BMJ  2003;326:1134 (24 May), doi:10.1136/bmj.326.7399.1134

Commentary

Challenge for emergency physicians

Harald Herkner, consultant1

1 Department of Emergency Medicine, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria harald.herkner@akh-wien.ac.at

The first 150 words of the full text of this article appear below.

Aortic dissection is relatively rare,1 but because patients may die rapidly doctors need to bear it in mind when patients present with chest pain. The likelihood of encountering a case of aortic dissection is higher in emergency departments than in primary care. In our department, located in a 2000 bed university hospital, we see about one patient a week with acute aortic disease.2 The fact that most electronic responses to the first part of this case report mentioned aortic dissection among their differential diagnoses suggests that, in this select group at least, awareness is high.

Like Peter Hartl, most patients with aortic dissection are seriously ill and are unlikely to be discharged from hospital inappropriately. The key role of the emergency physician is therefore to make an early accurate diagnosis. Every hour of delay worsens the patient's prognosis by 1%.3 Mortality is about 50% within the first 48 hours if . . . [Full text of this article]


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