AAA Repair Patient Hot Case

GENERAL APPROACH

• Emergency or Elective
• End-organ damage
• Complications
  – brain injury
  – spinal cord ischaemia
  – ileus
  – MI
  – lower limb ischaemia
  – compartment syndromes
  – renal injury

INTRODUCTION

CUBICLE

• dialysis

INFUSIONS

• vasoactives
• fluid boluses
• sedation
• analgesia
• transpyloric feeding: ileus, ischaemia
• TPN

VENTILATOR

• mode
• level of support
• level of oxygenation: FiO2, PEEP: ARDS, aspiration, nosocomial pneumonia
• elevated peak AWP: abdominal distension
• high PEEP: basal atelectasis

MONITOR

• ECG: arrhythmia
• CVP: number, waveform
• arterial trace: MAP, swing, pulsus paradoxus, pulse pressure, avoidance of hypertension
• temperature: SIRS

EQUIPMENT

• IDC: oliguria, anuria (multifactorial)
• dialysis
• intra-abdominal pressure measurement
• surgical scars

QUESTION SPECIFIC EXAMINATION

• hands/arms -> head -> chest -> abdo -> legs/feet -> back

-> general: jaundice (reabsorption of massive haematoma)
-> cardiovascular:
-> respiratory:
-> abdominal: incision, groins (puncture sites)
-> lower limbs: pulses, compartment syndrome

• neurological (if hypothermic, comment that will effect neurological assessment)

-> paralysed
-> quick
-> unconscious
-> conscious

• urine output over last 12 hours
• supra/infra-renal clamping
• endo-luminal vs open
• duration of shock prior to clamping
• cross clamp time
• mannitol or frusemide given intra-operatively
• enteral feeding
• lower limb pulses on Doppler

RELEVANT INVESTIGATIONS

• FBC: WCC, Hb, platelets
• CXR
• recent CT abdomen
• other organ failures
• ABG: gas exchange, metabolic state

OPENING STATEMENT

=

• Emergency/Elective
• End-organ function
• Complications

References and Links

• Hypertension post AAA repair
• Renal failure Post AAA Repair
• Myocardial ischemia post AAA repair