Aneurysm

Definition

• An aneurysm is a localized sac or dilation formed at a weak point in the wall of the aorta. (three layers of our blood vessels are the intima, media, externa)

• Due to high arterial pressure, aneurysms can enlarge and lead to complications by compressing surrounding structures.

• Interesting Fact: 90% of aneurysms occur within the first 10 cm of the aortic valves, raising concerns about potential dissections in this area.

  • closest to the heart

  • the aortic blood vessels are working against gravity, with the blood rushing against the walls because of the arch.

• aneurysm: bulging of the blood vessels

• dissection: rip through one or two layers of the blood vessels

• rupture: blood has ripped through all three layers of the blood vessel wall.

Etiology

Common Causes

• Marfan syndrome: A genetic disorder affecting connective tissue, increasing risk of aortic aneurysms.

• Congenital heart disease: Present at birth, which can predispose to vascular weaknesses.

• Hypertension: Chronic high blood pressure can damage blood vessel walls.

• Pregnancy: Can cause temporary changes in blood volume and pressure, potentially affecting vascular integrity.

• Trauma: Physical injuries can lead to structural weaknesses in blood vessels.

• Iatrogenic injuries: Accidental damage during medical procedures.

• Atherosclerosis: A condition where plaque builds up in arteries, weakening them over time.

Additional Information

• An aneurysm is also described as a weakened area of a vessel dilating 1.5 times its normal diameter.

• Often asymptomatic but may cause symptoms if it applies pressure to nearby vessels or structures.

• Potential Complication: Pulselessness may occur if the aneurysm obstructs an adjacent artery.

EMS Considerations

Initial Stabilization

• Establish two large-bore intravenous lines.

• Administer 100% oxygen to the patient.

• Provide continuous cardiac monitoring.

• Monitor urine output for indicators of organ perfusion.

• Perform and interpret a 12-lead ECG to assess heart function.

• Fluid Resuscitation: If hypotensive, administer Normal Saline at a rate of 20 mL/kg intravenously or intraosseously, titrating to achieve a systolic BP of 90 mmHg.

Assessment Protocols

Expectations from EMS Personnel

• Conduct accurate assessments to understand patient status.

• Collect comprehensive medical history to inform treatment.

• Maintain a capable skill set for immediate responses.

• Determine if there is sufficient time for thorough assessments or if urgency dictates rapid action.

Decision-Making Factors

• Patient presentation and mechanism of injury or nature of illness.

• Status of vital signs and findings from physical assessment.

• Consideration of time constraints and instinctive judgments.

Challenges in Medical Diagnosis

Reasons for Complexity

• Medical conditions can be hidden and hard to detect.

• Diverse potential diagnoses make it difficult to identify the pathology.

• Referred pain adds confusion to assessment.

• Important Reminder: Acknowledge personal limitations in diagnosis and treatment.

Information Gathering

• Collect information from various sources:

  • The patient

  • Family or bystanders

  • The environment

  • Behavioral observations

  • Assessment tools and personal knowledge.

Differential Diagnoses Approach

Steps for Evaluation

1. Identify the worst-case scenario to rule it out first.

2. Assess the next worst-case possibility after the initial assessment.

3. Once critical scenarios are ruled out, move on to likely options.

Vital Signs and Patient Information

Sample Vital Signs Data

• Patient 1:

  • Pulse: 110

  • Blood Pressure: 140/100

  • Respiratory Rate: 20

  • Saturation: 92%

  • Blood Glucose Level: 5.6 mmol/L

• Patient 2:

  • Pulse: 118

  • Blood Pressure: 106/90

  • Respiratory Rate: 36

  • Saturation: 100%

  • Blood Glucose Level: 26.3 mmol/L

Medications and Allergies

• Relevant medications for patients, indicating potential drug interactions or contraindications:

  • Patient 1: Rifampin, Codeine, Ibuprofen, Tegretol, Dilantin | No allergies reported.

  • Patient 2: Metformin, Buscopan, Amoxicillin, Lanoxin | Allergies to sulfa drugs and seafood.

ECG Findings

• Recording and interpretation of ECGs is crucial in assessing cardiac status.

• Example from Patient ECG: Nonspecific T wave abnormalities indicating potential digitalis effect.

Final Notes

• Practicing thorough assessments and keeping up-to-date with medical knowledge can drastically improve patient outcomes in emergency scenarios.

• Continuous education and simulations (e.g., table-top scenarios) help improve readiness for real-life medical cases.