急性腹胸痛[4]VIP免费

EmergencyMedicineandTechniqueDr.FengQi-ming(MD,PhD封启明)TheEmergencyDepartment,the6thpeoples’hospitalofShanghai,ShanghaijiaotongUniversityEmergencyMedicineandTechniqueDifferentialdiagnosis症状鉴别诊断①Chestpain胸痛②Abdominalpain腹痛③Fever发热Theintroductionofemergencymedicine急诊医学简介Non-trauma非创伤性急诊（内科、外科、儿科）trauma创伤Disastermedicine灾难医学firstaid院前急救Whatarequalifiedemergencyphysicianneeds1.Richinelementaryknowledgeofmedicine(丰富的医学基础知识)2.Havingrichclinicalexperience(丰富的临床经验)3.Mastertheprincipalsofdecision-makinginemergencymedicine(正确的急诊临床思维)4.Skilledtechniquesforemergency(娴熟的急救技术)Trachealintubation气管插管,Venipuncture深静脉穿刺，Cardiopulmonaryresuscitation心肺复苏5.Emergencyphysiciandiathesis(良好的心理素质)6.Theabilitytodealtwithaccidentappropriately(镇静处理突发事件)AcuteChestPain急性胸痛Decision-makingonAcuteChestpainatEarlyStage早期识别高危胸痛Recognizethedangerousofacutechestpain,especiallywiththoselife-threatening识别胸痛的危险程度,特别是威胁生命的胸痛Establishpainmanagementcentertoofferacomprehensiverangeofservicesforpatientswithtreatmentonacutechestpain.国外建立疼痛中心建立一系列胸痛诊疗程序High-riskChestPain急诊常见的高危胸痛Cardiogenicpain:AcuteCoronarySyndrome（UAP、AMI)高危心源性疼痛：急性冠脉综合征Non-cardiogenicpain:aorticdissection,pulmonaryembolismandtensionpneumothorax高危非心源性疼痛：主动脉夹层、肺栓塞、张力性气胸DiagnosisonAcuteChestPain急性胸痛诊断思路Medicalhistory,physicalexamination,laboratoryexaminationandspecialexaminationandtests(EKG、ChestX-ray、enzymology)病史、体格检查、辅助检查（EKG、胸片、酶学等）chestpaindivision(CardiogenicandNoncardiogenic)区分胸痛系心源性或非心源性Juddgementtheriskdegree判断危险度characteristicsofchestpain有助于胸痛的诊断和鉴别诊断的特点Locationofpain疼痛的部位，retrosternal,substernalQuality疼痛的性质,pressure,tightness,sharp,pleuritic,burningDuration,aggravationandalleviationofpain疼痛的时间及影响因素、缓解因素,exertion,cold,psychologicstress,nitroglycerinSimultaneoussymptomsofpain疼痛的伴随症状Previousmedicalhistory即往史locationofchestpain胸痛的部位AnginaPectorisandacutemyocardialinfarctionareusuallyretrosternal.mostpatientsdonotlocalizethepaintoanysmallarea.Theyaretypicallydescribedastightness,pressure,orsqueezing.Painmayradiatetothejaw,neck,arms,back,andepigastria.Theleftarmisaffectedmorefrequently.心绞痛与急性心肌梗死的疼痛常位于胸骨后或心前区，且放射到左肩和左上臂内侧。Thepainofesophagealdisease,mediastinalherniaandmediastinaltumerisalsoaretrosternal.食管疾患、隔疝、纵隔肿瘤的疼痛也位于胸骨后。spontaneouspneumothorax,acutepleuritisandpulmonaryembolismet.aloftenunilateralandpleuritic.自发性气胸、急性胸膜炎、肺栓塞等常呈患侧的剧烈胸痛。QualityofChestPain胸痛的性质Intercostalneuralgiacausesparoxysmalburningpainorprickingpain.肋间神经痛呈阵发性的灼痛或刺痛。Myosalgiaoftenoccurswithachingpain.肌痛则常呈酸痛；Ostalgiaoccurswithachingpainorboringpain骨痛呈酸痛或锥痛；Esophagitisanddiaphragmatoceleoftenoccurswithburningpainorheatburn食管炎、膈疝常呈灼痛或灼热感；QualityofChestPain胸痛的性质AnginaPectorisormyocardialinfarctionisusuallydescribedasaheaviness,pressure,orsqueezing心绞痛或心肌梗死常呈压榨样痛并常伴有压迫感或窒息感。Borningpainiscausedbytheerosionofaneurysmofaortawhenitcorrodeschestpain...