Ruptured Abdominal Aortic Aneurysm discovered by Pocket-sized ultrasound in low resource settings: A case report

Introduction: While AAA is a life-threatening condition that manifests suddenly in the Emergency department less is known about the use of hand-held ultrasound to diagnose it, especially in low-resource settings. Case presentation: A 78-year old man whose a known case of hypertension, the family reported he complained of severe loin pain then he collapsed at home, upon arrival to the ED patient was unconscious with unrecordable BP, pulses were intact, rapid sequence intubation (RSI) was done, ECG showed no ischemic changes, a few seconds later the patient becomes pulseless 1 cycle of CPR was done and the patient reverted to sinus rhythm then he was started on noradrenaline immediately, a few minutes later the lower limbs were noted to be paler and colder than upper limbs raising the suspicion of ruptured AAA, point of care US was done using hand-held ultrasound connected to a tablet, the ultrasound showed a ruptured AAA around 8 cm with intimal flap, surgical intervention was not available because of vascular surgery unavailability at that time, the patient becomes pulseless again CPR was initiated with no response despite the blood-transfusion, finally death was announced. Discussion and conclusion: Ruptured AAA is considered a vascular surgical emergency with a very high mortality rates, this case report highlights the importance of POCUS in emergency departments especially the cheaper models of hand-held ultrasound probes.