aortic aneurysm treatment and care

how should a suspected dissected AA be treated?

• minimise time spent on scene, rapidly transport to ideally a vascular/cardiac centre or ED

• ensure effective analgesia to treat pain

• analgesia also reduces sympathetic nervous system activity, which in turn reduces heart rate and bp which in turn reduces strain on vessel

• in hospital pt may be administered IV beta-blockers to lower HR and reduce stress on the vessel

what management could be considered from a ruptured AA?

• oxygen

• analgesia

• antiemetic

• IV fluids

• Blood

what is the aim of giving oxygen in AA dissection?

• as a result of bleeding, the vehicle delivering oxygen is lost

• there is not the blood left to deliver the oxygen to the tissues

• the heart becomes unable to circulate enough oxygen to meet the body’s metabolic needs

• supplemental oxygen increases the capacity of oxygen in the remaining blood

why is ondansetron beneficial in a ruptured AA?

• assists in patient care and comfort

• pain associated nausea

• nausea associated with medications given (such as morphine)

how does ondansetron work?

• ondansetron blocks serotonin from binding to receptors in the central and peripheral nervous system

• this reduces vagus nerve activation and signals to chemoreceptor trigger zone

• this blocks the vomiting reflex

discuss permissive hypertension in regards to a ruptured AA

• in a pt with suspected ruptured AA, fluids (sodium chloride) may be administered in the aim of increasing blood pressure just enough to avoid neurological deficit (such as a reduced GCS)

• sodium chloride does not contain oxygen, additionally an influx of fluid may blow off newly formed clots preventing further bleeding

why might blood be administered in a suspected dissected AA?

• introducing blood products into the blood stream, increases the body’s ability to transport oxygen to tissues and replaces blood lost

would you consider TXA for a suspected disected AA?