AAA Symptoms and Treatment Overview
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Questions and Answers

What is the primary symptom indicating a ruptured AAA?

  • Hypotension manifesting as syncope (correct)
  • Dull, vague abdominal pain
  • Severe, acute back pain
  • Sensation of a pulsatile mass

    • Which statement regarding the rupture of an AAA is true?

  • Ruptures are more likely to occur anteriorly.
  • An anterior rupture is less fatal than a posterior one.
  • Ruptures are equally dangerous in all locations.
  • A posterior rupture can lead to tamponade. (correct)

    • What condition is suggested by the presence of 'Blue Toe' Syndrome?

  • Micro emboli from aortic thrombus (correct)
  • Chronic arterial obstruction
  • Aneurysm size exceeding 5.4 cm
  • Severe hypotension

    • Which of the following is a recommended treatment for AAA management?

    <p>Control hypertension and quit smoking</p> Signup and view all the answers

    How frequently should small aneurysms (4.0 to 5.4 cm) be monitored?

    <p>Every 6 to 12 months using ultrasound or CT</p> Signup and view all the answers

    What is a common cause of hyperthyroid crisis?

    <p>Digitalis toxicity</p> Signup and view all the answers

    Which of the following is a key feature of diabetic ketoacidosis (DKA)?

    <p>Fruity breath</p> Signup and view all the answers

    In the context of hyperglycemic hyperosmolar state (HHS), which symptom is NOT typically present?

    <p>Fruity breath</p> Signup and view all the answers

    Which of the following conditions is often associated with myxedema coma?

    <p>Long-standing hypothyroidism</p> Signup and view all the answers

    What is the primary cause of dehydration seen in DKA?

    <p>Osmotic diuresis</p> Signup and view all the answers

    Which symptom is most indicative of thyroid storm?

    <p>Severe agitation and confusion</p> Signup and view all the answers

    What differentiates HHS from DKA regarding blood glucose levels?

    <p>Blood glucose in HHS is significantly higher than in DKA</p> Signup and view all the answers

    In which age group is myxedema more commonly observed?

    <p>Older adults</p> Signup and view all the answers

    What is a significant consideration when using CPAP for patients with heart problems?

    <p>It can lead to exhaustion due to increased breathing effort.</p> Signup and view all the answers

    What is the primary requirement for a patient to effectively use Bi-PAP?

    <p>They need to be able to spontaneously breathe and cooperate.</p> Signup and view all the answers

    Which drug is known as an antidote for benzodiazepine sedation?

    <p>Flumazenil</p> Signup and view all the answers

    At what dosage range does Propofol produce a state of deep sedation?

    <p>5-50 mcg/kg/min</p> Signup and view all the answers

    Which is NOT a common neuromuscular blocking agent (NMB) listed?

    <p>Morphine</p> Signup and view all the answers

    Why must RSI drugs never be administered until the provider is at the bedside?

    <p>It may induce respiratory arrest or other serious complications.</p> Signup and view all the answers

    What does the RAAS scale measure in relation to sedation?

    <p>Depth of sedation</p> Signup and view all the answers

    What is a critical requirement for tubing when delivering Propofol?

    <p>Change tubing at least every 12 hours.</p> Signup and view all the answers

    What is a significant risk associated with high levels of PEEP?

    <p>Barotrauma</p> Signup and view all the answers

    What is the normal pacemaker rate of the heart initiated by the SA node?

    <p>60-100 beats per minute</p> Signup and view all the answers

    In assist-control ventilation (ACV), how does the ventilator respond when a patient initiates their own breath?

    <p>The patient still receives the set tidal volume</p> Signup and view all the answers

    What is one of the main functions of the AV node?

    <p>Allowing for ventricle filling</p> Signup and view all the answers

    Which ventilation mode allows the patient to self-regulate the volume of spontaneous breaths?

    <p>Synchronized intermittent mandatory ventilation (SIMV)</p> Signup and view all the answers

    Which structure can assume the role of a pacemaker if higher sites fail, and at what rate?

    <p>Purkinje system at 20-40 beats per minute</p> Signup and view all the answers

    What is the primary purpose of pressure support ventilation (PS)?

    <p>To reduce the work of breaths</p> Signup and view all the answers

    What is true about patients using noninvasive ventilation?

    <p>They must be able to remove the mask if needed</p> Signup and view all the answers

    What is a critical first step in managing a spinal cord injury?

    <p>Limiting further destruction with immediate care</p> Signup and view all the answers

    How does continuous positive airway pressure (CPAP) function in relation to functional residual capacity?

    <p>It consistently prevents airway pressure from falling to zero</p> Signup and view all the answers

    What should be done immediately for a patient experiencing tension pneumothorax?

    <p>Perform needle decompression followed by chest tube insertion</p> Signup and view all the answers

    Which of the following is NOT a common presentation of autonomic dysreflexia?

    <p>Hypotension</p> Signup and view all the answers

    Which mode of mechanical ventilation typically provides the greatest control?

    <p>Pressure control intermittent mandatory respiration (PC-IVR)</p> Signup and view all the answers

    What does the term 'PEEP' stand for in ventilatory support?

    <p>Positive end-expiratory pressure</p> Signup and view all the answers

    What is the estimated average blood loss associated with a femur fracture?

    <p>1,276 mL</p> Signup and view all the answers

    What is a key intervention for treating poisoning situations?

    <p>Administer activated charcoal if applicable</p> Signup and view all the answers

    Which type of bite requires immediate antibiotics due to the risk of infection?

    <p>Cat bites</p> Signup and view all the answers

    What is a primary characteristic of neurogenic shock?

    <p>Loss of sympathetic nervous system innervation</p> Signup and view all the answers

    What is the primary purpose of performing a focused abdominal sonography for trauma (FAST) in suspected intra-abdominal hemorrhage?

    <p>To confirm blood loss in the peritoneal space</p> Signup and view all the answers

    In the management of elevated potassium levels, which of the following treatments does NOT involve insulin?

    <p>Calcium gluconate</p> Signup and view all the answers

    Which condition is characterized by sudden and potentially reversible loss of kidney function?

    <p>Acute kidney failure</p> Signup and view all the answers

    What distinguishes a STEMI from an NSTEMI on an ECG?

    <p>Development of Q waves</p> Signup and view all the answers

    In treating stable angina, which of the following is NOT typically used?

    <p>Antidysrhythmic drugs</p> Signup and view all the answers

    What does the treatment for sinus bradycardia depend on?

    <p>Presence of symptoms</p> Signup and view all the answers

    How does peritoneal dialysis primarily function to treat kidney failure?

    <p>Through dialysate exchange</p> Signup and view all the answers

    Which of the following options is indicated for an unstable patient experiencing atrial fibrillation?

    <p>Synchronized cardioversion</p> Signup and view all the answers

    Which medication is used to promote vasodilation and coronary collateral circulation in myocardial infarction treatment?

    <p>Nitrates</p> Signup and view all the answers

    In sinus tachycardia, which of the following can be a cause?

    <p>Severe dehydration</p> Signup and view all the answers

    Which treatment option requires rapid blood flow and access to a large blood vessel?

    <p>Hemodialysis</p> Signup and view all the answers

    What is the correct action when managing a patient in acute kidney failure?

    <p>Always place on a cardiac monitor</p> Signup and view all the answers

    What is the characteristic respiration pattern observed with sinus arrhythmia?

    <p>Speeds up and slows down with breathing</p> Signup and view all the answers

    Study Notes

    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

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    Medical Notes on AAA and Related Conditions PDF

    Description

    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.

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