An 80 year old woman arrests in your department. She had presented an hour earlier with back pain. You start to prepare for a subcostal view of the heart and this is what you see.
View 2 – longitudinal
Describe and interpret these scans
Image 1: Transverse view of the abdominal aorta during CPR. A large aneurysm is present with typical lamellated intraluminal thrombus.
Image 2: Longitudinal view of the abdominal aorta in the same patient. This is an hourglass shaped aneurysm. ROSC has been achieved and slow flow through the aneurysm can be seen. The slowly moving blood looks like wisps of passing cloud. This is known as spontaneous echo contrast or smoke.
Abdominal aortic aneurysm during cardiac arrest.
I prepare for the subcostal view in cardiac arrest during cardiac compression by initially looking at the abdominal aorta. I set the machine to record a 4 second loop. I adjust my depth and gain and then fan upward to look at the heart initially during compression and then recording during rhythm check. I have found a ruptured abdominal aortic aneurysm as the cause of arrest on several occasions.