Summary
Definition
History and exam
Key diagnostic factors
- 存在的危险因素
- 认知能力改变/激越
- 低血压
Other diagnostic factors
- 呼吸急促
- 心动过速
- 毛细血管再充盈时间延长
- 少尿
- 肌无力
- 紫绀
- 四肢发冷
- 外伤证据
- 瘀点
- 胸痛
- 发热
- 腹痛
- 颈静脉扩张 (jugular venous distension, JVD)
- 外周水肿
- 胸部一侧呼吸音消失
- 气管偏斜
- 心音低钝
- 下肢驰缓性麻痹
- 心脏杂音
- 膀胱扩张
- 面部和舌肿胀
- 荨麻疹皮疹
- 育龄期女性盆腔疼痛/阴道出血
Risk factors
- 年龄增长
- 合并症
- 心肌梗死
- 心肌病
- 心脏瓣膜疾病
- 心律失常
- 外伤
- 胃肠道出血
- 腹主动脉动脉瘤破裂
- 烧伤/热射病
- 胃肠道液体丢失：腹泻和呕吐
- 胰腺炎
- 脓毒症
- 全身过敏反应/中毒
- 脊髓或脑干损伤
- 内分泌疾病
- 肺栓塞
- 心脏填塞
- 新药（过敏性休克）
Diagnostic investigations
1st investigations to order
- 乳酸（动脉血气分析）
- 动脉血气分析
- 全血细胞计数（FBC）
- 尿素和肌酐
- 血清电解质
- 凝血检查（国际标准化比值 [INR]、活化部分凝血活酶时间 [aPTT]）
- 血糖
- 阴离子间隙
- C 反应蛋白 (CRP)
- 降钙素原 (PCT)
- 心电图（ECG）
- 气密试验的嘶嘶声：使用插管对张力性气胸进行减压
Investigations to consider
- 胸部 X 线检查
- 创伤超声重点评估 (focused assessment with sonography for trauma, FAST) 扫描
- 超声心动图
- 胸部超声
- 腹部超声
- 胸部、腹部和盆腔 CT
- 尿妊娠试验
- 盆腔超声检查
Treatment algorithm
所有患者
Contributors
Authors
Samuel J. Stratton, MD, MPH
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
Disclosures
SJS declares that he has no competing interests.
Acknowledgements
Dr Samuel J. Stratton wishes to gratefully acknowledge Dr Christoph Pechlaner and Dr Christian Wiedermann, previous contributors to this topic. CP and CW declare that they have no competing interests.
Peer reviewers
Patrick Nee, FRCP, FRCS, FCEM
Consultant in Accident & Emergency Medicine
St Helens & Knowsley Hospitals NHS Trust
Whiston Hospital
Prescot
UK
Disclosures
PN declares that he has no competing interests.
James Brown, MD, MMM
Vice-Chair and Program Director
Wright State University Department of Emergency Medicine
Dayton
OH
Disclosures
JB declares that he has no competing interests.
Differentials
- 单纯低血压
- 晕厥或先兆晕厥
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