Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

The single vehicle rollover accident is a highly complex crash mode and there is growing concerns about its incidents and consequences in central Australia. The aim of this paper is to assess: 1 The incidence and injury patterns of rollover accidents 2 Pre rollover characteristics on rollover propensity 3 The injury severity and outcome of rollover accidents The absence of speed limit, unfenced roads, vast distances traveled, unsealed roads and high use of alcohol makes the spectrum of MVA' s in NT unique.In this two year period of study from Jan 2004 -Dec 2005, there were 470 motor vehicle accidents of which 126 were single vehicle rollover accidents. 132 patients were admitted; 73 NT residents of which 45 were of aboriginal origin and 14 were international tourists. There were 37 deaths in Central Australian roads and 20 were due to single vehicle rollover accidents. None of the deaths occurred at the Alice Springs hospital . Most rollover accidents occur at a speed above 100 km/h. 24 patients had an ISS > 15 and 35% of all injuries were to head, neck and shoulder. Rollovers occurred when the vehicle left the road way and encountered a tripping mechanism such as soft dirt or loose gravel. Those who were belted fared better than those unbelted occupants. Completely ejected occupants were all unbelted. Mean time to hospital from time of accident was 8Hrs. Primary prevention strategies need to involve remote communities, tourists traveling in central Australia and address alcohol and restraint use.