Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9755547/

  Acute aortic dissection (AAD) is a rare condition but represents a time-sensitive disease for which a wrong and untimely identification in the triage phase could compromise the subsequent diagnostic, therapeutic path and patient’s prognosis. The emergency nurse plays a crucial role in identifying and managing patients with possible AAD. […] It is crucial to examine the emergency departments nursing approach to patients with suspected AAD. It is fundamental to have a rapid and standardized approach related to life-saving procedures, practices, and management of critical patients during the triage phase, with the assessment of the most common presentation of clinical signs and symptoms and patient management during each step in the emergency department. […] Early identification and diagnosis in ED allow prompt treatment that improves prognosis. The emergency nurse plays a crucial role in correctly identifying and managing patients with acute aortic dissection. High clinical suspicion from the triage stages, early diagnosis, monitoring, and initial clinical stabilization in the emergency department plays a key role while awaiting definitive treatment.

• #2 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  Aortic dissections are associated with significant mortality and morbidity, with rapid treatment paramount. […] Treatment focuses on initial resuscitation, transfer (if possible and required) to a suitable specialist centre, strict blood pressure and heart rate control and potentially surgical intervention depending on the type and complexity of the dissection. […] Effective post-operative care is extremely important, with awareness of potential post-operative complications and a multi-disciplinary rehabilitation approach required. […] Critical care clinicians play a key part in all these steps, from diagnosis through to post-operative care, and thus a thorough understanding is vital. […] The type of dissection and haemodynamic condition of the patient will have significant impact on the management strategy required, both on the intensive care unit and in the operating theatre.

• #3

• #4

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9755547/

  Correctly identifying signs and symptoms is crucial during the nursing triage phase. The Emergency Severity Index (ESI) is a simple-to-use, five-level triage algorithm that categorizes emergency department patients by evaluating both patient acuity and resource needs. […] Patients with chest pain who are physiologically unstable and require immediate interventions such as intubation or hemodynamic support should be triaged as ESI level-1. […] The triage nurse should keep a high level of suspicion in patients with chest pain localized anteriorly, between the base of the nose and the umbilicus and, posteriorly, between the occiput and the 12th vertebra. […] The presence of significantly different blood pressure values between the two arms (15mmHg) should raise suspicion of aortic dissection.

• #5

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9755547/

  Correctly identifying signs and symptoms is crucial during the nursing triage phase. The Emergency Severity Index (ESI) is a simple-to-use, five-level triage algorithm that categorizes emergency department patients by evaluating both patient acuity and resource needs. […] Patients with chest pain who are physiologically unstable and require immediate interventions such as intubation or hemodynamic support should be triaged as ESI level-1. […] The triage nurse should keep a high level of suspicion in patients with chest pain localized anteriorly, between the base of the nose and the umbilicus and, posteriorly, between the occiput and the 12th vertebra. […] The presence of significantly different blood pressure values between the two arms (15mmHg) should raise suspicion of aortic dissection.

• #6

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9755547/

  AAD is a rare condition with a high mortality rate. Classic studies indicate a mortality rate of 1%2% per hour in untreated patients. Early identification and diagnosis in the ED enable timely treatment that improves prognosis. The first person to see the patient is the emergency nurse, who plays a crucial role in correctly identifying and managing patients with AAD. Therefore, high clinical suspicion from the triage stages, early diagnosis, monitoring, and initial clinical stabilization in the emergency department plays a key role while waiting for definitive treatment.

• #7 Aortic dissection

  https://www.myamericannurse.com/aortic-dissection/

  Nursing knowledge prompts timely intervention. […] Knowledge of the risk factors for a dissection and common signs and symptoms can help nurses act quickly to ensure patients receive the care they need. Patient education should include explanation of common signs and symptoms and referrals for counseling about strenuous activity and family planning.

• #8 Acute Aortic Dissection: Overview, Pathophysiology & Risk Factors, Prehospital Care

  https://emedicine.medscape.com/article/756835-overview

  Aortic dissection is a life-threatening condition in which there is a tear in the aorta intimal layer, resulting in separation of the layers of the aortic wall. […] The mortality rate of patients with aortic dissection is 1-2% per hour for the first 24-48 hours and up to 50% in the first week. […] Initial therapy should begin when the diagnosis is suspected. This includes two large-bore intravenous lines (IVs), oxygen, respiratory monitoring, and monitoring of cardiac rhythm, blood pressure, and urine output. […] Aggressive management of heart rate and blood pressure should be initiated. […] Beta blockers should be given initially to reduce the rate of change of blood pressure (dP/dt) and the shear forces on the aortic wall. […] End organ perfusion should be evaluated. […] Aortic dissection associated with cocaine ingestion is challenging.

