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Lyme Disease — USMLE Step 2 CK MCQ

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HardLyme DiseaseLyme DiseaseUSMLE Step 2 CK

A patient with severe abdominal trauma has received massive transfusion and temporary abdominal closure. Peak airway pressure rises, urine output stops, bladder pressure is 29 mm Hg and vasopressor requirement increases despite optimized sedation and gastric decompression. What is the next step?

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Correct answer: D — Perform urgent decompressive laparotomy

A bladder pressure of 29 mm Hg with worsening ventilation, anuria and shock defines overt abdominal compartment syndrome. Because sedation and gastric decompression have failed, urgent decompressive laparotomy is required. Percutaneous drainage is useful only when a drainable fluid collection is the dominant cause and cannot be assumed here. Neuromuscular blockade and fluid removal are temporizing measures, not definitive treatment for progressive multiorgan failure. Renal replacement therapy does not relieve mechanical compression, and reducing PEEP does not decompress the abdomen.

Reference: World Society of the Abdominal Compartment Syndrome consensus guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC3680657/