AAA Symptoms and Treatment
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Questions and Answers

What symptom is most characteristic of a ruptured AAA?

  • Dull, vague abdominal pain
  • Severe flank pain
  • Syncope due to hypotension (correct)
  • Pulsatile mass sensation

Which of the following is an indication of 'Blue Toe' syndrome?

  • Micro emboli from aortic thrombus (correct)
  • Severe weight loss due to duodenal obstruction
  • Diminished femoral pulses
  • Acute pain in the abdomen

What is the recommended monitoring frequency for an AAA smaller than 4.0 cm?

  • Every month
  • Every 6 months
  • Every year
  • Every 3 years (correct)

Which complication is associated with vertebral body erosion in AAA?

<p>Severe back pain (A)</p> Signup and view all the answers

Which treatment is beneficial for managing small aneurysms between 4.0 and 5.4 cm?

<p>Regular monitoring with imaging (D)</p> Signup and view all the answers

What is the normal range for cardiac output (CO)?

<p>4-8 liters (C)</p> Signup and view all the answers

Which statement is true regarding stroke volume (SV)?

<p>Normal stroke volume ranges from 50-100 ml/beat. (D)</p> Signup and view all the answers

What does the systemic vascular resistance (SVR) primarily measure?

<p>The resistance faced by the left ventricle. (A)</p> Signup and view all the answers

What is the normal cerebral perfusion pressure (CPP)?

<p>60-100 mm Hg (B)</p> Signup and view all the answers

Which condition can increase intracranial pressure (ICP)?

<p>Arterial pressure fluctuations (D)</p> Signup and view all the answers

Which of the following accurately describes the relationship between PVR and SVR?

<p>PVR is one-sixth of the SVR. (B)</p> Signup and view all the answers

What is a potential complication associated with a Swan Ganz catheter?

<p>Air emboli (A)</p> Signup and view all the answers

When monitoring ICP, at what anatomical landmark should the external transducer be leveled?

<p>At the foramen of Monro (D)</p> Signup and view all the answers

What is the recommended position for a patient to effectively drain cerebrospinal fluid?

<p>Head elevated at 30 degrees (A)</p> Signup and view all the answers

What is a potential consequence of removing cerebrospinal fluid too quickly?

<p>Dumping syndrome (C)</p> Signup and view all the answers

Which of the following signs is indicative of increased intracranial pressure (ICP)?

<p>Decerebrate posturing (A)</p> Signup and view all the answers

Which drug is considered a first-line treatment for reducing brain swelling associated with sodium issues?

<p>Hypertonic saline solution (D)</p> Signup and view all the answers

What is a potential side effect of administering mannitol?

<p>Pulmonary edema (B)</p> Signup and view all the answers

How should the administration of corticosteroids be approached in patients with traumatic brain injuries?

<p>Only given to patients with brain tumors (C)</p> Signup and view all the answers

What is the significance of monitoring glucose levels in patients receiving corticosteroids?

<p>To avoid hyperglycemia and potential infections (D)</p> Signup and view all the answers

Which of the following treatments should be avoided in patients with traumatic brain injuries?

<p>Corticosteroids (A)</p> Signup and view all the answers

Which statement is true regarding the use of CPAP in patients with heart problems?

<p>It increases the workload of breathing. (D)</p> Signup and view all the answers

Which characteristic is essential for a patient to receive Bi-PAP therapy?

<p>They must be able to breathe spontaneously. (B)</p> Signup and view all the answers

What is the appropriate action to take if a patient is to receive propofol?

<p>Monitor sedation using the RAAS scale. (D)</p> Signup and view all the answers

What must be ensured before administering RSI drugs?

<p>The provider is present at the bedside. (B)</p> Signup and view all the answers

Which of the following agents is considered a common sedative for intubation?

<p>Etomidate (A)</p> Signup and view all the answers

What does a RAAS scale of 0 to -2 indicate about a patient's sedation level?

