ABDOMINAL COMPARTMENT SYNDROME

ABDOMINAL COMPARTMENT SYNDROME

SATURDAY, JULY 24, 2010

Compartment syndrome occurs when a fixed compartment, defined by myofascial elements or bone, becomes subject to increased pressure, leading to ischemia and organ dysfunction.Organ dysfunction caused by intra-abdominal hypertension (IAH) is considered to be abdominal compartment syndrome.The dysfunction may be respiratory insufficiency secondary to compromised tidal volumes, decreased urine output caused by falling renal perfusion, or any organ dysfunction caused by increased abdominal compartment pressure.

Abdominal compartment syndrome can be divided into the following 3 categories

* Primary or acute abdominal compartment syndrome: This occurs when intra-abdominal pathology is directly and proximally responsible for the compartment syndrome.(Penetrating trauma,Intraperitoneal hemorrhage,Pancreatitis,Rupture of abdominal aortic aneurysm and Perforated peptic ulcer)

* Secondary abdominal compartment syndrome: This occurs when no visible intra-abdominal injury is present but injuries outside the abdomen cause fluid accumulation.

* Chronic abdominal compartment syndrome: This occurs in the presence of cirrhosis and ascites, often in the later stages of the disease.

The morbidity of abdominal compartment syndrome is attributed to metabolic acidosis, decreased urine output, and decreased cardiac output.

Abdominal pain may precede the development of abdominal compartment syndrome and be directly related to a precipitating event, such as blunt abdominal trauma or pancreatitis.Abdominal pain and distension and signns of hypovolaemia are commonly present.

ABDOMINAL COMPARTMENT SYNDROME | MEDICAL POWERPOINT COLLECTION

Egyptian Lessons

My Egyptian tutor sits over that chair, in the smoking room, taking a deep breath of his cigarette. He closes his eyes while he inhales it, his facial expression changes to something like being high. Then he starts talking. I learned 7 lessons in my previous week from him.

The eighth lesson, which I learned by myself is Egypt played a great role in sending scholars, and teaching other Arabs. This fact was not absent from my mind. Yet, I didn’t really feel it until I started training as an anesthetist last week. The only consultant there, who happened to be my tutor and supervisor, was Egyptian. To tell the truth, I’m amazed by his qualities and addiction to his work.

Due to Muhammad Ali Pasha, Egypt started huge steps toward good education system. After a hundred years, some of Arabic countries got rid of Ottoman impact and initiated some education trails. Still, Egypt is the leader in cultural and educational fields until it started to be Mubark Egypt.

What did Muhammad Ali Pasha do to improve education? He realized that learning, in academicals institute, is the only path to stand next to great nations. Therefore, he adopted the European model. He used advisors from France. Also, he sent many scholars to there, such as Rifa'a Al Tahtawi.

The 7 Lessons

1^st Lesson: Think, take one second reconsidering what you want to say, do, or write. That may prevent many bad consequences. Also, it saves many hours after thoughtless decisions.

2^nd lesson: Always remember your role in the big theater, life, is being a doctor. “God has chosen you to do so”.  So, play it perfectly, because once you disturb it, many other relating characters will be distracted. And be careful, you never know when you play the patient part. Be faithful now, so they will be faithful for you when you need them.

3^rd lesson: When a system is screwed up, despite the need of a tight one, many regulations to compensate appear. As a peer to peer relationship without any guide lines to follow, you need to find the way to apply your demand. That may be in the form of gentle asking, with little bit of fun and sense of humor. Otherwise, it would be arranged forcefully by screaming, shouting, and applying unchallengeable power. So, keep the tension on the right tune which guaranties your requests to be fulfilled.

4^th lesson: Anesthesia is about using all of your senses to direct you toward the benefit of the patient. You should observe with your eyes: the surgery field, the patient face, the chest movements, sweating, the numbers over the monitor, and every little change. You utilize every part of your conscious to save the patient and achieve the best result. “In the end, this is a music promo, and you are, the anesthetist, is the conductor, the maestro”. I could notice the doctors giving analgesic agents when there’s wounding, applying force, or puncturing the patient skin. Although, the patient is sleeping, this pain, which he/she possibly feels, may transfer into the form of a nightmare. In future, all the memories of my patients during the surgery must be sweetmares :)

5^th lesson: Modesty is most important theme of a human being. As human beings, doctors are trusted on the rest of humans’ lives. He was looking at a patient over the bed, while telling me this. The patient was disfigured with some mental challenges. He said: “after dealing with such patient, you have no right to think anything of yourself. We all are alike”.

