Abdominal aortic aneurysm rupture

00:00

  • Abdominal aortic aneurysm rupture
An 73-year-old woman calls EMS and complains of sudden worsening of three days lasting abdominal pain. Today she vomited and she feels faint. The pain's getting worse with irradiation into tower back. The patient is brought by the ambulance to the emergency room - here she is conscious, clammy, hypotensive, afebrile, with inserted venous catether of G18 diameter. The abdomen is distended, painful, with impaired peristalsis. What tests will you perform in the ED?

Blood tests (full blood count, coagulation, ions, acid-base balance), abdominal X-Ray.

Incorrect answer

Blood test is a basic examination, which may help to the correct diagnosis. Abdominal X-Ray we would rather use in case of suspected ileus, clinical condiciton of the patient does not indicate it.


Back

Blood tests (full blood count, coagulation, ions, acid-base balance), abdominal ultrasound.

Correct answer

Blood test is a basic examination, which may help to the correct diagnosis. Abdominal ultrasound seems to be at this point the most beneficial imaging technique. RESULTS: A large hematoma in the right half of the abdominal cavity, free liquid in the subhepatic space.


Continue

Blood tests (full blood count, coagulation, ions, acid-base balance), ECG.

Incorrect answer

Blood test is a basic examination, which may help to the correct diagnosis. Although ECG is at the ED always done, here we have to use a different examination to find the origin of abdominal pain.


Back

Blood tests (full blood count, coagulation, ions, acid-base balance), abdominal CT.

Correct answer

RESULT: Abdominal aortic aneurysm + aneurysmatic dilatation of lower thoracic aorta. (Remark: The location of rupture cannot be identificated because of haemorrhagic shock at the time of examination.) Blood test is a basic examination, which may help to the correct diagnosis. Indication for CT examination is correct, but in the ED we must act as quickly as possible. That's why we prefer to use the fastest available method, which is abdominal ultrasound. According to the results and clinical condition of the patient we complete the examination with abdominal CT.


Continue

?

Help

EMS = emergency medical system, ED = Emergency department×
 
RR

21 bpm

HR

120 bpm

SpO2

95 %

BP

89/65 mmHg

ECG

sinus rhythm

Examination:
Past medical history: hypertension treated by drugs, Type 2 diabetes treated with oral antidiabetics, chronic bronchial asthma. Today the patient took 4 pills of Ibuprofen 400 mg.

Physical examination: the abdomen is diffusely painfull, distended, with impaired peristalsis, pulsating resistance

glc

Results

ABG

not available

CBC

not available

biochem.analysis

not available