AAA Symptoms and Treatment Overview

AAA Symptoms

• Dull, vague pain in abdomen, back, or flank
• Can be acute and severe in ruptured AAA
• Sensation of a pulsatile mass in abdomen
• Hypotension (often manifesting as syncope)
• Diminished femoral pulses

AAA Associated Complications

• Rupture in cases of ruptured AAA
• Vomiting and weight loss due to duodenal obstruction resulting from aortic thrombus
• Vertebral body erosion causing severe back pain
• "Blue Toe" syndrome

AAA Location of Rupture

• Most common place of rupture is the back or posterior
• Anterior rupture is associated with a high mortality risk

AAA Treatment

• Medical Management:
  • Control hypertension
  • Smoking cessation
  • ACE inhibitors/statins may be beneficial to those with small aneurysms (4.0-5.4)
• Monitoring:
  • Ultrasound or CT every 6-12 months for small aneurysms (4.0-5.4)
  • Ultrasound or CT every 3 years for aneurysms smaller than 4.0
• Open repair: involves cross-clamping and monitoring of kidneys, urine output, pedal pulses, and extremity movement; more complex
• Monitoring Neurologic, Peripheral Perfusion, and Renal Status

Hemodynamic Monitoring (Page 2)

• Each thin line = 10 cm
• Each thick line = 50 cm
• Markings on catheter for RV, PA, RA, and PAWP waveforms
• Measurement values shown for normal waveforms

Cardiac Output, Index, Resistance (Page 3)

• Cardiac Output (CO): normal range 4-8 liters; calculated as heart rate x stroke volume
• Cardiac index (CI): normal range 2.5-4.5 liters/min/m²
• Systemic Vascular Resistance (SVR): normal range 800-1200 dynes/sec/cm⁻⁵
• Pulmonary Vascular Resistance (PVR): normal range 50-250 dynes/sec/cm⁻⁵
• Potential risks include air emboli, thromboembolism, displacement, infection

Cerebral Perfusion Pressure (Page 3)

• CPP = MAP - ICP (where MAP is mean arterial pressure and ICP is intracranial pressure)
• Normal range is 60-100 mmHg

Intracranial Pressure (ICP) (Page 4)

• Factors influencing ICP: arterial and venous pressure
• Posture: keeping the head elevated is important
• Neuro assessments are key
• Monitor IICP to prevent pockets of infarction due to increased ICP
• Level should be maintained below 15 mmHg

ICP Treatment

• Manage to keep below 15 mmHg
• Maintain positioning to drain CSF
• Monitor frequently (at least every hour)
• Monitor neurological, glucose, and GI bleeding.

ICP Signs of Increased ICP

• Decerebrate or decorticate posturing.
• Headache (often worse in the morning).
• Vomiting (projectile).
• Changes in LOC (from calm, cool to agitated/comatose)

ICP Cushing Triad

• Hypertension (elevated blood pressure)
• Bradycardia
• Irregular respirations

ICP Medications Therapy (Page 4)

• Mannitol
• Osmotic effect; can cause pulmonary edema and CHF
• Decreases cerebral spinal fluid

ICP Other Considerations (Page 5)

• Hypertonic saline (3% saline) or normal saline
• Corticosteroids (with caution) for certain reasons and not with trauma cases
• Monitor glucose levels
• Lasix (furosemide) to decrease cerebral swelling
• Antipyretics (cooling blankets or medications for fever), and no shivering because that increases pressure.
• Barbiturates (use with caution)
• Antiseizure medications
• Monitor the brain waves on a continuous EEG or monitor (in case they are prone to seizures)

Cerebral Vasospasm/Subarachnoid Hemorrhage (Page 5)

• Silent Killer
• Severe headache in the beginning- only symptom until an event
• Hypertension, hypervolemia, and hemodilution therapy
• Prevention of further bleeding is of utmost importance and requires clipping or coiling to prevent further bleeding.

Brain Death (Page 6)

• Oculocephalic (doll's eyes) test
• Oculovestibular (cold water in the ear) test
• Apnea test

Ischemic vs. Hemorrhagic Stroke (Page 6)

• Ischemic stroke: caused by clot and not bleeding
• CT scan first to determine the type of stroke
• Ischemic stroke, time from onset is critical; FAST (facial drooping, arm weakness, speech difficulty, time)
• Hemorrhagic stroke: involves bleeding into the brain
• Aspirin within 24-48 hours after stroke

Traumatic Brain Injury (Page 6)

• Raccoon eyes

Ventilator (Page 7)

• PEEP: maintaining airway pressure at the end of expiration
• Monitor for cardiovascular issues, decreased cardiac output and hypovolemia.
• PEEP range is usually 5-10 (but 5 is ready to be extubated)
• ACV: breaths delivered at a predetermined rate and tidal volume
• SIMV: breaths delivered at pre-set rate and tidal volume but the patient makes their own breaths at the same time

Noninvasive Ventilation (Page 8)

• CPAP (continuous positive airway pressure)
• BiPAP(bilevel positive airway pressure) Respiratory support that uses a mask to keep the airways open. Used for those who do not want a breathing tube.

