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Supraventricular Tachycardia in a Patient With a Ruptured Abdominal Aortic Aneurysm: Conclusion

      A transport request was received from a free-standing emergency facility to transport a morbidly obese man with a ruptured abdominal aortic aneurysm (AAA). Weather conditions at the time prohibited rotor-wing transfer, so ground transport was arranged.
      The patient was a 58-year-old man being worked up for a possible back injury. During the evaluation, the patient had an episode of supraventricular tachycardia (SVT) with associated hemodynamic instability. Although the SVT corrected without intervention, the patient remained hemodynamically unstable. An abdominal computed tomographic (CT) scan with intravenous (IV) contrast demonstrated a 10-cm leaking abdominal aortic aneurysm. The patient complained of severe heartburn and abdominal pain. He had a significant medical history, including a previous three-vessel coronary artery bypass graft surgery, non-insulin-dependent diabetes, and chronic renal insufficiency. Physical examination was significant for limited mouth opening, limited neck mobility, a previous median sternotomy scar on the chest, and a markedly distended abdomen. Vital signs demonstrated a heart rate of 138 beats/min, respiratory rate 28 breaths/min, blood pressure 103/47 mmHg, and an oxygen saturation of 93% on 15 L/min by a nonrebreather (NRB) mask. Sinus tachycardia was identified on the monitor. Vascular access included an 18-gauge IV line in the right hand, a 16-gauge IV line in the left antecubital fossa, and a 7.5-French triple-lumen catheter in the right subclavian vein. Dopamine was running at 10 μg/kg/min. A unit of packed red blood cells (PRBCs) was also noted to be infusing at a rate of 999 mL/hour by infusion pump.
      Blood transfusion continued, and the dopamine was decreased to 5 μg/kg/min and eventually able to be discontinued. Despite this, approximately 15 minutes into the transport, the patient had another episode of SVT.
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      References

        • Bordalo AD
        • Ferreira D
        • Bordalo e Sá AL
        • Tuna JL
        • Correia MJ
        • Pais F
        • et al.
        A case of incessant junctional tachycardia in a female patient with aneurysm of the interauricular septum.
        Rev Port Cardiol. 1992; 11: 561-581
        • Wassef M
        • Baxter BT
        • Chisholm RL
        • Dalman RL
        • Fillinger MF
        • Heinecke J
        Pathogenesis of abdominal aortic aneurysms: A multidisciplinary research program supported by the National Heart, Lung, and Blood Institute.
        J Vasc Surg. 2001; 34: 730-738
        • Blanchard JF
        • Armenian HK
        • Friesen PP
        Risk factors for abdominal aortic aneurysm: Results of a case-control study.
        Am J Epidemiol. 2000; 151: 575-583
        • Lederle FA
        • Johnson GR
        • Wilson SE
        • Chute EP
        • Littooy FN
        • Bandyk D
        Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group.
        Ann Intern Med. 1997; 126: 441-449
        • Larsson E
        • Granath F
        • Swedenborg J
        • Hultgren R
        A population-based case control study of the familial risk of abdominal aortic aneurysm.
        J Vasc Surg. 2008; ([Epub ahead of print])
        • Banerjee A
        Atypical manifestations of ruptured abdominal aortic aneurysms.
        Postgrad Med J. 1993; 69: 6-11
        • Loughran CF
        A review of the plain abdominal radiograph in acute rupture of abdominal aortic aneurysms.
        Clin Radiol. 1986; 37: 383-387
        • Brewster DC
        • Cronenwett JL
        • Hallett Jr, JW
        • Johnston KW
        • Krupski WC
        • Matsumura JS
        Guidelines for the treatment of abdominal aortic aneurysms: Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery.
        J Vasc Surg. 2003; 37: 1106-1117
        • Reichart M
        • Geelkerken RH
        • Huisman AB
        • van Det RJ
        • de Smit P
        • Volker EP
        Ruptured abdominal aortic aneurysm: Endovascular repair is feasible in 40% of patients.
        Eur J Vasc Endovasc Surg. 2003; 26: 479-486
        • Antonello M
        • Frigatti P
        • Maturi C
        • Lepidi S
        • Noventa F
        • Pittoni G
        • et al.
        Open repair for ruptured abdominal aortic aneurysm.
        Ann Vasc Surg. 2008; ([Epub ahead of print])
        • Vohra R
        • Reid D
        • Groome J
        • Abdool-Carrim AT
        • Pollock JG
        Long-term survival in patients undergoing resection of abdominal aortic aneurysm.
        Ann Vasc Surg. 1990; 4: 460-465
        • Cannon WB
        • Fraser J
        • Cowell EM
        The preventive treatment of wound shock.
        JAMA. 1918; 70: 617