• #9

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9755547/

  Continuous nursing supervision must always be guaranteed to the patient, together with adequate intensive monitoring of vital signs. […] Recommended a nurse-to-patient ratio of 2:1 (two nurses to one patient). […] In all cases of AADs, initial medical therapy is focused on reducing wall stress to limit the extent of the dissection. […] It is essential to have adequate pain control (intravenous opioid analgesia). Pain management is an essential aspect of the patient management. […] Continuous monitoring of signs or symptoms associated with cardiac tamponade (Type A dissection), which may occur if the dissection proceeds proximally, is crucial. […] If type A AAD has been diagnosed, surgery will be the first-choice treatment. Surgery reduces 1-month mortality from 90% to 30%. The advantage of surgery over conservative therapy is particularly obvious in the long-term follow-up.

• #10 Aortic Dissection Nursing Management – RNpedia

  https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/aortic-dissection/

  Aortic dissection involves a tear in the medial layer of the aortic wall, causing blood to extravasate into the media and thus compromising blood flow to the brain, heart, and other organs. […] Nursing Diagnosis: Ineffective tissue perfusion related to compromised arterial blood flow secondary to blood extravasation via aortic dissection. […] Patient Monitoring: Continuously monitor arterial BP during acute phase to evaluate the patients response to therapy. […] Patient Management: Administer oxygen therapy as ordered. […] Keep the patient on bed rest to prevent further dissection. […] Nitroprusside may be ordered to lower BP. […] A ?-adrenergic blocking agent such as atenolol, esmolol, or propranolol may be ordered to reduce stress on the aortic wall. […] Anticipate surgical intervention.

• #11

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9755547/

  Continuous nursing supervision must always be guaranteed to the patient, together with adequate intensive monitoring of vital signs. […] Recommended a nurse-to-patient ratio of 2:1 (two nurses to one patient). […] In all cases of AADs, initial medical therapy is focused on reducing wall stress to limit the extent of the dissection. […] It is essential to have adequate pain control (intravenous opioid analgesia). Pain management is an essential aspect of the patient management. […] Continuous monitoring of signs or symptoms associated with cardiac tamponade (Type A dissection), which may occur if the dissection proceeds proximally, is crucial. […] If type A AAD has been diagnosed, surgery will be the first-choice treatment. Surgery reduces 1-month mortality from 90% to 30%. The advantage of surgery over conservative therapy is particularly obvious in the long-term follow-up.

• #12 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Pain management is an important but difficult aspect of medical therapy. Narcotics and opiates are the preferred agents. […] The major objectives of surgery for aortic dissection are to alleviate the symptoms, decrease the frequency of complications, and prevent aortic rupture and death. […] The operative mortality with ascending aortic dissection is usually less than 10%. Serious complications are rare. […] Postoperative complications for extensive disease involving the thoracoabdominal aorta include myocardial infarction, respiratory failure, renal failure, stroke, and paraparesis or paraplegia. […] Endovascular therapy is rapidly emerging as the preferred treatment for descending aortic dissection, provided vascular access is available. […] Intramural hematomas and penetrating atherosclerotic ulcers of the aorta are conditions that result in aortic dissection or rupture. Both are more common in the descending aorta; medical therapy is first-line treatment.

• #13 Management of acute aortic dissection and thoracic aortic rupture | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7

  Regardless of whether acute aortic dissection is type A or B, medical therapy to control pain and hypertension is essential in all patients. Beta blockers have the desired effect of reducing blood pressure and heart rate to the normal range. […] In patients with type A aortic dissection, surgical treatment is the gold standard; mortality is 50% within the first 48 h if surgery is not performed. […] In most patients with type B aortic dissection, medical therapy including analgesia, antihypertensive drugs, and bed rest is performed. However, complicated type B aortic dissection, such as descending aortic rupture, uncontrolled pain, and malperfusion of the aortic branch or lower extremities, is an indication for urgent surgery. […] Maintaining the hemodynamic condition of patients with free aortic rupture is difficult. The majority of patients with aortic rupture and continuous bleeding cannot survive even with massive transfusion and large doses of catecholamine. However, the hemodynamic status of patients with a contained rupture is relatively near stable, although blood transfusion should be started as soon as possible after the diagnosis is established.

