Episode 92 – Aortic Dissection Live from The EM Cases Course

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This is EM Cases Aortic Dissection Live from The EM Cases Course

While missing aortic dissection was considered “the standard” in the late 20th century, our understanding of the clinical diagnosis has improved considerably since the landmark International Registry of Aortic Dissection (IRAD) study in 2000. Nonetheless, aortic dissection remains difficult to diagnosis with 1 in 6 being missed at the initial ED visit. Why? The diagnosis is rare with and incidence of only 2.9/100,000/year, and the presentation is often atypical mimicking other more common diagnoses such as ACS and stroke.

Each hour that passes from the onset of symptoms portends a 1-2% increase in mortality so your early, timely diagnosis is key. The most important factor leading to a correct diagnosis is having a high clinical suspicion. We need to at least consider the diagnosis in all patients with chest, abdominal or back pain, syncope or stroke symptoms, yet we shouldn’t be working up every one of them, or else we’ll bankrupt the health care system with all the CT aortograms ordered. Herein lies the difficulty.

With the help of David Carr and Anton Helman we’ll discuss how to pick up atypical presentations without over-imaging as well as manage them like pros by reviewing: 

1. The five pain pearls

2. The concepts of CP +1 and 1+ CP

3. Physical exam pearls

4. Initial tests pearls and pitfalls

5. The importance of the correct order and aggressive use of IV medications

So with these objectives in mind…

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