循環器ジャーナル68巻2号

2020年04月発行

特集 心エコー図で何を見る？—スクリーニングから精査まで Ⅲ．ファーストタッチ編—救急に活かすために

胸痛・動悸・息切れ・浮腫へのアプローチ

著者： 飯塚祐基¹ 舩越拓¹

所属機関： ¹東京ベイ・浦安市川医療センター救急集中治療科（救急外来部門）

ページ範囲：P.238 - P.246

Point
・胸痛の診断はfive killer chest painを必ず鑑別に挙げながら診察を進める．バイタル異常を認めない重症患者も存在するため，安易に除外しない．
・動悸はショック徴候の有無が重要であり，必要なら電気的除細動を迅速に行う．既に症状が消失している場合はリズムと脈拍数が重要となるため，本人に手を叩いて再現してもらう．
・息切れは原因臓器別に考えると良い．心不全が原因の場合は病歴と診察で病態を把握したうえで，各種検査により原因を同定する．

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