<p>They may require less sedation. (B)</p> Signup and view all the answers

Which of the following is NOT a common neuromuscular blocking (NMB) agent?

<p>Propofol (C)</p> Signup and view all the answers

What effect does high-dose propofol administration have?

<p>Results in anesthesia. (C)</p> Signup and view all the answers

What is the primary function of the AV node in the cardiac conduction system?

<p>Relays impulse from the atria to the ventricles (C)</p> Signup and view all the answers

Which condition occurs above T6 after spinal shock subsides?

<p>Autonomic dysreflexia (C)</p> Signup and view all the answers

What is the estimated blood loss for a femur fracture according to the content?

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

Which is the recommended treatment for tension pneumothorax?

<p>Needle decompression followed by chest tube insertion (D)</p> Signup and view all the answers

What is a primary trigger for autonomic dysreflexia?

<p>Fecal impaction (C)</p> Signup and view all the answers

In the context of the cardiac conduction system, what is the role of the Purkinje system?

<p>Carries impulses to the ventricles and can act as a pacemaker if higher sites fail (C)</p> Signup and view all the answers

Which symptom is NOT associated with autonomic dysreflexia?

<p>Increased respiratory rate (A)</p> Signup and view all the answers

What is the primary treatment option for human bites that are 6 to 12 hours old?

<p>Antibiotics (D)</p> Signup and view all the answers

What intervention should be performed during the acute management of a spinal cord injury?

<p>Immobilization and stabilization of the cervical spine (A)</p> Signup and view all the answers

What condition results from prolonged immobility and compromised circulation following a femur fracture?

<p>Rhabdomyolysis (C)</p> Signup and view all the answers

What is the primary goal of administering TAPAZOLE, IODINE, and PROPRANOLOL in the context of an aortic rupture?

<p>To stabilize blood pressure and cardiac rhythm (C)</p> Signup and view all the answers

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

<p>To determine the presence of blood in the peritoneal space (C)</p> Signup and view all the answers

What is an important consideration when suctioning a patient in an emergency setting?

<p>Patients should always be pre-oxygenated before suctioning (C)</p> Signup and view all the answers

Which treatment is NOT typically indicated for elevated potassium levels?

<p>Hypertonic saline (B)</p> Signup and view all the answers

In the context of myocardial infarction, the administration of nitrates should be monitored due to their potential effect on which of the following?

<p>Blood pressure (D)</p> Signup and view all the answers

What distinguishes a STEMI from an NSTEMI in terms of ECG findings?

<p>ST segment elevations (A)</p> Signup and view all the answers

What type of angina is characterized by increasing frequency and severity of episodes?

<p>Unstable Angina (B)</p> Signup and view all the answers

In the management of sinus bradycardia, which intervention is appropriate for a symptomatic patient?

<p>Atropine administration (A)</p> Signup and view all the answers

What is the treatment of choice for stable SVT?

<p>Vagal maneuvers (C)</p> Signup and view all the answers

Which type of arrhythmia shows a rapid heart rate of 350-600 bpm and requires urgent management?

<p>Atrial Fibrillation (A)</p> Signup and view all the answers

Continuous renal replacement therapy (CRRT) is best described as:

<p>A continuous method for treating acute kidney injury (A)</p> Signup and view all the answers

How can oxygen saturation and cardiac rhythm be monitored during suctioning?

<p>With a pulse oximeter and ECG (A)</p> Signup and view all the answers

Which of the following medications is used for immediate relief of angina symptoms?

<p>Nitrates (D)</p> Signup and view all the answers

In the case of acute kidney failure, what is a defining characteristic?

<p>Sudden loss of kidney function due to various factors (A)</p> Signup and view all the answers

Flashcards

AAA Symptoms

Abdominal Aortic Aneurysm (AAA) symptoms can include dull abdominal, back, or flank pain, a pulsating abdominal mass, and hypotension (possibly leading to fainting).

