Monday, November 14, 2022

POCUS for aortic dissection

emDOCs - November 14, 2022 - By Joseph R. Peters and Jeremy Owens
Reviewed by: Stephen Alerhand, Brit Long
AAD with neurologic symptoms at onset is an uncommon presentation in the ED. The neurologic symptoms may be transient, and up to one-third of these patients may present without pain. Stroke is a dreaded complication of AAD and can present with altered mental status or aphasia making the expression of pain impossible.  Patients presenting with stroke symptoms or thoracic pain demonstrating unusual combinations of vital signs or exam findings may harbor AAD as the etiology of their condition. POCUS demonstrates the ability to rapidly rule in AAD in these patients via the identification of an intimal flap in any of the multiple locations the major arteries can be visualized: the aortic root, aortic arch, common carotid arteries, the descending thoracic aorta, and abdominal aorta. A dilated aorta or pericardial effusion may represent an indirect sign that an AAD is present. POCUS of the heart, the thoracic aortic arch, the carotid arteries, and abdominal aorta revealing these signs expedites advanced imaging, consultant mobilization, and accurate decision-making in the care of patients with AAD.