The Patient who has had an Abdominal Aortic Aneurysm Repair
16/4/11
Examinations Book
GENERAL APPROACH
Emergency or Elective
End-organ damage
Complications
- brain injury
- spinal cord ischaemia
- ileus
INTRODUCTION
- MI
- lower limb ischaemia
- compartment syndromes
- renal injury
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
Jeremy Fernando (2011)

- 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
Jeremy Fernando (2011)