What if you were told today was the last day of your life?

Being in a warzone, we often think of life and death in terms of battle injury. Gunshots, mortars, vehicle rollovers, or IED's exploding. But, what if it was you who was, in essence, a ticking time bomb? Today we saw a patient, C, who presented with migrating pain from the throat, to the epigastrum, to the back, and then it went away. Lucky for a doctor's spidey-sense, he obtained a CT Scan of C's abdomen. C had an aortic dissection from the level of the aortic valve (the top) alllllllllllllllllll the way to his legs!! And he's sitting in our EMT saying, "I just don't feel well, but I can't quite tell you what it is." His life went from going to sleep feeling fine, to waking up with localized pain, to being told his chances of surving the next 24 hours are 50/50. So, what if today was the last day of your life?

What is an aortic dissection?
"Aortic dissection is a tear in the wall of the aorta that causes blood to flow between the layers of the wall of the aorta and force the layers apart. Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs. Aortic dissections resulting in rupture have an 80% mortality rate, and 50% of patients die before they even reach the hospital. If the dissection reaches 6 cm, the patient must be taken for emergency surgery."

Basically his aorta is ripping apart in layers, and since the blood is not flowing through the true lumen of the vessel and the dissection expands into the vessel space, the organs are not perfusing. Since the dissection affects the aorta from heart to hips (or more), all of his organs are at risk. This includes the brain, one of the kidneys is already compromised, the bowels, the lungs, and of course the heart...pretty much everything. If this rips through from any location, he will die. He will bleed out. If the dissection gets worse and prevents blood flow to orgrans, he will go into organ failure and he will die. He could develop clots that go to his lungs, heart, or brain.... and he could die. The outlook is grim...but C left here alive.

The risk of rupture is higher with uncontrolled blood pressure. High blood pressure+smaller lumen vessel= high velocity blood flow and turblence. Think of using your finger on a hose to make it spray. So, Dr. S ordered blood pressure and heart rate controlloing medications. The risk of low blood pressure is lower cerebral perfusion pressure. Is his brain getting enough oxygen? It's a risk to weigh when the other option is rupture.

C knows how serious his condition is. I can't imagine what is going through his mind. No one wakes up thinking the next step they take could be their last. We are all aware that life is a gift and is taken away all too easily by accidents, long term illness, and war, but you don't generally believe that it's your own body that is fused to detonate if you trip the wire.

C is currently on a plane to LRMC where he will go straight to Homburg for surgery. This is an emergency situation and because he was in Iraq, it took 10 hours for a team to get here and it will take 7-9 hours for them to get to LRMC. Pray that he lives that long.

I wanted to write more, but sleep is calling to me....