6^th lesson: When you do a mistake, you must admit it. There’s a shortage of stuff in the department, and a lot of stress. I wanna explain the situation in a little bit of details. There’re 3 triangles in anesthesia: anesthetist agents; which inducts sleeping, muscles relaxant agents; which make muscles very paralyzed and weak, and the analgesics; the painkiller. We use opioids (i.e.: morphine) to ease the patients pain. Yet opioids suppress the breathing. In cesarean section to deliver a baby, one shall not give opioids for the sake of the patients breathing/respiratory function. Yet, given all the previous conditions in the department, a doctor gave opioids instants of muscle relaxant. He confesses all the excuses can’t justify his mistake. However, he admitted his mistake, informed other doctors to take what it needs to save the just born baby. My tutor told me that patient comes first, even when you do mistake, fatal one, you have to admit. Take the blame. It’s a mission of saving a human life not your ass.

Lastly 7^th lesson: “Saudi Arabia was just a desert, tent, and camel. Over one night all that has changed to well established and rich country. Nevertheless, people are not taking well care of their country. Why? What is the future of this place?” The answer could take another entry soon.

 In the end, I realized one important lesson after 6 years in medical school. I don’t study medicine to be a doctor, but to heal people. Anyway, most of you know that I rarely praise some body. Yet, I have nothing to say but thank you very much my wise teacher and doctor. 


P.S: please vote for the best lesson.

رسالة لا تعنيكم!

قبل أن ابدأ، إن كنتِ تبحثين عن أفكارٍ مبدعة أو كتابة متميزة بين هذه السطور، رجاءً لا تكلفي عينيك جهد الابصار، لا يوجد هنا ما يستحق القراءة.

و لكن فضولك اللحوح، المشابه لعقلي البأس، سيدفعك التلصص على حروفي، و استراق النظرة تلو النظرة لكلماتي تعريها جفونك، و يعاشرها وجدانكِ.

لذا، سأبوح لك، أولا، بما استوحش صدري سكناه، و استعاب قلبي جواره، و استثقل عقلي حمله. هناك على بستان الورد القرنفلي، القابع فوق شفاهك، أصبحت ألمح شيئاً من الندى. ما ألفت مثله أن يطال مثلكِ. أغفلت عنه فكري، و ألجمت فوق فمي بسمةً ساخرة، تحبس ورائها لساناً سؤول و عقلا شكوك. و يالظنوني، تلك التي لازالت تفضي لي أن أحيد عن طريقي المعتاد ، صباحاً،  إلى سريري و أزورَ أرضاً استودعتُ ترابها راحة البال.

يالجنوني، كيف أطعت شيطاني، و رفعت السور المهتريء الأطراف، و إذا بيد الله غلت عنه ما تحت معصمي، و قذفتني بعيداً عن مساري. و صارت مبسوطة يده، سبحانه، كما يشاء. تشبع عَطِشةُ الثغر، فتجود بآهاتٍ مكتومة تحت هيبة سلطاني. قفي هنا قليلاً، أتصرين أن تكملي؟ سأبوح لك، لست من تظنينَ!

لماذا كنتِ تخفين في أرضك بذور جنوني؟ أكنتِ حقاً تسألين الله أن يرويها؟ تعرفيني لست إلهاً، أو ملاكاً، و لن تستطيع حاستي السادسة أن تكتشف مكنون حاستك السادسة. و ما ظننتك مريماً تحتاج رباً يلد لها نبياً. يالتربتك، رطبة، عاث البلل فيها فساداً. هناك فضيحة في الجو. أكاد أن اسميها فاحشة. صنيعك أقض مضجعي، و هجرتُ طريقك، فأضعت السرة و نسيت أن أتذكرَ و أصنعَ. لن أقبل إلها أن يشاطرني عرشي، و لا أريد عيسى أو هرقل سليلاً أو ابنا.

أريد أن أبكي كالضعفاء. لست ضعيفا، لكني خسرت معركةً تحت مضيق خصرك الذي أحصنتُ، و عند ضفاف فمك الذي استعمرتُ. لستُ كوفئاً للتحدي، لذا سأبكي. لن أبكي، كنت تضحكين، و ربك، أتذكرين كيف كنتِ تضحكين؟ آهٍ كيف كنت تقولين اسمي، و تهمسين به حيناً و أخرى تصرخين. لماذا صرتِ تسكتين طويلاً؟ أنتِ التي اعتدت ضحكاتها في حصص الحنان عند التاسعة و النصف، و العاشرة..

أعلم أني أخسر معركة الرجاء و التمنعِ. و يبدو لي أن الأرض التي آوت حمائمي، أصبحت تغني فيها عصافيرُ جديدة. و تقوم بيني و بينها أشجارٌ تؤتي أكلها كل حين. لا أريد أن أرى كيف صارت. و أريدكِ إن وصلتي لهذه الحروف، أن تغمضي عينيك، ما عدتُ أعنيك.

أنا حر،

طليق،

أفكر،

مجنون،

يالجنوني، كنتِ تستلذي نبضه، و تقولين عنه عبقرة. مبدعٌ مجنون. حلقةُ الوصل بين الآدمي أو الآدمية و الإبداع هو الجنون.

