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Chest pain (GI (Peptic ulcer disease, gallbladder disease, liver abcess,…
Chest pain
GI
Peptic ulcer disease
gallbladder disease
liver abcess
pancreatitis
Order
EKG
SPO2
IV
舌下NTG 0.3-0.6 mg
airway and vital signs
BP
wide pulse pressure
aortic insufficency
pulsus paradoxus
pericardial effusion
inspiratory fall of systolic pressure >10 mmHg
HR
tachycardia
severe chest pain (>100bpm)
bradycardia
RR
tachypnea(都會發生)
shallow, painful,breathing due to pleural cause
EKG
STEMI
normal
AD也會
Pulmonary
pleura
pleural effusion
lung
neoplasm
pneumonia
pulmonary vascular
PE
Pulmonary hypertension
esophageal
spasm
rupture
reflux
cardiac
pericarditis
myocarditis
MI (stable unstable angina)
Musculoskeleton
costochondritis
precordial catch syndrome
mediastimum
lymphoma
thymoma
Breast
Fibroadenoma
Mastitis
vascular
thoracic aortic aneurysm or aortic dissection
Skin
Herpes zoster
Question
LQQOPERA
1.Q
2.vital signs
3.why admitted
4.past Hx of MI?
Major threat
2A2P
ACS
fatal dysarrthymia
cardiogenic shock
Aortic dissection
cardiac tamponade
aortic rupture
acute aortic insufficiency
MI
Pneumothorax
hypoxia
hypotension, 影響到血型動力學
tension pneumothorax
PE
acute right ventricular failure
psychi
Aortic dissection
transthoracic echocardiography
aortic dissection flap
會CVS surgery recommendation
NMR, aortography
order血6-8unit packed RBC
ICU control BP
ACS-non ST elevation MI or unstable angina
relieved after 1-3 NTG
adjustment in antianginal medication
need for ICU care
at rest
first episode
need more than3 dose of NTG or IV morphine
繼續monitor cardiac enzyme
pericarditis
echo:pericardial effusion
ibuprofen 400-800mg PO q6h, indomethacin 25-75 mg PO Q8H
asprin 650-975 mg