Wednesday, January 1, 2014

AAA and Dissecting AAA

Ran on this call about a month ago, and I want to talk about it.

You are dispatched to a patient with "chest pain." ATF 58 y/o M laying supine on couch. Pt is alert, GCS 15. Pt stated that he is having severe chest pain, that does radiate. He states that the pain is a "10" out of 10, and severe pressure. As you lift up his shirt, do perform a 12-lead ECG, you notice severe ecchymosis on his abdomen (ABD), that starts from the front and wraps all the way around to his back. The pt states that he has no ABD pain. You ask him how long he has had the bruising, and he stated that it was not there when he went to bed last night. Wife states that they went to bed around 10:00p. It is now 12:00a. Overall, your general impression of your pt, not good at all.

At this point, you realize that, most likely, the patient is not having an MI, but he in indeed had a ruptured abdominal aorta.  You immediately transport your pt, priority 1, to the closest, appropriate hospital.

After you drop your pt off in the ED, you talk with the doctor, and he states that the pt indeed have a rupture. They are preparing the pt to be air-lifted to a hospital with higher-level care.


Why would you NOT want to give ASA and/or Nitro to this patient?
-ASA is an anticoagulant, which prevents the clotting of blood.
-Nitro is a dilator, which will cause a faster bleed.

What is a AAA?
-Abdominal Aortic Aneurysm

What causes a AAA?
-HTN, Heart Surgery, Aging, Atherosclerosis, Blunt trauma to the chest or ABD

What causes it to rupture?
-The wall of the artery gives-way, due to all the pressure, thus causing it ti tear open, allowing the blood to pour into the ABD cavity.


The following will explain the signs/symptoms of a AAA. This information has been obtained from: Mediline Plus. (

The symptoms usually begin suddenly, and include severe chest pain. The pain may feel like a heart attack, and can:
  • Be described as sharp, stabbing, tearing, or ripping
  • Be felt below the chest bone, then move under the shoulder blades or to the back
  • Move to the shoulder, neck, arm, jaw, abdomen, or hips
  • Change position -- pain typically moves to the arms and legs as the aortic dissection gets worse
Symptoms are caused by a decrease of blood flowing to the rest of the body, and can include:
  • Anxiety and a feeling of doom
  • Fainting or dizziness
  • Heavy sweating (clammy skin)
  • Nausea and vomiting
  • Pale skin (pallor)
  • Ecchymosis of the abdomen 
  • Rapid, weak pulse
  • Unequal BP's
  • Shortness of breath -- trouble breathing when lying flat (orthopnea)
Other symptoms may include:
  • Pain in the abdomen
  • Stroke symptoms
  • Swallowing difficulties from pressure on the esophagus

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