AAA Rupture Location

A ruptured AAA is more likely to cause less immediate danger if located in the back due to tamponade effect.

AAA Complications

Complications of AAA include reduced femoral pulses, microemboli that cause 'blue toe' syndrome, duodenal blockages (causing vomiting, weight loss), and vertebral erosion (leading to severe back pain).

AAA Treatment Strategies

AAA management prioritizes controlling high blood pressure, quitting smoking, and managing other risk factors. Medical treatment like Statin and ACE inhibitors are used in some cases.

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AAA Monitoring

Smaller AAAs (less than 4.0 cm) are monitored less frequently than larger ones, typically every 3 years.

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Cardiac Output (CO)

The amount of blood pumped by the heart in one minute. Normal range is 4-8 liters.

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Cardiac Index (CI)

Measures the amount of blood pumped per minute per square meter of body surface area. Normal range is 2.5-4.5 liters.

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Stroke Volume (SV)

The amount of blood ejected from the heart with each beat. Normal range is 50-100 ml/beat.

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Systemic Vascular Resistance (SVR)

The resistance the left ventricle faces as it pumps blood throughout the body. Normal range is 800-1200.

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Pulmonary Vascular Resistance (PVR)

The resistance the right ventricle faces as it pumps blood through the lungs. Normal range is 50-250.

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Cerebral Perfusion Pressure (CPP)

The pressure needed to ensure adequate blood flow to the brain. Calculated as MAP - ICP.

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Increased Intracranial Pressure (ICP)

Pressure within the skull. Normal range is less than 15 mmHg. Values greater than 20 mmHg are concerning.

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Factors Affecting ICP

Influenced by arterial pressure, venous pressure, posture, including head of bed elevation.

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ICP Drainage Position

Position the patient at 30 degrees to facilitate drainage of cerebrospinal fluid (CSF) from the brain.

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CSF Drainage Rate

Remove CSF slowly at a rate of 20-30 ml per hour to avoid rapid pressure changes in the brain.

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Dumping Syndrome

Rapid removal of CSF can lead to a sudden drop in pressure, causing cerebral blood flow to shift, a condition known as dumping syndrome.

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Decerebrate Posturing

Extensor posturing characterized by arms extended and rotated outwards, indicating severe brain injury.

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Decorticate Posturing

Flexor posturing with arms flexed towards the body, indicating moderate brain injury.

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Cushing Triad

A sign of increased ICP characterized by high blood pressure, slow heart rate, and irregular breathing.

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Mannitol (Osmitrol)

A drug that draws fluid from the brain into the bloodstream, reducing swelling by decreasing CSF production.

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Hypertonic Saline

A concentrated salt solution that draws water from the brain into the bloodstream, reducing swelling.

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CPAP for Heart Problems

Continuous positive airway pressure (CPAP) should be used cautiously with patients with heart problems because it can increase their workload and worsen their fatigue.

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Bi-PAP Requirements

Bilevel positive airway pressure (Bi-PAP) requires the patient to be able to breathe spontaneously and cooperate with the treatment. They must be able to remove the mask themselves and remain awake and alert.

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Bi-PAP Safety Precautions

When using Bi-PAP, ensure a good mask fit, monitor for secretions, and provide bedside supervision to prevent mask removal.

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Benzodiazepines for Sedation

Benzodiazepines like Ativan (lorazepam) and Versed (midazolam) are commonly used for sedation. Flumazenil (Romazicon) is the antidote.

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Propofol Sedation

Propofol (Diprivan) is another common sedative. It has a short half-life and requires a dedicated IV line and frequent tubing changes.

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Neuromuscular Blocking Agents (NMBs)

NMBs like Zemuron (rocuronium), Norcuron (vecuronium), Tracrium (atracurium), Pavulon (pancuronium), and Succinylcholine temporarily paralyze muscles.

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RSI Drug Administration

Rapid sequence intubation (RSI) drugs, including sedatives and paralytics, should NEVER be given until the provider is at the bedside.

