Page 65 - Critical Care Notes

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Diagnostic Tests
■ Abdominal ultrasound (first line of diagnostic testing)
■ CT scan of the abdomen
■ Abdominal x-ray
■ Echocardiogram may be useful
■ Aortogram
■ MRI
■ Preoperative labs and type and crossmatch for surgery
Management
■ Administer beta blocker to lower arterial pressure to the lowest SBP (120 mm
Hg or less). Use alpha-beta blocker labetalol (Trandate) or metoprolol
(Lopressor) in place of nitroprusside and a beta blocker; do not give direct
vasodilators such as hydralazine.
■ If aneurysm ruptures:
■ Administer IV propranolol (Inderal) to ↓ myocardial contractility and keep
HR 60–80 bpm.
■ Administer nitroprusside to maintain MAP 70–80 mm Hg.
■ Provide fluid resuscitation.
■ Administer morphine for pain.
■ Prepare patient for emergency surgery.
Postoperative Management
■ Goal of postoperative care is to reduce afterload and pressure at the
repair site.
■ Administer IV nitroprusside with esmolol (Brevibloc) or labetalol (Trandate)
and titrate the dosage to keep systolic BP below 120 mm Hg as ordered.
■ Starting immediately after surgery, continuously monitor the patient’s neu-
rological status, cardiac rhythm, RR, hemodynamics, urine output, core
body temperature, fluid and electrolyte imbalance.
■ Provide analgesia. Morphine recommended.
■ Monitor for acute renal failure, ischemic colitis, spinal cord ischemia, and
aortoenteric fistula.
■ Assess patient’s gastrointestinal function.
■ Report urine output less than 0.5 mL/kg/hr, which indicates dehydration,
volume deficit, or decreased renal function.
■ Anticoagulants may be needed to prevent thrombi formation.
■ Assess for poor peripheral perfusion.

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