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.
Department of Advanced Clinical Practice, Duke University Hospital, Duke University School of Nursing (Ms White), Emergency Department, Duke University Hospital (Ms Crowe), Department of Pharmacy, Duke University Hospital (Dr Mando-Vandrick), and Division of Emergency Medicine, Duke University Medical Center (Drs Broder and Wendell), Durham, NC.
Corresponding Author: Ann White, MSN, RN, CCNS, CEN, CPEN, Duke University Hospital, Durham, NC 27710 (firstname.lastname@example.org).
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Disclosure: The authors report no conflicts of interest.