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Raas Scale for Sedation

The Raas scale measures the level of sedation. A score of 0 to -2 indicates adequate sedation, while higher positive numbers indicate deeper sedation.

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SA Node Pacemaker

The sinoatrial (SA) node is the natural pacemaker of the heart, initiating electrical impulses at a rate of 60-100 beats per minute.

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AV Node Function

The atrioventricular (AV) node relays electrical impulses from the atria to the ventricles, delays the impulse to allow ventricle filling, and blocks excessive atrial impulses.

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What happens if the SA node fails?

If the SA node fails, the AV node takes over as the pacemaker, but at a slower rate of 40-60 beats per minute.

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Bundle of His Function

The Bundle of His connects the AV node to the ventricles, carrying impulses through bundle branches to stimulate ventricular contraction.

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Purkinje System Role

The Purkinje system extends from the bundle branches and spreads electrical impulses throughout the ventricles. It can become the pacemaker if higher sites fail, but at a much slower rate (20-40 beats per minute).

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Tension Pneumothorax Treatment

Tension pneumothorax requires immediate needle decompression followed by insertion of a chest tube.

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Femur Fracture Complications

Femur fractures can lead to significant blood loss, compartment syndrome, and rhabdomyolysis.

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Rhabdomyolysis Consequences

Rhabdomyolysis leads to elevated lactic acid (metabolic acidosis), myoglobin release (renal failure), and increased potassium levels.

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Autonomic Dysreflexia

Autonomic dysreflexia occurs in patients with spinal cord injuries above T6 and is characterized by sudden hypertension, headache, sweating, flushing, and bradycardia.

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Autonomic Dysreflexia Trigger

Common triggers for autonomic dysreflexia include tight clothing, full bladder, bowel impaction, skin stimulation, and pain.

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Retroperitoneal Aortic Rupture

A serious medical emergency where the aorta, the main blood vessel in the body, ruptures in the space behind the abdominal cavity. This can lead to severe internal bleeding and shock.

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FAST Exam

A focused assessment with sonography for trauma. It's a quick ultrasound scan used to check for internal bleeding in the abdomen, particularly in the case of trauma.

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Suctioning Procedure

A medical procedure to remove secretions from the airways, often used in patients who are unable to cough on their own. It's typically done every 2-4 hours and as needed.

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Suctioning Precautions

Pre-oxygenate the patient, limit suctioning to 10 seconds, monitor oxygen saturation and EKG for heart rhythm problems, and never use normal saline in the endotracheal tube.

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Elevated Potassium Treatment

High potassium levels in the blood can be dangerous. Common treatments include calcium gluconate, bicarbonate, insulin, glucose, and kayexalate (a medication that removes potassium through the stool).

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Acute Kidney Failure

A sudden decline in kidney function, often due to illness, injury, or toxins. With early detection, it's often reversible.

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Chronic Kidney Disease

A long-term condition where the kidneys gradually lose their ability to function. Progresses slowly over time.

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Hemodialysis

A process that filters and cleanses the blood for patients with kidney failure. Requires access to a large blood vessel.

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CRRT: Continuous Renal Replacement Therapy

An intensive form of dialysis, performed continuously rather than intermittently, for managing severe kidney failure.

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Peritoneal Dialysis

A form of dialysis where a solution is introduced into the abdominal cavity, absorbing waste products from the blood.

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MI (Myocardial Infarction)

Heart attack. A condition where the heart muscle is damaged due to lack of blood supply. Symptoms can vary from no symptoms to sudden cardiac arrest.

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MI: Chest Pain

Typical heart attack chest pain radiates to the neck, jaw, shoulder, back, or left arm. It may feel like pressure or tightness. Pain can also be felt in the stomach (epigastric).

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MI: Aspirin

Chewable aspirin is given during a heart attack to help thin the blood and prevent future clots. Dosage is 81-325 mg.

