Echo images Matthew Oliver (Emergency Physician) Text Genevieve Carbonatto
There is a BAT call. The ambulance are bringing in a man with severe back pain. 5 minutes later a 70 year old man is wheeled into the rescusitation room. He is in severe distress. He states he was lifting a box when he developed severe acute chest pain radiating to the back and associated with abdominal pain. His pain prevents any further history to be taken. He is combative and diaphoretic. He has 2 iv lines. His BP is 140 systolic in both arms and his HR 48/min. While on the resus trolley a focussed point of care ECHO is performed. Because of his agitation a subcostal view is obtained first
This is his subcostal view. What can you see?
There is a dissection flap in the aortic root
This is his 4 chamber/5 chamber view. What can you see?
Ketamine boluses were given to control his agitation along with fentanyl for analgesia. An urgent CT aortogram confirmed a Stanford type A dissection, the entry point being at the mid ascending aorta. The dissection extended to the coeliac trunk and extended down the left renal artery.
He was immmediately transferred to theatre for repair of his dissection.
Transthoracic ECHO is not the best modality for investigating a possible dissection but it should be done regardless as it may reveal an intimal flap, a widened ascending aorta (>4cm), the presence of a pericardial effusion or pericardial tamponade and aortic regurgitation.