Round 6 (MW) – Weakness

You are working at Clerkship General when the base command phone rings –











“Hey doc just wanted to give you a heads up on this stroke alert we’re bringing you – we have a 70yo M with sudden onset left arm numbness and weakness, last known well 2 hours ago, we’ll be there in about 5 minutes”











Initial Vital Signs:











HR 120











BP 180/90











RR 22











O2 97%











Temp 97.7F











Critical Actions:











1. Check a blood glucose











2. Diagnose Aortic Dissection











3. Give Esmolol first, titrate to HR<60











4. Give Nicardipine/Clevidipine second, titrate for SBP 100-120











5.   Consult cardiothoracic surgery for type A dissection











Further Reading:











EMCrit – Aortic Dissection