EM Quick Hits Video on Aortic Dissection Management Medications with Anand Swaminathan
Aortic Dissection 3-pronged approach to heart rate and blood pressure control
Aortic dissection is a hypertensive emergencies. Rapid control of both blood pressure and heart rate are essential to minimize extension of acute aortic dissection.
- Adequate analgesia: should be achieved before the diagnosis of aortic dissection is confirmed and before attempts at HR and BP control, to mitigate the contribution of catecholaminergic drive from pain to HR and BP
- Fentanyl 1mcg/kg q15-20 minutes
- Heart rate control: target HR 50-60BPM
- Esmolol (500-1000mcg/kilo) bolus followed by an infusion (50mcg/kg/min with reassessments every 5-10 minutes)
- Labetalol may be used as an alternative, which improves both HR and BP
- Blood pressure control: target SBP 90-100mmHg
- Nicardipine or Clovidipine are preferred agents if available
- Diltiazem 0.25-0.35mg/kg over 2 minutes, followed by a 5-10mg/hr infusion to target BP is acceptable as an alternative
- Nitroprusside may additionally be used though reflex tachycardia may be an issue
Episode 92 – Aortic Dissection Live from The EM Cases Course
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