In the context of aortic dissection, what should be done if the patient is unstable?

In the management of an unstable patient with suspected aortic dissection, immediate surgery is typically the standard approach. Unstable patients, particularly those who may be experiencing critical complications such as significant hemorrhage or compromised organ perfusion due to the dissection, require urgent surgical intervention to prevent further morbidity or mortality.

While transesophageal echocardiography (TEE) can be a useful tool in diagnosing aortic dissection, especially as it provides rapid assessment of the aorta and can visualize the dissection, it is not the priority in a critically unstable scenario. In such cases, the focus should be on stabilizing the patient and proceeding to surgical intervention as quickly as possible.

Other diagnostics like spiral CT angiography are useful for evaluation but can delay surgery and are not the immediate priority when the patient is unstable. Intravenous fluids might be necessary to stabilize blood pressure or volume, but this alone is not sufficient to address the underlying issue presented by an aortic dissection.

Thus, the protocol for unstable patients emphasizes the need for immediate surgical intervention, ensuring that life-threatening complications can be addressed promptly.