For AAA patients

Editorial Team / Admin · Mar 15, 2015

You can't fix dead. However, you can attempt to get the patient into the OR and try to repair the ruptured AAA. Doesn't always end happily, but if the patient isn't a DNR, then you do what you can and what next of kin agrees to once the emergent phase has ended.

AnnieOaklyRN, BSN, RN, EMT-P · Mar 15, 2015

You can do CPR, pray, you can get them to an OR, you can even have the best surgeon in the world... Bottom line if a AAA ruptures the patient is dead no matter what you do, as there will be no blood going round and round, and in the minutes it takes to get them to the OR and open the abdomen, replace their entire blood volume, they are already brain dead.

AAA rupture or Thoracic AA rupture are just one of those things we just cannot fix once it has ruptured and the patient bleeds out!

Annie

Sam. W, MSN, APRN · Mar 15, 2015

You can't fix dead. However, you can attempt to get the patient into the OR and try to repair the ruptured AAA. Doesn't always end happily, but if the patient isn't a DNR, then you do what you can and what next of kin agrees to once the emergent phase has ended.

I work in LTC, I am just wondering if I should do CPR, because there is no Emergency room or doc nearby. If AAA ruptures, one of the nurses said we have to do CPR, we have to chart that we did CPR if the patient is not DNR.

calivianya, BSN, RN · Mar 15, 2015

I would do CPR to cover my own butt. Whether it makes sense or not doesn't matter - the lawyer/judge/jury/whatever looking it over isn't going to understand why CPR wasn't done if you get sued. If you do CPR, at least you can chart that you did something.

Libby1987 · Mar 15, 2015

How do you confim a ruptured AAA in the first couple of minutes in LTC? Because I think that might be a question by the family behind the full code status if you don't initiate CPR.

(Don't we wish people would choose their code status based on something besides emotion).

ETA What are the chances of it being witnessed with your ratios?)

blondy2061h, MSN, RN · Mar 15, 2015

There would be no way to confirm an AAA in LTC unless it was already diagnosed. Hopefully if it was diagnosed they have either made themselves a DNR or scheduled surgery quickly.

Editorial Team / Admin · Mar 16, 2015

I work in LTC, I am just wondering if I should do CPR, because there is no Emergency room or doc nearby. If AAA ruptures, one of the nurses said we have to do CPR, we have to chart that we did CPR if the patient is not DNR.

You forgot to mention that in your first post. If the patient has a known AAA that is the size where surgery is a consideration, hopefully they've already made plans to have it repaired or made themselves a DNR. If the patient has an unknown AAA, how are you going to be able to make the determination that a ruptured AAA is the issue? Heck, how would you make that determination even if it's a known AAA? Without diagnostic abilities at your facility, you can't determine the cause of someone's respiratory or cardiac arrest. Follow your facility's policies about full codes and CPR.

Sam. W, MSN, APRN · May 27, 2015

If it is not in the patient's diagnoses I would not know about the AAA....And it's 7cm, like a lemon..her family finally agreed to sign a DNR about a week later after admission.

How do you confim a ruptured AAA in the first couple of minutes in LTC? Because I think that might be a question by the family behind the full code status if you don't initiate CPR.
(Don't we wish people would choose their code status based on something besides emotion).
ETA What are the chances of it being witnessed with your ratios?)

ScrappytheCoco · May 28, 2015

As an old ED doc told me when I was a new grad: "Don't worry honey you can't make him more dead."

resqbug · May 28, 2015

A ruptured AAA can cause excruciating pain and someone can take up to a few hours before they actually die. If not done already, I would make sure you guys already have orders for comfort measures for immediate use once it happens.

blondy2061h, MSN, RN · May 28, 2015

A ruptured AAA can cause excruciating pain and someone can take up to a few hours before they actually die. If not done already, I would make sure you guys already have orders for comfort measures for immediate use once it happens.

A truly ruptured AAA will only take minutes to cause death. Having generous pain medication orders in someone who is dying and wants natural death allowed is a good idea, though.