• #14 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  When managing an acute aortic dissection, initial treatment should concentrate on resuscitation and stabilisation of the patient whilst deciding and preparing for definitive intervention. […] Tight blood pressure control and reduction of the rate of pressure rise during systole is vital to reduce the chances of the dissection propagating further. […] Patients presenting to non-specialist centres will require urgent transfer to a cardiothoracic centre. […] Surgery is the standard treatment for acute type A aortic dissection. […] The extent of the operation means significant analgesia is required to ensure the patient can mobilise and ventilate adequately. […] Post-operative pulmonary complications (PPCS) are frequently reported following aortic dissection repair. […] Rehabilitation in critical care is provided following comprehensive individual assessment by the physiotherapist, with the formulation of a rehabilitation plan and patient orientated goals.

• #15 Care for the patient with aortic dissection | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-854/care-patient-aortic-dissection

  Care for the patient with aortic dissection […] Medical management of aortic dissection: Overall management goals: Decrease aortic wall stress […] Options to achieve these goals: Labetalol infusion (15mg bolus, then 5mg/hr) […] Endpoints of therapy: Systolic blood pressure <110 mmHg [...] Clinical indications for surgery: "complicated" type B dissection: Features suggesting instability: Refractory hypertension [...] Monitoring: Right radial arterial line: dissection flap may influence the left arm pressures [...] Analgesia is essential - pain and distress are potent triggers for hypertensive episodes [...] Surgical management of Type A dissection is a variation on the theme of aortic root replacement and repair [...] Uncomplicated Type B: the vast majority of these can be managed non-operatively [...] Complicated Type B usually need early TEVAR.

• #16 Care for the patient with aortic dissection | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/cardiovascular-intensive-care/Chapter-854/care-patient-aortic-dissection

  Care for the patient with aortic dissection […] Medical management of aortic dissection: Overall management goals: Decrease aortic wall stress […] Options to achieve these goals: Labetalol infusion (15mg bolus, then 5mg/hr) […] Endpoints of therapy: Systolic blood pressure <110 mmHg [...] Clinical indications for surgery: "complicated" type B dissection: Features suggesting instability: Refractory hypertension [...] Monitoring: Right radial arterial line: dissection flap may influence the left arm pressures [...] Analgesia is essential - pain and distress are potent triggers for hypertensive episodes [...] Surgical management of Type A dissection is a variation on the theme of aortic root replacement and repair [...] Uncomplicated Type B: the vast majority of these can be managed non-operatively [...] Complicated Type B usually need early TEVAR.

• #17 Aortic Dissection Nursing Management – RNpedia

  https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/aortic-dissection/

  Aortic dissection involves a tear in the medial layer of the aortic wall, causing blood to extravasate into the media and thus compromising blood flow to the brain, heart, and other organs. […] Nursing Diagnosis: Ineffective tissue perfusion related to compromised arterial blood flow secondary to blood extravasation via aortic dissection. […] Patient Monitoring: Continuously monitor arterial BP during acute phase to evaluate the patients response to therapy. […] Patient Management: Administer oxygen therapy as ordered. […] Keep the patient on bed rest to prevent further dissection. […] Nitroprusside may be ordered to lower BP. […] A ?-adrenergic blocking agent such as atenolol, esmolol, or propranolol may be ordered to reduce stress on the aortic wall. […] Anticipate surgical intervention.

• #18 Aortic Dissection

  https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection

  Aortic dissection is the most common acute aortic syndrome, and it is an important differential of chest pain. […] Immediate cardiothoracic referral on strong suspicion. […] Large bore IV access. […] Cross match 6 units of packed cells and consider alerting blood bank (to activate massive transfusion protocol). […] Fluid resuscitation with blood products if required (no more than MAP 65). […] Fentanyl PCA to control pain (decreases sympathetic output). […] Target HR 60-80. Esmolol may be given as an initial bolus of 40 mg IV infusion 20mg/min OR Labetalol to 20 mg IV with repeat doses of 20-40 mg every 10 minutes to effect or a total dose of 300 mg OR Metoprolol may be given in 5mg repeated 5 minutely to a 15mg initial bolus infusion 5mg/hr. […] Target right arm BP 100-120 systolic: Right arm likely most accurate, or use higher number.

