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PAST MEDICAL HISTORY:-He smoked for 20yrs 2 packets a day. History of hypertension, COPD and emphysema. Admitted a year ago with respiratory related illness. Uses inhalers and has very poor exercises tolerance. Has had CVA which affected the right side of the body but could not remember when it occurred…
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Download file to see previous pages The initial observations showed. The patient was very cold, tachycardia with a pulse rate 100-105beats/minute, respiration 24-30/min, in respiratory distress and cyanosed. On auscultation had wheeze on both sides 4liters of oxygen was given. BP Systolic 84-80mmHg, dystolic65-62mmHg. He was complaining of back pain left side but no chest pain. The GP had been in to see him and thought it was abdominal pain and prescribed cocodamol. The patient was cachexic and pale. The working diagnosis for the ambulance crew was Dysphonic.
ACCIDENT AND EMERGENCY DEPARTIMENT:- On arival vital signs 35 degree centrgrade,pulse122/min,respiration2/min, BP120/81mmHg. Blood sugar20.3mmol/L saturating oxygen 97%. On examination femoral pulse was absent. Rectal examination bowel was soft. The chest x-ray showed no focal mass. ECG showed ischemic changes of the heart. Blood gas was within normal. Abdominal x-ray showed partial gas with mega colon. Full blood count, urea and electrolyte and coagulation study were done. Urinalysis showed protein presence. NaCl 0.9% was given for low blood pressure. Morphine 10mg IV was given stat CT scan abdomen showed ruptured aortic and vascular atherosclerosis. Diagnosis of Abdominal Aortic Aneurysm was made. The patient was explained the findings, consent obtained for surgery and he was prepared for Theatre. A preoperative check list was done and he was taken to theatre with all the documents.
OPERATING THEATRE:-The surgeon inserted stent graft, which is a tube of conventional graft fabric containing two stent. Because the aneurysm was ruptured the patient received 470mls cell saver blood, 11units RCC, 1000mls gelofusine, 3000mls 0.9%normal saline, 1000mls20%mannitol, 1unit platelet.
Abdominal aortic aneurysm is the swelling of the aorta. Aorta is the body's largest artery (the blood vessel that carries oxygen-rich blood). This artery extends from the heart down through the chest and abdominal region, where it divides into a blood vessel that supplies each leg. Although an aneurysm can develop anywhere along the aorta, most occur in the section running through the abdomen (abdominal aneurysms). Abdominal Aortic Aorta (AAA) can be treated by means of open surgery and the close or endovascular surgery.
Open surgery
The most common and widely used treatment for aneurysm is the open surgery. This includes the replacement of the swollen part of the aorta with artificial graft. The graft is made of material that does not wear out. It is sawn in place with a permanent suture material.
The open surgery is done by making an incision depending on the location of the aneurysm. If the aneurysm is confined to the abdomen, then an incision either in the abdomen or on the side or flank may be used. The open surgery may cause a severe blood loss, greater trauma to the aorta and patient must stay in the intensive care for a longer time. This procedure is not recommended to patients who have high risk of complications. The surgery must be determined by the medical team before proceeding into the operation.
Endovascular surgery or closed surgery
In recent years, a treatment has been developed to repair an aneurysm without major surgery or an ...Download file to see next pagesRead More
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