 Today, you're working in the emergency department. A 65-year-old female comes in. She has severe upper back pain. At triage, her vitals are as follows, hypertension, tachycardia, tachypnea, a normal oxygen saturation. You immediately put her on a cardiac monitor, ask the nurse to put in two large briV and perform a 12-lead ECG. The patient describes the pain as sudden onset and severe. It is mostly in her back but radiates to the front of her chest. She describes it as a tearing, sharp pain. There is associated mild shortness of breath. She has no cardiac risk factors except smoking. On examination, she is uncomfortable with her back pain. On her vital signs, her blood pressure is still high. When you repeat the blood pressure in the other arm, there is a discrepancy between the two. Her head and neck exam is normal. On her chest examination, her cardiac examination is normal. Her rest exam is also normal. The only finding you see is that her left radial pulse is weaker than her right radial pulse. The rest of the examination is normal. The 12-lead ECG that you have ordered has come back and is normal except sinus tachycardia. You now order a chest x-ray and ask the nurse to draw a routine blood work. The chest x-ray shows a wide medial stynum. Based on her findings and her examination so far, he is suspicious of a neortic dissection. You now order the following. IV medication to decrease her blood pressure, CT angiography, and you notify the vascular surgeon. Your CT scan confirms the neortic dissection. The vascular surgery team comes down and takes over the care of the patient. You now move on to see your next patient in the emergency department.