• #19 Aortic Dissection Nursing Management – RNpedia

  https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/aortic-dissection/

  Aortic dissection involves a tear in the medial layer of the aortic wall, causing blood to extravasate into the media and thus compromising blood flow to the brain, heart, and other organs. […] Nursing Diagnosis: Ineffective tissue perfusion related to compromised arterial blood flow secondary to blood extravasation via aortic dissection. […] Patient Monitoring: Continuously monitor arterial BP during acute phase to evaluate the patients response to therapy. […] Patient Management: Administer oxygen therapy as ordered. […] Keep the patient on bed rest to prevent further dissection. […] Nitroprusside may be ordered to lower BP. […] A ?-adrenergic blocking agent such as atenolol, esmolol, or propranolol may be ordered to reduce stress on the aortic wall. […] Anticipate surgical intervention.

• #20 Aortic Dissection: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection

  Aortic dissection is a life-threatening condition that requires immediate care. […] Without quick diagnosis and care, an aortic dissection can cause sudden death. […] This is a life-threatening condition. Get emergency treatment right away. […] Aortic dissection treatment depends on the location of the tear and dissection. […] For Type A aortic dissection (when it involves the first part of the aorta close to your heart), you need immediate surgery. […] For Type B aortic dissection, you need emergency surgery if the dissection cuts off blood flow to your vital organs and body parts. […] A provider may prescribe medications like beta-blockers to lower your heart rate and blood pressure. […] Youll need to take them for the rest of your life. […] Avoiding tobacco products is important after an aortic dissection, too.

• #21

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9755547/

  Continuous nursing supervision must always be guaranteed to the patient, together with adequate intensive monitoring of vital signs. […] Recommended a nurse-to-patient ratio of 2:1 (two nurses to one patient). […] In all cases of AADs, initial medical therapy is focused on reducing wall stress to limit the extent of the dissection. […] It is essential to have adequate pain control (intravenous opioid analgesia). Pain management is an essential aspect of the patient management. […] Continuous monitoring of signs or symptoms associated with cardiac tamponade (Type A dissection), which may occur if the dissection proceeds proximally, is crucial. […] If type A AAD has been diagnosed, surgery will be the first-choice treatment. Surgery reduces 1-month mortality from 90% to 30%. The advantage of surgery over conservative therapy is particularly obvious in the long-term follow-up.

• #22 Aortic Dissection: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection

  Aortic dissection is a life-threatening condition that requires immediate care. […] Without quick diagnosis and care, an aortic dissection can cause sudden death. […] This is a life-threatening condition. Get emergency treatment right away. […] Aortic dissection treatment depends on the location of the tear and dissection. […] For Type A aortic dissection (when it involves the first part of the aorta close to your heart), you need immediate surgery. […] For Type B aortic dissection, you need emergency surgery if the dissection cuts off blood flow to your vital organs and body parts. […] A provider may prescribe medications like beta-blockers to lower your heart rate and blood pressure. […] Youll need to take them for the rest of your life. […] Avoiding tobacco products is important after an aortic dissection, too.

• #23 Management of acute aortic dissection and thoracic aortic rupture | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0287-7

  Regardless of whether acute aortic dissection is type A or B, medical therapy to control pain and hypertension is essential in all patients. Beta blockers have the desired effect of reducing blood pressure and heart rate to the normal range. […] In patients with type A aortic dissection, surgical treatment is the gold standard; mortality is 50% within the first 48 h if surgery is not performed. […] In most patients with type B aortic dissection, medical therapy including analgesia, antihypertensive drugs, and bed rest is performed. However, complicated type B aortic dissection, such as descending aortic rupture, uncontrolled pain, and malperfusion of the aortic branch or lower extremities, is an indication for urgent surgery. […] Maintaining the hemodynamic condition of patients with free aortic rupture is difficult. The majority of patients with aortic rupture and continuous bleeding cannot survive even with massive transfusion and large doses of catecholamine. However, the hemodynamic status of patients with a contained rupture is relatively near stable, although blood transfusion should be started as soon as possible after the diagnosis is established.

• #24 Aortic Dissection (Type A, Type B and Chronic Dissection) | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/aortic-dissection-type-type-b-and-chronic-dissection

  The decision to proceed with surgery for Type B aortic dissections is based on various factors, including the patient’s clinical condition, the extent of the dissection, the presence of complications, and individualized assessments by the medical team. […] It’s important to note that the management of chronic aortic dissections is highly individualized, and treatment plans may vary from patient to patient.

