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