References
Management of the ruptured abdominal aortic aneurysm: challenges facing paramedics
Abstract
An abdominal aortic aneurysm (AAA) is a localized dilatation of the abdominal aorta resulting from degenerative cardiovascular disease. Such aneurysmal arteries pose few problems for many patients and are simply monitored and managed conservatively within the community. However, the ruptured abdominal aortic aneurysm is a time-critical medical emergency requiring timely surgical intervention in order to offer any chance of survival. Even when recognized early, 90% of patients will suffer an out-of-hospital cardiac arrest before arriving at the emergency department and of those who reach theatre, only 40% will survive. This article aims to increase the paramedic practitioner's knowledge and understanding of AAA through a holistic discussion of the prehospital recognition and early management. Particular emphasis will be placed on fluid replacement therapy and analgesia with specific reference to the issues associated with aggressive fluid resuscitation, and the potential benefits elicited through the use of opiate analgesia and subsequent pharmacologically induced hypotension. This article further aims to set the prehospital management into the wider context, thus providing paramedic practitioner's with an insight into how prehospital interventions affect the patients’ ultimate outcome and postoperative quality of life.
An abdominal aortic aneurysm (AAA) is a localized dilatation (ballooning) of the abdominal aorta which frequently occurs infra-renally and is superior to the bifurcation of the common iliac arteries (Gilbert et al, 2006) (Figure 1). In similarity with other cardiovascular emergencies, various risk factors including smoking, excessive alcohol consumption, sedentary lifestyle and co-morbidities such as hypertension and diabetes mellitus lead to the onset of atherosclerotic processes which predispose individuals—particularly men aged 60–70—to AAA (Rodin et al, 2003).
Various pre-existing medical conditions, particularly inherited connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome, increase an individuals risk of developing an AAA. An initial diagnosis is made by physical examination and subsequently confirmed by X-ray, ultrasound or computerized tomography (CT) scanning.
Small, non-dissecting aneurysms are typically monitored and managed conservatively (Lederle et al, 2002). Conservative management focuses on the prevention of expansion and typically involves health and lifestyle advice relating to diet and exercise coupled with preventative pharmacological interventions including the use of ACE inhibitors, statins and beta blockers.
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