• #25 Management of acute type B aortic dissection – UpToDate

  https://www.uptodate.com/contents/management-of-acute-type-b-aortic-dissection

  Management of acute type B aortic dissection […] The goals of initial medical management of acute type B aortic dissection are to control pain and limit the extension of the dissection using anti-impulse therapy. […] We agree with major interdisciplinary guidelines that generally suggest reserving intervention (surgical or endovascular) for those who develop complications related to the dissection (eg, dissection extension, malperfusion, aneurysm formation, rupture, persistent pain). […] Determining the location of the aortic dissection, duration since onset of symptoms/occurrence, severity of symptoms, and etiology are important, as these impact prognosis and management.

• #26 Aortic Dissection (Type A, Type B and Chronic Dissection) | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/aortic-dissection-type-type-b-and-chronic-dissection

  When you come to the University of Michigan Health Frankel Cardiovascular Center, youll find experts with decades of experience diagnosing and treating aortic dissections. […] Our Comprehensive Aortic Program is among the best in the nation for emergency care of patients with aortic dissections. […] The goals of aortic dissection treatment include: Treating complications, especially malperfusion syndrome which is the loss of blood supply to vital organs. […] Medical management serves as a bridge to surgical intervention. Surgeons and the medical team work to stabilize the patient’s condition, optimize blood pressure control, and ensure the patient is in the best possible state for surgery. […] Medical management of Type B aortic dissections aims to stabilize the patient’s condition, control blood pressure, and reduce the risk of complications.

• #27 Aortic Dissection

  https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection

  Aortic dissection is the most common acute aortic syndrome, and it is an important differential of chest pain. […] Immediate cardiothoracic referral on strong suspicion. […] Large bore IV access. […] Cross match 6 units of packed cells and consider alerting blood bank (to activate massive transfusion protocol). […] Fluid resuscitation with blood products if required (no more than MAP 65). […] Fentanyl PCA to control pain (decreases sympathetic output). […] Target HR 60-80. Esmolol may be given as an initial bolus of 40 mg IV infusion 20mg/min OR Labetalol to 20 mg IV with repeat doses of 20-40 mg every 10 minutes to effect or a total dose of 300 mg OR Metoprolol may be given in 5mg repeated 5 minutely to a 15mg initial bolus infusion 5mg/hr. […] Target right arm BP 100-120 systolic: Right arm likely most accurate, or use higher number.

• #28 Aortic Dissection

  https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection

  Place art line. […] BP control after Beta blocking: Sodium Nitroprusside 0.3 microgram/kg/min IV titrated to effect. […] Correct coagulopathy. […] Stanford Type A – Surgical repair represents the mainstay of treatment. […] Stanford Type B – Medical management is the gold standard although endovascular surgery sealing of the intimal entry tear offers potential management in the complicated tears. […] Immediate risks to the patient include haemodynamic collapse (Aortic rupture), aortic regurgitation, AMI, tamponade, haemothorax, end organ ischemia (further progression of dissection), altered consciousness or neurologic compromise (carotid involvement), and associated complications of branch vessel involvement (renal, mesentery).

• #29 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Pain management is an important but difficult aspect of medical therapy. Narcotics and opiates are the preferred agents. […] The major objectives of surgery for aortic dissection are to alleviate the symptoms, decrease the frequency of complications, and prevent aortic rupture and death. […] The operative mortality with ascending aortic dissection is usually less than 10%. Serious complications are rare. […] Postoperative complications for extensive disease involving the thoracoabdominal aorta include myocardial infarction, respiratory failure, renal failure, stroke, and paraparesis or paraplegia. […] Endovascular therapy is rapidly emerging as the preferred treatment for descending aortic dissection, provided vascular access is available. […] Intramural hematomas and penetrating atherosclerotic ulcers of the aorta are conditions that result in aortic dissection or rupture. Both are more common in the descending aorta; medical therapy is first-line treatment.

• #30 Aortic Dissection

  https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection

  Place art line. […] BP control after Beta blocking: Sodium Nitroprusside 0.3 microgram/kg/min IV titrated to effect. […] Correct coagulopathy. […] Stanford Type A – Surgical repair represents the mainstay of treatment. […] Stanford Type B – Medical management is the gold standard although endovascular surgery sealing of the intimal entry tear offers potential management in the complicated tears. […] Immediate risks to the patient include haemodynamic collapse (Aortic rupture), aortic regurgitation, AMI, tamponade, haemothorax, end organ ischemia (further progression of dissection), altered consciousness or neurologic compromise (carotid involvement), and associated complications of branch vessel involvement (renal, mesentery).

