Category: Critical Care Nursing Many patients with thoracic aortic dissection complain of chest, back or abdominal pain that radiates to the back often describe the pain as sharp. It can also present in a painless fashion, manifesting as syncope, stroke or evolving heart failure.
Category: Critical Care Nursing Patients with thoracic aortic dissection who are younger than 40 years are more likely to have Marfan syndrome, Loeys-Dietz syndrome, bicuspid aortic valve, prior aortic surgery or aortic aneurysm.
Category: Critical Care Nursing Risk factors for thoracic aortic dissection include hypertension, male sex, pregnancy, atherosclerosis, diabetes mellitus, cocaine use, valvular disease, prior cardiac surgery, Ehlers-Danlos syndrome, Turner syndrome and giant cell arteritis.
Category: Critical Care Nursing Thoracic aortic dissection results from a tear in the aortic intima. The Stanford system classifies dissections as type A (involving the ascending aorta) or type B (involving the aorta distal to the left subclavian artery).
Category: Critical Care Nursing High-risk patients with hemodynamic instability and RV dysfunction resulting from pulmonary embolism may require systemic thrombolysis, with surgical embolectomy or catheter-directed thrombolysis.
Category: Critical Care Nursing Initial treatment of low-risk patients with pulmonary embolism involves anticoagulation with subcutaneous low-molecular weight heparin or fondaparinux, IV unfractionated heparin or direct oral anticoagulants.
Category: Critical Care Nursing A ventilation/perfusion scan can be time consuming and difficult to perform in mechanically ventilated patients, and interpretation is challenging in the presence of other lung pathology when ruling out pulmonary embolism.
Category: Critical Care Nursing CT pulmonary angiography can be rapidly performed and is the diagnostic test of choice for stable patients in whom there is moderate to high suspicion of pulmonary embolism, given its high sensitivity and specificity.
Category: Critical Care Nursing In pulmonary embolism, the ECG is often normal, but may show sinus tachycardia (the most common finding), Brugada pattern, atrial fibrillation or the classically reported S1Q3T3 (McGinn-White) pattern.
Category: Critical Care Nursing Signs of pulmonary hypertension and right heart failure may be present in pulmonary embolism. Lung examination may reveal crackles, decreased breath sounds, wheezing, rhonchi or a pleural friction rub.
Category: Critical Care Nursing Unexplained tachypnea or tachycardia may be the only diagnostic clue in pulmonary embolism. Hypoxia, though typical, is not a universal finding, and its absence cannot exclude pulmonary embolism.
Category: Critical Care Nursing Chest pain resulting from pulmonary embolism is often pleuritic and associated with dyspnea, hemoptysis, cough or syncope. Physical examination findings are generally nonspecific in pulmonary embolism.
Category: Critical Care Nursing All patients suspected of having acute coronary syndrome should be treated with aspirin, if not contraindicated (e.g., aortic dissection also suspected), or alternatively prasugrel or ticagrelor if there is aspirin allergy.
Category: Critical Care Nursing There are no specific physical examination findings of acute coronary syndrome, but if it is severe enough to induce left ventricular dysfunction, signs such as hypotension and an S3 or S4 heart sound can be present.
Category: Critical Care Nursing In the absence of an obvious cause of chest pain (e.g., shingles), a chest x-ray and ECG should be obtained. A chest CT can help diagnose a number of causes including pulmonary embolism, aortic dissection, pneumothorax and pneumonia.
