Saturday, August 22, 2020

Aortic Dissection

EmDocs - September 03, 2019 - By Long D / Reviewed by: Koyfman A and Long B
  • Consider symptomatic or ruptured AAA in any patient (especially elderly) with abdominal pain, flank pain, back pain, syncope, especially if he/she is presenting with hypotension.
  • The RUSH exam is key in any hypotensive patient and can rapidly diagnose AAA.
  • Resuscitation of rAAA includes 2 large bore IVs, early blood products, minimizing crystalloid, permissive hypotension, tranexamic acid, and delayed airway management.
  • As soon as a AAA or rAAA is diagnosed or suspected, vascular surgery consultation is recommended. Surgery is required for definitive management.
  • Permissive hypotension is maintaining BP as low as possible to maintain end organ perfusion in an attempt to preserve hemostasis.
  • Vascular surgery guidelines recommend a 90-minute time from first medical contact to definitive operative management for ruptured AAA, with a 30-minute time from first medical contact to transfer to a center with definitive management.
  • REBOA is a potential therapy to attempt in the crashing AAA patient, but should not be used if it delays time to the operating room for definitive management."