Aortic Dissection - Diagnosis and Acute Management

Pain: Chest, Back, Abdo, Migrating, Above & below diaphragm, Abrupt onset, Max intensity at onset, Tearing, Ripping, Sharp, Requiring opioids, Can be intermittent, Can be painless

Px: High or low BP, Pulse deficit, New diastolic murmur, Focal neuro deficit, Bilat BP diff (can be normal)

Management - Diagnose with CTA. Call CV Surgeon.

1) Control Pain - Fentanyl 25-50mcg IV

2) HR < 60 

     Labetalol 10-20mg IV bolus, 0.5-2mg/min, or

     Esmolol 500mcg/kg bolus, 50-300mcg/kg/min

3) SBP <110 *Use arm with higher BP

     Nitroprusside 0.25-0.5mcg/kg/min, or

     Nicardipine 5mg/hr



- Dr. Sarah Foohey @SarahFoohey



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