mmHg decreases cardiac output and causes respiratory distress, she says. "Sometimes these symptoms can initially be confused with sepsis."
Patients who received fluid resuscitation and had to remain in the ED, such as septic patients, also may be at risk for this condition, she says. "Document and communicate the amount of fluid a patient has received," says Holleran. "This should raise suspicion if the patient develops respiratory distress and hypotension."
For transfer patients, find out their history, including accidents, injuries, or treatment before admission to your facility, says Holleran. Ask about surgery, medications, amount of fluid, and blood administration, she advises.
Patients most at risk are those with severe abdominal and pelvic trauma, says Jean M. Marso, RN, BSN, trauma coordinator at University of Colorado Hospital in Denver. "Secondary abdominal compartment syndrome is an early complication of traumatic shock resuscitation in patients with major nonabdominal injury," she notes.
Marso refers to a study that showed 9% of shock resuscitation trauma patients developing secondary abdominal compartment syndrome. All presented with severe shock, had severe injuries, and required aggressive shock resuscitation.1
The condition may occur in the absence of intra-abdominal hemorrhage after vigorous fluid resuscitation for shock from any cause, says Marso. "It has been reported as a complication of pancreatitis, intestinal obstruction, neoplasm, and severe burns."
Any patient requiring massive volume resuscitation is at risk, adds Marso. "Emergency nurses need to be highly aware of outcomes related to their care of the patient in the ED," she says. "Prudent assessment related to accurate patient intake and output is of utmost importance."
Communication of intake and output to ongoing caretakers is of equal importance, stresses Marso. "If the patient is going to the OR, it is usually anesthesia that will be monitoring their volume resuscitation," she says. "There must be clear communication of the patient’s intake and output for continued resuscitation."
Document an accurate intake and outtake so that other caregivers can identify discrepancies and patient response to volume resuscitation, says Marso. "The most important thing for ED nurses to be aware of is that this can occur due to volume resuscitation," says Marso. "Keep this in the forefront when discussing volume resuscitation with physicians."
In the past, ED nurses often thought there was no time to worry about consequences, says Marso. "Nurses thought that whatever we did in the ED was justified because we are saving lives, and any problems that result from our actions would have to be dealt with later," she says. "Gone are the days of keep hanging bags’ in reference to fluid administration."
The ED now is viewed as a critical care area, adds Marso. "Critical thinking is the standard for emergency nursing care," she says. "This means that at all times the nurse is keeping in mind the projected outcome of their actions in regard to the patient’s complete hospital stay."
Reference
- Balogh Z, McKinley BA, Cocanour CS, et al. Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg 2002; 184:538-543.
Sources
For more information about intra-abdominal hypertension, contact:
- Reneé Semonin Holleran, RN, PhD, Nurse Manager, Adult Transport Service, Intermountain Health Care LifeFlight, 250 North 2370 West, Salt Lake City, UT 84116. Telephone: (801) 321-3322. E-mail: [email protected].
- Jean M. Marso, RN, BSN, Trauma Coordinator, University of Colorado Hospital, Department of Trauma Services, 4200 E. Ninth Ave., Mail Stop: A021-630, Denver, CO 80262. Telephone: (303) 372-8905. Fax: (303) 372-0267. E-mail: [email protected].
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