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.