2-004-06. Disease of chest organ : Decision-making General part

2-004-06. Disease of chest organ :  Decision-making General part

**Centent(목차) **
Chest pain, young adult
Hypertension, simple
Palpitation, normal ECG

l  Disease of chest organ

Chest pain, young adult

           Chest pain

                      |

           Young < 45 & previous healthy               N – R/O angina pectoris

                      |

           If,

           : angina nature                                    à go aMI protocol

           or medical risk factor

                      |

           : 12 lead ECG                                       à R/O angina pectoris

                      | complete normal

           :consider, pericarditis

                      |

           : trauma Hx (even cough) & tenderness, direct

                      |                                            - direct tender àchest CT

                                                                   Not à chest 상 중격동 넓으면 chest CT

           : Consider pnuemothorax            if history of Pneu à chest X-ray first

                                                                   Not à R/O cardiogenic

                      |

           Careful history & exam, repeat

Chest PA 상 aorta dissection 배제 전에 aspirin plavix 주지 않도록 유념

Hypertension, simple

           Hypertension

                      |

           Repeat 30 min bed resting                    

           No hypertension                                  - go panic protocol

                      |>160/100

           : consider, red flag sign

           IICP, Burn, acute renal diz, headtrauma                  - brain CT

                      |

           IM contact 하되 impression 은 아래에 따른다.

                      |                                                       |

                      |                                                       |

           Systolic                                              diastolic

                      |                                                       |

           Four extremity BP check              drug list review

           à 대동맥 협착 또는 박리 의심                          |

                      |                                            :consider

           12lead ECG                                         renal artery diz

           à        heart block                              renal parenchymal diz

                      |                                            endocrine diz

           : Seek & consider                                 (aldo,pheo,cushing)

           Systemic condition                                           |

           Fever, anamic, thyrotoxic, anxiety              |

                      |                                                       |

                                             Repeat & careful exam

Palpitation, normal ECG

Conscious sensation of cardiac activity

                      |

           : V/S                                                 - IM contact

           Unstable V/S or poor perfusion sign

           or history of cardiac diz

           Previous healthy N –

                                               - MC 구환은 ECG 확인후 early contact

                      |

           :12 lead ECG                            -

           Arrhythmia associated palpitation à cardiac diz

                      |

           Drug list review

(B-agonist, vasopressor, theophyline, vasodilator)

           |

Medical risk factor

           |

           General medical problem

           (fever, pain)

           à consider 2ndary palpitation

                      |

           : consider psychogenic palpitation

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