Agitation and Aortic Dissection

This case was written by Dr. Lubna Saffarini; a PGY5 Emergency Medicine Resident at Rashid Hospital Trauma Center – Dubai Health Authority. She is interested in medical education and critical care. The scenario was reviewed by Dr. Chafika Lasfer (Certified Emergency Medicine Consultant) and Dr. Yasser Armaghan (Emergency Medicine Specialist). 

WHY IT MATTERS

In the emergency department we frequently encounter critically ill patients brought into the resuscitation area with minimal history who require multiple emergency interventions in a time sensitive manner. This case highlights prioritization of assessment and treatment goals, clinical assessment in suspected aortic dissection, utilization of bedside ultrasound, and important management steps in aortic dissection.

CLINICAL VIGNETTE

53 year old male with uncontrolled hypertension and sudden onset back pain with non-bloody emesis. Brought in by paramedics to the resuscitation area very agitated and combative with a BP reading of 240/120. He has a normal blood glucose. No history of seizures, loss of consciousness, fever, or substance use. 

CASE SUMMARY

A 53 year old male with untreated hypertension presents with a history of vomiting, back pain and acute agitation. Once he is sedated, assessment will reveal an acute aortic dissection. He will require prompt treatment, intubation, and disposition planning.

DOWNLOAD THE CASE HERE:

Source = https://www.flickr.com/photos/iem-student/28434522267/
Source = https://www.coreultrasound.com/uotw-80-answer/

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