The implementation of A&E diagnostics, education & policy change for Aortic Dissection
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STOP THE MISDIAGNOSIS OF THIS KILLER
Aortic Dissection Education, Process, Policy Change & Improved Diagnosis
In 2015, our father Tim Fleming suddenly became very unwell, presenting all of the classic symptoms of Aortic Dissection; severe and sudden onset of pain in his back, chest and abdomen. Sadly, it appears to us that all of the markers and indicators were missed. The correct diagnosis of an Aortic Dissection was not made when Dad initially presented to A&E. Dad paid the ultimate price with his life.
This petition is an urgent call to parliament for the implementation of a robust policy to improve the diagnosis of and long-term care of those with, and those at risk of, aortic dissection in the United Kingdom and the Republic of Ireland.
Aortic dissection occurs when there is a partial tear in the aortic wall. This tear then spreads along the length of the aorta. This can rupture or interrupt the blood supply to vital organs. If the tear occurs in the first part of the aorta, in the front of the chest, it is called a type A dissection. If it occurs in the aorta in the back of the chest it is a type B dissection.
Aortic dissection can affect adults of any age. It is an important cause of maternal death. Untreated type A dissection is almost always fatal. Type B dissection is much less dangerous and is rarely fatal in the short term in Great Britain.
Treatment for type A dissection requires emergency open heart surgery. This will save the life of over three-quarters of patients. About 2800 patients per year suffer a type A dissection in Great Britain. Half of these die almost immediately after the onset. Although the number of operations for type A dissection is increasing, still only two-thirds of patients who could be saved undergo an operation
These people do not die because Emergency Medicine lacks the facilities to treat them. Cardiac surgical units across the country have the capacity to carry out extra operations. The problem is that people are not diagnosed quickly enough, if at all. With an improved diagnosis of aortic dissection, 500 people per year in Great Britain, or 10 people per week, could be saved who currently die.
Patients with aortic dissection typically suffer sudden severe chest pain. The pain can settle completely and routine tests carried out in the Emergency Department can be normal. To make the diagnosis it is necessary to carry out an emergency CT scan. Too often a diagnosis of aortic dissection is not considered and a CT scan is not ordered at all.
Emergency Departments see many patients with chest pain and only a few will have an aortic dissection. However, we know that in Emergency Departments which ask the question ‘why is this not aortic dissection’ for all patients with chest pain, the number of CT scans performed increases greatly and no patients with an aortic dissection have the diagnosis missed.
TIME FOR CHANGE
This is an urgent call for the government to implement the following actions across Emergency Medicine in the UK and Ireland:
1. POLICY - The introduction of policy and guidelines for timely identification and treatment of Aortic Dissection for emergency services and A&E departments across Emergency Medicine.
2. DIAGNOSTICS - The implementation across Emergency Medicine of consistent, routine emergency diagnostics for Aortic Dissection – once a heart attack is ruled-out, doctors should routinely check for Aortic Dissection.
3. EDUCATION - Training, information and education for our medical professionals to ensure rapid, consistent adoption of the identified best practice
4. PROCESS - Organisation of emergency cardiac surgical services so that patients with aortic dissection are always treated by surgeons with the appropriate experience.
PLEASE SIGN THIS PETITION TO STOP THE MISDIAGNOSIS OF THIS KILLER
Timely detection and treatment of Aortic Dissection will save lives.
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