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所在平台: Udemy |
课程主页: https://www.udemy.com/course/cardiology-in-emergency-room-leaptraining/
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课程名称：急诊室心脏病学 课程概述：本课程提供了一种系统性的方法，帮助医务人员处理胸痛患者的紧急情况。课程内容包括： - **初步评估**：对胸痛患者进行及时分诊，特别是当患者表现出内脏类型胸痛的症状（如不适、沉重感或疼痛）、异常生命体征和呼吸困难时，立即将其放置于心脏监测仪上。 - **快速 ECG 测试**：在患者到达急诊室后 10 分钟内进行心电图（ECG）检查。对持续性疼痛或疼痛变化的患者进行序列心电图检查，重点观察 T 波变化、ST 段变化、病理性 Q 波及新出现的束支传导阻滞或持续性室性心动过速。 - **生命体征监测**：建立静脉通路并在血氧饱和度低于 93% 时提供补充氧气。优先处理立即生命威胁，确保气道、呼吸和循环的稳定。 - **病史采集**：深入询问疼痛的特征、相关症状以及其他心肺疾病的病史。同时要注意非典型胸痛如右臂放射痛、上腹部疼痛、胸壁压痛和消化不良等情况。 - **排除其他危急病症**：如主动脉夹层、肺栓塞、气胸、心包炎、心包填塞、肺炎及食管破裂等。 **检查方法**： - **胸部 X 光**：用于评估宽大纵膈以指示主动脉夹层或肺炎的实变。 - **床边超声**：如有条件可进行，帮助快速评估心脏情况。 **心电图解读方法**： 1. 宽窄比较 2. 快慢判断 3. 规律性与不规律性 4. 缺血化 5. 心律分析 6. 轴向分析 7. 间隔时间分析 前 3 步重点识别致命性心律失常，接下来的步骤专注于判断心肌梗死或心脏缺血的情况，而后续步骤则提供潜在心脏病因的线索。 **目标**：培养既能在医学和精神层面上帮助他人的明智医生，为医生提供理论与实践相结合的训练，使他们能够准确诊断所有常见和少见疾病，同时应对诊断过程中可能遇到的各种问题和障碍，致力于培养一个综合素质高、目标明确的医生。
APPROACH TO A PATIENT WITH CHEST PAIN• Initial approach• Prompt triage• Place on cardiac monitor on patient with visceral type of chest pain (discomfort, heaviness, or aching), abnormal vital signs, and dyspnoea.• ECG performed within 10 minutes of ER visit.• Establish IV line and supplemental oxygen if SpO2< 93 %• Focus on immediate life threat and stabilize airway, breathing and circulation• Take focused history concerning on character of pain, presence of associated symptoms, and history of other cardiopulmonary conditions.• Be aware of atypical chest pain like radiation to right arm, epigastric pain, chest wall tenderness, dyspepsia.• Rule out other life-threatening conditions like aortic dissection, pulmonary embolism, pneumothorax, pericarditis, pericardial tamponade, pneumonia and oesophageal rupture.Investigation:• 12 lead ECG: within 10 minutes of ED arrival and interpreted by ER doctor. Serial ECGs for persistent pain or changes in pain. Focus on ECG changes like T wave changes, ST segment changes of >0.5 mm, pathological Q waves, new or presumably new bundle branch block or sustained Ventricular tachycardia.• Chest X- ray to assess wide mediastinum indication aortic dissection or consolidation for pneumonia.• Point of care echocardiography- if availableAPPROACH TO ECG INTERPRETATION1. Wide vs narrow2. Fast vs slow3. Regular vs irregular4. Ischaemia5. Rhythm6. Axis 7. IntervalsSteps 1-3: identify fatal arrhythmiasStep 4: identify MI or cardiac ischemiaSteps 5-7: provide hints of underlying cardiac etiologiesleap training About Us Creating a wise, educated doctor who helps others medically and spiritually Training doctors to diagnose all common and rare diseases, both in theory and in practice, on real patients Training doctors to deal with all problems and obstacles that lead to an error in diagnosis Creating an integrated doctor who masters his work, knows his goal and has the ability to meet his personal needs and ambition
