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“AAA”

Abyss upon abyss — grave danger!

First noticed in the A.M., the discomfort, an ache, seemed similar to the arthritic discomfort of history, but as the day went on, the irritation progressed, becoming persistent and more then annoying. Finally the right hip ache, a real pain, presented to the medical system. The quick evaluation thoroughly relied on a former history of injury and arthritis. A high blood pressure was taken to reflect the push of the pain, and was treated with an injection of an NSAID. This perhaps helped and the blood pressure was noted to be remarkably lower. The ache eased in respite so OTD with discharge instructions  including a prescription for analgesia.

After a stop at a pharmacy to fill these medications, the arrival at the home coincided with the collapse. The pain, that had briefly relented and retreated to an ache, was now a serious abdominal blow. A frantic 911 call brought first responders, who found a pale, anxious and diaphoretic patient with barely detectable blood pressure. A paramedic unit was dispatched and upon arrival established an IV of LR with a rapid infusion of 500 ml. This brought the blood pressure up, but now as the shearing pain and anxiety implied, this was clearly a race against something much more ominous then arthritis.

Now back in the emergency room, a new evaluation of a borderline blood pressure, with absent femoral pulses,tachycardia and significantly increasing abdominal girth brought a more dire diagnosis. A ticking time bomb in the form of a pulsating mass creates a whirlwind of activity. Large bore intravenous lines, drawn labs with stat requests for uncrossed blood. A distant cardiovascular surgeon was contacted, consulted and the patient was accepted for transfer. From an air transport center, a request for flight accepted and a helicopter was dispatched.

The day ebbing through evening, and the departing bird passing out of the city lights, into the dark toward the desperate destination of dissection, dissecting and dissected and where all the current interventions are designed to buy time to the definitive treatment, cardiovascular surgery.

Into this multitasking milieu of tangled lines, pressure bagged blood and unnumbered bags of lactated ringers. Someone wants to take the patient for a CT exam, but this is decided in discussion to be a further delay to the definitive destination. With transfer to flight stretcher, caribiner clipped lines, secured straps and out the door, “in house” time is less then 15 minutes.

Loading the pilot is informed of need for rapid air transport with possible trendelenberg.