Best Case Ever 13: Aortic Dissection

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 12 November 2012

⏱️ 6 minutes

🔗️ Recording | iTunes | RSS

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Summary

Dr. David Carr, the past author of Tintinalli's chapter on occlusive arterial disease, tells us his Best Case Ever related to Aortic Dissection. In the related Episode 28: Aortic Dissection, Acute Limb Ischemia & Compartment Syndrome, we discuss the breadth of presentations and key diagnostic clues of Aortic Dissection. We review the value of ECG, CXR, biomarkers and the use of Transesophageal Echo and CTA in this sometime elusive diagnosis. We debate lots of clinical pearls and pitfalls when it comes to acute limb ischemia, and end with a discussion on the trials and tribulations of Compartment Syndrome. [wpfilebase tag=file id=398 tpl=emc-play /] [wpfilebase tag=file id=399 tpl=emc-mp3 /]

Transcript

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0:00.0	In anticipation of episode number 28 on vascular emergency pearls and pitfalls, we have with us, Dr. David Carr, who's been with us before on emergency medicine cases.
0:28.7	He's one of the authors of the Tintanelli chapter on occlusive arterial disease, and he's going to be telling us about his best case ever when it comes to
0:38.7	vascular catastrophes. Dr. Carr, let it rip. This was a fantastic case. It was a case that was
0:47.1	seen by one of my most esteemed diagnosticians. This patient was a 66-year-old female who was sitting on the couch watching
0:56.2	TV on a Sunday afternoon. All the sudden, while she was watching TV, she noticed an acute
1:03.1	onset of paralysis of her lower limbs. She had no pain, but she couldn't move her limbs. She shuffled herself using her arms off the couch
1:14.2	and got the phone and called 911. When the first responders arrived to her place, she said,
1:22.0	I'm fine. And they said, I thought you were paralyzed. She said, it's not anymore. They did an assessment that showed vital
1:28.9	signs. A heart rate of 76, a blood pressure of 160 over 90. She was a febri. She says, I feel totally
1:35.6	fine. They persuade her to go to the emergency department. And she comes to a busy emergency department
1:41.7	where she's seen by this excellent doctor.
1:50.1	And she's seen by this doctor who just kind of hears the story and says to herself,
1:52.5	something's not right.
1:57.8	Emergency medicine is a lot of the art and not the science.
2:02.2	It's a lot of meeting knowing that at any shift you'll meet 20, 30, 40 strangers in their time of need. And you have to judge the severity of their symptoms based
2:10.0	in the person saying it. We know that patients can have the same complaints, but have totally
2:15.9	different diagnosis. The person who's never, ever been to an
2:19.4	emergency department in his life at 80 years old, when she comes to the emergency department,
2:24.6	probably has something significantly wrong. And the doctor who saw this patient, her senses were
2:29.9	telling her, something's up with this patient. I believe her. She's legitimate. She's not a
2:36.7	complainer. Something's wrong despite a completely normal neurologic exam. She postulated the differential,
2:45.2	and she said, I wonder if this person had a spinal artery TIA.
	...

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