Protocols for Managing Suspected Aortic Dissection in the Emergency Room

Claudia Miller^*
*Correspondence: Claudia Miller, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Canada, Email:

Introduction

Aortic dissection is a rare but life-threatening condition that involves a tear in the inner layer of the aorta, the main blood vessel carrying oxygenrich blood from the heart to the rest of the body. This tear causes blood to flow between the layers of the aortic wall, leading to a separation of these layers, a process known as dissection. Aortic dissection often presents as an emergency, with rapid diagnosis and intervention being critical for improving survival outcomes. In the Emergency Room (ER), the presentation of aortic dissection can be confusing, as it shares symptoms with other common conditions such as acute myocardial infarction, pulmonary embolism and stroke. However, without timely intervention, aortic dissection can rapidly lead to complications such as aortic rupture, organ ischemia, or even death. Therefore, emergency room physicians must be able to quickly identify suspected cases and implement effective management protocols to stabilize the patient and prepare for potential surgical intervention. This article aims to provide a comprehensive overview of the protocols for managing suspected aortic dissection in the emergency room. We will explore the pathophysiology, symptoms and diagnostic approaches to this condition, along with the evidence-based protocols that ER teams follow to ensure the best possible outcomes for patients. By understanding the importance of these protocols, healthcare providers can better navigate the complexities of aortic dissection in high-pressure emergency settings [1].

Description

Aortic dissection is a medical emergency that requires immediate attention and intervention. The condition is most commonly associated with high blood pressure, but it can also occur in individuals with connective tissue disorders, a history of aortic aneurysms, or even traumatic injury to the chest. Aortic dissection can be classified into two main types: Stanford Type A and Type B. Type A involves a tear in the ascending aorta, while Type B involves the descending aorta. The management of these two types differs, with Type A typically requiring urgent surgical intervention, while Type B may sometimes be managed conservatively or with endovascular repair [2]. The symptoms of aortic dissection are often sudden and severe, including sharp, tearing chest pain, which may radiate to the back, shoulders, or abdomen. Other symptoms may include fainting, dizziness, shortness of breath, or signs of stroke, such as numbness or weakness on one side of the body. Because of the wide range of symptoms that can overlap with other medical conditions, aortic dissection is often difficult to diagnose quickly, which can delay treatment and lead to poor outcomes [3]. In the emergency room, the first step in managing a suspected aortic dissection is a rapid and thorough assessment. The physician must obtain a detailed patient history, focusing on risk factors such as hypertension, family history of aortic disease, or recent trauma. A physical exam should look for signs of shock, differential blood pressure in the arms, or neurological deficits, all of which could suggest aortic dissection. Once the suspicion is raised, imaging studies are critical to confirm the diagnosis. A contrast-enhanced CT scan is the gold standard for diagnosing aortic dissection, providing detailed information about the extent and location of the tear. In some cases, Magnetic Resonance Imaging (MRI) or Trans Esophageal Echocardiography (TEE) may be used [4]. Once diagnosed, the next step is stabilizing the patient. Blood pressure control is paramount, as high blood pressure can exacerbate the dissection and increase the risk of rupture. Beta-blockers and vasodilators are commonly used to lower blood pressure and reduce the heartâ??s pumping force. If the dissection involves the ascending aorta (Type A), immediate surgical consultation is necessary for possible emergency surgery. For Type B dissections, the management may be more conservative, focusing on blood pressure control and monitoring. Timely decision-making and the ability to collaborate with a multidisciplinary team, including cardiovascular surgeons, radiologists and anesthesiologists, are critical to the success of aortic dissection management in the ER. In situations where surgery is required, preparing the patient for intervention as quickly as possible is essential for improving survival rates [5].

4.Conclusion

In conclusion, aortic dissection is a medical emergency that requires rapid recognition and intervention. Adherence to established emergency room protocols is essential for ensuring the best possible outcomes for patients. Early diagnosis, appropriate imaging, blood pressure control and timely surgical consultation can make the difference between life and death. However, challenges remain, particularly in cases where the diagnosis is delayed due to symptom overlap with other conditions. Emergency room protocols must continue to evolve based on emerging research and advancements in diagnostic technology. Furthermore, ongoing education and training for healthcare professionals are crucial for improving awareness and response times in high-pressure situations. As healthcare providers work together in multidisciplinary teams, the ability to diagnose and treat aortic dissection quickly will continue to improve, reducing morbidity and mortality rates associated with this devastating condition.

References

1. Kimura, Naoyuki, Tetsu Ohnuma, Satoshi Itoh and Yusuke Sasabuchi, et al. “Utility of the Penn classification in predicting outcomes of surgery for acute type a aortic dissection.” Ame J Cardiol 113 (2014): 724-730.

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2. Vahanian, Alec, Friedhelm Beyersdorf, Fabien Praz and Milan Milojevic, et al. “2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).” Eur Heart J 43 (2022): 561-632.

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