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MI: Nitrates

Nitroglycerin is a medication that dilates blood vessels, improving blood flow to the heart muscle. It can be given sublingually, intravenously, or topically.

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MI: Morphine Sulfate

Morphine is used to relieve pain and anxiety during a heart attack. It's administered intravenously, typically 2-8 mg diluted in normal saline.

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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 the abdomen
  • Hypotension (often manifesting as syncope)
  • Usually occurring in ruptured AAA cases
  • Diminished femoral pulses

Associated Complications

  • Blue Toe Syndrome
  • Duodenal obstruction (vomiting, weight loss)
  • Due to micro-emboli from aortic thrombus
  • Vertebral body erosion, causing severe back pain

Where AAA Ruptures

  • Best place for rupture is in the back or posterior because it can tamponade and hold pressure, if it ruptures anteriorly it is a life-threatening situation

Treatment

  • Medical Management:
    • Control hypertension
    • Quit smoking
    • Control other risk factors
    • ACE inhibitors and/or statins may be beneficial
  • Monitoring small aneurysms (4.0 to 5.4): Ultrasound or CT scans every 6-12 months
  • Monitoring smaller aneurysms (less than 4.0cm): CT scans every 3 years
  • Open repair is more complex and requires careful monitoring of kidneys, urine output, and pedal pulses to ensure extremities remain functional.
  • Monitor neurologic, peripheral perfusion, and renal perfusion status

Hemodynamic Monitoring (Page 2)

  • Markings on catheter: thin lines=10 cm, thick lines= 50 cm
  • Various types of waveforms and values are shown (RV, PA, RA, PAWP).

Cardiac Output (CO), Cardiac Index (CI), Stroke Volume (SV), Systemic Vascular Resistance (SVR), and Pulmonary Vascular Resistance (PVR)

  • Normal CO is 4-8 liters
  • Normal CI is 2.5-4.5 liters
  • Normal SV is 50-100 ml/beat
  • Normal SVR is 800-1200
  • Normal PVR is 50-250

Cerebral Perfusion Pressure (CPP)

  • Pressure needed to ensure blood flow to the brain
  • Calculated by CPP=MAP-ICP

Intracranial Pressure (ICP)

  • Factors influencing ICP: arterial pressure, venous pressure
  • Posture: keep head elevated
  • Neuro assessments are crucial
  • Keep patient at 30 degrees to drain cerebrospinal fluid slowly.

Hypertonic Saline Solution

  • 3% Saline used as a first-line treatment for brain swelling
  • Monitor sodium and potassium levels during use

Cerebral Vasospasm/Subarachnoid Hemorrhage (SAH)

  • Silent killer, symptoms may be delayed until it happens
  • Worse headache of their life
  • Calcium channel blockers for brain protection
  • Clipping of aneurysm is a common surgical procedure to prevent rebleeding
  • Coiling (another surgical procedure)

Other Medical Conditions

  • Various medical conditions including brain death, ischemic stroke, hemorrhagic stroke, traumatic brain injury, pneumothorax, femur fracture, autonomic dysreflexia, spinal cord injury are discussed.
  • Treatment options, diagnoses, and monitoring of these are also included.

Rhythms, Monitor, and Drugs

  • Various cardiac rhythms and their corresponding treatments are detailed. (e.g., sinus bradycardia, sinus tachycardia, atrial tachycardia, atrial fibrillation, ventricular tachycardia, ventricular fibrillation, asystole)
  • Associated drugs (e.g., atropine, calcium channel blockers, lidocaine, amiodarone, digoxin) for various conditions are also noted.
  • Detailed information on treatment procedures for various conditions like cardiac rhythm abnormalities and related interventions (e.g., defibrillation, pacing).

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Medical Notes on AAA and Related Conditions PDF

Description

This quiz explores the symptoms, complications, and treatment options for Abdominal Aortic Aneurysms (AAA). Learn about the critical signs indicating a rupture and the management strategies employed to handle AAA effectively. Perfect for medical students and healthcare professionals.

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