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Nontraumatic Thoracic Aortic Dissection (2014)

  • 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

 

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