NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationHard
A 55-year-old male is experiencing sudden onset of severe, tearing back pain that radiates to his abdomen. He is pale and diaphoretic. His blood pressure is 180/100 mmHg, pulse 120 bpm, and respirations 20 bpm. He has a history of poorly controlled hypertension. Given these findings, which of the following conditions should the EMT suspect?
- APneumothorax
- BAortic dissection
- CPulmonary embolism (PE)
- DAcute myocardial infarction (AMI)
Show answer & explanationAnswer & explanation
Correct answer: B. Aortic dissection
The patient's presentation of sudden onset, severe, tearing back pain radiating to the abdomen, combined with a history of poorly controlled hypertension and elevated blood pressure, is highly suggestive of an aortic dissection. This condition involves a tear in the inner layer of the aorta, leading to blood flowing between the layers and causing characteristic tearing pain.
Why the other options are wrong
- A. Pneumothorax typically causes sudden pleuritic chest pain and shortness of breath, often unilateral, but not the tearing pain pattern described.
- C. Pulmonary embolism typically presents with sudden shortness of breath, pleuritic chest pain, and sometimes tachycardia, but not usually severe tearing back/abdominal pain.
- D. While AMI can cause severe pain and diaphoresis, the tearing character of the pain and radiation to the back/abdomen, along with severe hypertension, are less typical than for an aortic dissection.
Aortic Dissection Recognition
Aortic dissection is a life-threatening condition caused by a tear in the inner layer of the aorta, leading to blood splitting the aortic wall. It presents with sudden, severe, 'tearing' or 'ripping' pain, often radiating to the back, and is strongly associated with hypertension.
- Sudden, severe, 'tearing' or 'ripping' pain.
- Pain often radiates to the back or abdomen.
- Strongly associated with uncontrolled hypertension.
- Can lead to pulse deficits or blood pressure differences between limbs.
Memory trick: Tearing Back Pain? Think Aorta!