Deep Dive MW R6

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