Ruptured Abdominal Aortic Aneurysm Presenting as Septic Shock

Autor:	Aaron Brockshus, Clay M. Merritt, Chase Donaldson, Bryon Davis
Rok vydání:	2020
Předmět:	medicine.medical_specialty Lower gastrointestinal bleeding Aortic Rupture 0211 other engineering and technologies 02 engineering and technology 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine 021110 strategic defence & security studies business.industry Septic shock Public Health Environmental and Occupational Health General Medicine Emergency department Staphylococcal Infections Mycotic aneurysm medicine.disease Shock Septic Abdominal aortic aneurysm Surgery Systemic inflammatory response syndrome Transplantation Shock (circulatory) medicine.symptom business Aneurysm Infected Aortic Aneurysm Abdominal
Zdroj:	Military Medicine. 185:e2189-e2191
ISSN:	1930-613X 0026-4075
DOI:	10.1093/milmed/usaa205
Popis:	A patient presented to the emergency department with undifferentiated shock 4 days after discharge from a hospitalization for a lower gastrointestinal bleed. The patient fulfilled 4/4 of the Systemic Inflammatory Response Syndrome criteria and 3/3 of the quick Sequential Organ Failure Assessment criteria on presentation to the emergency department, notably, without a localized source of infection and no localizing symptoms. After admission, the patient’s hemoglobin was found to have dropped more than expected after intravenous (IV) fluid administration, suggesting a potential alternative or concurrent etiology of the patient’s shock state. A digital rectal and focused assessment with sonography in trauma exam were performed and negative. The patient was then diagnosed with a ruptured infrarenal abdominal aortic aneurysm contained in the retroperitoneum by repeat point-of-care ultrasound. The patient was hemodynamically stabilized and taken for emergent grafting without confirmatory imaging. The patient was later found to also have 4/4 blood cultures positive with methicillin-sensitive Staphylococcus aureus associated with an aortic valvular vegetation and a mycotic aneurysm which contributed to the abdominal aortic aneurysm rupture. This case supports the use of comprehensive point-of-care ultrasound imaging to more rapidly and more definitively differentiate types of shock and etiologies of a shock state which can lead to more timely changes in management and improvement in outcomes.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::434be2ff33c763e7ca15fb1610c6e3d1 https://doi.org/10.1093/milmed/usaa205 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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