كيف أكمل جملة واحدة دون ذكرك فيها؟

كيف أخذ نفساً كاملاً، و لا أتذكر فيه عطرك، و حقول الياسمين؟

كيف ينبض قلبي؟؟ لا يعينك أمري، لكنك تعنين كل سكناتي و حركاتي.

أنا تواقٌ لطعم الحرية. كيف أصيرُ حراً و أنا أسيركِ. و أغلب الظن أن علاقتي معكِ، كالرق و النخاس. أباعُ لمن يلفت الانتباه أكثر.

عزمت أمري، غداً سأعود في نفس الطريق إلى سريري، سأحرقهُ، و أنثر رماده. و أصلي لأي روح تسمع ندائي، أن تشتري جسدي سكنى لها، ثمنا بخسا، و إني من الشاكرين. 

all the credit of the picture goes to villesgodgirl's you can find her in this link  

New Arrival

Arrival to Wonderland

Life is pointless, even being absent is. I spent my last 3/52 (3 weeks) in 6 feet under hole, just next to rats, insects, worms, manure, and other brothers in earth. Now it’s time to undo and dig to the surface as a new soul is invading my body. I’m shedding the coffin pieces over my flesh. I’m feeling like a mummy, yet a well dress one. I wipe out the dust and clean the sand from my new clothes. Well, I’m dressed very great by them for a purpose, we may mention it later.

When first rays of sun meet my eyes, I close them. It’s very shiny and burning. In one eye blink I can remember everything had happened. I’ve been taken to the other realm. To be more specific, I paid it a visit without an invitation. The population there is massive and hugely over inhibited. I couldn’t find a place to linger there. Everybody was staring to me in disgust. They are really sick of new comers. I stayed there dazzled; they are not different than me, to tell the truth we are very alike, like twins. I couldn’t understand what is happening, until a little different young child stopped and told me: “These all are you.” The boy was dressed in very fancy clothes, while I was in a casual, below the average t-shirt, jeans, and sandal.

A day later, the same boy, or another clone of him came and took me with him inside a hole. The hole opened into the sky. I could see some clouds, some rain angels, Zeus, and the fellows. The kid told me that we have one chance in each form we live. All the Ahmeds I’ve seen earlier represent me for one moment of life. If a cat has 7 souls, then apparently I have more than 7 billion soul. Each soul is wasted every moment it lives.  However, as they’re sick of human and their endless trails to come to the later life kingdom, I shouldn’t stay there for long. Karma is taking place this time as I abused my earlier chance, also for that I was bad guy, I’ll be sent in worse form.

So, here I’m dressed in a Burberry shirt, with folded sleeves to show the pattern of Burberry texture. I am wearing a Diesel jeans that at least costs something around 700 riyal, and I’ve never dreamed of wearing such. Also, gosh I have a pair of Gucci shoes; it’s not from china town, and it makes me fly from happiness. I’m outfitted just like the child I’ve seen upstairs. They kept my Emporio Armani eye glasses, still this thing hasn't changed. I can’t understand what a worse form they put me into. No argument that human beings are the worse form to be created into. We have needs; these needs drive us crazy to satisfy. We have brain, working brain, which analyzes every minor thing. Abu Bakr, the first Caliph preferred to be created as a camel, hopeless and helpless. It’s about the idea of free will, even if some of my friends argue that we can’t decide it. I think we can force our free will on others, regardless of we can practice it by ourselves.

What makes me worse than before? I could figure that after 18 years, when I met somebody who looks like previous Ahmed. First, I spent my life seeking for fame through shoes and ass kissing to have money to buy more shoes. I have a huge collection of Fendi, Gucci, Versace, Burberry, LV, Prada, Channel, Valentino, Lomar Thobe, and Pierre Cardin shoes and other clothes.  There’s also a little secret about my clothes, I desired once or twice to buy my underwear from Victoria Secret. I tried to change my eye glasses to cavalli one, but the old one is fixed on my face. I don’t care to be called the shoes man or the "shoes ass". Mr. Bush is not better than me as I don’t mind people throw shoes on me to collect it. Anyway, the “somebody” told me: “a man whose core is only expensive shoes and glimmers appearance is only worth his shoes and appearance.”

Honestly, since I’ve started my new life, I have been busy all the time. I can’t find any minute to do anything except for shaving my face to be more like an ape, spending hours in malls to find a new expensive goods, seeking attention, and ass kissing. How silly Ahmed was in his previous life. This is my current life. Good bye Ahmed. I left you in the graveyard.

