Answer
Assure adequate breathing, maintain oxygenation, treat shock, and obtain useful historical information.
Establishing the diagnosis in the field is usually difficult or impossible, but certain salient features of aortic dissection may be observed. It is life threatening if not quickly recognized and treated.
Radio communication with the receiving hospital permits the medical control physician to direct care and select a capable destination hospital, while permitting the emergency department (ED) to mobilize appropriate resources.
In the rare event that the diagnosis can be made based on prehospital information, the physician directing prehospital care should request transport to a facility capable of operative treatment of an aortic dissection.
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Aortic dissection
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Chest radiograph of a patient with aortic dissection. Image courtesy of Dr. K. London, University of California at Davis Medical Center.
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Chest radiograph of a patient with aortic dissection presenting with hemothorax.
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Chest radiograph demonstrating widened mediastinum in a patient with aortic dissection.
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Angiogram demonstrating dissection of the aorta in a patient with aortic dissection presenting with hemothorax.
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Electrocardiogram of a patient presenting to the ED with chest pain; this patient was diagnosed with aortic dissection.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with an ascending type A aortic dissection showing the intimal flap. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient with a type A aortic dissection involving the ascending and descending aorta. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
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Patient showing a type B aortic dissection with extravasation of blood into the pleural cavity. Image courtesy of Kaiser-Permanente.
