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1、ApproachtoChestPainLeventeBatizy,DOSeptember15,2005ChestPain5%ofEDvisits5millionpts/yrAccuratediagnosisremainsachallengeChestPainVisceralOftenreferredAching,heaviness,discomfortDifficulttolocalizepainSomaticSharp,easilylocalizedChestPainDefinitionsAcuteChestPain:Acute-suddenorrecentonset(usuallywi
2、thinminutestohours),presentingtypically<24hrsChest-thoraxmidaxillarytomidaxillaryline,xiphoidtosuprasternumnotchPain–noxiousuncomfortablesensationAcheordiscomfortInitialApproachTriageChestpainSignificantabnormalpulseAbnormalbloodpressureDyspneaTheseptsneedIV,O2,Monitor,ECGInitialApproachEvaluation
3、:AirwayBreathingCirculationVitalSignsFocusedexamCardiac,pulmonary,vascularInitialApproachHistory:CharacterofpainPresenceofassociatedsymptomsCardiopulmonaryhistoryPainintensity,0-10painInitialApproachSecondaryexam:HistoryQuality,radiation/migration,severity,onset,duration,frequency,progressionandpr
4、ovokingorrelievingfactorsofpainRiskfactorsPhysicalexamReviewoldrecords/ekg’sCategorizingChestPainChestWallPainSharp,PreciselylocalizedReproducible:Palpation,movementPleuriticorRespiratoryCPSomaticpain,SharpWorsewithbreathing/coughingVisceralCPPoorlylocalized,aching,heavinessCausesTable49-1Chestwal
5、lCostosternalsyndCostochrondritisPrecordialcatchsyndSlippingRibSyndXiphodyniaRadicularSyndIntercostalNerveFibromyalgiaPleuriticPulmonaryEmbolismPneumoniaSpontaneouspneumoPericarditisPleurisyCausesTable49-13.VisceralPain:TypicalExertionalAnginaAtypicalAnginaUnstableAnginaAcuteMyocardialInfarction(A
6、MI)AorticDissectionPericarditisEsophagealRefluxorspasmEsophagealRuptureMitralValveProlapseCategorizingChestPain AssessmentofRiskFactorsCAD:CigaretteSmokingDiabetesHypertensionHypercholesterolemiaFamilyHistoryCategorizingChestPain AssessmentofRiskFactorsAorticDissection:MiddleAgedMaleHypertensionMa
7、rfanSyndromeCategorizingChestPain AssessmentofRiskFactorsPulmonaryEmbolismHypercoagulableDiathesisMalignancyRecentImmobilizationRecentSurgeryChestpainincidentalsACSAMIRareunder30y/oexceptwithcocaineuseGIcocktailm
