Aortic Dissection

Aortic Dissection

history/vitals/focused exam; cardia/abd/lung/CNS

DD:Unstable angina, MI, Aortic aneurysm

CXR poratble
EKG 12 lead
Echo(Trasn Esophageal) would be reasonable test to be done after CXR
(ER setting, getting a CT is difficult CT and other investigation takes longer time).

Arterial catheter for pressure monitoring & also cardiac monitor in view of non specific st-t wave changes
Control BP with SNP IV infusion+ Beta Blocer or Labetolol IV infusion (single agent titrate)
do ABG,CXR,CKMB,Trop I,EKG-Rule out other causes
Prepare for surgery - CBC,Chem7,UA,Gp and Cross Match, Pt ,PTT
CT scan chest
Surgical Consult- (doesnt help in CCS- still ask for it!!)
If no immediate need for surgery after looking at the Echo-ICU transfer
Rpt CXR and monitor ( cost effective)

If surgery indicated; Based on the size, presence of AR etc
ORDER THORACIC AORTIC ANURYSMECTOMY