traumatic aortic aneurysm care

[Happiness]

Correct me if im wrong but this condition is rare and in 13 years I have seen one. I was one of the crew that helped medivac him out. As I try to learn from my calls I had asked the nurse why the dr thought this was the issue. He said that if you ever hear one you will know. I put my steth and listened and he was right it has a very distinced sound. It was wooshing sound like you hear with a baby ultrasound heart beat. I personally have never heard about the side to do a BP.

I now in my assessment take a bp on both sides and when listening to the abdonminal area I will listen for that sound.

I have been told by one of our Dr about if the BP is different and I was told that it is an indication to hardening of the arteries.

[tniuqs]

Any one have the link to this article ?

[Happiness]

sorry didn't read tramatic

[tniuqs]

Correct me if im wrong but this condition is rare and in 13 years I have seen one. I was one of the crew that helped medivac him out. As I try to learn from my calls I had asked the nurse why the dr thought this was the issue. He said that if you ever hear one you will know. I put my steth and listened and he was right it has a very distinced sound. It was wooshing sound like you hear with a baby ultrasound heart beat. I personally have never heard about the side to do a BP.

I now in my assessment take a bp on both sides and when listening to the abdonminal area I will listen for that sound.

I have been told by one of our Dr about if the BP is different and I was told that it is an indication to hardening of the arteries.

Try http://www.cardiosource.com/heartsounds/index.asp

[Just Plain Ruff]

Any one have the link to this article ?

It's a copyrighted article and I cannot post it here.

I'll see if I can get permission from the editors.

It's found on the website www.ems-ce.com but to see the article you have to be a member of the site.

[spenac]

It's a copyrighted article and I cannot post it here.

I'll see if I can get permission from the editors.

It's found on the website www.ems-ce.com but to see the article you have to be a member of the site.

Couldn't we all just use your password? :twisted:

But hey docs please give us some info on this subject. As a student I am now really curious but I have not found any info on it. Thanks Ruff.

[CBEMT]

In suspected thoracic aortic dissection, taking the BP in both arms is not only okay, it is encouraged.

'zilla

How about abdominal?

60's y/0 female, dx of AAA within the last year, no need for sx intervention at last ultrasound. Hx of renal failure. Chief complaint is LUQ/flank pain radiating to the back. Recently taken off a BP med due to it's effects on the one kidney she still has.

BP right arm- 180's, consistently.

BP left arm- 120's, consistently.

[Spock]

I may be crazy but there is nothing better than getting a stat page for a leaking aortic aneurysm other than maybe a GSW to the chest. We put the NIBP on the right and the arterial line in the left. Why? Because the NIBP unit is on the right and the art line transducer is on the left. No other reason. We do compare the values and if there is a big difference we also will put in a femoral art line if we have time which we frequently do not. I have never heard of the BP cuff on the left being a problem and can't think of any good reason why that would be a problem. The issue is the exact location of the aneurysm which is determined by CT, CT angio and transesophageal echo. If it is above the aortic valve but before the arch the surgeon can usually get a clamp on it and we can go on bypass in the usual manner. If it goes into the arch the surgeon canulates the left femoral artery and vein for bypass and we do a circulatory arrest which means we cool the patient to around 18 degrees centigrade and shut off the pump. The surgeon then sews in a new arch. Descending aneurysms are done through a left lateral approach and we put in a double lumen endo tube and deflate the left lung. Challenging cases all the way around and that is why I love doing cardiac.

Anyone that wants to call me a sick SOB feel free because you are correct.

Live long and prosper.

Spock

[firedoc5]

Correct me if im wrong but this condition is rare and in 13 years I have seen one. I was one of the crew that helped medivac him out. As I try to learn from my calls I had asked the nurse why the dr thought this was the issue. He said that if you ever hear one you will know. I put my steth and listened and he was right it has a very distinced sound. It was wooshing sound like you hear with a baby ultrasound heart beat. I personally have never heard about the side to do a BP.

I now in my assessment take a bp on both sides and when listening to the abdonminal area I will listen for that sound.

I have been told by one of our Dr about if the BP is different and I was told that it is an indication to hardening of the arteries.

You're right, Hap. It is rare. But at one point we had three in a period of five days. The ER staff, the Cardiologists, and a Pulmonologist could not believe it. And all three were brought in by me and the same partner. We were being considered to be put on the "bad luck" list. Why, I have no idea.

From that experience Brad and I sort of had a crash course from two of the docs on aortic aneurysms by one of the docs. Whenever I had a pt. complaining of chest pain radiating to the back or flank I would immediately think of those three pts. and the possibility of another one.

Two were flown out and one was operated on in less then 30 mins. after we brought him in. Only one didn't make it.

But like in my previous post I said I had heard the arguments about taking bilateral BP's, pros and cons. We always did anyway. One of the mid-night ER nurses was one that got on to us for doing so.

[Just Plain Ruff]

ok, on further investigation the article referenced was the Brady book and not the Bledsoe book. My bad. But I emailed Dr. Bledsoe and he did not concur with this article's premise on the left arm blood pressure.

I'll try to find contact information with the brady people.