My Patient Has No Blood Pressure: Have They Got an Abdominal Aortic Aneurysm? Point-Of-Care Ultrasound of the Abdominal Aorta in Hypotensive Patients

Ultrasound ◽  
2011 ◽  
Vol 19 (4) ◽  
pp. 236-241 ◽  
Author(s):  
Audra Gedmintas ◽  
Matthew Grabove ◽  
Paul Atkinson
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Point Of Care ◽  
Abdominal Mass ◽  
Sudden Onset ◽  
Point Of Care Ultrasound ◽  
Mass Detection ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Threatening Situation

Among patients presenting to the emergency department (ED) with undifferentiated hypotension, how can point-of-care ultrasound (PoCUS) help identify abdominal aortic aneurysm (AAA) as the cause of the hypotension? Many hypotensive patients in the ED are critically ill, with only minutes available to find the cause of the hypotension and treat it before the patient decompensates. While the classic description of the presentation of a ruptured AAA is of collapse with sudden onset abdominal pain and a palpable, pulsatile abdominal mass, detection of AAA by palpation is notoriously unreliable, and many patients are unaware of their underlying condition. This life-threatening situation is made even more difficult by virtue of the fact that the patient is often too unstable to travel for traditional diagnostics such as computed tomography. This article will address the use of PoCUS for the detection of AAA in the evaluation of the hypotensive patient.

scholarly journals Ruptured Abdominal Aortic Aneurysm Presenting as Septic Shock

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2189-e2191
Author(s):  
Bryon Davis ◽  
Aaron Brockshus ◽  
Clay Merritt ◽  
Chase Donaldson
Keyword(s):  
Emergency Department ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Point Of Care ◽  
Aneurysm Rupture ◽  
Point Of Care Ultrasound ◽  
Shock State ◽  
Localized Source ◽  
Source Of Infection ◽  
Abdominal Aortic

Abstract A patient presented to the emergency department with undifferentiated shock 4 days after discharge from a hospitalization for a lower gastrointestinal bleed. The patient fulfilled 4/4 of the Systemic Inflammatory Response Syndrome criteria and 3/3 of the quick Sequential Organ Failure Assessment criteria on presentation to the emergency department, notably, without a localized source of infection and no localizing symptoms. After admission, the patient’s hemoglobin was found to have dropped more than expected after intravenous (IV) fluid administration, suggesting a potential alternative or concurrent etiology of the patient’s shock state. A digital rectal and focused assessment with sonography in trauma exam were performed and negative. The patient was then diagnosed with a ruptured infrarenal abdominal aortic aneurysm contained in the retroperitoneum by repeat point-of-care ultrasound. The patient was hemodynamically stabilized and taken for emergent grafting without confirmatory imaging. The patient was later found to also have 4/4 blood cultures positive with methicillin-sensitive Staphylococcus aureus associated with an aortic valvular vegetation and a mycotic aneurysm which contributed to the abdominal aortic aneurysm rupture. This case supports the use of comprehensive point-of-care ultrasound imaging to more rapidly and more definitively differentiate types of shock and etiologies of a shock state which can lead to more timely changes in management and improvement in outcomes.

scholarly journals Rapid Bedside Ultrasound Evaluation of a Ruptured Abdominal Aortic Aneurysm With a Prior Repair

2021 ◽  
Author(s):  
Juliet Corcillo ◽  
Joshua Stierwalt ◽  
Andrea Kaelin ◽  
Brian Murray
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Point Of Care ◽  
Stable Condition ◽  
Aortic Aneurysms ◽  
Point Of Care Ultrasound ◽  
Ultrasound Evaluation ◽  
Abdominal Aortic ◽  
Active Extravasation ◽  
Definitive Repair

ABSTRACT Ruptured aortic aneurysms carry a high risk of morbidity and mortality, particularly if not rapidly identified. We present an 87-year-old male, with a history of hypertension and prior endovascular aortic repair, who presented to the Emergency Department (ED) with several days of epigastric abdominal pain radiating to his back and flanks. The patient acutely deteriorated in the ED, and point-of-care ultrasound rapidly identified active extravasation from an abdominal aortic aneurysm with visualization of prior endograft. Point-of-care ultrasound in this patient expedited the diagnosis, resuscitation, and transfer to the operating room with definitive repair by vascular surgery. The patient recovered and was discharged in stable condition.

