Cardiac tamponade was more frequent in the pain-free group as well. 3 These patients presented more frequently with a persistent disturbance of consciousness, syncope, or a focal neurological deficit. While IRAD reported a painless aortic dissection rate of about 5 percent, a more recent study out of Japan reported that 17 percent of aortic dissection patients had no pain. The combination of severe migrating and intermittent pain should raise the suspicion for aortic dissection. The pain can be intermittent as dissection of the aortic intima stops and starts.
Migrating pain has a +LR of 7.6.1 In addition to the old adage, “Pain above and below the diaphragm should heighten your suspicion for aortic dissection,” severe pain that progresses and moves in the same vector as the aorta significantly increases the likelihood of aortic dissection.If you find yourself treating your chest pain patient with IV opioids to control severe colicky pain, think about aortic dissection.Just like a patient who presents with a new-onset, severe, abrupt headache should be suspected of having a subarachnoid hemorrhage, if a patient describes a truly abrupt onset of severe torso pain with maximal intensity at onset, think aortic dissection. Think of aortic dissection as the subarachnoid hemorrhage of the torso.When fewer than three questions were asked, dissection was suspected in only 49 percent.
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#Irad dissection how to#
In this column, I’ll elucidate how to improve your diagnosis rate, without overimaging, by explaining five pain pearls, the concepts of “CP +1” and “1+ CP,” physical exam nuances, and how best to initially utilize tests. However, early, timely diagnosis is essential because each hour that passes from the onset of symptoms correlates with a 1 percent to 2 percent increase in mortality. Yet, we shouldn’t be working up every one of them, creating a resource utilization disaster. Aortic dissection must be considered in all patients with chest, abdominal, or back pain syncope or stroke symptoms.