DOI: 10.36347/sjmcr.2016.v04i04.006

Pages: 200-202

An 84-year-old female fell unconsciousness after complaining of suffering from pain. She was still unconsciousness on arrival. An urgent cardiac echo suggested dissection of the aorta with cardiac bloody tamponade. We decided to start permissive hypotensive therapy. Enhanced computed tomography confirmed that the patient had type an acute aortic dissection (AD) with cardiac tamponade. After she was returned to the emergency room for preparation for radical operation, her respiration ceased, and she entered cardiac arrest (electrical pulse less activity). Urgent pericardiocentesis was performed under bag mask ventilation with manual chest compression. After the patient had absorbed approximately 50 mL of bloody fluid, spontaneous circulation was restored. She underwent tracheal intubation with sedation and was moved to an operation room for replacement of the ascending aorta. Postoperative course was uneventful. After rehabilitation, she was discharged on Day 14 of hospitalization. We believe the key points contributing to our success were 1) early recognition of type an acute AD with cardiac tamponade by ultrasound, 2) conducting permissive hypotensive therapy under systolic blood pressure of 90 mmHg, 3) simultaneously preparing pericardiocentesis in the emergency room when the patient entered cardiac arrest, in addition to radical operation by a consulting cardiac surgeon.