Abdominal aortic aneurysm discovered in the emergency department with Point of Care Ultrasound (POCUS) in a patient who presented in acute congestive heart failure

2020 ◽  
Vol 21 ◽  
pp. 100857
Author(s):  
Mollie Powell ◽  
Diana Mora-Montero ◽  
Dakota Lane
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Abdominal Aortic

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.

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 P079: Manual pressure (the modified peace sign) as an aid to sonographic aortic visualization-a pilot study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S105
Author(s):  
K. Leech-Porter ◽  
D. Lewis ◽  
J. Fraser ◽  
P.R. Atkinson
Keyword(s):  
Emergency Department ◽  
Abdominal Aortic Aneurysm ◽  
Clinical Practice ◽  
Pilot Study ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Body Habitus ◽  
Gas Dispersion ◽  
Abdominal Aortic ◽  
Manual Pressure

Introduction: Point-of-care-ultrasound is an established tool in the early diagnosis of abdominal aortic aneurysm (AAA), with a reported pooled sensitivity of 97.5% and pooled specificity 98.9%. Despite these impressive numbers, body habitus and bowel gas often render emergency department (ED) PoCUS for AAA inconclusive. We devised a manual aid “the modified peace sign technique” to improve visualization of the aorta, consisting of placing the divided fingers of the free hand of the sonographer around the probe to increase gas dispersion and improve the view of the obscured aorta. We tested the technique on volunteers during a training course when the initial scan was indeterminate due to inability to view the aorta from sub-xiphoid to bifurcation. Methods: In our pilot study, 7 physicians were asked to make a best attempt to perform an aortic scan. If they were unable to visualize the aorta, they were asked to use the modified peace sign technique. Participants recorded the number of times which they used the technique and the frequency that the technique allowed for a complete aortic scan, previously unobtainable. All scans were supervised by certified PoCUS physicians. Results: The technique was used a total of 25 times. Following failure to complete an aortic scan using their best attempt, participants were subsequently able to obtain a complete aortic scan 70% (95% CI 48 to 83%) of the time using the modified peace sign technique. Conclusion: In our pilot study, the modified peace sign technique had an estimated effect size of 70% improvement for visualization of the aorta in volunteers. Further studies are required to validate the technique in clinical practice.

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.

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