Think of aortic dissection as the subarachnoid hemorrhage of the torso. When fewer than three questions were asked, dissection was suspected in only 49 percent. What is the radiation of pain? (It is in the back and/or abdomen in aortic dissection.)Ī 1998 study that reviewed a series of aortic dissection cases showed that for the 42 percent of physicians who asked about these three things, the diagnosis was suspected in 91 percent. What was the pain intensity at onset? (It is abrupt in aortic dissection.). What is the quality of pain? (The pain from aortic dissection is most commonly described as “sharp,” but the highest positive likelihood ratio is for “tearing.”). Ask the following three things of all patients with torso pain:. The Five Pain Pearls of Aortic Dissection Irad aortic dissection how to#
In this column, I’ll elucidate how to improve your diagnosis rate, without overimaging, by explaining five pain pearls, the concepts of “CP +1” and “1+ CP,” physical exam nuances, and how best to initially utilize tests. However, early, timely diagnosis is essential because each hour that passes from the onset of symptoms correlates with a 1 percent to 2 percent increase in mortality.
Yet, we shouldn’t be working up every one of them, creating a resource utilization disaster. Aortic dissection must be considered in all patients with chest, abdominal, or back pain syncope or stroke symptoms.
Comment Period Open for ACEP Draft Thoracic Aortic Dissection Clinical PolicyĮxplore This Issue ACEP Now: Vol 36 – No 11 – November 2017. 
Thoracic Aortic Dissection Clinical Policy Approved by ACEP Board.
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