Aortic aneurysm

[webby2525]

My Sup and I and my preceptor were having a discussion yesterday and he brought up Aortic Aneurysms due to traumatic injury. His thought was since having the pt in an upright position during transport is standard as laying the pt down would cause them to bleed and ultimatley go into arrest, would a KED be effective in to keep the legs up and then lay pt down on litter. Our thoughts (my preceptor and I) were that the muscular flexion when the pt is sitting up is the cause of the decreased blood loss, not the postion of the feet as if the pt was sitting. So if the pt was in a sitting position but laying on the litter, the muscles would relax and blood loss owuld resume. I was wondering if this is the case or maybe my Sup has a point.

[WelshMedic]

First off, I think you're talking about a traumatic aortic rupture rather than an aneurysm, an aneurysm being a sub-acute problem which develops because of peripheral vascular disease and hypertension rather than trauma.

My own take on the subject is that any traumatic rupture would have to have a tamponade if the patient is to survive, one would then assume that a sitting postion would be best for this very rare category of patient.

Carl.

[AZCEP]

The traumatic aortic rupture is dead. Very simple, no muss, very little fuss.

An actively dissecting thoracic, or abdominal aneurysm is a different matter altogether. More often than not, they won't be able to hold still due to the pain. Relaxing or maintaining abdominal muscle tension as you describe, would be difficult at best.

Very possible I missed where you were going with this, but that is my take for now.

[als_medic_uk]

The mortality rate of a ruptured Aorta is very high around 50% will die, you want to keep them sat, as the main 'stand point' in emergency care is reduce the BP and heart rate [usually using BP lowering drugs] and either a beta blocker or verapamil to slow the pulse and make the heart beat with less strength. Ideally feet over the side of the bed/ gurney or rest sitting up with the legs hanging down.

Aortic dissections are uncommon, but definitely not rare.

Regards.

[WelshMedic]

AZCEP,

there are rare circumstances where a rupture can develop a tamponade. I have seen it myself......one minute a patient is alert and orientated, the next (because of movement) he's as dead as a dodo....

Carl.

[coolparamedic]

I have never seen an AAA but I have heard from several medics that MAST pants work really well to tamponade the AAA. Have any of you ever tried it and how did it work if you have?

[Ridryder 911]

I have seen a few aortic tears secondary from trauma, one was unique enough that when we laid him down he immediately went out, by instinct we immediately raised him up and was able to tamponade it off enough to say good bye to his spouse... I have yet seen one live.

AAA used to have a high percent of mortality as well, but with recent improved surgical repairs the survival rates are increasing. In regards to MAST, I definitely would not use. Even though the tamponade theory might seem applausal, we used to use them for such and again, never seen a survivor. Raising the blood pressure or increasing pressure on the aneurysm itself by pushing on it I would suggest be detrimental. Like another post described, lowering stress and the blood pressure is the key, as well as immediate evaluation and surgical repair.

R/r 911

[zmedic]

I have never seen an AAA but I have heard from several medics that MAST pants work really well to tamponade the AAA. Have any of you ever tried it and how did it work if you have?

I think the only thing MAST pants are still aproved for in many places is pelvis fractures.

[zmedic]

http://www.health.state.ny.us/nysdoh/ems/policy/s97-04.htm

[Chief1C]

Last summer I had an AAA patient, of course at the time I didn't know this. I was sitting in front of a business, and they pulled in beside be asking for help. Pt was barely conscious, orig. c/c was chest pain, abd was soft but severely distended, and slightly discolored. No trauma according to the family. BP was nil, even on the NiBP it was 0/0; pt wasn't breathing enough to sustain life to begin with, but we dealt with that as normal. Pt went into cardiac arrest six times, as recorded by the AED, little CPR while they got the AED on and the heart rthymn was restored. Arrested again, shocked twice and restored the HR; and yet again pt arrested and again HR was restored. We went through this once more, and got ALS on board. Intubated, line started, arrested again, ACLS on board and yet again his heart rate was back into the 60's. However, even squeezing the IV bags, couldn't get his blood pressure back.

Had him on a board to begin with, b/c I >HATE< CPR boards, and this makes it easier to move the patient. We had the cot in the shock position, that didn't do any good, I suggested to OMC that we use the Shock Suit as a last ditch effort. Put on the Shock pants (MAST), got the BP back to 60/40, HR in the 60's. Got into the ER okay, gave him LR & blood while they waited for a medevac and flew the pt to a better facility. Died in the OR of what was diagnosed as a AAA. That was the third time I've used the MAST for shock, however only one patient survived.