胸痛PPT医学课件（英文版）.pptVIP

Approach to Chest Pain Levente Batizy, DO September 15, 2005 Chest Pain 5% of ED visits 5 million pts/yr Accurate diagnosis remains a challenge Chest Pain Visceral Often referred Aching, heaviness, discomfort Difficult to localize pain Somatic Sharp, easily localized Chest Pain Definitions Acute Chest Pain: Acute - sudden or recent onset (usually within minutes to hours), presenting typically 24 hrs Chest - thorax midaxillary to midaxillary line, xiphoid to suprasternum notch Pain – noxious uncomfortable sensation Ache or discomfort Initial Approach Triage Chest pain Significant abnormal pulse Abnormal blood pressure Dyspnea These pts need IV, O2, Monitor, ECG Initial Approach Evaluation: Airway Breathing Circulation Vital Signs Focused exam Cardiac, pulmonary, vascular Initial Approach History: Character of pain Presence of associated symptoms Cardiopulmonary history Pain intensity, 0-10 pain Initial Approach Secondary exam: History Quality, radiation/migration, severity, onset, duration, frequency, progression and provoking or relieving factors of pain Risk factors Physical exam Review old records/ekg’s Categorizing Chest Pain Chest Wall Pain Sharp, Precisely localized Reproducible: Palpation, movement Pleuritic or Respiratory CP Somatic pain, Sharp Worse with breathing/coughing Visceral CP Poorly localized, aching, heaviness Causes Table 49-1 Chest wall Costosternal synd Costochrondritis Precordial catch synd Slipping Rib Synd Xiphodynia Radicular Synd Intercostal Nerve Fibromyalgia Pleuritic Pulmonary Embolism Pneumonia Spontaneous pneumo Pericarditis Pleurisy Causes Table 49-1 3. Visceral Pain: Typical Exertional Angina Atypical Angina Unstable Angina Acute Myocardial Infarction (AMI) Aortic Dissection Pericarditis Esophageal Reflux or spasm Esophageal Rupture Mitral Valve Prolapse Categorizing Chest Pain Assessment of Risk Factors CAD: Cigarette Smoking Diabetes Hypertension Hypercholesterolemia Family History Categorizing Chest Pain Assessment