Ruptured Aortic Aneurysm (RAA) - Assessment & Treatment

Question 1

RAA - Classic signs of

Answer 1

• > 50YO
• Severe pain in abdo (AAA), back/chest (Thoracic AA)
• History of hypertension
• pain killers ineffective,
• tearing pain
• collapse
• syncope
• Vomiting
• Cold and sweaty (shock)

Question 2

RAA - Overall aproach to

Answer 2

I would want to approach using a DRABCDE system to assess how acutely unwell the patient is and be able to assess if they are deteriorating.
This will also help inform my secondary survey.
The secondary survey will enable me to narrow down the differential diagnosis.

Question 3

RAA - DRABCDE (expect to find)

Answer 3

RESPONSE:
• Collapse

CIRCULATION:
• Tachycardia – compensation for hypovolaemia
• Hypotension – due to hypovolaemia from bleeding into thoracic or abdo cavity
• Bilateral lower limb ischaemia
• Signs of inadequate perfusion
• ? >20mmHg diff in BiLat BP = indicator but not common

Question 4

RAA - ECG

Answer 4

o Rule out referred pain from Acute Coronary Syndrome
o May be having MI due to Ruptured AA
o With thoracic aortic dissection, the ECG will either be normal or shows only nonspecific ST-T changes

Question 5

RAA - Questioning

Answer 5

o HPC – Collapse?
o SOCRATES – very good for differential

o PMH – Hypertension, Smoker, new diagnosis of renal colic in pt >50 = high level of suspicion, hypercholesterolaemia, previous abdo/aortic surgery, known aneurysm?, Marfans

o Meds – Drugs for hypertension (Beta blockers, ACE inhibitors, Diuretics, etc)

o SHx -

Question 6

RAA - Inspection

Answer 6

• Area of pain
• Pulsating mass
• Bruising
• Bilateral lower limb ischaemia
• Signs of inadequate perfusion

Question 7

RAA - Palpate

Answer 7

o quality of radial pulses – strength, rhythm, rate, comparison with apex beat
o Very light to avoid any further damage
o Pulsating mass?
o Mass?
o Pain? Region? Boarding? Guarding?

Question 8

RAA - Percuss

Answer 8

o If abdominal – help with differential

Question 9

RAA - Auscultate

Answer 9

o Bruits (Aortic) – sign of aneurysm due to turbulent blood flow

Question 10

RAA - Diffential Diagnosis Notes

Answer 10

Cannot diagnose AA prehospitally,

Can gain a high level of suspicion to help the patients treatment

Differential diagnosis for a ruptured TAA - chest pain, especially MI with cardiogenic shock or massive pulmonary embolism.

Differential diagnosis for ruptured AAA - other causes of abdominal pain, including acute abdomen.

Question 11

RAA - Treatment & Management

Answer 11

1. Correct any major ABCD problems
2. If suspected leaking or ruptured aortic aneurysm:
3. correct A&B and time critical transfer to appropriate hospital or follow local guidelines
4. Provide pre-alert
5. Continue management en-route
6. Oxygen if needed (

Question 12

RAA - Extrication

Answer 12

Trolley if possible or chair then trolley

Question 13

RAA - Treatment (Need to be prompt)

Answer 13

If patient is showing signs of shock due to possible AA they can deteriorate very quickly.

No more than 1/3 reach hospital alive and 20% of those who do get to hospital will not get to theatres in time.

5L of blood can be lost in 3-4 mins