- Inclusion: Adult ≥ 18 with suspected acute nontraumatic thoracic aortic dissection
- Exclusion: Traumatic aortic dissection, pediatric, pregnant
- Level A: None
- Level B:
- CTA to exclude thoracic aortic dissection (accuracy similar to that of TEE and MRA).
- Do not rely on abnormal bedside TTE result to definitively establish diagnosis
- Level C:
- Do not use clinical decision rules alone to identify very low risk acute thoracic aortic dissection. Decision to pursue further work up discretion of EP.
- Do not rely on d-dimer alone to exclude the diagnosis of aortic dissection
- Immediate surgical consultation or transfer to higher level of care if TTE suggestive or dissection
- Decrease BP and pulse if elevated. No specific targets.
ACEP Clinical Policy: Critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. PDF