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
