**7.1 Acute management of aortic dissection involves immediate resuscitation**

	- First line—Beta-blockade using labetalol (20 mg iv initially, followed by either 20–80 mg iv boluses every 10 min to a maximal dose of 300 mg or an infusion of 0.5–2 mg/min IV), esmolol (250–500 mcg/kg IV loading dose; then infuse at 25–50 mcg/kg/min, and titrate to maximum dose of 300 mcg/kg/min).
	- Second line—In patients with asthma, allergy, or any contraindication to beta-blockade, calcium channel blockers diltiazem and verapamil can be used.
	- Third line—Vasodilator therapy. If blood pressure remains above 120mmHg and heart rate < 60/min, nitroprusside infusion (0.25–0.5 mcg/kg/min titrated to a maximum of 10 mcg/kg/min) can be initiated. This vasodilator therapy should not be used without first lowering heart rate with beta-/ calcium channel blocker.
	- Pain control using iv opioids (tramadol, morphine, fentanyl)
	- Specific management depends on site of dissection
