Abdominal Aortic Aneurism March 2018 | by EMauthor This is a serious problem in the older patients with a high mortality, intra-peritoneal ruptures are rapidly fatal. More commonly the patients present with retro-peritoneal rupture which still carry a high mortality unless the condition is diagnosed early, resuscitation starts promptly and surgery performed early. Presentations •Classic = sudden abdominal and or flank pain in a patient with a known aneurysm. •May look pale, sweaty and in shock or these features are transient •Back pain may be the only feature •Patient may present with painless collapse of no obvious reason •Patient may present with signs of lower limb ischaemia Examination •Tender pulsatile abdominal mass is felt in many cases •There may absent or weak femoral pulses on one or both sides •NB not easily palpable in obese patients or large retroperitoneal haematoma •Bedside abdominal ultrasound is mandatory Management •Assess Airway, Breathing and Circulation and resuscitate accordingly •Oxygenate •Insert two large bore cannula and take blood for FBC, LFT, U&Es, Clotting screen and G&S •Start IV crystalloid the aim is to maintain BP at around 90 mm systolic •Analgesia with small doses of IV opiate titrated to the patient’s needs particularly if hypertensive •Cardiac monitoring •ECG •Urinary catheter with hourly urine output measurement if time Inform the surgical registrar or SHO urgently as soon as the diagnosis is suspected and he / she can arrange transfer to the regional vascular transfer if Basildon is not on-call. Arranging a CT aortagram is strictly the surgical team’s responsibility but you may want to arrange this to facilitate the process as a courtesy measure. |
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