Type A Aortic Dissection Pre Transfer

Published 23/03/2023

Type A Aortic Dissection Pre Transfer

Pre-transfer Type A dissection:




RIJ CVC & left radial arterial line






Nasal cannulas


Syringe drivers

Syringes with iv antihypertensive medications


Airway trolley

Clinical Setting:

I: You are the ICU registrar on a nightshift

S: Outreach/Outliers registrar calls and says that she/he is transferring a hypertensive crisis to the unit straight from the CT scan

B: 52M patient, smoker, otherwise fit and healthy presented to A&E 2 hours ago with sudden onset chest pain. Lines inserted while awaiting transfer to CT.

A: Normal ECG, awaiting CTPA report

R: Called as the patient has just arrived to the unit.

Potential Clinical Course:

  • Initially A own, B SpO2 92% on 4L NC. C HR100 bpm, SR, BP 200/96, D awake, oriented, complaining of pain in the centre of his chest
  • Starts becoming more tachycardic. If assessed- bilateral upper limb weakness 3/5.
  • Radiology consultant on call calls- type A dissection involving ascending aorta, carotid arteries and aortic arch.
  • Contact vascular surgeons and tertiary centre – start organising the emergency transfer
  • Can call in a second registrar for help
  • Continues to stabilize the patient- appropriate infusions and interventions before transfer (short acting iv beta blockers, short acting iv antihypertensives)
  • If appropriate blood pressure control not achieved- patient starts to drop blood pressure with rising lactate and dropping Hb.
  • Calls the on call consultant for help.

Info Sheet For Faculty

  • Initial settings:    
    • SpO2 92% on 4L NC
    • RR 18/min
    • HR100 bpm SR
    • BP 200/96


  • Progress to:       
    • SpO2 90% on 4L NC
    • RR 20/min
    • HR 110bpm SR
    • BP 210/100


  • If beta blockers and antihypertensives started:
    • SpO2 92% on 4L NC
    • RR 20/min
    • HR 70 bpm SR
    • BP 160/70


  • If appropriate medications not commenced:
    • SpO2 88% on 4L NC
    • RR 28/min
    • HR 120 bpm SR
    • BP to 100/40


  • Further observations depend upon actions

Faculty Roles

Bedside Nurse 1:

  • You are a critical care nurse
  • You have teaken handover from a resus nurse of a patient who is complaining of chest pain. Handed over to you as a hypertensive crisis and was brought to ICU straight from CT.
  • The registrar is at the bedside with you.
  • You are concerned because the patient looks pale and sweaty, unlike a hypertensive crisis patient.
  • You take direction well, and can perform tasks asked if you in a timely fashion
  • You are helpful and prompt the candidate ‘is there anything else we should do?’, ‘should I run a gas?’, ‘has the line been x-rayed and is safe to use?’.


Bedside Nurse 2:

  • You are a new starter – you have never seen someone so hypertensive before
  • You are quite startled when asked questions/given directions, requiring instructions to be repeated to you
  • If the candidate names equipment using technical terms then you inform them that you don’t know what that is; you are also not familiar with the IV medications as you have never used them before
  • You are keen to help, but are unwilling to do anything beyond your skill set