Aortic Dissection


Pathophysiology

Symptoms

Differential

Diagnosis


ED Care & Disposition

All pts with aortic dissection or strongly suspected aortic dissection require Emergent Vascular or Thoracic Surgical Consultation & prompt radiographic confirmation of the diagnosis, which is best directed by the operating surgeon.

  1. Initial (ED or ICU)
  2. Medical/Pharmaceutical (ED or ICU)
  3. Surgical/Procedural

Disposition

  1. Immediate surgical consult when considering Dx (BEFORE confirmation)
  2. Admit to ICU; monitor hemodynamics & urine output
  3. Long term therapy (+/- surgery)

Complications

Sudden onset chest/back pain
+
Pulsatile abdominal mass
STABLE UNSTABLE?
Tearing, Ripping pain
Pulsatile mass
+
Hypotension
HypOtension
Abdominal Pain
HypErtension
Chest Pain
AAA until proven otherwise
Aortic Aneurysm
Aortic Dissection
Immediate Laparotomy
Pulsatile abdominal mass
Abdominal bruit
Atherosclerosis
Intimal Tear
Inter-scapular Back Pain
Asymmetric Pulses & BP measurement
 
Abdominal Ultrasound to Dx and F/U TEE
5 cm 5 cm Ascending Descending
Asymptomatic Symptomatic Or Ruptured Pain in Anterior Chest Inter-scapular Back Pain

Monitor
(Ultrasound)

Surgery

Surgical Emergency

Medical Management
(Ultrasound)
AAA growing 0.5 cm in 6 months is at high risk for rupture