Pressure bandage over venous conduit harvesting site causing compartment syndrome in a patient with intra-aortic balloon pump: An unusual cause.

Intra Aortic Balloon Pump (IABP) is conventionally used to support coronary perfusion and weaning from cardiopulmonary bypass. IABP in situ has its own share of complications. We present a case where a patient on IABP support who had reduced peripheral pulsations of the ipsilateral limb and was initially misdiagnosed as IABP catheter associated thromboembolism. A negative embolectomy ruled out the same. Further looking for the cause of reduction of ipsilateral pulses it was found that the tight compressive bandage at saphenous vein conduit harvesting site had led to development of compartment syndrome (CS).

Síndrome compartimental del abdomen en el paciente crítico / Abdominal compartment syndrome in critically ill patients

En la última década se ha observado un incremento de la literatura disponible sobre hipertensión intrabdominal (HIA) y síndrome compartimental del abdomen. Dado las importantes implicancias fisiopatológicas del aumento de la presión intrabdominal (PIA) en la función de órganos dentro y fuera del abdomen, este tópico es y será trascendente en los próximos años para una población de pacientes críticamente enfermos tanto neonatales, pediátricos como adultos. El objetivo de la presente revisión es efectuar una puesta al día sobre definiciones, epidemiología, metodología de medición, implicancias fisiopatológicas, hallazgos radiológicos y opciones terapéuticas. Mensajes claves a conocer por el lector son: (1) el índice de masa corporal y la resucitación con volumen predicen el desarrollo de HIA; (2) la HIA aumenta las presiones intratorácicas, intracraneana y de llenado cardíaco, y disminuye la compliance ventricular izquierda, de la pared torácica y total del sistema respiratorio; (3) la HIA causa atelectasia y aumenta el contenido de agua extravascular pulmonar; (4) la mejor presión positiva de fin de espiración (PEEP) debe ser indicada para contrarrestar la HIA; (5) estrategias de ventilación protectora deben de estar orientadas por DPpl (presión plateau-PIA); (6) presiones transdiafragmáticas e indicadores volumétricos reflejan mejor la precarga; (7) la HIA es un predictor independiente de falla renal aguda; (8) la HIA gatilla translocación bacteriana y desarrollo de síndrome de falla orgánica múltiple; (9) se recomienda la monitorización de la presión de perfusión abdominal en casos seleccionados.

Correlation between timing of ASV administration and complications in snake bites.

AIMS OF STUDY : The present study was undertaken to study the relationship between the time of anti-snake venom (ASV) administration due to late arrival of patient at hospital and subsequent development of complications. MATERIAL AND METHODS: All patients of snake bite that presented to our institution over a period of 1 1/2 years were included in the present study. A detailed clinical history, clinical examination and investigations were carried out. The patients were administered ASV within 10 minutes of presentation. The bite to needle time (time between the bite and start of ASV) was noted. The patients were then followed up to note any subsequent development of complications. The end-point of the study was normalization of haematological and neurological parameters. RESULTS: Fifty patients became eligible for the study. Twenty patients (40%) had complications while remaining 30 patients (60%) were uncomplicated. An attempt was made to study relationship between bite to needle time and subsequent development of complications. It was found to be significant at 5% level of significance (p<0.05) by chi square test. CONCLUSION: Incidence of complications was directly proportional to the duration of venom in the blood prior to neutralization by ASV due to late arrival of patient at hospital. The early institution of ASV is beneficial in preventing complications however severe is the systemic envenomation.