The 58-year-old patient presents to the emergency department of a community hospital complaining of worsening back pain that started a few days ago. He states, “I thought maybe I had slept wrong and gotten a spasm, but I’m not sure. I didn’t fall or get hit or anything. The ibuprofen I took definitely didn’t help.” His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. A pulsating abdominal mass is noted; otherwise, his assessment is benign. The nurse advocates for which treatment option?

Question

The 58-year-old patient presents to the emergency department of a community hospital complaining of worsening back pain that started a few days ago. He states, &ldquo;I thought maybe I had slept wrong and gotten a spasm, but I&rsquo;m not sure. I didn&rsquo;t fall or get hit or anything. The ibuprofen I took definitely didn&rsquo;t help.&rdquo; His blood pressure is 174/96 mmHg and heart rate is 96 bpm. He reports being out of his antihypertensive medication for the past week while he was out of town. Other history is notable for arthritis in the hands and a 44-pack-year smoking history. He drinks socially but denies illicit drug use. A pulsating abdominal mass is noted; otherwise, his assessment is benign. The nurse advocates for which treatment option?

Accepted Answer

Transfer to the tertiary care center for endovascular aneurysm repair for an abdominal aortic aneurysm. The patient with back pain without specific cause, hypertension, smoking history, and a pulsating abdominal mass has a symptomatic abdominal aortic aneurysm (AAA). It requires urgent repair. However, because the patient is healthy and in no acute distress, the best option is transfer to a tertiary care center where a specialist can perform an endovascular aneurysm repair. This procedure is associated with lower mortality than open AAA repair. However, had the patient been decompensating, the open AAA repair is appropriate. The patient does not have an intestinal obstruction. Sending the patient home with antihypertensive medications does not address the patient&rsquo;s life-threatening condition.

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