Aortic Dissection
A tearing or ripping pain in the chest that radiates to the back suggests aortic dissection. Patients may have unequal blood pressures between arms, a pulse deficit, or neurological signs. Hypertension is a major risk factor.
Abdominal Aortic Aneurysm
A rupturing abdominal aortic aneurysm presents with sudden abdominal, back, or flank pain, along with hypotension and a pulsating abdominal mass. Older male smokers are at highest risk.
Prehospital Management
Give oxygen, keep the patient still, and transport rapidly to a facility with surgical capability. Do not aggressively palpate a pulsatile abdominal mass. Avoid giving aspirin or nitroglycerin when dissection is suspected, and call for ALS support if available.