Acta chirurgica Iugoslavica
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Intra-abdominal compartment syndrome (ACS) are increasingly recognised to be a contributing cause of organ dysfunction and mortality in critically ill patients. The term abdominal compartment syndrome (ACS) describes the clinical manifestations of the pathologic elevation of the intra abdominal pressure (IAP). This syndrome is most commonly observed in the setting of severe abdominal trauma. ⋯ Preventing ACS by the identification of patients at risk and early diagnosis is paramount to its successful management. Because of the frequency of this condition, routine measurement of intra abdominal pressure should be performed in high risk patients in the intensive care unit. Surgical decompression is definitive treatment of fully developed abdominal compartment syndrome, but nonsurgical measures can often effectively affect lesser degrees of IAH and ACS.
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Originally the main idea was to obtain a stable patella, i.e., to stabilize the "slipping patella". In the past many conditions like patella alta, ligamentous laxity, PF bone hypoplasia, weakness of the quadriceps muscle, genu valgum or genu recurvatum were thought to predispose to patellar instability. For a long period muscle exercises were instituted to strengthen the weak m.vastus medialis and to make vastus lateralis stronger. ⋯ Muscle imbalance as well as anatomical abnormalities are the basis both for patellar instabilities and reasonable surgical procedures were: proximal extensor mechanism realignment, proximal capsular reefing, patellar tendon splitting and its medial transfer. On the other hand bone procedures on the hypoplastic lateral femoral condyle were also performed by Albee, as well as tibial tubercle transfer and trochleoplasty by deepening of the trochlea (Dejour). An understanding of the pathoanatomic basis is the corner stone for
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Acutelunginjury (ALI) and its more severe form acute respiratory distress syndrome (ARDS) are syndromes with a spectrum of increasing severity of lung injury defined by physiologic and radiographic criteria. There are many clinical disorders as sociated with the development of ALI/ARDS and can be divided into those associated with direct or indirect lung injury. Early detection and protective lung ventilation strategy contribute to lowering the mortality rate.
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Anemia is common in critically ill patients and carries risk of reduced oxygen carriage and worse outcomes. Transfusion, however, carry their own risk, and the physician must balance the risks of anemia with the risk of transfusion in each patient. ⋯ This protocols consider that acute hemorrhage has been controlled, the initial resuscitation has been completed, and the patient is stabile in the intensive care unit without ongoing bleeding. The trigger for PRBC transfusion in patients without severe cardiovascular disease is hemoglobin g/dL (or a hematocrit %).
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The damage control laparotomy is an advancement in the management of massively injured trauma patients. Massive liver injuries, pelvic trauma and some retroperitoneal injuries are some of the indications for this approach. The damage control laparotomy is the phased approach to severe abdominal injury that might best be described with the acronym STIR (Staged Trauma Injury Repair). ⋯ Careful replacement of blood and blood products along with correction of hypothermia, acidosis and optimalization of oxygen transport represents a critical phase in this management approach. Once the coagulation profile has normalized, planned re-intervention, with repeat abdominal exploration to remove the packs and perform definitive surgical repair and reconstruction takes place. When applied judiciously, the damage control laparotomy with the staged abdominal repair and reconstruction for severe trauma is associated with an improved outcome in the selected group of patients.