Podcast 91 – Treatment of Aortic Dissection - a podcast by Scott D. Weingart, MD FCCM

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Aortic Dissection

Lower Dp/Dt and Blood Pressure

Control Pain with fentanyl

Control Heart Rate/Inotropy with esmolol

See the esmolol drip sheet (YOU MUST CHECK ALL NUMBERS WITH YOUR OWN PHARMACY)

Control Blood Pressure

With in order of preference: clevidipine, nicardipine, nitroprusside, nitroglycerin

What about if the patient can't get beta-blockers?

What about labetalol?

A-lines

Why is the Patient's Blood Pressure Low?



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Myocardial Infarction





Andy Neill thankfully addressed my erroneous assumption that MIs in Dissection would only be right coronary infarctions

Does an anterior STEMI rule out dissection? - Emergency Medicine Ireland

and check out this article as well (J Emerg Trauma Shock 2011;4:273-278)





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Site of Blood Pressure Measurement



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Rupture of the Aorta



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Aortic Insufficiency



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Pericardial Tamponade





Neurodeficits

Intubation

Do a high-icp/vascular intubation (More to come on this)

Update



* Nicardipine and Esmolol are compatible and can be given through the same IV



Amal Mattu's Law of 4's

History



* Abrupt onset of Thorax Pain

* Ripping or Tearing

* Migrating Pain

* History of Aortic Problems (like TAA)



Physical



* Hypotension

* Pulse Deficit

* Neuro Deficit

* New Murmur



Aortic Dissection Score

Tsutsumi Y, Tsujimoto Y, Takahashi S, et al. Accuracy of aortic dissection detection risk score alone or with D-dimer: a systematic review and metaanalysis. Eur Heart J Acute Cardiovasc Care. 2020; https:// doi.org/10.1177/2048872620901831.

Now on to the Podcast...





 

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM