ເຈັບຫນ້າເອິກ, ການຄຸ້ມຄອງຄົນເຈັບສຸກເສີນ

By ຄຣິສເຕຍໂນ ອັນໂຕນິໂນ On Jan 26, 2023

ອາການເຈັບຫນ້າເອິກ, ຫຼືຄວາມບໍ່ສະບາຍຫນ້າເອິກ, ແມ່ນເຫດການສຸກເສີນທົ່ວໄປທີສີ່ທີ່ຜູ້ຊ່ຽວຊານດ້ານ EMS ຕອບສະຫນອງ, ເຊິ່ງກວມເອົາປະມານ 10% ຂອງການໂທ EMS ທັງຫມົດ.

Causes of chest pain can vary from minor problems, such as indigestion or stress, to serious life-threatening emergencies, such as heart attack or pulmonary embolism

When treating their patients, medical first responders will often pay close attention to how the chest pain is described to better understand the severity of the emergency.

For most people, chest pain may present itself as a “stabbing,” “burning,” “aching,” “sharp,” or “pressure-like” sensation.

Chest pain may also radiate, or move, to other areas of the body, including the ຄໍ, arms, spine, back and upper abdomen.

Other symptoms associated with chest pain can include nausea, ອາການປວດຮາກ, dizziness, shortness of breath, anxiety, and sweating.

The type, severity, duration, and associated symptoms of chest pain can help guide the diagnosis and treatment of this medical emergency.

Diagnosing the cause of chest pain is challenging and requires an understanding of the possible causes, a careful physical examination, patient medical history, and attention to detail.

What Is Chest Pain?

Chest pain is pain or discomfort in the chest.

The pain typically occurs in the front of the chest, and may be described as a sharp or dull pressure, heaviness, or squeezing.

Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath.

Causes of Chest Pain

Chest pain falls into one of two categories, heart-related pain or non-heart-related pain.

Under the category of heart-related pain, there is also a type of pain called angina (also known as angina pectoris), which is caused by a lack of blood flowing to the heart.

Serious and relatively common causes of chest pain may include any of the following conditions:

Acute coronary syndrome, such as a heart attack (31%)
Gastroesophageal reflux disease (30%)
Muscle or skeletal pain (28%)
Pneumonia (2%)
Pulmonary embolism (2%)
Pneumothorax or pericarditis (4%)
Aortic dissection (1%)
Shingles (0.5%)
Other common causes include esophageal rupture and anxiety disorders. Determining the cause of chest pain is based on a person’s medical history, a physical exam, and other medical tests.

Management of chest pain is based on the underlying cause.

Initial treatment often includes medications, like aspirin and nitroglycerin.

When the cause is unclear, however, the person will be transported to a nearby hospital or medical facility for further evaluation.

In children, the most common causes for chest pain include:

Musculoskeletal (76–89%)
Exercise-induced asthma (4–12%)
Gastrointestinal illness (8%)
Psychogenic causes (4%)
Chest pain in children can also have congenital causes.

When to Call Emergency Number for Chest Pain

If you suspect that you are having a heart attack, immediately call Emergency Number or go to your nearest hospital or emergency clinic.

If you have unexplained chest pain lasting more than a few minutes, seek emergency medical help right away rather than trying to diagnose the cause yourself.

How to Treat Chest Pain

Some causes of chest pain are life-threatening, such as heart attack or pulmonary embolism.

For this reason, if you have unexplained chest pain lasting more than a few minutes, you should seek emergency medical help immediately.

ໂທຫາເບີສຸກເສີນ. Do not try to ignore or wait out the symptoms, because it could be an indication of a heart attack or other serious medical condition.

Call Emergency Number, and if EMS services are not available have someone drive you to the nearest hospital.

You should only drive yourself to a medical facility as a last resort.

Doing so can put you or others at risk if your condition suddenly worsens.

Chew an aspirin. Chewing 2 tablets of aspirin (150 mg) may reduce the risk of death by as much as 24% if taken in the early stages of a heart attack.

Do not take aspirin if you are allergic, have problems with bleeding, or if you take other blood-thinning medications.

Most importantly, avoid taking aspirin if your doctor has instructed you to avoid it for any reason.

Take nitroglycerin, if prescribed. If you think you’re having a heart attack and your doctor has prescribed nitroglycerin for you, take it as directed.

Nitroglycerin can be ingested either as a tablet (under the tongue) or via a transdermal patch over the chest.

Nitroglycerin can reduce the chest pain and improve the blood supply to the heart.

Begin CPR, if directed. If a suspected heart attack victim is unconscious, call Emergency Number and an EMS dispatcher may advise you to begin cardiopulmonary resuscitation (CPR).

If you haven’t received CPR training, medical experts recommend performing only chest compressions (about 100 to 120 per minute).

ໃຊ້ພາຍນອກອັດຕະໂນມັດ defibrillator (AED), if available.

If the heart attack victim is unconscious, and an AED is immediately available, follow the device instructions and use it.

How Do EMTs & Paramedics Treat Chest Pain

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For all clinical emergencies, the first step is rapid and systematic assessment of the patient. For this assessment, most EMS providers will use the A B C D E ວິທີການ.

