從臨床癥狀與體征判斷疾病危險程度40

1、朝陽急診首都醫(yī)科大學(xué)急診醫(yī)學(xué)系附屬北京朝陽醫(yī)院急診科李春盛 唐子人朝陽急診主訴 現(xiàn)病史 既往史 個人史體格檢查: 生命體征: 朝陽急診臨床醫(yī)生職責(zé)臨床醫(yī)生職責(zé) 從癥狀和體征中查出疾病并判斷其危險程度！朝陽急診病史病史從主訴及現(xiàn)病史中尋找潛在的危險因素。 朝陽急診病史病史 正確對待病人主訴。 朝陽急診生命體征：體溫生命體征：體溫朝陽急診生命體征：呼吸頻率生命體征：呼吸頻率朝陽急診生命體征：血壓生命體征：血壓lbp80/60mmhg 即認為低血壓即認為低血壓 140/90mmhg 即認為血壓高即認為血壓高l但判斷血壓正常與否與當時狀態(tài)有關(guān)但判斷血壓正常與否與當時狀態(tài)有關(guān)l腦卒中腦卒中bp180/1

2、10mmhg 不降壓不降壓l低血壓要結(jié)合心率尿量判斷低血壓要結(jié)合心率尿量判斷朝陽急診生命體征：心率生命體征：心率朝陽急診意識狀態(tài)意識狀態(tài)朝陽急診 原因：原因：tips-aeiou 朝陽急診朝陽急診 ：朝陽急診glascow昏迷計分表昏迷計分表觀察項目 標準分最佳的睜眼反應(yīng)有目的地或自發(fā)性4口頭命令3疼痛刺激2無反應(yīng)1口語反應(yīng)定向的對答5失定向4不恰當?shù)脑~匯3含混的發(fā)言2無反應(yīng)1運動反應(yīng)服從口頭命令6對疼痛的局部反應(yīng)5對疼痛的逃避反應(yīng)4屈曲反應(yīng)（去皮層強直）3伸展反應(yīng)（去大腦強直）2無反應(yīng)1總分 3項15分朝陽急診生命體征變化生命體征變化 朝陽急診類型類型朝陽急診檢查檢查朝陽急診腰穿腰穿 朝陽急

3、診 胸痛胸痛朝陽急診 胸痛胸痛朝陽急診 胸痛胸痛- -體征體征朝陽急診 胸痛胸痛- -體征體征：朝陽急診 胸痛胸痛- -實驗室檢查實驗室檢查朝陽急診 胸痛胸痛- -實驗室檢查實驗室檢查朝陽急診朝陽急診朝陽急診 v 血管迷走性（血管迷走性（vasovagal） e 異位妊娠（低血容量性）異位妊娠（低血容量性）ectopic pregnancy s 情境情境 situation s 頸動脈竇過敏頸動脈竇過敏 carotid sinus sensitivity e l 全身血管阻力全身血管阻力low systemic vascular resistance s 鎖骨下動脈盜血鎖骨下動脈盜血 subc

4、lavian steal 朝陽急診朝陽急診朝陽急診朝陽急診朝陽急診 腹痛腹痛- -檢查檢查朝陽急診腹痛伴隨癥狀：腹痛伴隨癥狀：朝陽急診朝陽急診 朝陽急診朝陽急診朝陽急診朝陽急診朝陽急診朝陽急診朝陽急診 頭痛頭痛l頭痛急癥：頭痛急癥：朝陽急診朝陽急診 頭痛頭痛朝陽急診朝陽急診朝陽急診朝陽急診朝陽急診nwkthpembj7g4c1z-w&t!qymvjrgodl9i6f3b0y(v%s#oxluiqfnbk8h5d2a+x*u$rznwkshpemaj7g4c1z)w&t!pymvjrgocl9i6e3b0y(v%r#oxltiqfnbk8g5d2a-x*u$qznvkshpdma

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