Aortic Dissection Pearls
Aortic dissection is caused by a tear in the tunica intima, the innermost layer of the wall of the aorta.
Evaluation:
1. Consider aortic dissection in any patient presenting with chest/abd/back pain that is:
• Abrupt onset and severe
• Maximal at onset
• Tearing/sharp/stabbing
2. Assess for high risk associations:
• Connective tissue disorder e.g. Marfans, EDS
• FHx of aortic dissection
• Aortic valve disease
• Cardiac surgery/catheterization
• Thoracic aortic aneurysm
3. Examine for:
• Pulse deficit/differential BP
• New AR murmur
• Focal neuro deficit
• Shock
Treatment - ED goal is to reduce aortic wall stress by reducing HR and BP:
• Control pain: i.v. opiates
• Control heart rate: i.v. ß-blocker, Target HR~60
• Control blood pressure: e.g. i.v. NTG (Target SBP 100-120, Target MAP 60-75)
PeterboroughEM @PeterboroughEM
#Aortic #Dissection #diagnosis #management #vascular