• #31 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Pain management is an important but difficult aspect of medical therapy. Narcotics and opiates are the preferred agents. […] The major objectives of surgery for aortic dissection are to alleviate the symptoms, decrease the frequency of complications, and prevent aortic rupture and death. […] The operative mortality with ascending aortic dissection is usually less than 10%. Serious complications are rare. […] Postoperative complications for extensive disease involving the thoracoabdominal aorta include myocardial infarction, respiratory failure, renal failure, stroke, and paraparesis or paraplegia. […] Endovascular therapy is rapidly emerging as the preferred treatment for descending aortic dissection, provided vascular access is available. […] Intramural hematomas and penetrating atherosclerotic ulcers of the aorta are conditions that result in aortic dissection or rupture. Both are more common in the descending aorta; medical therapy is first-line treatment.

• #32 Nursing care of patient with aortic dissection – Kauvery Hospital

  https://www.kauveryhospital.com/nightingale/nursing-care-of-patient-with-aortic-dissection/

  Nursing Management […] Immediate postoperative care […] – Patient was stabilised and transferred to post operative ward. […] – Transferred to specialised cot with sterile equipments clothes. […] – Placed under Warmer for thermoregulation, according to patient demand at least for initial 4 hrs. […] – Chest X-ray was taken to obtain the baseline lung assessment. […] – Connected to ventilator, All lines are secured. Bundles chart maintained as per HIC protocol. […] – Vitals are stable, B.P maintained. Patient was extubated after being conscious oriented. […] Late Post operative […] – After B.P was stabilised, ionotrophic support was weaned as per Doctors order. […] – ICD drain was assessed, when its below 100ml or serous discharge comes out, Drain will be removed. […] – 4th hourly once ABG was taken, correction was done according to doctors order.

• #33 Nursing care of patient with aortic dissection – Kauvery Hospital

  https://www.kauveryhospital.com/nightingale/nursing-care-of-patient-with-aortic-dissection/

  – He was managed with necessary supports total ICD drain was 1360ml.patient was extubated. […] – Fourth hourly once back care was given. […] – B.P maintained between 110 to 70 mm of Hg. […] – Heart rate should be maintained less than 100bpm. […] – Active and passive mobilization done. […] – Deep breathing coughing Exercise was encouraged and taught about Spirometry.

• #34 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  When managing an acute aortic dissection, initial treatment should concentrate on resuscitation and stabilisation of the patient whilst deciding and preparing for definitive intervention. […] Tight blood pressure control and reduction of the rate of pressure rise during systole is vital to reduce the chances of the dissection propagating further. […] Patients presenting to non-specialist centres will require urgent transfer to a cardiothoracic centre. […] Surgery is the standard treatment for acute type A aortic dissection. […] The extent of the operation means significant analgesia is required to ensure the patient can mobilise and ventilate adequately. […] Post-operative pulmonary complications (PPCS) are frequently reported following aortic dissection repair. […] Rehabilitation in critical care is provided following comprehensive individual assessment by the physiotherapist, with the formulation of a rehabilitation plan and patient orientated goals.

• #35 Nursing care of patient with aortic dissection – Kauvery Hospital

  https://www.kauveryhospital.com/nightingale/nursing-care-of-patient-with-aortic-dissection/

  – He was managed with necessary supports total ICD drain was 1360ml.patient was extubated. […] – Fourth hourly once back care was given. […] – B.P maintained between 110 to 70 mm of Hg. […] – Heart rate should be maintained less than 100bpm. […] – Active and passive mobilization done. […] – Deep breathing coughing Exercise was encouraged and taught about Spirometry.

• #36 Aortic Dissections: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/aortic-aneurysm/aortic-dissections/treatment

  Treatment for an aortic dissection must be promptimmediate surgery is usually needed. […] People generally maintain a regime of blood pressure medications for the rest of their life. In addition, patients maintain regular appointments with their cardiologist to monitor the aortic dissection. […] Maintaining a healthy lifestyle becomes very important after an aortic dissection. Eating healthy and engaging in daily physical activity is important to maintain a healthy life. people who have had an aortic dissection may continue with mild to moderate physical activity such as: […] It is important to recognize the symptoms of an aortic dissection. Aortic dissection is a serious condition that requires immediate medical treatment.

