Medical Cases

Aneurysm

  • Definition: An aneurysm is a localized sac or dilation formed at a weak point in the wall of the aorta.
  • Key Points:
    • High pressure in the arterial system can cause aneurysms to enlarge.
    • They may compress surrounding structures leading to complications.
    • Location: 90% of aneurysms occur within the first 10 cm of the aortic valves, affecting the implications for dissections in this area.

Etiology of Aneurysms

  • Common Causes:
    • Marfan syndrome
    • Congenital heart disease
    • History of hypertension
    • Pregnancy
    • Trauma
    • Iatrogenic injuries (caused by medical examination or treatment)
    • Atherosclerosis

Symptoms and Complications

  • An aneurysm often produces no symptoms but may cause problems if it compresses other vessels or structures.
  • Pulselessness can occur if the aneurysm cuts off another vessel, such as an artery.

EMS Considerations for Aneurysms

  • Initial Stabilization:
    • Place 2 large-bore intravenous lines
    • Administer 100% oxygen
    • Provide a cardiac monitor
    • Monitor urine output
    • Perform and interpret a 12-lead ECG
    • Fluid Resuscitation: If hypotensive, administer Normal Saline 20 mL/kg IV/IO bolus prn and titrate to a systolic BP of 90 mmHg.

Decision-Making in Aneurysm Cases

  • What is Expected:

    • Accurate assessments
    • Collect proper patient history
    • Demonstrate a capable skill set
    • Assess time constraints or urgency in treatment

  • Decision Factors:

    • Patient presentation and medical history
    • Mechanism of injury or nature of illness
    • Vital signs and physical assessment
    • Gut instinct and timing considerations

Differential Diagnoses

  • Identifying Worst Case Scenarios:
    • Determine the worst case and the next potential worst conditions
    • Rule out critical issues before moving on to less severe possibilities

Challenges in Diagnosis

  • Medical conditions often have overlapping symptoms, making it difficult to pinpoint the exact issue.
  • Common challenges include:
    • Hidden conditions
    • Complexity of the conditions presented
    • Referred pain complicating diagnosis
    • A need for self-awareness of limitations in diagnosis

Summary of Vital Signs and ECG Findings

  • Example 1:

    • Pulse: 110
    • Blood Pressure: 140/100
    • Respirations: 20
    • O2 Saturation: 92%
    • Blood Glucose Level: 5.6 mmol/L
    • Medications: Rifampin, Codeine, Ibuprofen, Tegretol, Dilantin.
    • No known allergies.

  • Example 2:

    • Pulse: 118
    • Blood Pressure: 106/90
    • Respirations: 36
    • O2 Saturation: 100%
    • Blood Glucose Level: 26.3 mmol/L
    • Medications: Metformin, Buscopan, Amoxicillin, Lanoxin.
    • Allergies to sulfa drugs and seafood.

ECG Findings

  • Detailed analysis of ECG readings is crucial.
  • Example 1: Abnormal ECG showing nonspecific T wave abnormality, likely digitalis effect.
  • Vital information pertaining to heart rhythms and abnormalities should be interpreted carefully.

In-Class Exercises

  • Engagement in tabletop scenarios related to medical cases will enhance practical understanding of situations involving aneurysms and emergency responses.