A patient presents with tearing epigastric pain that radiates to the back. Which assessment is most appropriate?

• A. Start IV fluids and monitor
• B. Administer antacids
• C. Take femoral and pedal pulses for deficits
• D. Check blood pressure

Answer: (C)

Tearing epigastric pain that radiates to the back raises strong concern for aortic dissection, a life-threatening condition where the inner layer of the aorta tears and blood can flow between layers, compromising blood flow to downstream vessels. A key bedside clue is a pulse deficit in distal arteries caused by the dissection interfering with arterial flow. Assessing femoral and pedal pulses for deficits directly tests for this sign, helping you identify vascular involvement early and triage the patient for urgent transport to definitive imaging and surgical care. While measuring blood pressure and establishing IV access are important, they don’t provide the same immediate evidence of distal perfusion problems. Administering antacids would miss the seriousness of a potential dissection and delay appropriate management.