Authors: Biruthvi Vignarajah, Hannah Downing, Riad Hosein / Editor: Steve Corry-Bass / Reviewer: Ahmad Alabood / Codes: GP1, RP7, SLO3, SLO6 / Published: 19/03/2020 / Reviewed: 24/04/2024
A 76-year-old male, with a known Abdominal Aortic Aneurysm (AAA), is seen in the Emergency Department (ED) after being transferred to your centre for an urgent vascular surgery review having initially presenting with worsening abdominal pain.
He denies any nausea or vomiting, change in bowel habits, fevers, difficulty breathing, or chest pain.
On initial assessment, he is found to be hypotensive (BP 84/54) and tachycardic (HR 124). His abdomen is generally tender and tense. Bowel sounds are present.
Chest is clear, heart sounds dual, but he appears pale, is diaphoretic, and clinically hypovolaemic. The patient has a background of ischaemic heart disease, paroxysmal atrial fibrillation (on rivaroxban), permanent pacemaker, COPD, CKD, and AAA (under surveillance).
22 responses
Excellent case , very interesting
Interesting module, Thanks
Good case, Emphasis on overall evaluation and management in elderly and considering other differential instead of focusing on focused diagnosis.
Interesting. Thank you.
Interesting. Thank you.
Good learning module. Interesting case.
Good learning Module
Educative CT images , not necessary to have dissection in all patient presented with AAA and abdominal pain . DD is important to rule out other life threatening condition
very good and interesting case
Excellent module
Good informative read.
very good information
informative
informative
Good case
Good
Excellent Case
Had a very similar case recently, keeping differentials wide is very important
Very informative
I wonder why he needs a fluid resuscitation when his blood pressure is sitting at SBP of 84 and our first differential is a aortic rupture, I think he should get a bed side ultra sound done and then if any free fluid detected as in this case he should get blood instead of fluids. We can permit some hypotension in this case I believe.
Challenging
An informative guide on the importance of keeping differentials wide even when the presentation is pointing to a specific diagnosis