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