injuries poisoning
Aortic Disruption (Traumatic)
Treatment of Traumatic Aortic Disruption
Blood pressure control Surgical repair or stent placement In patients with traumatic aortic disruption, fluid resuscitation is indicated, but impulse control therapy (decreasing heart rate and blood pressure, usually with a beta-blocker) should be started once other sources of hemorrhage have been excluded. Targets are heart rate≤90 beats/minute and systolic blood pressure≤120 mm Hg; and patients should not perform a Valsalva maneuver. Measures should be taken to avoid coughing and gagging if patients require endotracheal intubation (eg, pretreatment with 1 mg/kglidocaineIV) or nasogastric intubation (eg, avoiding any resistance to tube passage). Previously, definitive treatment was immediate operative repair, but endovascular stent placement is now the treatment of choice. Surgical repair can be delayed while evaluating and treating other potentially life-threatening injuries. 