Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with sudden onset of severe, "tearing" or "ripping" chest pain radiating to the interscapular region. Associated symptoms include diaphoresis, nausea, and dyspnea. Pertinent negatives include no history of recent trauma or cocaine use. Current vitals show hypertensive urgency/emergency.
Clinical Examination Findings
Patient appears in acute distress, diaphoretic, and tachycardic. Cardiovascular exam reveals a new-onset diastolic decrescendo murmur at the right upper sternal border (suggestive of aortic regurgitation). Pulse deficit noted between upper extremities (asymmetric radial pulses). Blood pressure discrepancy >20 mmHg between arms. Neurological exam: alert and oriented, no focal deficits.
Treatment Protocol
Immediate stabilization initiated: Strict blood pressure control (target SBP 100-120 mmHg) and heart rate control (target HR <60 bpm) using IV beta-blockers (e.g., Esmolol or Labetalol). Pain management with IV opioids. Emergent cardiothoracic surgery consultation for surgical repair. NPO status maintained.