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