Simon Rose


Aortic Dissection: The Silent Killer. Essential Knowledge for Early Recognition and Clinical Guidance for Pre-Hospital Clinicians

Date: Wednesday 12th May

Aortic Dissection (AD) is a time critical emergency, killing more people per year than road traffic collisions. It is a true silent killer. In the UK AD affects about 4000 people per year, around 2000 of these will be dead within 30 days. Many of these deaths are preventable, people die because they are not diagnosed quickly enough, if at all.  
AD occurs when there is a partial tear in the aortic wall. If the tear occurs in the ascending aorta, it is type A dissection. If it occurs in the descending aorta, type B. Untreated type A dissection is almost always fatal. AD can affect adults of any age, although the mean age is 65 years, half are under 60. Whilst death in pregnancy is very rare 11% of maternal deaths from cardiovascular causes are due to aortic dissection. Definitive treatment for aorta dissection requires emergency cardiac surgery. This will save the lives of 80% of these patients.

Patients with aortic dissection typically suffer severe chest pain and crucially this is of rapid onset. The pain may settle completely by the time of arrival at ED. Routine tests are often normal. To make the diagnosis it is essential that an emergency CT scan is performed. Currently there is a failure to even consider the diagnosis of aortic dissection in between 15% and 57% of patients presenting with an acute aortic dissection.

PURPOSE
Paramedics have a vital role to play in the diagnosis of AD. As the first point of contact, they will often see these patients at the height of their pain and in there truest clinical presentation. The purpose of this presentation is to enhance the understanding, knowledge and management of this time critical condition for all pre-hospital clinicians. With enhanced knowledge providing the catalyst for earlier and more frequent recognition of aortic dissection many more lives can be saved. 

RELEVANCE
This presentation is intertwined with a case study presented by a patient’s relative. She openly tells her father’s story of a misdiagnosed AD and only a week later her aunt’s story of surviving an AD. This case study not only grounds this presentation in a human focus but will also illustrate the important role paramedics can play in saving the lives of these patients. 

IMPLICATIONS
After this presentation attendees will have an increased knowledge of AD, such as associated risk factors, symptoms, pain characteristics and key examination findings as well as an easy to use assessment tool which can be used in pre-hospital practice. Crucially, this knowledge enhancement will lead to increased recognition of AD by paramedics. This will enable them to present a stronger clinical impression at the ED, increasing the probability of a CT scan and formal diagnosis of aortic dissection. Together we can prevent deaths from aortic dissection. Together we can stop this silent killer. 

 

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Simon Rose MCPara, Paramedic, East of England Ambulance Service

Simon is a HCPC registered Paramedic working for the East of England Ambulance Service.  After noticing that very minimal training was given to pre-hospital staff on aortic dissection, he started working closely with the Think Aorta Campaign. Simon on behalf of the campaign created and delivered the first Think Aorta lecture to paramedic students at the University of East Anglia before expanding to other universities and organisations within the east of England. Simon now leads the pre-hospital education branches of the newly formed Aortic Dissection Charitable Trust and the Think Aorta Campaign, as well as consulting on JRCALC’s vascular emergencies guidelines.  

To date he has helped enhance the knowledge of approximately 500 pre-hospital clinicians on the time critical condition of aortic dissection.