Telemedicine-guided point-of-care ultrasound can be feasible and effective in a life-threatening situation: The case of a field hospital during the COVID-19 pandemic (Preprint)

2020 ◽  
Author(s):  
Tarso Accorsi ◽  
Karine De Amicis Lima ◽  
Alexandra Brigido ◽  
Deborah Belfort ◽  
Fabio Habrum ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Acquisition Time ◽  
Point Of Care Ultrasound ◽  
Field Hospital ◽  
Portable Ultrasound ◽  
Local Staff ◽  
Assessment Protocol ◽  
Life Threatening ◽  
Threatening Situation

BACKGROUND Lightweight portable ultrasound is widely available, especially in inaccessible geographical areas. It demonstrates effectiveness and diagnosis improvement even in field conditions but no precise information about protocols, acquisition time, image interpretation, and the relevance in changing medical conduct exists. The COVID-19 pandemic implied many severe cases and the rapid construction of field hospitals with massive general practitioner (GP) recruitment. OBJECTIVE This prospective and descriptive study aimed to evaluate the feasibility of telemedicine guidance using a standardized multi-organ sonographic assessment protocol in untrained GPs during a COVID-19 emergency in a field hospital. METHODS Eleven COVID-19 in-patients presenting life-threatening complications, attended by local staff who spontaneously requested on-time teleconsultation, were enrolled. All untrained doctors successfully positioned the transducer and obtained key images guided by a remote doctor via telemedicine, with remote interpretation of the findings. RESULTS Only four (36%) general practitioners obtained the appropriate key heart image on the left parasternal long axis window, and three (27%) had an image interpreted remotely on-time. The evaluation time ranged from seven to 42 minutes, with a mean of 22.7 + 12. CONCLUSIONS Telemedicine is effective in guiding GPs to perform portable ultrasound in life-threatening situations, showing effectiveness in conducting decisions.

scholarly journals Rolipram Prevents the Formation of Abdominal Aortic Aneurysm (AAA) in Mice: PDE4B as a Target in AAA

Antioxidants ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 460
Author(s):  
Saray Varona ◽  
Lídia Puertas ◽  
María Galán ◽  
Mar Orriols ◽  
Laia Cañes ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Inflammatory Cells ◽  
Progressive Increase ◽  
Phosphodiesterase 4 ◽  
Inflammatory Conditions ◽  
Abdominal Aortic ◽  
Threatening Condition ◽  
Life Threatening ◽  
Effective Therapeutic Strategy

Abdominal aortic aneurysm (AAA) is a common life-threatening condition characterized by exacerbated inflammation and the generation of reactive oxygen species. Pharmacological treatments to slow AAA progression or to prevent its rupture remain a challenge. Targeting phosphodiesterase 4 (PDE4) has been verified as an effective therapeutic strategy for an array of inflammatory conditions; however, no studies have assessed yet PDE4 in AAA. Here, we used angiotensin II (AngII)-infused apolipoprotein E deficient mice to study the involvement of the PDE4 subfamily in aneurysmal disease. PDE4B but not PDE4D was upregulated in inflammatory cells from both experimental and human AAA. The administration of the PDE4 selective inhibitor rolipram (3 mg/kg/day) to AngII-challenged mice (1000 ng/kg bodyweight/min) protected against AAA formation, limiting the progressive increase in the aortic diameter without affecting the blood pressure. The drug strongly attenuated the rise in vascular oxidative stress (superoxide anion) induced by AngII, and decreased the expression of inflammatory markers, as well as the recruitment of macrophages (MAC3+), lymphocytes (CD3+), and neutrophils (ELANE+) into the vessel wall. Rolipram also normalized the vascular MMP2 expression and MMP activity, preserving the elastin integrity and improving the vascular remodelling. These results point to PDE4B as a new therapeutic target for AAA.

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