• #37 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  Management in intensive care is required while organ dysfunction persists. […] Patients with aortic dissection will need lifelong follow up as they are at risk of further aneurysmal complications and will require effective blood pressure control typically under 120/80mmHg to reduce that risk. […] Successful treatment relies on rapid diagnosis, strict blood pressure control, minimal delays to definitive treatment and MDT input.

• #38 Aortic dissection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aortic-dissection/diagnosis-treatment/drc-20369499

  An aortic dissection is a medical emergency requiring immediate treatment. Treatment may include surgery or medications, depending on the area of the aorta involved. […] After treatment, you may need to take medication to control your blood pressure for the rest of your life. You may need regular CT scans or MRI scans to monitor your condition.

• #39 Aortic Dissection: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection

  When you survive aortic dissection even if you dont have surgery you need to see a provider regularly (usually, every three to 12 months) for follow-up imaging with a CT or MRI. […] It’s important to go to an aortic center of excellence that has a lot of experience and has a multidisciplinary approach to care.

• #40 care after aortic dissection | Aortic Aneurysm and Dissection | Forums

  https://patient.info/forums/discuss/care-after-aortic-dissection-556400

  The Medical profession treat these as two different disciplines but appear to conjoin them as to suit themselves with patients but appear not to speak to each other very much? […] My follow up Scans were at 6 Months and an XRay at 12 months, next due at 2 years this April and my Stent had not moved and was fine. […] I have had breathing issues since the surgery so now a pulmonologist is also involved. Since surgery I have had a cat scan and several chest X-rays. […] My cardiologist scripted cardio rehab but I learned Medicare does not cover cardiac rehab following aortic dissection. […] From what I’ve read about aortic dissection, the standard for care seems to be CT or MRI scans at 3 months, 6 months, and one year after surgery and then annually after that. […] He said that keeping my blood pressure low and taking a beta-blocker to reduce the force with which the heart contracts are the most important things I need to do.

• #41 Acute Aortic Dissection: Overview, Pathophysiology & Risk Factors, Prehospital Care

  https://emedicine.medscape.com/article/756835-overview

  Up to one third of patients with acute aortic dissection may have their diagnosis missed. […] Use of a multiparametric algorithm that comprises the aortic dissection detection-risk score (ADD-RS) with D-dimer may aid in ruling out acute aortic dissection. […] The American College of Radiology has established ACR Appropriateness Criteria for the diagnosis and treatment of suspected aortic dissection. […] Urgent surgical intervention is required in type A dissections. […] Patients with symptomatic dissection should undergo immediate repair, especially if it is leaking or expanding. […] Symptomatic patients require admission to a center experienced in cardiopulmonary bypass and operative care. […] Emergency intervention is recommended in the setting of complicated acute type B aortic dissection. […] Follow-up examinations with radiologic studies are recommended at 3-month intervals for the first year and every 6 months for the next 2 years.

• #42 Aortic Dissection: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16743-aortic-dissection

  When you survive aortic dissection even if you dont have surgery you need to see a provider regularly (usually, every three to 12 months) for follow-up imaging with a CT or MRI. […] It’s important to go to an aortic center of excellence that has a lot of experience and has a multidisciplinary approach to care.

• #43 Aortic dissection

  https://www.myamericannurse.com/aortic-dissection/

  Nursing knowledge prompts timely intervention. […] Knowledge of the risk factors for a dissection and common signs and symptoms can help nurses act quickly to ensure patients receive the care they need. Patient education should include explanation of common signs and symptoms and referrals for counseling about strenuous activity and family planning.

• #44 Aortic Dissection Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Overview

  https://emedicine.medscape.com/article/2062452-treatment

  Once a thoracic dissection is suspected, consult a thoracic surgeon. […] Provide the following long-term care for patients with aortic dissection, whether treated medically or surgically: At 1 month, a follow-up check for any new symptoms, such as chest or back pain, and signs suggestive of progression of the aortic dissection.

• #45 care after aortic dissection | Aortic Aneurysm and Dissection | Forums

  https://patient.info/forums/discuss/care-after-aortic-dissection-556400

  The Medical profession treat these as two different disciplines but appear to conjoin them as to suit themselves with patients but appear not to speak to each other very much? […] My follow up Scans were at 6 Months and an XRay at 12 months, next due at 2 years this April and my Stent had not moved and was fine. […] I have had breathing issues since the surgery so now a pulmonologist is also involved. Since surgery I have had a cat scan and several chest X-rays. […] My cardiologist scripted cardio rehab but I learned Medicare does not cover cardiac rehab following aortic dissection. […] From what I’ve read about aortic dissection, the standard for care seems to be CT or MRI scans at 3 months, 6 months, and one year after surgery and then annually after that. […] He said that keeping my blood pressure low and taking a beta-blocker to reduce the force with which the heart contracts are the most important things I need to do.

