Chapter 50

Question 1

What are the risk factors for AAA?

Answer 1

Age > 60, male, smoking history, hypertension, CAD

Question 2

What is differential diagnoses for acute abdominal pain and patients over 50?

Answer 2

AAA, Acute MI, perforated peptic ulcer, pancreatitis, mesenteric ischemia

Question 3

What physical examination findings point to ruptured abdominal aortic aneurysm?

Answer 3

Pulsatile mid abdominal mass, cold clammy extremities

Question 4

After physical examination which should be done?

Answer 4

Imaging to increase diagnostic accuracy including abdominal CT scan or bedside ultrasound

Question 5

When is that surgery be consulted?

Answer 5

After imaging

Question 6

What is preferred over open repair in AAA? Why?

Answer 6

Emergency (EVAR) endovascular aneurysm repair; Open repair has a surgical mortality of 40 to 50%

Question 7

What preoperative antibiotic prophylaxis to be given to abdominal aortic aneurysm rupture surgical patients?

Answer 7

IV Cefazolin or IV vancomycin if allergic to penicillin

Question 8

What is all done after positive imaging?

Answer 8

IV fluids, anti-medics, analgesia, surgical consultation, pre-op orders, transferred to ICU

Question 9

After emergency orders how should a patient be managed if unstable (SBP < 90)? Stable?

Answer 9

Immediately consult vascular surgery and surgical intervention without delay. If (> 90 and talking) then urgent confirmatory test is required along with consult and Surgical intervention

Question 10

Although the test may not be obtained before surgery what are the pre-op orders?

Answer 10

CBC, BMP, PTT/PT/INR, blood type and crossmatch, IV cefazolin and NPO

Question 11

What home medications Should be deseed in this patient?

Answer 11

Metoprolol and aspirin

Question 12

What is the definitive therapeutic order for this patient?

Answer 12

Repair aortic aneurysm abdominal, stat (aneurysmectomy)