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Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Pseudoaneurysm Screening after Pediatric High Grade Solid Organ Injury.

Morgan Schellenberg1, Brent Emigh1, Chance Nichols1

  • 1Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.

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|October 25, 2022
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Summary

Pseudoaneurysm screening is infrequent in pediatric high-grade solid organ injuries. Delayed CT angiography (dCTA) and contrast-enhanced ultrasound (CEUS) yield requires further study to optimize diagnosis.

Keywords:
computed tomography angiographycontrast-enhanced ultrasoundpseudoaneurysmsolid organ injurytrauma

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Area of Science:

  • Pediatric Trauma Surgery
  • Diagnostic Imaging
  • Vascular Surgery

Background:

  • High-grade solid organ injuries in children can lead to pseudoaneurysms (PSA).
  • Optimal screening strategies for pediatric PSA remain undefined.
  • Delayed CT angiography (dCTA) and contrast-enhanced ultrasound (CEUS) are potential screening tools.

Purpose of the Study:

  • To determine the yield of dCTA and CEUS in diagnosing pseudoaneurysms (PSA) in pediatric patients with high-grade solid organ injuries.
  • To evaluate the current practices and outcomes of PSA screening in this population.

Main Methods:

  • Retrospective review of patients under 18 with AAST grade ≥3 abdominal solid organ injury (01/2017-10/2021).
  • Exclusion criteria included transfers, death within 48 hours, and immediate organ removal.
  • Selective PSA screening using dCTA or CEUS based on attending physician discretion.

Main Results:

  • Forty-two patients met inclusion criteria; 26% underwent PSA screening.
  • Delayed CT angiography (dCTA) was used in 21% and contrast-enhanced ultrasound (CEUS) in 5% of patients.
  • One pseudoaneurysm was diagnosed via dCTA following splenic injury; CEUS identified no PSAs.

Conclusions:

  • Pseudoaneurysm screening is infrequently performed in pediatric high-grade solid organ injuries.
  • Concerns regarding radiation from dCTA may influence screening choices, favoring CEUS.
  • Further research is needed to establish PSA incidence and the diagnostic accuracy of dCTA and CEUS.