Acute aortic dissection

Regardless of whether surgery is indicated, the initial focus of care for all acute dissections is blood pressure control. A unique aspect is the issue of 'shearing forces,' whereby a wide pulse pressure, separate from an elevated mean arterial pressure, increases the likelihood of tearing of the aortic wall. Therefore the goal is an arterial pulse waveform which is more blunted than usual, in addition to lowering mean blood pressure ( Panacek 1994). Sodium nitroprusside is the most reliable agent for the careful reduction of blood pressure to normal levels; however, it may actually widen the pulse pressure. To prevent this, a b-blocker is added. Although propranolol or other b-blockers may be used, the most titratable agent is esmolol given by constant infusion. Initial blood pressure control in these patients should take priority over angiographic studies. This is one setting in which blood pressure may be cautiously reduced, to levels below normal if necessary, to help control pain symptoms.

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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