01.16.2023 - By Zack Olson, MD and Michael Estephan, MD
Aortic Dissection – when there is a tear in the intima layer of the aorta and the blood dissects the intima away from the media creating a false lumen in the aorta
* Historical Features
* Be VERY suspicious with ABRUPT onset of chest/back pain that reaches MAXIMAL SEVERITY immediately after onset of pain.
* Chest pain or Back pain with a neurologic deficit
* Pain “above and below the diaphragm”
* Diagnosis
* CT Angiography of chest abdomen and pelvis is gold standard
* Can see widened mediastinum on CXR or dissection flap on POCUS
* Treatment
* Pain control first
* Heart rate control second (goal <60bpm, use esmolol)
* Blood pressure control third (goal 100-120SBP, use nicardipine/clevidipine)
* CT Surgery consult (should go directly to OR with a Type A dissection)
* Arterial Line placement
Further Reading:
Core EM – Aortic Dissection
LITFL – Aortic Dissection