Sim Blog: Ruptured AAA

Sim Blog: Ruptured AAA

72 year old female collapsed at home – now hypotensive and less responsive.
— PMH/AF and Hypertension. Meds/Warfarin NKDA

Observations

A – Patent

B – Bilat Air Ent, Sats 95% (21%)

C – HR 111, BP 89/56

D – GCS E3 V3 M5

E – Temp: 36.5°C

Clinical Findings

  • Generalised Tender Abdomen

  • Palpable pulsatile mass in abdomen

  • Cool Peripheries


Why We Simulated

Rupture of an Abdominal Aortic Aneurysm remains a catastrophic diagnosis: "For patients who suffer rupture of an AAA before hospital arrival more than 50% do not survive to reach the emergency department; for those who do, the survival rate drops by about 1% per minute." [1]

Presentations to the ED may be vague rather than the classical back pain. Those at risk (particularly >65 yrs with atherosclerotic disease) presenting with back pain, collapse or indeed hypotension should have AAA considered and imaging considered.

This scenario also demonstrated a "no-win" scenario, as the patient's condition was never going to improve depsite aggressive management. Cases such as this can be very challenging for the team as stopping resuscitation can be a difficult decision. It is important that team members understand why it is appropriate to stop. This should also be communicated to family if they are present during the resucitation.

References:

  1. Medscape – AAA

Further Reading:

Learning Outcomes

  1. The Massive Transfusion Protocol can be life saving in bleeding patients.

  2. The Rapid Infuser can deliver a large vol of blood/fluid quickly.

  3. Stopping resuscitation can be VERY hard – but once reversible causes have been addressed it should be considered.

Positive Feedback

  • Good Communication from Team Leader and Sharing of Mental Model.

  • Team remained calm despite escalating level of challenge in the scenario.

  • Decision to stop included the whole team.

Special thanks to Dr Scott Knapp (@DrSKnapp) for joining as Faculty.
Edit & Peer Review by Rebecca Prest
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