[為紀念今日打十號風球,我決定出個post]
[大家留哂係屋企被逼睇我廢話...wahahaWaHaHaWAHAHA...]
有日,一個睇落都相當肥胖嘅中年男士,訓住係床比救護員推入黎急症室。男士睇落都仲相當清醒。
醫生:「做咩事架?」
男士:「好肚痛呀!」
醫生:「痛左幾耐呀?點樣痛法呀?」
男士:「幾日啦,壓住壓住咁痛呀。本來唸住過兩日無事,今日太痛落街睇醫生,點知一落街就真係頂唔順要叫白車!」
醫生聽完,就叫姑娘幫手量血壓、做心電圖之類,開始唸下肚痛點解會搞到咁。點知,姑娘就突然之間拎住心電圖衝過黎比醫生睇。
醫生一睇完,「oh sh**」一句就衝左出去,臨走掉低左一句「你自己睇」。
我一攞起張心電圖,我都心唸一句「oh sh**,STEMI(心肌梗塞是也)」。
大家一見到,全部都即刻忙亂起黎。抽血嘅抽血,打豆嘅打豆;係五分鐘裏面,心臟科醫生都已經出現埋會診,幫病人做心臟超聲波。
心臟科醫生一睇完,「oh sh**」;將超聲波轉比我同醫生睇,我地再加多兩句「oh sh**」。從心臟超聲波可見,大塊心臟肌肉都已經唔識郁,明顯到我小小醫學生都一望就見到。
心臟科醫生:「我地而家要即刻幫你通波仔,如果唔係你生命真係會有危險。」
男士嚇到哦左一聲,簽完紙就比人推左上去通波仔。
人的心臟主要有三大條冠狀血管提供血液,大家估下佢塞左幾多?
===我是分隔線===
心臟病同電視節目一樣,都有好多種,正確名稱為「冠狀動脈疾病(Coronary Artery Disease)」,簡稱「冠心病」,可以引發嘅徵狀,醫學界通稱「Acute Coronary Syndrome(急性冠狀動脈綜合症)」,簡稱「ACS」。
若果我地望住個心臟,如果冠狀動脈塞左:
(1) 唔劇烈運動就無事,我地稱之為「穩定性心絞痛(Stable Angina)」
(2) 坐定定都會無啦啦心絞動,是為「非穩定性(Unstable Angina)」
(3) 坐定定都痛,塞到心肌開始壞死,是為「心肌梗塞(Myocardial Infarction,簡稱 MI)」
而只有 (2) 同埋 (3) 會被歸類為 ACS。
[MI其實仲會分為 ST-Elevation MI (STEMI) 同埋 Non-ST-Elevation MI (NSTEMI),但分別對普羅大眾黎講太難啦,只需要知道STEMI比較嚴重,(亦即係故事發生個款)就足夠。]
心絞痛或心肌梗塞所引致嘅痛原來相當獨特,醫學界一般會咁樣形容:
Compressing chest pain at left lower chest, with radiation to the neck, jaw, and left arm, often accompanied by palpitations, shortness of breath, and sweating.(左面心口拿住痛,會好似成噸重嘢壓實,抽到上頸同埋左手手臂都會痛,痛起上黎標哂冷汗,心口之前都試噗噗咁狂跳。)
可惜,呢種最典型嘅痛法,其實唔會次次都發生,亦唔一定會一有就符合以上講嘅所有野,有時可以只有其中幾樣亦得,有時更加可以痛都唔痛,所以一切都並唔係咩金科玉律。非典型嘅痛,醫書就會話係女士同埋有糖尿病嘅病人中比較常見。
無論如何,當大家一運動起上黎就會心口痛(無熱身拉親當然唔計)、或者坐定定都會痛到標哂冷汗,咁就要盡快睇醫生啦!
P.S. 附圖就係一張顯示住STEMI嘅心電圖,ST Elevations即係箭咀指住嘅地方。
===我是分隔線===
開估時間。
頭先中年男士有嘅三條冠狀動脈,係塞足三條,通波仔亦係通足三條。一路做嘅時候,旁邊嘅人都不斷話:「佢撐到黎急症室真係一個奇蹟...」。
st-elevation myocardial infarction 在 臨床筆記 Facebook 的最佳貼文
Post-resuscitation care: ERC–ESICM guidelines 2015 - EDITORIAL
The ERC-ESICM guidelines on post-resuscitation care are intended to be practical and more didactic, i.e. they tell the clinician exactly what to do. They cover the whole post-cardiac arrest patient pathway and include elements of pre-hospital care, in-hospital treatment and finally rehabilitation.
