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    Thoracic Aortic Dissection (beta)

    Official guideline from the American College of Emergency Physicians.

    Summary by Eric Steinberg, DO
    Strength
    Level A
    Level B
    Level C

    Clinical Predictors

    Clinical Predictors
    1. In an attempt to identify patients at very low risk for acute nontraumatic thoracic aortic dissection, do not use existing clinical decision rules alone. The decision to pursue further workup for acute nontraumatic aortic dissection should be at the discretion of the treating physician.

    Diagnosis

    D-dimer
    1. In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on D-dimer alone to exclude the diagnosis of aortic dissection.
    Imaging
    1. In adult patients with suspected nontraumatic thoracic aortic dissection, emergency physicians may use computed tomography (CT) angiogram to exclude thoracic aortic dissection because it has accuracy similar to that of transesophageal echocardiogram (TEE) and magnetic resonance angiogram (MRA).
    2. In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on an abnormal bedside transthoracic echocardiogram (TTE) result to definitively establish the diagnosis of thoracic aortic dissection.
    3. In adult patients with suspected nontraumatic thoracic aortic dissection, immediate surgical consultation or transfer to a higher level of care should be considered if a transthoracic echocardiogram (TTE) is suggestive of aortic dissection. [Consensus recommendation]

    Intervention

    Intervention
    1. In adult patients with acute nontraumatic thoracic aortic dissection, decrease blood pressure and pulse if elevated. However, there are no specific targets that have demonstrated a reduction in morbidity and mortality.
    What do the icons mean?  
    Research PaperDiercks DB, Promes SB, Schuur JD, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Suspected Acute Nontraumatic Thoracic Aortic Dissection. Ann Emerg Med. 2015;65(1):32-42.e12.