Upon suspicion of aortic dissection, what is the most appropriate immediate management step?

In cases of suspected aortic dissection, the immediate management focuses on reducing the heart rate and blood pressure to limit further cardiac stress on the aorta that could lead to complications. Starting intravenous beta blockers is critical because they help decrease the heart rate and contractility, which in turn reduces aortic wall stress and the risk of progression of the dissection.

Sodium nitroprusside may be initiated alongside beta blockers to help lower blood pressure effectively; however, the primary focus should first be on heart rate control. The use of these medications together allows for a rapid and effective way to stabilize the patient while preparing for further diagnostic imaging and surgical intervention if necessary.

Optioning for MRI is not appropriate in an emergency setting as it is time-consuming and not the preferred initial imaging study for aortic dissection; a CT scan or echocardiogram is typically used instead. While nitroglycerin and aspirin might be helpful in other settings, they do not address the primary concern of controlling the hemodynamic state in aortic dissection. IV sodium nitroprusside alone does not sufficiently manage the heart rate, which is crucial in this scenario. Thus, starting IV beta blockers and sodium nitroprusside represents the most comprehensive immediate