A 37-year-old man driving an automobile travelling at a rapid speed hits a tree. At arrival to the Trauma Center, aortic disruption is suspected. Which of the following statement(s) is/are true concerning the patient’s diagnosis and management?

a. If undiagnosed, a thoracic aortic disruption is associated with a 50% mortality within the first 24 hours 

b. Transesophageal echocardiography is a promising new modality for the diagnosis of aortic injury

Blunt injuries to the thoracic aorta occur in as many as 20% fatalities due to motor vehicle accidents. About half of these patients die at the scene. It is estimated that of the 50% who survive the initial injury, half will die within the first 24 hours and 90% will die within 10 weeks without surgical treatment. Blunt aortic disruption is associated with the mechanism of abrupt deceleration. Therefore, this mechanism of injury should lead to high index of suspicion. A chest radiograph is a useful screening procedure. Abnormal findings on chest film, or suspicion of the injury, must be aggressively investigated. Due to the very high morbidity of missed injuries, angiography is the diagnostic study of choice in patients at significant risk. Transesophageal echocardiography is a promising modality for the diagnosis of aortic injury, especially in patients who cannot be transported to the angiography suite. Early experience has shown transesophageal echo to be a very sensitive method, with very few missed injuries in experienced hands. Injuries to the aorta require surgical repair. The technique of aortic repair has been the subject of some controversy primarily due to the risk of spinal cord ischemia with cross clamping of the thoracic aorta. The complete use of cardiopulmonary bypass with full heparinization, however, has been shown to increase the mortality of patients who have other cerebral and vascular injuries, and is probably contraindicated in the blunt trauma patient. Most surgeons favor cross clamping of the aorta with expeditious repair of the injury. Rapid surgical repair is vital to survival of the patients. Preoperative management of patients with aortic disruption involves careful control of blood pressure and avoidance of hypertension. Pharmacologic control of blood pressure is indicated to avoid possible rupture before surgical repair. The use of sodium nitroprusside, however, should be avoided in patients with head injuries because the vasodilatory effect of this drug may cause an increase in intracranial pressure. A short-acting beta agonist such as esmolol or labetolol is probably the best choice if blood pressure control is needed.