Skip Navigation LinksHome > January/March 2013 - Volume 35 - Issue 1 > Acute Aortic Emergencies—Part 2 Aortic Dissections
Advanced Emergency Nursing Journal:
doi: 10.1097/TME.0b013e31827145d0
Cases of Note

Acute Aortic Emergencies—Part 2 Aortic Dissections

White, Ann MSN, RN, CCNS, CEN, CPEN; Broder, Joshua MD, FACEP; Mando-Vandrick, Jennifer PharmD, BCPS; Wendell, Jonathan MD; Crowe, Jennifer BSN, RN

Section Editor(s): Campo, Theresa M. DNP, APN, NP-C, CEN; Column Editor

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Abstract

Patients with aortic disease are some of the highest acuity patients that emergency clinicians encounter. Dissection is the most common aortic catastrophe and involves separation of the aortic layers in a longitudinal fashion leading to diminished perfusion and systemic ischemia. Characteristics of pain, branch vessel involvement, and incidence lead to an understanding of patient presentation, morbidity, and mortality. Diagnosis, selection of diagnostic studies, the degree of preoperative ischemia, and risk of operative mortality can be accomplished using validated clinical decision tools. Emergency interventions are guided by the type of dissection according to the Stanford classification system. Medical management includes pain control and anti-impulse, antihypertensive therapy through vasodilatation and blockage of the sympathetic β-response. The patient may then be evaluated for open surgical intervention, aortic fenestration, endovascularly placed stent grafts, or a combination possibly in a staged approach. Morbidity includes rupture, stroke, paraplegia, acute renal failure, bowel ischemia, and peripheral ischemia.

© 2013 Lippincott Williams & Wilkins, Inc.

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