Chapter#37_Disorders of the Aorta Flashcards
Aneursym is found
Accidently
Slide#19
Common Manifestation of Aneursym
Pain
Interscapular Pain
In aneurysm
Inner lining of the artery is destroyed in aneuyrsm. Tear in the inner lining of arterial wall
Only be found accidently:
Brain aneurysm
Thoracic Aneurysm
Abdomen aneurysm
3 types of aneurysm
Aortic Dissection
Thoracic
Abdominal
In aneurysm
Weakening of the atrial wall
Risk Factors for aneuyrsm
Women
Increase in Age
Slide#3 Atheroscleorosis
Hardening of arteries
Slide#10 Big risk factor for atherosclerosis
the plaque dries up and breaks up
Risk factors for atheroscleorosis
Risk factors slide#11 and slide#12
CAD
PAD
HP
Hyperlipedemia
Inflammatory and infections?
Risk factors slide#11 and slide#12
Modifiable risk factors are Tobacco and Obesity
Slide#15
True or False Aneurysm
A. Fusiform anf Sacculated are true aneursym
B. part is false shows aortic disection = walls leaks.
«Test Qn»
In TIA (transient ischemic attack)
You will feel:
Coughing
Obstructing Swallowing
Dysphagia «Test»
Slide#21
TIA
Suppress on superior vena cava
Edema of Face and Arms Problem with flow
In Aneusrym
Audible pulse or brui detected in brui = Brui Heard
Slide #22
s/s Aneuyrsm
Epigatric Pain
Altered Bowel Elimination
Intermittent Claudication
AAA Hx what is prohibited
Palpitations is prohibited
Listen to Brui
Abdomen X-Ray/ CT-scan
Never ascultate over top of abdomen
Slide #24
Rupture into retroperitoneal space
Qn. How do you know with aneurysm pt. is bleeding?
Grey Turners sign
BP drops
Tachycardia
RR increases
Absent pedal pulses when rupture as there is no circulation
Aneurysm rupture
Action to be taken: Fluid + Blood Transfusion immediately
Cold and Clammy
Absent pedal pulse = Take BP
Slide#26
with aneursym, pedal pulses not felt, BP is very important
Diagnostic: Chest X-ray
Chest Pain actions
If not MI, then AA making chest pain
Slide#26 #27
Monitor aneurysm size
6 cm or more is serious
CT scan for aneursym where is it anterior or posterior
Slide#28
Thrombosis
Slide#30
Goal of aneursym
Prevent neurysm from rupturing
Post-op aneuyrsm
Monitor for bleeding
Blood clot
SCD
Slide#33
Op aneurysm: Doctor determines
any kind of comorbidities that will influence pt. surgical risk
Lung,
Heart,
Kidney
Genetic Disorder: Marfan Syndrome = Operate immediately
Note:
90% Mortality with AAA rupture
Slide#35
Pre-op aneurysm
NPO
Pt. wakes up will have tubes coming out from everywhere
8 hours to do surgery
Electrolytes K, Na shoudl be goof
Type and cross blood match = it is an arterial operation
PT/ PTT/ aPTT everything should be good.
Slide# 50
Potentially lehtal complication in emergency repair
IAH + ACS
Compartment means closed = swollen after surgery
Compartment syndrome:
Reduces blood flow to viscera
Eng-organ perfusion impaired
IAH Treatment
Open surgical compression
Percutaneous drainage
Position dorsal = Intraabdominal decompression = lots of fluid needed
Indications of Sneuyrsm rupture
Pale/ Diaphoresis/ Weakness/Tachy/ Hypotension
Slide#56
Indications fo ruptured AAA
Pain in abdomen, back, groin, priumblical pain
Assess: Take Vital Sign = BP + Tachycardia
Slide#63
Post-op care
CVP (Central Venous Pressure)
Arterial line monitoring for accurate BP
- Give pain med for pt. control BP
- Check urine o/p
- Accurate urinary o/p > since its abdominal
Replace fluid for low urine o/p
Slide#68
Avoid injection for septic shock
Administer antibiotics
Not high = not going for sepsis monitor WBC
Slide#73
Renal Perfusion Status
Urinary output low
BUN and Creatinine measured
Aortic disection = lumen is destroyed is type A or type B (true or false aneuyrsm?) destruction of arterial wall of artery
Slide#83
Cause of aterial wall xxxxxxxx called
Aortic dissection
Slide #86
Scapular radiating from scapular to spine to lungs
Nitro will not work
Sharp and worse pain ever with aneuyrsm mimics
MI
But not really MI
Its angina = hear a new high pitch sound called heart murmur
With Aneuyrsm / aortic dissection
Slide # 87
Tear: causes blood to ooze out
Dyspnea = develop as pain
Complication of aortic dissection results in
HF
Aortic dissection leads to
Cadiogenic Shock
Pt. ray or cyanotic, eventually pt. can die
In aorta develops to
Cardiac Tamponade
Slide#89
Pericardial sac fluid accumulates = how can your heart expan?
Pericardialcentesis
Aortic disection cause
HTN leads to aortic dissection then BP drops
Goal with aortic dissection
to decrease the SBP = 120 to minimize injury to arterial wall and destroy inner lining of artery
Slide#88 and Slide#89
Cardiac tamponade is resolved by
Pericardialcentesis
Pericardial sac is filled with fluid= how can the heart expand
Pericardialcentesis
Cardiac Tamponade s/s
Narrowed pulse pressure
Distended Neck Veins
Muffled Heart Sound
Diagnostic Slide#91
CXR
CT scan
3D bleeding coming from MRI transection
PPE (TTE)
Slide#93: Pain Mgmt
Slow heart give beta blockers like Esmolol
Morphine = SNS stimulation
CC decreases HR
Give ACE
Slide#95
Temporary Chain
TEVAR (Thoracuc Endovascular Aortic Repair)
Prevent Paralysis
