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Great response.

Some answers for the above questions

No difference in of BP in both the arms

FAST/Echo is normal but I am not that good enough to identify right ventricular strain pattern(Rins a bell on something obvious)

Patient GCS is 15/15 all thoughout except during the episode of collpase(which lasted less than 1-2min).BP was stable and not getting worse/better even after cautious fluid resuscitation.So there is no indication for intubation at anytime of his stay in ED or prehospital.

ECG-Sinus tachycardia.

You guys are spot on.It was not a convincing Dissection h/o clinical symptoms/signs and his clinical condition is not worseing since then event happened.But i could be wrong as well

My first Differential is PE but patient ended up having CT thorax+Angiogram which showed a shower of clots in his pulmonary vasculature.Ofcourse dissection must be ruled out before any anticoagulation is started on him.

Thanks guys for interest.Will keep posting some more in the next few days.