• Self-directed learning
• Hands-on or experiential learning

Description – Where were you? What was the event/experience? What happened? What did you do? Who was there? What did other people do? What were your learning goals? What did you learn?

 Tragic case of otherwise fit and well looking 41 year old male. Collapsed in hospital surgical assessment unit, initially complained of abdo pain. Had CT which showed ruptured splenic artery aneurysm. Aneurysm coiled by interventional radiology, feeding branch only, too unstable to coil efferent branch. Groin wound developed false aneurysm and bleed which was not amenable to endovascular treatment. Further CTA revealed several aneurysms in profunda femoris and tibial vessels, review of initial CTA revealed slightly abnormal visceral vessels, in particular the gastric and hepatic vessels. Further surgical repair of groin pseudo-aneurysm attempted but all arteries and veins were extremely friable and catastrophic blood loss curtailed the attempted surgery, leg ischaemia ensued and amputation was inevitable 10 days post initial collapse. It became apparent after the initial coiling attempt that an extremely unusual condition was the cause, vascular type Ehlers Danlos is the current working diagnosis, tissue typing, genetic testing and rheumatology opinion all being considered.

Feelings – What did you think and feel before the event? What did you think and feel during the event? What do you think others thought and felt? What did you think and feel after the event? What do you think and feel now? What do others think and feel now?

 5 of our consultant vascular surgeons and 3 consultant interventional radiologists all involved with this case are devastated by the outcome. I scanned the patient myself in presence of medical staff and his wife (a nurse). I can't remamber many more upsetting cases than this one.

As a result, I have researched this sad condition.

Evaluation – What was good and bad about the event/experience? What went well? What didn’t go so well? What did you do well? What did you and others contribute to the situation (positives and negatives)? Did the event meet your expectations? How did this benefit service users? How did this contribute to the quality of the service you deliver?

 Sad to say very little went well for the patient. It has however highlighted a rare condition affecting blood vessels and other hollow organs, vascular Ehlers-Danlos syndrome, (vEDS).

Our unit staff (3 vascular sonographers) were all involved in scanning this case as well as attempting ultrasound compression for occlusion of groin false aneurysm.

We have monthly meetings and wil discuss our attitude to referrals for scans for ??AAA in young patients, which were previously rejected.

Analysis – What are the reasons this situation happened? What sense can you make out of the situation? How could this have been a more positive experience for everyone involved?

Conclusion – What else could you have done? How could this have been a more positive experience for everyone involved? What could you have done differently? How did this improve your practice? What new skills do you need to develop? What new knowledge do you need?

 Not very much could have been done in this case as far as our input goes.

Perhaps we should consider scanning other vessels when a young person is first found to have an aneurysm on ultrasound then maybe the vEDS diagnosis could be considered before any intervention or surgery takes place. Surgery in vEDS is invariably unsuccessful but would have to be undertaken if life/limb was threatened.

Action plan – What do you need to do now? What is your very next action? What do you need to learn? What CPD can you now do to meet your learning needs? What support do you need to achieve your learning goals? What will you do in the future if this happened again?

Vigourously researching vEDS and will propose amendments to our aneurysm screening protocol for younger subjects. Ehlers-Danlos support.uk is good website for straightforward information.

Which KSF dimensions does this CPD activity help you to meet?

How has this activity enabled you to meet the dimensions?

How has this activity helped you maintain a continuous, up-to-date and accurate record of your CPD activities?

On line self directed learning.

How is this activity different to other activities you have done? How does it demonstrate that you do a mixture of learning activities? How is it relevant to your current or future practice?

 It is related to a rare condition.

In what way has this CPD activity contributed to the quality of your practice and the service you deliver?

 We will discuss and probably change our attitude to requests for aneurysm screening in younger patients.

Service users can be patients, carers, referrers, colleagues, other professionals, students and learners, service purchasers, commissioners or members of a community of practice. In what way has this CPD activity benefited service users? In what way did you intend this activity to benefit service users?

 See above.