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1、EmergencyMedicineandTechniqueDr.FengQi-ming(MD,PhD封启明)TheEmergencyDepartment,the6thpeoples’hospitalofShanghai,ShanghaijiaotongUniversityEmergencyMedicineandTechniqueDifferentialdiagnosis症状鉴别诊断Chestpain胸痛Abdominalpain腹痛Fever发热Theintroductionofemergencymedicine急诊医学简
2、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WhatarequalifiedemergencyphysicianneedsRichinelementaryknowledgeofmedicine(丰富的医学基础知识)Havingrichclinicalexperience(丰富的临床经验)Mastertheprincipalsofdecision-makinginemergencymedicine(正确的急诊临床思维)Skilledte
3、chniquesforemergency(娴熟的急救技术)Trachealintubation气管插管,Venipuncture深静脉穿刺，Cardiopulmonaryresuscitation心肺复苏Emergencyphysiciandiathesis(良好的心理素质)Theabilitytodealtwithaccidentappropriately(镇静处理突发事件)AcuteChestPain急性胸痛Decision-makingonAcuteChestpainatEarlyStage早期识别高危胸痛Recog
4、nizethedangerousofacutechestpain,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:AcuteCor
5、onarySyndrome（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、Ches
6、tX-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,substernalQuality疼痛的性质,pressure,tightness,sharp,pleuritic,b
7、urningDuration,aggravationandalleviationofpain疼痛的时间及影响因素、缓解因素,exertion,cold,psychologicstress,nitroglycerinSimultaneoussymptomsofpain疼痛的伴随症状Previousmedicalhistory即往史locationofchestpain胸痛的部位AnginaPectorisandacutemyocardialinfarctionareusuallyretrosternal.mostpatien
8、tsdonotlocalizethepaintoanysmallarea.Theyaretypicallydescribedastightness,pressure,orsqueezing.Painmayradiatetothejaw,neck,arms,back,andepigastria.Thele
