traumatic aortic aneurysm care

[Just Plain Ruff]

I was going over some CEU articles tonight and found something that I am unsure is correct and if it is correct, just what is the pathophysiology behind it.

this is what was written in the article:

"If blood pressue is taken on the left side, it can cause additional back pressure on th aneurysm and cause rupture."

I've not heard this or if I have it went in one ear and out the other.

Can someone tell me (Doc's and you know who you are feel free to chime in here) what the pathophysiology behind this is?

I'll be doing some of my own research but I'm sure the docs or others can enlighten me and the board members.

thanks in advance.

[firedoc5]

I had heard that a long time ago. And since I've heard the arguements like a ping-pong match. So I'm not sure myself.

[WolfmanHarris]

Now I was under the impression that a deficit in blood pressures between the two arms is a hallmark symptom of aortic aneurysm? That's why I try to take my first manual BP on one arm and when I toss on the lifepack I put it on the other arm. I'd appreciate some insight into this too.

- Matt

[spenac]

Maybe left arm closer to heart leading to blood being forced against the weak spot thus completing the tear. I do not recall that in any of my text books, Dr Bledsoe can correct me if I missed it in his, as can the writers of the other Paramedic texts. I to look forward to the real answer.

[WolfmanHarris]

I just reviewed Bledsoe and there was nothing in the text. Nothing about taking bilat BP's either (just a quick mention of pulse deficits). I must have gotten that one from an instructor during lecture, though a physician asked me if I'd taken bilateral BP's on a CP Pt. during clinical.

[Doczilla]

In suspected thoracic aortic dissection, taking the BP in both arms is not only okay, it is encouraged.

'zilla

[WolfmanHarris]

Thanks Doczilla! Now I went and hit my patho book this afternoon, but I can't figure out what about the aneurysm causes the difference in BP's. Any direction or where I might want to look to figure this out? A starting point concept to consider?

[Just Plain Ruff]

Hey DocZ so the quote I put in the original post is wrong or is it suspect?

I talked to 2 physicians and 2 critical care nurses as well as the two other medics I'm working with and they all think that what was in the article was wrong.

The question I have is if the article is correct in what it says, then why by taking the blood pressue in the left arm would this cause back pressure and cause the aneurysm to rupture?

I think the author is incorrect. As do the group I talked to today.

If it is incorrect I want to send a request for correction or clarification to the author of the article.

[chbare]

Agree with Doczilla on this, assessing pressures in both arms is a commonly encouraged assessment technique.

Take care,

chbare.

[tniuqs]

In suspected thoracic aortic dissection, taking the BP in both arms is not only okay, it is encouraged.

'zill/quote]

Agreed:

In the field differences in L vs R is a misnomer for dx of suspected thoracic aortic dissection (especially ... if you have a high thoracic aortic dissection) honestly its a death sentance plain an simple, and even on the OR table one needs to be pumped (ECMO) went it is above the renal arteries, if it has already disected your done like dinner.

If I had a choice of a way to go ... this would be the way, to the next plain, its danm near instantaneous, there is fuck all an EMS provider could do!

My High School football coach, whent this way moving him from CCU bed to a cot to go to another facility for surgery, cross clamping was the only option we had, no Bi pass at that Facility.

We and the very experianced RN called (aka Giggles) we saw the angiogram ... at 10 cm at the arch he was done.

I shot the tube in 5 seconds as the RRT.

he was such a good man but he did not suffer.