Knowing when to scan the abdominal aorta in point-of-care ultrasound (POCUS)

An abdominal aortic aneurysm (AAA) can easily be mistaken for a simple case of back pain. So how do you know when to perform (or refer for) an ultrasound? In this video, we'll investigate the case of an elderly gentleman who presents with back pain after forgetting to take his painkillers, and consider the critical clue that should lead your differential diagnosis to an AAA.

In this course, you’ll learn how to use point-of-care ultrasound (POCUS) to diagnose the most important problems seen in the acute care setting. This course is ideal for anyone who’s just starting to use POCUS, whether you work in an emergency department, a general ward, the ICU, or a private clinic. Learn how to use POCUS to increase your success rate and decrease complications when performing common procedures.

[00:00:00] In this lesson, we're going to review how to perform a point-of-care ultrasound to evaluate for your abdominal aorta. Let's start with a case. You have a 67-year-old male who has a history of hypertension and chronic back pain who comes to you for worsening back pain. His exam is pretty unremarkable except for some tenderness to his lumbar spine but you noticed that his blood pressure is a little bit low. He tells you the story that he ran out of his narcotic prescription

[00:00:30] three days ago and now has worsening back pain. So, what are you going to do? Are you going to refill his prescription and send him on his way? Are you worried about anything else? Well, if you're not, you should be. The top of my differential would be a ruptured AAA, that's a ruptured abdominal aortic aneurysm. He's an elderly gentleman, he's hypertensive with back pain, and now he's got hypotension. A ruptured AAA should be on the top of your list. When performing an abdominal aortic scan,

[00:01:00] your focused question on bedside ultrasound or point-of-care ultrasound is very simple. Is there an AAA or not? For many years, screening with ultrasound for an abdominal aortic aneurysm has been the standard of care. But in the acute setting, if a patient comes in with back pain and hypotension and you find an AAA on your bedside ultrasound, that patient is considered to have a ruptured AAA until proven otherwise.