Ruptured AAA:

Pre-op issues:

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%