Aortic Dissection

Aortic dissection. You could argue it’s one of the hardest diagnosis to make in the emergency department. In the first of three videos on aortic dissection, Dr. Ran Ran shares his thoughts on diagnosing dissection. He discusses chest pain in the emergency department and how important the history and physical exam are. He describes his approach to abnormal vitals signs and what this means for resuscitation. Additionally, he gives his thoughts on the often-mentioned likelihood ratios and how this actually plays out in his clinical practice. Lastly, he goes through the workup of aortic dissection including what pushes him to CTA the chest, how he uses the d-dimer, and the utility of ultrasound in dissection.

In video two of three on aortic dissection, Dr. Ran discusses how to manage aortic dissection and the complications that can arise from it. Choosing the correct medication for blood pressure and heart rate control can be difficult. Dr. Ran clarifies which medications he prefers and in what situation. In concordance with his philosophy of always being prepared for the worst in the ED, he goes over the devastating complications that can arise and how to address each one. These include managing pericardial effusion and tamponade, hypotension, and intubating someone with a dissection.

In the last installment on aortic dissection Dr. Ran discusses managing patients with aortic dissection in the ICU. He touches on how important goals of care conversations are and to set expectations for the course early. He goes on to talk about post-operative care, particularly why it is important to understand what happened in the OR. Managing drips, common blood pressure goals after surgery, and important data points to trend are covered as well. Lastly, to close out the series Dr. Ran gives his insight into pitfalls ED providers can fall into when diagnosing and managing aortic dissection.