What D.C.s Must Know About the Other Kind of Aneurysm
by Lori Holt
in Risk Management
on December 28, 2016
Most Doctors of Chiropractic are well versed in the clinical aspects and risks associated with cerebral aneurysms, but another type of aneurysm that hasn’t received nearly the “hype” is the abdominal aortic aneurysm (AAA).
However, because these types of aneurysms are also potentially life threatening, it’s important for doctors to understand AAAs. Less than 50 percent of people with a ruptured abdominal aortic aneurysm survive.
The good news is the outcome is usually good when an AAA is monitored carefully and if surgical repair is performed before the aorta ruptures. Unfortunately, there are often no symptoms, but they may include a pulsating abdominal mass with rhythmic throbbing.
Because of the lack of symptomology, obtaining an accurate history takes on special significance. The following are risk factors for an AAA:
- Peripheral vascular disease
- Family history
- More than 55 years of age
- High blood pressure
To identify an AAA, listen to the patient’s abdomen with a stethoscope. If the patient has an abdominal aortic aneurysm, there will be a “blowing” murmur over the aorta or a “whooshing” sound. The following tests may help with identification:
- Abdominal X-ray
- Abdominal ultrasound
- MRI of the abdomen
- CT scan of the abdomen
- Angiography of the aorta
Abdominal aneurysms are often detected by D.C.s through lateral films of the lumbar spine. The radiograph may show an abnormal projection on the aorta or a calcific rim. This information may provide an early clue in the identification of an aortic aneurysm, allowing you to appropriately refer a patient who otherwise had no clinical symptoms.
Signs of an Emergent Situation
A rupture of an abdominal aortic aneurysm is a medical emergency. Signs of one in progress include:
- The abdomen is rigid and there is an abdominal mass with a pulsating sensation.
- Pain in the abdomen. The pain is severe, sudden, persistent or constant. It is not colicky or spasmodic. It may begin suddenly, then radiate to the groin, buttocks or legs.
- There is pain in the low back that is severe, sudden and persistent, and the pain may radiate.
- Skin is pale, clammy and diaphoretic.
- There is a rapid pulse and unusual heartbeat sensations.
- Dry skin and/or mouth and excessive thirst.
- Anxiety, light-headedness with upright posture and nausea and vomiting.
- Rapid heart rate (tachycardia) when rising to standing position.
- Fatigue, shock and impaired ability to concentrate.
In the event of a medical emergency, such as a ruptured AAA, contact EMS in your area. Remain with the patient, keeping him or her as calm and comfortable as possible until 911 personnel arrive.
This article appeared in NCMIC’s Examiner magazine, a publication for NCMIC policyholders with compelling case studies and practical tips for avoiding a malpractice allegation. View the current issue of Examiner for more case studies and articles.
About The Author
Lori Holt, RN-BC
Professional Relations Representative - NCMIC Insurance Company
Lori Holt joined the corporate relations staff in 2012 and hit the ground running - literally - as she travels to various colleges and state associations to present on risk management and office emergencies. She also assists at homecomings and other events where NCMIC has a presence. Lori was bor
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