Aortic Aneurysm
A 62-ycar-old man was admitted to the intensive care unit (ICU) with substernal chest pain. The chest pain was unrelieved by nitroglycerin. The pain decreased in intensity after 8 mg of morphine sulfate. His admitting ECG was normal. His chest x-ray revealed a widened mediastinum, and an aortogram demonstrated a thoracic aneurysm. He has nitroprusside infusing at 1.0 mcg/kg/min to maintain his systolic blood pressure below 100 mm Hg. Suddenly, the patient yc11s out, "The pain, the pain ... it's back ... it's even worse than before." A rapid assessment reveals the following:
Following relief of the patient's pain with morphine and notification of the phy1ician, the nune anticipates the patient will need:
(A) STAT chest x-ray
(B) STAT CT scan of the chest
(C) Cardiac catheterization
(D) STATMRI
Based on the deecription of the location of the pain, the nuree 1u1pect1 the di11cction i1 located in the:
(A) Ascending thoracic aorta
(B) Transverse thoracic aorta
(C) Descending thoracic aorta
(D) Abdominal aorta
Medical management of a thoracic aortic anearynn is focused on:
(A) Maintaining the systolic BP less than 120 mm Hg
(B) Maintaining the diastolic BP less than 40 mm Hg
(C) Maintaining the heart rate less than 100 bcats/min
(D) Reducing the CO to less than 2.0 L/min