封启明--幻灯片.pptVIP

Emergency Medicine and Technique Dr. Feng Qi-ming (MD, PhD 封启明) The Emergency Department, the 6th peoples’ hospital of Shanghai, Shanghai jiaotong University Emergency Medicine and Technique Differential diagnosis 症状鉴别诊断 Chest pain 胸痛 Abdominal pain 腹痛 Fever 发热 The introduction of emergency medicine急诊医学简介 Non-trauma 非创伤性急诊（内科、外科、 儿科 ） trauma 创伤 Disaster medicine 灾难医学 first aid 院前急救 What are qualified emergency physician needs Rich in elementary knowledge of medicine (丰富的医学基础知识) Having rich clinical experience (丰富的临床经验) Master the principals of decision-making in emergency medicine (正确的急诊临床思维) Skilled techniques for emergency(娴熟的急救技术) Tracheal intubation气管插管, Venipuncture 深静脉穿刺，Cardiopulmonary resuscitation心肺复苏 Emergency physician diathesis(良好的心理素质) The ability to dealt with accident appropriately(镇静处理突发事件) Acute Chest Pain急性胸痛 Decision-making on Acute Chest pain at Early Stage早期识别高危胸痛 Recognize the dangerous of acute chest pain, especially with those life-threatening 识别胸痛的危险程度,特别是威胁生命的胸痛 Establish pain management center to offer a comprehensive range of services for patients with treatment on acute chest pain. 国外建立疼痛中心建立一系列胸痛诊疗程序 High-risk Chest Pain急诊常见的高危胸痛 Cardiogenic pain:Acute Coronary Syndrome （UAP、AMI) 高危心源性疼痛：急性冠脉综合征 Non-cardiogenic pain:aortic dissection, pulmonary embolism and tension pneumothorax 高危非心源性疼痛：主动脉夹层、肺栓塞、张力性气胸 Diagnosis on Acute Chest Pain急性胸痛诊断思路 Medical history, physical examination , laboratory examination and special examination and tests (EKG、Chest X-ray、enzymology) 病史、体格检查、辅助检查（EKG、胸片、酶学等） chest pain division (Cardiogenic and Non cardiogenic)区分胸痛系心源性或非心源性 Juddgement the risk degree 判断危险度 characteristics of chest pain有助于胸痛的诊断和鉴别诊断的特点 Location of pain疼痛的部位，retrosternal, substernal Quality 疼痛的性质, pressure, tightness, sharp,pleuritic,burning Duration, aggravation and alleviation of pain疼痛的时间及影响因素、缓解因素, exertion, cold, psychologic stress, nitroglycerin Simultaneous symptoms of pain