Intubation Drugs (Page 8)

• Benzodiazepines (e.g., Ativan, Versed)
• Propofol
• Common sedation agents for assisting intubation

Rapid Sequence Intubation Drugs (Page 9)

• Etomidate, Ketamine and Propofol
• Commonly used to sedate patients quickly before intubation

ABGs (Page 9)

• pH: 7.35-7.45 values

End-Stage COPD (Page 10)

• Pulmonary hypertension
• Smaller meals because less oxygen uptake
• Rest
• Brochodilators
• Corticosteroids
• Infection prevention

Esophageal Varices (Page 10)

• Portal hypertension can enlarge veins
• Highly likely to bleed
• Watch for sharp foods because it can cause bleeds from veins
• Treat with endoscopic ligation, banding, or balloon tamponade

Acute Pancreatitis (Page 10)

• Severe abdominal pain (often near the belly button) that may radiate to back
• Decreased bowel sounds
• Possible low-grade fever

Cirrhosis (Page 11)

• Terminal complication of liver disease
• Avoid alcohol, aspirin, acetaminophen, and NSAIDs

Hepatic Encephalopathy (Page 11)

• Terminal liver disease complication
• Ammonia levels increase, causing cerebral edema
• Flapping hand tremor (asterixis)
• Lactulose to help bowels expel ammonia
• Monitor glucose closely and infections as infections love sugar.

HHS vs DKA (Page 11)

• HHS: less common than DKA, primarily in type 2 diabetic patients; caused by very high blood sugar levels
• DKA: more common in type 1 diabetics and often associated with illness or infection; causes elevated ketones in the blood
• HHS and DKA can be life threatening
• Monitor blood glucose and electrolyte levels

Hyperthyroidism (Page 12)

• Myxedema: puffiness, facial and periorbital edema, mask-like affect
• Thyroid storm/crisis: due to infection, trauma, emotional stress

Retroperitoneal Aortic Rupture (Page 13)

• Suspect intraabdominal hemorrhage (FAST exam)
• If hemorrhage suspected, focused abdominal sonography for trauma (FAST) test to assess for blood in the peritoneal space (hemoperitoneum).
• Medical emergency

Suctioning (Page 13)

• Every 2-4 hrs PRN
• Preoxygenate
• Monitor O2 sats and EKG for dysrhythmias
• Normal Saline is NOT for ETT

Elevated Potassium (Page 13)

• Calcium gluconate
• Bicarbonate (bicarb)
• Insulin
• Glucose
• Kayexalate

Chronic/Acute Renal Failure (Page 13)

• Sudden loss or kidney function caused by illness, injury, or toxins
• Can be reversible if caught early.

MI (Page 14)

• Unique symptoms for each patient, ranging from no symptoms to cardiac arrest.
  • Chest pain (may or may not be present)
  • Radiating pain (may radiate to arm, back, neck, or jaw)
  • Shortness of breath
  • Weakness, nausea, or vomiting
  • Cold sweats
  • Delay history in pain areas
• Nitroglycerin, Morphine Sulfate.

Spinal Cord Injury (Page 17)

• Critical that initial care & management is implemented ASAP
• Spinal shock, loss of reflexes, flaccid paralysis (below injury level)
• Neurogenic shock, loss of sympathetic nervous system innervation, hypotension, bradycardia
• Temperature dysregulation (unable to regulate body temperature)
• Assess, alert, breathing, circulation, and disability (ABCDEs)

Various Rhythms (Pages 15-24)

• Different ECG rhythm diagnoses discussed including Sinus Bradycardia, Sinus Tachycardia, Idioventricular Escape Rhythm, Atrial Tachycardia, Atrial Flutter, Atrial Fibrillation, Premature Ventricular Contractions (PVCs).
• Treatment (medical interventions) and related considerations of each rhythm type.
• Additional considerations such as drugs, monitoring, and unstable/stable diagnoses

Pneumothorax (Page 26)

• Simple
• Open
• Tension

Femur Fracture (Page 26)

• Study group average blood loss = 1276mL
• Compartment Syndrome, Rhabdomyolysis (increase in lactic acid and myoglobin; causes renal failure)

Autonomic Dysreflexia (Page 26)

• Above T6 spinal cord injuries (after spinal shock, usually)
• Triggers: tight clothing, distended bladder/bowel, skin stimulation/pain, fecal impaction
• Intervention: sit upright, assess triggers
• Medications to manage blood pressure: nitroglycerine, nitroprusside, or hydralazine

This quiz covers the key symptoms, complications, and treatments associated with Abdominal Aortic Aneurysms (AAA). Review the management strategies and learn about the typical locations of rupture and potential complications. Test your knowledge on AAA and enhance your understanding of this critical condition.