Animal studies suggest that after return of spontaneous circulation (ROSC), hyperoxia may worsen neurological injury. Clinical data on neurological injury are conflicting but a recent study of air versus supplemental oxygen in ST-elevation myocardial infarction showed deleterious effects of oxygen treatment. As soon as arterial blood oxygen saturation can be monitored reliably, the ERC-ESICM recommendation is to titrate the inspired oxygen concentration to maintain the arterial blood oxygen saturation in the range of 94–98 %. As yet, there are no prospective data defining an optimal plasma carbon dioxide target in the post-cardiac arrest patient, and observational data are inconsistent. Until further data are available the recommendation is to aim for normocarbia.
If cardiac arrest has been caused by an acute coronary occlusion, achieving coronary reperfusion as soon as possible is a high priority. Emergent cardiac catheterisation laboratory evaluation (and immediate percutaneous coronary intervention (PCI) if required) should be performed in adult patients with ROSC after out-of-hospital cardiac arrest (OHCA) of suspected cardiac origin with ST-elevation (STE) on the ECG. This recommendation is relatively non-controversial; the management of those patients with a likely cardiac cause of their cardiac arrest but without STE on the ECG is less well defined. In general, it is reasonable to discuss and consider emergent cardiac catheterisation laboratory evaluation after ROSC in patients with the highest risk of a coronary cause for their cardiac arrest. The ERC-ESICM guidelines include recommendations on the timing of computed tomography (CT) scanning in relation to coronary catheterisation and these are summarised in a post-cardiac arrest algorithm.
The prevention of post-ROSC hyperthermia and the implementation of targeted temperature management (TTM) remains a strong recommendation in the ERC-ESICM guidelines. There is no international consensus on the precise target temperature—the current recommendation is to maintain a constant temperature in the range 32–36 °C for 24 h.
Predicting the final neurological outcome of those who remain comatose after resuscitation from cardiac arrest is problematic and it is now generally accepted that decisions about withdrawal of life-sustaining treatment (WLST) have been made far too early. The ERC and ESICM have already published guidelines on prognostication after cardiac arrest and these have been incorporated into the 2015 post-resuscitation care guidelines. The principles of prognostication are that it is generally delayed until at least 3 days after cardiac arrest and it is multimodal.
Many cardiac arrest survivors have cognitive and emotional problems long after hospital discharge. To date, there have been few structured programmes to rehabilitate these patients and this is a component of the patient pathway that can be improved considerably. The ERC-ESICM guidelines provide recommendations on the follow-up care for post-cardiac arrest patients.
Since 2010, considerable progress in clinical research has created important advances, making these post-resuscitation guidelines immediately applicable in many patients. However, there are still knowledge gaps, which require further investigation. Temperature management is probably the field in which most questions remain unsolved. Should we use a specific cooling technique? What is the best sedation strategy during cooling? Who are the best candidates for a lower target temperature target (32–34 °C)? Should we start cooling during transport to hospital? As early pneumonia is very frequent in cooled patients, should we give prophylactic antibiotics? Ongoing clinical studies might provide definitive conclusions in the very near future. The optimal management of post-resuscitation circulatory failure also remains controversial. Although some clinical data suggest 75 mmHg as a target for mean arterial pressure, this should be further investigated in prospective studies. The use of steroids during the post-resuscitation shock also requires further exploration. Brain injury is the cornerstone of outcome: new imaging and electrophysiological investigations will help to refine the neuroprognostication strategy that has been proposed. Finally, follow-up care for survivors is now recommended but we need high-level evidence for this rehabilitation phase.
While further science is awaited, we sincerely hope that these 2015 guidelines will help intensive care clinicians to treat their post-cardiac arrest patients.
http://bit.ly/1GJLsHZ
st-elevation myocardial infarction 在 ECG for Beginners. ECG Diagnosis of ST Elevation ... - YouTube 的推薦與評價
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