acememerapsf

safetyalert

Subject: Aortic Dissection


Aortic Dissection is over-represented in the EMER database.  Currently, 2% of incidents (5/272) involve an aortic dissection.  The incident categories in reports involving aortic dissections are diagnostic error and delay to treatment.


The diagnosis of aortic dissection can be difficult because the patients present with atypical chest, abdominal or back pain, with or without limb symptoms.  In some  patients, the pain resolves.  All five EMER patients were put on an “ACS rule-out” pathway with ECGs and troponin.  One patient had a normal VQ after a positive d-dimer.  Equal bilateral BPs and the absence of mediastinal widening on CXR are not sufficiently accurate to rule out an aortic dissection.1  A delayed diagnosis can be fatal – two EMER patients were found deceased in the days after discharge from ED.

 

report ED incidents to emer.org.au

Patient Safety Alert No. 1 /09/11/2015. Follow us on Twitter at @EmerMedER Information obtained from Emergency Medicine Events Registry - an online, anonymous incident reporing system for Emergency Department doctors in Australia and New Zealand. Contact [email protected]. Reference: 1.http://lifeinthefastlane.com/ccc/acute-aortic-dissection