Aortic Dissection
Thu, 10/21/2021 - 6:00am
Editor:
History:
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Severe pain
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Ripping / tearing pain
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Thorax pain
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Abrupt
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Migrating
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Hx of aortic disease or connective tissue disorder
Physical Exam:
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Look uncomfortable?
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Neuro deficit
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Pulse deficit (touch the feet)
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New diastolic murmur
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Vital signs abnormalities?
Diagnostics:
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CTA CAP: test of choice in ED
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MRA
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TEE
Goals:
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Get patient to OR, prevent rupture:
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Decrease chronotropy, inotropy, afterload
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HR (goal 60) / decrease catecholamine surge: esmolol
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BP (goal SBP 100-110): nicardipine, clevidipine, nitroprusside
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Arterial Line!!
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What if they are hypotensive? Think of why:
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Acute MI
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Not common! < patients with STEMI found to have AAS
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Usually RCA
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Aortic insufficiency
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Aortic rupture
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Pericardial tamponade
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Look with POCUS