ວິທີການ ABCDE (Airway, Breathing, Circulation, Disability, Exposure) ແມ່ນໃຊ້ໄດ້ໃນທຸກກໍລະນີສຸກເສີນທາງດ້ານຄລີນິກສຳລັບການປະເມີນ ແລະການປິ່ນປົວທັນທີ. ມັນສາມາດຖືກນໍາໃຊ້ໃນຖະຫນົນທີ່ມີຫຼືບໍ່ມີ ອຸປະກອນ.

ມັນຍັງສາມາດຖືກນໍາໃຊ້ໃນຮູບແບບທີ່ກ້າວຫນ້າທາງດ້ານຫຼາຍບ່ອນທີ່ມີການບໍລິການທາງການແພດສຸກເສີນ, ລວມທັງຫ້ອງສຸກເສີນ, ໂຮງຫມໍຫຼືຫນ່ວຍບໍລິການດູແລແບບສຸມ.

ຄໍາແນະນໍາການປິ່ນປົວ & ຊັບພະຍາກອນສໍາລັບຜູ້ຕອບທໍາອິດທາງການແພດ

Treatment guidelines for chest pain with heart attack can be found on page 27 of the National Model EMS Clinical Guidelines by the National Association of State EMT Officials (NASEMSO).

ຄໍາແນະນໍາເຫຼົ່ານີ້ຖືກຮັກສາໄວ້ໂດຍ NASEMSO ເພື່ອອໍານວຍຄວາມສະດວກໃນການສ້າງຄໍາແນະນໍາທາງດ້ານຄລີນິກຂອງລະບົບ EMS ຂອງລັດແລະທ້ອງຖິ່ນ, ໂປໂຕຄອນ, ແລະຂັ້ນຕອນການປະຕິບັດງານ.

ຄໍາແນະນໍາເຫຼົ່ານີ້ແມ່ນອີງໃສ່ຫຼັກຖານຫຼືຄວາມເຫັນດີນໍາແລະໄດ້ຖືກຈັດຮູບແບບສໍາລັບການນໍາໃຊ້ໂດຍຜູ້ຊ່ຽວຊານ EMS.

The guidelines include a rapid assessment of the patient for symptoms of chest pain, which may include:

ການຫາຍໃຈສັ້ນ
ອັດຕາການຫາຍໃຈຜິດປົກກະຕິ ຫຼືຄວາມພະຍາຍາມ
ການນໍາໃຊ້ກ້າມເນື້ອເສີມ
ຄຸນນະພາບຂອງການແລກປ່ຽນອາກາດ, ລວມທັງຄວາມເລິກແລະຄວາມສະເຫມີພາບຂອງສຽງລົມຫາຍໃຈ
ຫາຍໃຈຍາກ, rhonchi, rales, ຫຼື stridor
ໄອ
ສີຜິດປົກກະຕິ (cyanosis ຫຼື pallor)
ສະພາບຈິດໃຈຜິດປົກກະຕິ
ຫຼັກຖານຂອງ hypoxemia
ອາການຂອງເສັ້ນທາງຫາຍໃຈຍາກ

ການປິ່ນປົວກ່ອນໂຮງ ໝໍ ແລະການແຊກແຊງອາດຈະປະກອບມີ:

ເຕັກນິກການລະບາຍອາກາດທີ່ບໍ່ຮຸກຮານ
ເສັ້ນທາງເດີນອາກາດ Oropharyngeal (OPA) ແລະ nasopharyngeal airways (NPA)
Supraglottic airways (SGA) ort extraglottic devices (EGD)
Intubation Endotracheal
ການຄຸ້ມຄອງຫຼັງການ intubation
ການບີບອັດຂອງກະເພາະອາຫານ
Cricothyroidotomy
ຂົນສົ່ງໄປໂຮງ ໝໍ ທີ່ໃກ້ທີ່ສຸດເພື່ອສະຖຽນລະພາບທາງເດີນຫາຍໃຈ

ຜູ້ໃຫ້ບໍລິການ EMS ຄວນອ້າງອີງເຖິງ CDC Field Triage Guidelines ສໍາລັບການຕັດສິນໃຈກ່ຽວກັບຈຸດຫມາຍປາຍທາງການຂົນສົ່ງຄົນເຈັບທີ່ໄດ້ຮັບບາດເຈັບ.

EMS Protocol for Atraumatic Chest Pain

Protocols for pre-hospital treatment of chest pain and discomfort vary by EMS provider and can also depend on the patient’s symptoms or medical history.

If the cause of chest pain is atraumatic, a typical protocol might follow these initial steps:

Conduct scene size up, primary assessment, and immediate life-saving interventions. Have an AED nearby and ready.
In patients exhibiting shortness of breath or hypoxia (SPO2 < 94%), administer oxygen to improve respiratory symptoms or saturation (94–99%).
Avoid exerting the patient (i.e., if possible, patient should be carried) and place in a position of comfort unless necessitated by other factors.
Request Advanced Life Support (ALS) considering their availability and hospital proximity. Consider transport to a receiving facility with emergency cardiac catheterization (PCI) capability. Minimize on scene time.
Obtain baseline vital signs, history, and conduct a secondary assessment attentive to contraindications to fibrinolytic therapy (recent bleeding, surgery, etc.) and cardiac compromise.

Initiate treatment of oral aspirin and sublingual nitroglycerin or glyceryl trinitrate. Prompt transport is important — DO NOT delay transport to administer these treatments.