Deep Dive MW R6

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 16 January 2023

⏱️ 22 minutes

🔗️ Recording | iTunes | RSS

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Summary

Aortic Dissection – when there is a tear in the intima layer of the aorta and the blood dissects the intima away from the media creating a false lumen in the aorta

* Historical Features

* Be VERY suspicious with ABRUPT onset of chest/back pain that reaches MAXIMAL SEVERITY immediately after onset of pain.

* Chest pain or Back pain with a neurologic deficit

* Pain “above and below the diaphragm”

* Diagnosis

* CT Angiography of chest abdomen and pelvis is gold standard

* Can see widened mediastinum on CXR or dissection flap on POCUS

* Treatment

* Pain control first

* Heart rate control second (goal <60bpm, use esmolol)

* Blood pressure control third (goal 100-120SBP, use nicardipine/clevidipine)

* CT Surgery consult (should go directly to OR with a Type A dissection)

* Arterial Line placement

Further Reading:

Core EM – Aortic Dissection

LITFL – Aortic Dissection

Transcript

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0:00.0	Hello, students. My name is Mike Estefan, and I thank you for joining me today on today's
0:06.5	episode of the EM Clerkship podcast. Today's episode will be a deep dive on this month's case,
0:14.3	aortic dissection. Before we begin, just a quick word from our sponsors at Pearson Rabbit's
0:20.3	insurance. Pearson Rabbit's is my
0:22.8	personal disability insurance broker. Disability insurance, specifically own occupation disability
0:29.9	insurance, is super important for health care providers, especially physicians. We go through a
0:36.1	minimum of seven years of training, at least four board
0:39.4	certification exams, and countless hours studying to obtain the knowledge and qualifications
0:45.3	that allow us to practice clinically in a competent manner. You want to protect your time and your
0:52.7	financial investment. It would be truly tragic if something happened to you where you were no longer able to practice clinically.
1:01.0	Own Occupation Disability Insurance allows you to retain the majority of your salary if such a tragedy occurred.
1:09.0	Think about how often you see strokes in the ER. This could
1:13.7	very well be you one day. Don't wait until it's too late. Schedule a consultation appointment
1:19.3	with Stephanie Pearson and her team at www.personravitz.com. Thanks for listening and now back to
1:26.4	our episode. So today, we are going to be talking
1:30.7	about aortic dissections. We're going to start from the basics, so going all the way back to
1:35.7	anatomy, pathophysiology, and the different types of dissections. And then we will move on to
1:41.8	discuss the clinical presentation, the diagnosis, and the treatment.
1:46.3	And guys, you know me by now. I like to get lost in the detail sometimes. If this style of
1:51.9	teaching is not viving with you, please let me know. Send me emails with feedback. Again,
1:57.8	Mike at e.mclerkship.com. Okay, let's get through the boring stuff real quick.
2:04.5	A basic anatomy refresher. Everyone's favorite, right? The proximal part of the aorta is called the
	...

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