Red flags
- Cardiac tamponade (Type A)
- Malperfusion (limb, mesenteric, renal, neuro)
- Aortic regurgitation with HF
- Pulse deficit
First steps
- ABCDE, 2 large-bore IV, cross-match 6 U
- Analgesia (morphine)
- Reduce shear stress: HR <60, SBP 100-120
- β-blocker FIRST (labetalol or esmolol) before vasodilator
Key investigations
- CT angiogram aorta (gold standard)
- TOE if unstable
- ECG (exclude STEMI), troponin
- D-dimer, lactate, cross-match, coagulation
Differentials
- STEMI (esp inferior — RCA compromise possible in dissection)
- PE
- Pericarditis
- MSK pain
Initial management
- Type A → emergency CT surgery
- Type B → medical; TEVAR if complicated
- IV labetalol 10-20 mg boluses then infusion
- Add nitroprusside/nicardipine if BP high after HR control
Referral
- Immediate cardiothoracic surgery
- Vascular surgery for TEVAR
- ICU admission
AI clinical assessment
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This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
