Critical Care Scenarios Episode 66: Aortic dissection with Travis Hughes
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Oct 11, 2023 Travis Hughes, vascular surgery fellow from the University of Kentucky, discusses aortic dissection, advancements in treatment, managing impulse and blood pressure, medications, patient monitoring, blood pressure and heart rate control, use of anti-platelet medications, and long-term complications in aortic dissection repairs.
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ICU Monitoring And NPO Until Stable
- Admit acute dissections to ICU, place a right-sided arterial line, and keep patients NPO initially in case urgent OR is needed.
- Monitor pulses and abdominal exam frequently to detect evolving malperfusion.
Timing Matters: Early Control Impacts Outcome
- Faster control of impulses after symptom onset correlates with lower mortality; early remodeling and thrombosis of the false lumen begin within weeks.
- Acute period is high-risk and merits urgent attention to hemodynamics.
Assess Renal Malperfusion Before Reflex Volume
- For declining urine output evaluate dissection morphology and check renal vessel involvement with duplex or CTA before assuming volume loss.
- Consider a trial of volume if appropriate, but use bedside renal duplex to assess malperfusion quickly.