An abdominal aortic aneurysm is an enlarged area in the lower part of the aorta, the major blood vessel that supplies blood to the body.
· Sudden collapse/ syncope,
· Age > 60 yrs,
· Usually severe abdominal, loin or back pain,
· Hypotension and syncope (40% present with only syncope) but may even be hypertensive initially
80% are asymptomatic prior to diagnosis.
Be VERY cautious diagnosing new renal colic in over 60’s year-olds, it is an aneurysm until proven otherwise!
There may be few clinical findings.
Often appear distressed, pale, sweaty & tachycardic with mottled skin of the lower abdomen
Only 75% are palpable, < 50% are pulsatile.
Exclude other causes.
Involve surgical team ASAP.
Don’t delay surgery while investigating patients- the first line investigation is laparotomy!
1. ABC’s and Resuscitation as indicated,
2. High flow Oxygen,
3. Baseline observations and continuous monitoring,
4. IV access 2 x large bore lines,
5. FBC, U&E’s, LFT’s, Lipase, Coagulation studies, cross match 6 units,
6. Arterial Blood Gases (Arterial line preferable),
8. IV crystalloid/ Gelofusine to maintain Systolic Blood Pressure at 90mmHg (Don’t aim for normotension),
9. Analgesia IV Morphine 2.5-5 mg increments until comfortable,
11. Nil by mouth,
12. Focused Assessment with Sonography in Trauma (FAST), if available, to look for free fluid in the peritoneum,
13. CXR, CT, USS abdomen- as guided by , time, facilities & clinical stability,
Consider use of pneumatic anti-shock suit (MAST) for transfer.