小结
定义
病史和体格检查
关键诊断因素
- direct trauma to the thorax and neck
- dyspnea
- confusion
- tachypnea
- accessory breathing muscle use
- stridor
- inability to speak
- retraction of intercostal spaces
- cyanosis
- loss of airway/gag reflex
其他诊断因素
- anxiety
- headache
- hypoventilation
- cardiac rhythm disturbances
- underlying neuromuscular disorder
- drug use
- seizure
- coma
- asterixis
- papilledema
危险因素
- cigarette smoking
- young age
- older age
- pulmonary infection
- chronic lung disease
- upper airway obstruction
- lower airway obstruction
- alveolar abnormalities
- perfusion abnormalities
- cardiac failure
- peripheral nerve abnormalities
- muscle system abnormalities
- opioid and sedative medications
- toxic fumes and gases
- traumatic spinal injury
- traumatic thoracic injury
- central nervous system (CNS) disorders
- acute vascular occlusion
- pulmonary effusion
- pneumothorax
- hypercoagulable states
诊断性检查
首要检查
- pulse oximetry
- arterial blood gases
需考虑的检查
- CBC
- D-dimer
- serum bicarbonate (HCO₃)
- Cardiac troponin I and/or T
- ECG
- chest x-ray
- pulmonary function tests
- Urine or serum toxicology
- chest CT
- CT pulmonary angiography (CTPA)
- ventilation/perfusion lung scan
- capnometry
- cardiothoracic ultrasound
新兴检查
- transcutaneous CO₂ monitoring
治疗流程
airway obstruction
no acute upper airway obstruction: stable
no acute upper airway obstruction: unstable
撰稿人
作者
Samuel J. Stratton, MD, MPH
![Samuel J. Stratton](/api/image/853/en-us/normal/853-auth-1_default.jpg)
Professor
Fielding School of Public Health
David Geffen School of Medicine at UCLA
Los Angeles
Deputy Health Officer
Orange County Health Care Agency
Health Disaster Management/Emergency Medical Services
Santa Ana
CA
利益声明
SJS declares that he has no competing interests.
同行评议者
C. Michael Roberts, MA, MD, FRCP
Consultant Physician
Barts Health
London
UK
利益声明
CMR declares that he has no competing interests.
Ken Miller, MD, PhD
University of California
Irvine and Orange County Fire Authority
Irvine
CA
利益声明
KM declares that he has no competing interests.
Christopher Kahn, MD, MPH
Assistant Professor of Clinical Emergency Medicine
Department of Emergency Medicine
University of California
Irvine and Orange County Fire Authority
Irvine
CA
利益声明
CK declares that he has no competing interests.
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