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Aortic dissection

  • Admission orders

    • Admit: ICU
    • Diagnosis: Aortic Dissection
    • Condition: Critical
    • Vital Signs: ICU Routine with Continuous BP Monitoring
    • Allergies:
    • Nursing:
      • Neuro check q 1 hour.
      • Check pulses in the legs q 1 hour
      • Monitor I/O
    • Diet: NPO
    • Activity: Absolute Bedrest
    • Labs:
      • CBC, chem qday
      • LFTs
      • coags: PT, PTT
      • cardiac enzymes: CK-MB, troponin
      • EKG
      • CXR
      • CT with contrast of chest and abdomen
    • IV: KVO with 1/2 NS
    • Special:
    • Medications:
      • Labetalol 5 mg IV now, then 1 mg/min continuous infusion. Titrate up to achieve SBP 95-110 mmHg over the first hour
      • Morphine sulfate 1-4 mg IV q 1 hour as needed for pain
    • Call house officer: decreased LE pulses, Urine output < 30 mL/h, SBP > 120 mmHg, DBP > 80 mmHg, HR > 80 bpm
  • Discharge

    • criteria: no planned surgery, pain free, BP controlled on PO meds
    • education: BP control, meds, low Na diet
    • f/u within 1 week
  • Treatment

    • Ascending dissection: surgery.
    • Descending dissection: iv beta blockers to keep HR < 60, SBP 100-120

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