Simini Boards Cast
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Simini Boards Cast
Chapter 86 - Part E: Successful Lavage, Dead Patient: The Peritoneal Failure Pattern
In this BoardsCast episode, we conclude our Tobias Chapter 86 – Peritoneum & Retroperitoneum series with one of the most dangerous misconceptions in soft-tissue surgery:
“The abdomen looks good after lavage, so the patient is going to be fine.”
Wrong.
The peritoneum has a predictable failure pattern — and if you don’t recognize it, a patient who looks stable can decompensate and die hours after a “successful” surgery.
You’ll learn:
- Why visual improvement during surgery does not mean biologic recovery
- How peritoneal cytokine storms drive postoperative collapse
- Why lavage removes debris, but not the inflammatory cascade
- The difference between controlled peritonitis and irreversible physiologic failure
- Board-relevant predictors of decompensation after lavage
- Why some patients die despite technically perfect surgery
- What parameters (lactate, mentation, perfusion, abdominal fluid trends) matter more than the surgeon’s eyes
If you’ve ever wondered why some septic abdomen cases crash unexpectedly, this episode explains the underlying systemic physiology — and how to avoid the peritoneal failure trap.
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