- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Chapter 148 Pathophysiology, diagnosis, and management of aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 688) Aortic dissection
Aortic dissection represents a splitting apart of the layers of the aortic wall, with blood under pressure entering the dissection plane and propagating for long distances along the aorta. The pain is said to be the most severe that a human being can experience. Pain is felt substernally with ascending dissection and between the shoulder blades for descending dissection. A high degree of clinical suspicion is essential in order for the diagnosis not to be missed. Because the dissection process can impair any branch of the aorta, the patient may present with symptoms related to any organ in the body. D-dimer is 100% sensitive at detecting aortic dissection (but non-specific). The ‘Triple Rule-Out CT Scan’ can confirm the clinical suspicion of aortic dissection, while at the same time ruling-out the other two cardiac conditions that can take a patient’s life acutely. Ascending dissection (Type A) is a surgical emergency because of the likelihood of intra-pericardial rupture. Descending dissection (Type B) is usually treated medically (with ‘anti-impulse’ therapy with β-blockers and afterload reducers). This condition is highly litigated and lethal if missed on initial presentation. Using D-dimer and liberal imaging will prevent mis-diagnosis and save lives.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Part 5.1 Physiology
- Part 5.2 Cardiovascular monitoring
- Part 5.3 Acute chest pain and coronary syndromes
- Part 5.4 Aortic dissection
- Chapter 148 Pathophysiology, diagnosis, and management of aortic dissection
- Part 5.5 The hypotensive patient
- Part 5.6 Cardiac failure
- Part 5.7 Tachyarrhythmias
- Part 5.8 Bradyarrhythmias
- Part 5.9 Valvular problems
- Part 5.10 Endocarditis
- Part 5.11 Severe hypertension
- Part 5.12 Severe capillary leak
- Part 5.13 Pericardial tamponade
- Part 5.14 Pulmonary hypertension
- Part 5.15 Pulmonary embolus
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care