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FIRE

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Suspected aortic dissection

❑ Look for the following cardinal signs & symptoms: ❑ Sudden onset chest pain (tearing/ripping/sharp or stabbing) ❑ Asymmetric blood pressure in extremities ❑ Shock ❑ Pulse deficit ❑ Evolving aortic regurgitation murmur

Unstable patient

Stable patient

❑ Order urgent TTE ❑ Look for the following high risk features: ❑ Pericardial effusion ❑ Regional wall motion abnormality (RWMA) ❑ Dilated root ❑ Aortic regurgitation (AR)

Continue with diagnostic approach

❑ Aortic dissection confirmed ❑ Transfer to Cardio-thoracic unit ❑ Perform TEE in CCU or cardiac OR

❑ Proceed to surgery

Look for the following: Intimal flap and tear
Intimal entry
Mobile linear flap in short axis view
Small central true lumen communicating with false lumen