Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.

3Feb/121

Aortic Dissection

Erin Noste, MD

  • Aortic dissection is a "chest pain and ______ syndrome", think about the diagnosis when you have a patient who presents with chest pain and: headache, back pain, abdominal pain, syncope, neuro symptoms, renal failure, leg pain, or arm pain
  • Think dissection when patients present with sudden and severe pain, 84.8% of patients in the IRAD study presented with abrupt onset of pain and 90.6% of patients presented with severe pain
  • Check and document bilateral pulses (carotid, radial, femoral, DP, PT), even though 15.1% of patients in IRAD had a documented pulse deficit
  • When dissection is highly suspicious or diagnosed treat hypertensive patients aggressively, consider treating before sending for imaging. Goal SBP 100-120 mmHg and HR < 60 bpm. Treat first with a beta blocker (esmolol), then, if needed add a vasodilator such as nitroprusside

Hagan P. et al. The International Registry of Acute Aortic Dissection (IRAD). JAMA. 2000;283:897-903

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