胸背部痛.PDFVIP

森脇龍太郎，石川康朗／編 序−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−石川康朗，森脇龍太郎−••••••••••••3 カラーアトラス−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− 10 略語一覧−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− 11 第 章 【総論】致死的疾患を見逃すな！ 1 1 総論：致死的疾患を見逃さない−−−−−−−−−−−−−−−−−−−−−佐藤洋子，堀　進悟−••••••••••14 1疫学　2胸背部痛の鑑別疾患　3胸背部痛の診療の流れ　4病歴聴取　5身体所見　 6検査 One More Experience ◦胸痛経過観察プロトコール Pros Cons ◦大動脈解離の診断におけるD-dimerの有効性 2 胸背部痛の発症機序と致死的疾患別の特徴−−−−−−−−−−−−−−山内雅人−••••••••••23 1体性痛と内臓痛　2虚血性心疾患　3急性大動脈解離　4肺血栓塞栓症　5胸膜炎・心 膜炎　6肋間神経痛（帯状疱疹を含む）　7気胸 One More Experience ◦急性冠症候群としてのリスク評価 Pros Cons ◦虚血性心疾患の診断名 3 胸背部痛患者のアプローチ −−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−− −•••••••••• a）病歴聴取（医療面接） 足利貴志 29 1疾患からみたアプローチ　2症状の形態からみたアプローチ One More Experience ◦疼痛の原因 contents b） 致死的疾患を見逃さないための胸背部痛患者観察法−−−−−−−−−−中田一之−••••••••••35 1身体所見　2見逃してはならない胸背部痛をきたす疾患　3胸背部痛をきたす致死的疾患 別身体所見　4身体所見より考えられる帰宅の有無の判断 One More Experience ◦所見に乏しいのは重要な所見　 ◦適切な診察が行われたか？ c）まず行うべき検査−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−松村昭彦−••••••••••42 1心電図モニター，パルスオキシメトリー　2尿検査　3血液検査　4胸腹部X線　5心電 図　6その他の特殊検査 4 Disposition 診断が判然としないときの取り扱い−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−−石川康朗−••••••••••46 1診断が判然としない場合とは　2次なるステップ　3最終的ステップ One More Experience ◦ 「第一印象は重要であるが，裏付けが乏しい場合は，もとに 戻る！」 第 章 【ケーススタディ】あらゆる原因を見抜き対処する！ 2 1 急性冠症候群 a）急