Ticking time bomb: abdominal aortal aneurism detected at prehospital level

The cause of sudden death is increasingly more frequent due to abdominal aortal an-eurism (AAA). This ticking “time bomb” in the abdomen is particularly inconven-ient for diagnosis and treatment at the prehospital level. We present a rare case of prehospitally detected AAA that like the ticking time bomb threatened to rupture. Case scenario. A 66 years old male called Emergency Medical Services (EMS) due to unbearable pain (9/10 at the pain intensity scale) of crescendo type in the right gluteal region and the right hip. Four days before, due to a sudden feeling of pain within the above quoted region he underwent neu-rological, orthopedic and urological ex-aminations. The diagnosis of coxarthrosis/coxalgia was made. He was treated with analgesics with suggested rest. Anamnes-tically, he was previously healthy, without family history of AAA. He is a several-year smoker and hypertonic. Physical findings: conscious, orientated, eupnoic, afebrile, normal skin color, with visible mucosa, excessive sweating and obesity. Ausculta-tory findings of the lungs and heart were also within normal limits. SaO2 = 99%. Blood pressure (BP) on both hands was 170/100 mmHg. ECG: sinus rhythm with a frequency of 80/min, without acute ST-T changes. The abdomen above the chest was with palpable pulsating tumefaction (size 5-6 cm) in the right inguinum that was res-piratory immovable. Lazarević sign nega-tive. Prehospital diagnosis was made: sus-pected AAA. On admission: treated as the emergency case, after multislice computed tomography (MSCT) and angiographic findings indication for emergency surgi-cal intervention was made. He was of good general condition and satisfactory local status. Ten days after surgery the patient was released from hospital with prescribed antihypertensive and antiaggregant therapy, and was also forbidden smoking. Conclusion. The reported case is the con-firmation that AAA represents a ticking “time bomb” in the organism that requires emergency prehospital recognition, emer-gency care and high emergency transport to a hospital.

aneurism, abdominal aorta, ticking time, bomb, prehospital, detection

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