SVS Guidelines Bundle

Abdominal Aortic Aneurysm

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17 Figure 1. Suspected Ruptured Abdominal Aortic Aneurysm (rAAA) Algorithm YES NO Emergent In-house Vascular Surgery Evaluation Evaluation of Any Patient Suspected of Having a rAAA: • Airway, Breathing, Circulation (ABC) protocol • General assessment • Vital sign monitoring Diagnosis: • Clinical diagnosis of a rAAA in patients: • Age > 50 with abdominal or back pain AND hypotension • Known AAA and symptoms abdominal or back pain, hypotension, or impending cardiovascular collapse • Radiologic confirmation (ultrasound or CT) only required when: • Alternative diagnosis is more likely on clinical grounds Immediate Management: • Intravenous access with two large bore peripheral IVs (central and/ or arterial not immediately necessary) • Permissive hypotension (to maintain a mental status and target systolic pressure 70-90 mmHg) • Lab work or x-rays should be obtained only to confirm the diagnosis of rAAA Consideration of Transfer to Regional Center: • If appropriate vascular services cannot be provided: • Patients with good functional status and without severe co- morbidity should be transferred without delay • Patients previously declined elective surgery should still be considered for transfer and subsequent treatment • Patient should be discussed with a receiving vascular surgeon: • Goals of care • Medical comorbidities • Hemodynamics • Contraindication for transfer: • Patients suffering from ongoing cardiac arrest Emergency Department Door to Intervention = Less than 90 Minutes 30 minutes Recommendation Time Guide Rapid Transfer: • Physician-to-physician phone handoff • If images are obtained at referring hospital, they must be transferred with patient • In-transit care: vital sign monitoring and permissive hypotension Emergent Evaluation by Receiving Vascular Surgery Team Intervention by Vascular Surgery Team 30 minutes 30 minutes

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