Regardless the rubbish I just mentioned earlier, which is very accurate when it’s applied on some people, I think I left Ahmed really in Riyadh. It’s like being married here, while it’s the full freedom of bachelor in Riyadh. Life here, in Qatif, along with the family, friends, community I know, and endless list of duties is really consuming. I am writing this entry on Thursday, and for 2 weeks I haven’t written anything. The 2 last articles were written in Riyadh. So, what is Riyadh for me? Is it really the place I wanna live in forever? Or It could be just the solitary life provides me with the optimal conditions of living and working. Am I lateralized after 6 years there? I guess what I fancy the most in Riyadh that I don’t have to deal with shoes asses, as well as I can freely exclude any of them once I meet.

the credit for the picture goes to my friend Nikos, in this link, and this link

Books I

Dear readers,
I just started reading (The Black Swan). I finished Avicenna book.
This new book seems very awesome.
What about you?
Anything new?




- Posted using BlogPress from my iPhone

Location:Qatif,Saudi Arabia

Pirates Ship

It sails all along the darkness. The sea is a bit calm, and silent. Yet, all the 4 dimensions are gloomy, confusing, and blurred. The 46 pirates ship knows where and when to attack. Despite all troubles it faces; gathering, building, surfing, orienting, and directing, it eventually reaches its destination. The coast is buried beneath the waves. The pirates start invading all storage yards, and use it to multiply. And by a specific well designed mechanism, they establish one of the greatest states in whole world: human being.

Assuming that humans are the smartest creature is not correct. The pirate ship/zygote is managing its invading project better than Jack Sparrow; I mean captain Jack, or any other great pirate or invader. Later on, the organs inside of us act spontaneously, and without the brain interruption. They work better than the brain, itself, or any other organism. For example, heart has its own regulator, or head which works to maintain optimal level of effort. Also in case of starving, liver starts to make glucose from primitive sources. The whole glucose is delivered to the stream of blood, which passes all over the body. Eventually, it is only consumed by the brain, as it needs it the most. The liver itself, the glucose factory, doesn’t use any piece of sugar it makes.  This’s a masterpiece, and no wonder many humans were worshiped. Who is the great master behind this design?

In medicine for many diseases, there’s no definitive cure. All we can provide is a treatment, a compensating one. High blood pressure, for example, is only treated with medications for life. There’s no such anti-hypertensive pill which stops it and reverse all the effects. However, the same medications we use currently may cause new troubles; dry cough, dizziness, and erectile dysfunction, which mean no intercourses. “Once the paper is scrambled up, it can’t be perfect again.” We have one thing of everything, except for the liver. In the sense we can’t make a new muscle if any muscle in the body is torn. Even the normal function mechanism is one of its kind, once it’s disturbed it goes crazy and can’t be returned to its initial state. So, we’re challenged on the level of a tissue as well as the level of whole regulatory process which is contributed by many tissues and elements.

Technology for now can’t fix and restore our health. The idea is; we’re still in the first step in our body understanding milestone. I’m not pessimistic but who knows what troubles, hybrid, genetic mutations, and defects we may face in future. That’s due to diseases we suffer of, currently, without our knowledge, or due to new illnesses we will face. I know many new approaches are on the nuclear and chromosomes level. Still, can we handle millions of information inside this small cluster of protein? Manipulating such tiny things may lead to fatal mistakes, such as mutations. Repeated mutations for a cell usually lead to cancer. Viruses could be the key, those small, smart, and mean particles, and barely alive organism. They depend on the invaded cell tools to live and multiply. What a lovely and easy life they live.

Medicine whole idea is pursuing after eternity. This is also whole humanity concern; good life quality and longer life span is the aim, just like elves. However, we, doctors, can’t give life, and as a result we can’t take it. Those who give, only those shall take. You give work, and you take reward; a fancy car or Gucci shoes for example. You give life, you, and only you shall take it. It’s obvious the pirate ship is strong enough to force its right to live. And some people drive this force with the power of a million Saudi Riyal in the wedding ceremony. This is the argument in the mercy killing, I don’t mean marriage, abortion, and vegetated people termination.

This is a medical case: 37 old Saudi lady. We detect that she is pregnant with a mutated fetus, or even sickle cell one. Shall we terminate the pregnancy and safe her the effort, time, money, and suffering? To tell the truth, around 50% of first 12 weeks spontaneous abortions are due to chromosomal defect, like missing chromosome or extra one. So, nature is playing its rule, and what a business we have to play as nature? This is another case of an end stage cancer patient. We provide the patient some morphine to ease his pain. It takes only a little bit more dose of morphine to take this patient to his final rest. Who agrees to rest this man? Please, don’t forget that chemotherapy, he received, did participate in his current condition.

Earth planet and life were going fine, until human decided to interrupt the peace. Yet, the way it was moving contributed to the death of a lot of people. Nowadays, people minimized that amount, increasing life sum. As a result, do they have the right to correct death number according to what they think?

all the credit for the last picture (life is an option you can live with) goes to Danny Hammontree, you find him in this link.