一位 55 歲高血壓病史病人主訴胸部突然出現「撕裂感」，並放射至背部。護理師應懷疑何種狀況？
A 55-year-old client with a history of hypertension reports a sudden, severe "tearing" sensation in the chest radiating to the back. Which condition should the nurse suspect?
- AEsophageal rupture食道破裂
- BMyocardial infarction心肌梗塞
- CAortic dissection✓ 正解主動脈剝離
- DPulmonary embolism肺栓塞
撕裂感胸痛放射至背部是主動脈剝離的典型徵象。高血壓是主動脈剝離的主要危險因子，當主動脈內膜受損，血液在動脈層間流動，會引發劇烈疼痛。心肌梗塞多為壓迫感，肺栓塞則是呼吸困難與胸膜性疼痛，需精確區分以決定緊急處置方向。
A tearing chest pain that radiates to the back is the classic presentation of aortic dissection. Hypertension is the primary risk factor; when the aortic intima is disrupted, blood flows between the layers of the aortic wall, producing severe pain. Myocardial infarction typically presents as pressure or squeezing, and pulmonary embolism produces dyspnea with pleuritic pain; accurate differentiation is essential to determine the appropriate emergency management.
美台臨床對於主動脈剝離的初步檢查皆以 CTA 為主，但美國急診醫師執照範疇內較早會考慮給予強效降壓藥控制血壓。