READING TIME: 5.5 MINUTES
On one fine Sunday afternoon at Storifield Royal, a pre alert was received from paramedics
” 77 year old male has had a sudden onset of severe back and bilateral leg pain an hour ago. Now he cant feel his legs. He is too agitated due to pain so we have not been able to record any observations. Patient looks pale and unwell. ETA is 5 minutes”
So we geared ourselves up to receive the patient with likely dissection. Here is the timeline of this case.
00:00 Patient arrives to ED
00:01 Monitoring ,O2 applied. 2 x large bore IV inserted.Blood sent
00:03 Analgesia prescribed. P 118/min BP 105/66
00:05 ECG done. Ultrasound performed.
Longitudinal view of aorta showing dilated aorta with false lumen. Intimal flap of aorta can be seen moving with cardiac contraction. 
Figure 1: Longitudinal view showing the dissecting flap separating the true and the false lumen.
Figure 2: Transverse view. Aortic Aneursym measuring 5.1 cm
00:07 Surgeons and ITU bleeped
00:08 Patient arrested. PEA followed by asystole
00:16 CPR discontinued
These epic 16 minutes tells the story why dissecting aortic aneurysms are ticking time bomb.
Rapid.Ultrasound in.Shock(R.U.S.H) examination can promptly diagnose life threatening causes of shock in ED.
Read in detail about the RUSH exam by following the links in foot notes.
RCEM recently has raised awareness regarding missed aortic dissections
Inspirations
The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll.
Rapid Ultrasound for Shock and Hypotension – the RUSH Exam