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

  1. 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”
  2. Diagnosis
    • CT Angiography of chest abdomen and pelvis is gold standard
    • Can see widened mediastinum on CXR or dissection flap on POCUS
  3. 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