What Paramedics need to know about Aortic Dissection
Paramedics need to know that aortic dissection is a serious condition that requires immediate attention:
Suspicion
Have a high suspicion for aortic dissection, especially if the patient has chest pain, back pain, or abdominal pain.
Transport
Rapidly transport the patient to a hospital with cardiothoracic surgery capabilities.
Monitoring
Establish two large-bore IVs and continuously monitor the patient's cardiac rhythm, blood pressure, and heart rate.
Oxygen
Administer oxygen to maintain an O2 sat of greater than 90%.
Blood pressure
If the patient is hypertensive, lower their blood pressure to less than 110/systolic. A beta blocker is a good first choice agent.
Heart rate
Target a heart rate of less than 60 beats per minute.
Shock
If the patient is hypotensive and showing signs of shock or altered mental status, be prepared to give an IV fluid bolus.
Diagnostic studies
Perform ECG, transthoracic echocardiography, and blood tests. ***** A computed tomography scan (CT) with contrast is first-line for definitive diagnosis. *****
Aortic dissection occurs when blood is forced between the layers of the aorta, causing the layers to separate. The mortality rate for aortic dissection is 1-2% per hour for the first 24-48 hours.
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