• #46 What is aortic dissection: What you need to know about the causes, types and more – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/heart-and-vascular-articles/2022/january/silent-killer-everything-you-need-to-know-about-aortic-dissection

  After years of treating patients with aortic dissections, I routinely get questions about the signs and symptoms associated with an aortic dissections, how to prevent aortic dissections and what treats are available. […] The first step of care is making sure the patient’s blood pressure is controlled, and if surgery is required, the dissection is more commonly repaired with a stent. […] The best way to prevent an aortic dissection is making sure your blood pressure is well under control. It is important to comply with all medical therapy to maintain a healthy blood pressure long term. This will protect your aorta from complications that could leave to serious consequences.

• #47 Management of acute aortic dissection in critical care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10572474/

  Management in intensive care is required while organ dysfunction persists. […] Patients with aortic dissection will need lifelong follow up as they are at risk of further aneurysmal complications and will require effective blood pressure control typically under 120/80mmHg to reduce that risk. […] Successful treatment relies on rapid diagnosis, strict blood pressure control, minimal delays to definitive treatment and MDT input.

• #48 Nursing care plan for aortic dissection

  https://nursipedia.com/nursing-care-plan-aortic-dissection/

  Nursing care plan for aortic dissection is a vital part of providing effective care for patients with this serious medical condition. […] An effective nursing care plan can help to reduce the risk of mortality, reduce pain and promote independence. […] An individualized plan of care must be created for each patient with aortic dissection. […] Interventions should focus on pain management, control of underlying causes and promotion of adequate oxygenation. […] Rationales for interventions include decreasing pain, controlling the underlying causes, promoting adequate oxygenation and monitoring for complications. […] The effectiveness of the nursing care plan should be evaluated on a regular basis. […] Early identification of symptoms, along with proper assessment, diagnosis, interventions and evaluation is crucial for optimal outcomes.

• #49 Aortic Dissection Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/aortic-dissection-nursing-diagnosis/

  Aortic dissection is a life-threatening condition characterized by a tear in the inner layer of the aorta, allowing blood to flow between the layers of the aortic wall, forcing the layers apart. […] This nursing diagnosis requires immediate attention and care as it can lead to aortic rupture, organ ischemia, or cardiac tamponade if left untreated. […] The nursing assessment for aortic dissection is crucial for early detection and prompt intervention. Here are steps in the assessment process: […] Nursing interventions for aortic dissection focus on stabilizing the patient, managing symptoms, and preventing complications. Here are the interventions: […] The following are the common nursing care planning goals and expected outcomes for aortic dissection: […] The patient will maintain stable vital signs within normal limits

• #50 Aortic Dissection Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/aortic-dissection-nursing-diagnosis/

  Provide clear, concise information about the condition and treatment plan. Rationale: Knowledge can help reduce fear of the unknown and promote a sense of control. […] The patient will maintain blood pressure within the target range (typically systolic BP between 100-120 mmHg). […] The patient will demonstrate improved peripheral perfusion with warm extremities and capillary refill 3 seconds. […] The patient will maintain urine output 30 mL/hour. […] The patient will maintain palpable peripheral pulses of equal strength bilaterally. […] The patient will demonstrate capillary refill 3 seconds in all extremities. […] The patient will report no numbness, tingling, or coldness in extremities. […] The patient will verbalize an understanding of aortic dissection and its management by the end of the educational session. […] The patient will correctly explain the purpose and side effects of prescribed medications. […] The patient will demonstrate the ability to monitor blood pressure and recognize warning signs requiring medical attention.

• #51 Aortic Dissection (Type A, Type B and Chronic Dissection) | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/aortic-dissection-type-type-b-and-chronic-dissection

  The decision to proceed with surgery for Type B aortic dissections is based on various factors, including the patient’s clinical condition, the extent of the dissection, the presence of complications, and individualized assessments by the medical team. […] It’s important to note that the management of chronic aortic dissections is highly individualized, and treatment plans may vary from patient to patient.

• #52

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