Aortic Dissection

AORTIC DISSECTION CHIEF COMPLAINT Aortic dissection HPI Patient came with following SYMPTOMS •Chest pain •Syncope •Altered mental status •Anxiety •Hemiparesis •Hemiplegia •Ptosis •Miosis •anhidrosis •Dyspnea •Orthopnea •Dysphagia •Flank pain •Hemoptysis •Hematuria •Oliguria •Anuria •Limb paresthesias •Limb pain •Limb weakness SEVERITY: o Mild o Moderate o Severe o Absent o Normal o Increased o Decreased o Stable o No significant change from prior visit o Details

HISTORY (PMFSH) •PAST HISTORY  Marfan disease  Ehlers-Danlos disease  Connective tissue diseases  Diabetes  Hypertension  Syphilis •ALLERGY  Drugs  Environment •FAMILY HISTORY  Hypertension  Diabetes  Heart diseases  Syphilis •SOCIAL HISTORY  Habits • Alcohol • Tobacco • Drugs  Occupation____ ROS PHYSICAL EXAMINATION •Blood pressure o Increased o Decreased o Blood pressure differential of greater than 20 mm Hg •Heart o Muffled heart sounds o A new diastolic murmur •Pulse o Asymmetrical pulses o Carotid pulse

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 Progression of bruits  Development of bruits Brachial pulse  Progression of bruits  Development of bruits Femoral pulse  Progression of bruits  Development of bruits Pulsus paradoxus Jugular venous distension Kussmaul sign

SPECIFIC DATA LIKE GRADING ETC Anterior chest pain - Ascending aortic dissection Neck or jaw pain - Aortic arch dissection Interscapular tearing or ripping pain - Descending aortic dissection TESTS TO BE ORDERED •Blood tests o CBP o BUN o Creatinine o Troponin o Creatine kinase (CK) o Hemoglobin and Hematocrit •Urine examination •D-dimer •Chest radiography •Angiography •CT scan •CT angiography •Echocardiography •USG •Transthoracic echocardiography (TTE) •Transesophageal echocardiography (TEE) •MRI •Contrast-enhanced magnetic resonance angiography (CE-MRA) •Contrast 3D MRA •ECG

ASSESSMENT/PLAN & INSTRUCTIONS/EDUCATION TREATMENT Oxygen ________ Respiratory monitor____ Blood pressure ______ Urine output_____ MEDICATION Nifedipine Esmolol 250-500 mcg Labetalol Propranolol Metoprolol Nitroprusside Morphine sulfate FOLLOW UP