What is the prehospital for a patient with a ruptured abdominal aortic aneurysm (AAA)?

Updated: Jan 08, 2019
  • Author: Saum A Rahimi, MD, FACS; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Prehospital care of patients having symptoms compatible with or suggestive of AAA or aortic dissection consists of the following:

  • Ensuring adequate breathing
  • Maintaining oxygenation
  • Treating shock
  • Obtaining useful information concerning the history so as to expedite treatment on arrival at the emergency department (ED)

All patients with a suspected aortic aneurysm should receive 100% oxygen along with continuous electrocardiographic (ECG) and vital sign monitoring while en route to the hospital. Large-bore (14- or 16-gauge) intravenous (IV) lines should be inserted en route if possible.

Establishing the diagnosis in the field is usually difficult or impossible, but certain salient features of aortic aneurysm or dissection may be observed. Both can pose a threat to life if not quickly recognized and treated. Patients older than 50 years with sudden onset of abdominal pain should be presumed to have a ruptured AAA and should receive attentive airway management and vigorous fluid resuscitation, as indicated.

Patient presentation during the prehospital phase of care varies, depending on whether the aneurysm is acutely expanding or leaking or whether it involves the thoracic aorta or the abdominal aorta. Radio communication with the receiving hospital permits the medical control physician to direct care, and it facilitates selection of a capable destination hospital while permitting the ED to mobilize appropriate resources.

The physician directing prehospital care should request transport to a facility capable of operative treatment of an AAA in the rare event that the diagnosis can be suspected on the basis of information available for arrival at the hospital.

Use of military antishock trousers (MAST) to reverse shock due to ruptured AAA might seem beneficial, but it may actually be detrimental. Although the application of MAST theoretically offers temporary stabilization by compressing the leaking AAA and expanding hematoma, it can also lead to an undesirable reduction in cardiac output. Expeditious transport of unstable patients whose condition is deteriorating is a therapeutic imperative.


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