Aortic Dissection - Diagnosis and Acute Management
Pain: Chest, Back, Abdo, Migrating, Above & below diaphragm, Abrupt onset, Max intensity at onset, Tearing, Ripping, Sharp, Requiring opioids, Can be intermittent, Can be painless
Px: High or low BP, Pulse deficit, New diastolic murmur, Focal neuro deficit, Bilat BP diff (can be normal)
Management - Diagnose with CTA. Call CV Surgeon.
1) Control Pain - Fentanyl 25-50mcg IV
2) HR < 60
Labetalol 10-20mg IV bolus, 0.5-2mg/min, or
Esmolol 500mcg/kg bolus, 50-300mcg/kg/min
3) SBP <110 *Use arm with higher BP
Nitroprusside 0.25-0.5mcg/kg/min, or
Nicardipine 5mg/hr
- Dr. Sarah Foohey @SarahFoohey
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