# Pulse or AAA?



## bonesaw (Apr 11, 2013)

Saw a thread about this topic and it got me thinking... I have seen/felt a pulse on those ridiculously skinny people before. If there is a true AAA, will there be a noticeable difference between that and a normal pulse?


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## the_negro_puppy (Apr 11, 2013)

It depends, where are you taking the pulse?

Carotid? radial, brachial?

I'm a little confused by the question.

Are you talking about differing blood pressures in each arms?

Or are you talking about the 'pulsatile mass' in the abdomen around the area of the aneurysm?


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## VFlutter (Apr 11, 2013)

In most people, not just skinny, you will be able to palpate a pulse from the abdominal aorta. Palpate about a finger breadth left of the navel and you should feel a faint pulse. This is best assessed when the person is laying supine. You should not feel a mass just a pulse. With an AAA you will have a strong pulsating mass that is most likely palpable in any position and may even be displaced from its normal anatomical position depending on the size and type of aneurysm. Also the patient will usually feel a pulsating sensation in the abdomen.


This would most likely be palpable medial/lateral to where you normally would feel a pulse. It also slightly displaces the abdominal aorta superior to the aneurysm.


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## Merck (Apr 11, 2013)

Yep, a pulse from the abdominal aorta will be palpable, especially in skinny people.  It is unlikely that you will encounter a AAA without some sort of history of having one - they can be stable for some time and are not as amenable to repair.  If it is new and currently dissecting - don't worry, you'll know.


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## VFlutter (Apr 11, 2013)

Merck said:


> It is unlikely that you will encounter a AAA without some sort of history of having one - they can be stable for some time and are not as amenable to repair.  If it is new and currently dissecting - don't worry, you'll know.



Most non-ruptured AAA go undiagnosed until inadvertently discovered during diagnostic imaging. I have had a few found during work ups prior to cardiac caths. I do not think it would be that unlikely to encounter a AAA without prior history.

But then again my patient population is at a higher risk and incidence so maybe I just see more.


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## Merck (Apr 11, 2013)

Well, the advantage of an ultrasound certainly increases the chances of finding an as yet undiagnosed aneurysm.  My point was only that on a regular call there is little chance that the paramedic will be the first one to call 'aneurysm!'.


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