Aortic aneurysm

Question 1

What is it and where its most common

Answer 1

-localized dilation and weakening of arterial wall
-most common abdominal or thorax
-only worrying if there’s tear in intima or a full blown rupture of the aorta

Question 2

Aneurysm, dissection, rupture
Primary concern, common outcome, urgency

Answer 2

Aneurysm- risk of rupture or embolism, gradual enlargement, monitored unless symptomatic or large
Dissection- disruption of blood flow, potential rupture, organ ischemia, often an emergency
Rupture- massive haemorrhage, rapid death, immediate emergency

Question 3

Aortic aneurysm signs and symptoms

Answer 3

-usually asymptomatic until too large or rupture
-sometimes AAA detected as palpable pulsatile mass with bruits (whooshing noise)
-often present with non descript back/abdominal pain
-dissection/ rupture= severe pain, shock, tachycardia, hypotension, loss of palpable pulse

Question 4

Risk factors

Answer 4

-atherosclerosis- fatty deposits
-hypertension
-trauma
-marfan syndrome- effects connective tissue
-smoking
-family Hx
-syphilis and other infections
-congenital defects (birth defect)

Question 5

Aortic aneurysm rupture/ dissection differential diagnosis

Answer 5

-ACS
-PE
-muscular back pain
-other abdominal complaint
-resolved abdominal complaint

Question 6

Treatment and management

Answer 6

-oxygen if hypoxic
-analgesia (not morphine if hypotensive)
-permissive hypotension- systolic between 70-90 mmHg unless reduced LOC

Question 7

When to direct to arterial centre

Answer 7

-sudden onset abdominal/ lower back pain with previously diagnosed AAA that hasn’t been repaired
-sudden onset lower back pain/ abdominal with age 50+ and palpable AAA
-outside of this patients should go to ED

Question 8

When to convey to nearest ED

Answer 8

-cardiac arrest
-can’t manage airway safely
-end of life
-patient has advanced directive declining surgery even if life is at risk