Arteriovenous malformation is something I had never heard of until a recently. In a nutshell it’s a connecting of the high pressure arteries directly to the low pressure venous side without passing through a capillary bed. These connections can bunch together and are prone to leaking or bursting.

We attended to a patient in her early forties. She had an AVM diagnosed some time ago and had experienced several small bleeds resulting in arm numbness to tingling in the roof of her mouth. These events all self resolved without intervention. She was also undergoing radiotherapy a part of an ongoing treatment regime.

This morning she had her breakfast and then went to the toilet. Her partner heard a yell and then incomprehensible sounds. He opened the toilet door and found her to have minimal movement down the right side of her body. She couldn’t get off the toilet and had trouble balancing on the seat. He called for the ambulance and helped support her until the crew arrived.

Once on scene we had to carry the patient out of the toilet and onto the stretcher. In the back of the truck the patient started vomiting and her conscious state began to decline.

From toilet to truck to hospital the decline was remarkably rapid. Her conscious state went from a GCS 14 to GCS 8 in a matter of 20 minutes.

She was sent away for a CT and as they returned the attending nurse just mouthed the words to me “it’s full of blood”.

From loving partner to tragic victim. So rapidly. So unexpectedly. As a paramedic it is all you can do to get them to hospital as fast as you can. It still leaves you feeling that more could have been done.

Drop us a comment if you’ve experienced an AVM. What did you do for the patient? What was the outcome?