Assessment |
Diagnosis: · Unstable: abdo ultrasound · Stable: CT AAA Volume status: · End-of-bed: GCS, WOB, colour, warmth · Vital signs: RR, HR, BP · VBG: Hb, lactate |
Prioritisation |
Timing of surgery: · Uncontained rupture: surgical control before resus · Contained rupture: resus before surgical control Blood pressure control: · Uncontained rupture: avoid sympatholysis to prevent death · Contained rupture: ensure sympatholysis to prevent pop Induction risks: · Risk of CVS collapse > risk of aspiration · Mitigate with mRSI (1.2mg/kg rocuronium + apnoea) |
Induction collapse |
Problems: · Cardiac depressant · Sympatholytic · Relaxant -> release of tamponade · IPPV -> impedance to venous return Solution: · CSL 1L · Ketamine 10-50mg until dissociated · Suxamethonium 1.5mg/kg when dissociated · Adrenaline 10mcg/mL · Sevoflurane 0.5% + N2O 50% |
Bleeding to death |
Problems: · Uncontrolled bleeding · Lots of jobs Solution: · Cross-clamp ASAP · Someone for anaesthetic · Someone for access · Someone for transfusion |
Access |
· Large PIVC x 2 · Pump set + rapid fluid warmer |
Monitoring |
· Standard |
Blood |
· O negative · Cross-matched · Cell saver |
Drugs |
· CSL 1L · Ketamine 10-50mg until dissociated · Suxamethonium 1.5mg/kg when dissociated · Adrenaline 10mcg/mL · Sevoflurane 0.5% + N2O 50% |
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