小结
定义
病史和体格检查
关键诊断因素
- 低血压
- 心动过速
- 皮肤改变
- 少尿
- 精神状态改变
- 存在的危险因素
- 发热
- 胸痛
- 呼吸困难
- 缺氧
- 体温过低
其他诊断因素
- 腹痛
- 外周水肿
- 颈静脉压（jugular venous pressure, JVP）升高
- 心音低沉或微弱
- 心律失常
- 瘀点疹
- 荨麻疹
- 血管性水肿
- 胸部一侧呼吸音减弱
- 气管偏移
- 膀胱充盈
- 四肢驰缓性麻痹
危险因素
- 年龄增长
- 合并症
- 心肌梗死
- 心肌病
- 心脏瓣膜疾病
- 心律失常
- 创伤
- 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
- 药物诱发
诊断性检查
首要检查
- 乳酸（动脉血气分析结果）
- 静脉血气（VBG）或动脉血气（ABG）
- 葡萄糖
- 全血细胞计数
- 尿素和电解质
- 凝血功能检查
- C 反应蛋白
- 降钙素原
- 心电图（ECG）
需考虑的检查
- 胸部 X 线检查
- 尿液分析和尿妊娠试验
- 感染筛查
- 床旁超声
- 胸部、腹部和盆腔 CT
- 计算机断层扫描肺动脉造影 (CTPA)
- 长骨 X 线检查
- 脊柱 X 光
治疗流程
所有患者
撰稿人
专家顾问
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
UK
利益声明
AA declares that he has no competing interests.
Clovis Rau, MBBS, BSc, FRCEM DipIMC
ST6 Emergency Medicine
Barnet Hospital
Royal Free NHS Foundation Trust
UK
利益声明
CR declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
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
利益声明
SJS declares that he has no competing interests.
同行评议者
Paul Frost
Reader (clinical)
Centre for Medical Education
School of Medicine
Cardiff University
Honorary Consultant in Intensive Care Medicine
University Hospital of Wales
Cardiff
UK
利益声明
PF declares that he has no competing interests.
Michael Toolis, MBBS, FCICM, GDipClinUS
Consultant Intensivist
Monash Health
Melbourne
Australia
利益声明
MT declares that he has no competing interests.
编辑
Annabel Sidwell
Section Editor, BMJ Best Practice
利益声明
AS declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Luisa Dillner
Head of Research and Development, BMJ
利益声明
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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