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Aortic Dissection, Thoracic, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Aortic dissection begins when there is an intimal tear.

  • Blood then dissects through the media under aortic systolic pressure.

  • It is thought that hypertension is a major factor in the d...

Diagnosis

Signs and Symptoms

History

  • Chest pain:

    • May be absent in as many as 15% of patients

    • Substernal if type A dissection

    • Intrascapular if descending thoracic dissection

    • Lumbar if abdominal aorta involve...

Treatment

Pre-Hospital

  • Monitor

  • IV access

  • Oxygen

Initial Stabilization/Therapy

  • 2 large-bore IV lines

  • Continuous cardiac monitoring

  • Pulse oximetry

  • Oxygen

  • Type and cross

Ed Treatment/Procedures

  • BP reduction to redu...

Follow-Up

Disposition

Admission Criteria

  • All patients with acute aortic dissection should be admitted to the intensive care unit.

  • Emergency cardiothoracic surgery consultation should be obtained, especia...

Pearls and Pitfalls

  • Untreated, nearly 75% of patients with ascending aortic dissection can be expected to die within 2 wk, with a mortality of 1–3%/hr in the 1st 48 hr.

  • Majority of patients present wit...

Additional Reading

  • Harris  KM, Strauss  CE, Eagle  KA, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: The International Registry of Acute Aortic Dissection (...

Codes

ICD9

441.01 Dissection of aorta, thoracic 

ICD10

I71.01 Dissection of thoracic aorta 

SNOMED

  • 233994002 dissection of thoracic aorta (disorder)

  • 301899003 Proximal aortic dissection

  • 426948001 Aneurysm of...

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