Aneurysm Arturo — Abdominal Aortic Aneurysm
Pulsatile abdominal mass, sudden tearing back pain, and a dropping BP — never palpate deeply once rupture is suspected
Arturo, a 68-year-old smoker with longstanding hypertension, comes to the ED with sudden, severe back and abdominal pain, and the triage nurse feels a pulsatile mass just left of his umbilicus.
Arturo's aortic wall has weakened and ballooned over years of untreated hypertension and smoking. Most AAAs are silent until they grow large enough to be felt as a pulsatile mass or until they rupture, producing sudden severe abdominal or back pain with hypotension. A ruptured AAA is a surgical emergency where the priority is rapid recognition, avoiding deep palpation, and getting the client to the operating room, not aggressive fluid resuscitation that can raise pressure against a leaking wall.
Read Aneurysm Arturo's full story →The story arc
The setup
Arturo has smoked for 40 years and has poorly controlled hypertension, both major risk factors for aneurysmal degeneration of the aorta.
The turn
An incidental ultrasound during a routine visit shows a 4.8 cm infrarenal aortic aneurysm, and Arturo is scheduled for surveillance imaging every six months.
The crisis
Arturo suddenly develops tearing back and abdominal pain, his blood pressure drops to 82/54, and a pulsatile, tender abdominal mass is now palpable.
The save
The nurse avoids deep palpation of the abdomen, keeps Arturo NPO, obtains large-bore IV access with permissive hypotension fluid strategy, and the surgical team rushes him to emergent repair.
NCLEX study section — Abdominal Aortic Aneurysm
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.