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A 58-year-old male with a history of hypertension presents with sudden onset of severe tearing chest pain radiating through to his back. He is tachycardic, hypotensive and tachypnoeic. He states he is a Jehovah's Witness and refuses blood transfusions.

1. List (3) key clinical features suggestive of aortic dissection. 3 marks

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2. Outline your immediate actions in the ED. 4 marks

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3. Discuss the specific considerations in the management of this patient due to his refusal of blood products. 3 marks

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Q: What is the difference between capacity and competence?

4. State definitive treatment options for aortic dissection. 2 marks

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