Edmonds E, Kelly A M
Emergency Medicine and Intensive Care, Western Hospital Footscray.
Aust Health Rev. 1997;20(4):40-8. doi: 10.1071/ah970040.
One of the most common reasons why patients attend emergency departments in Australia is chest pain that is potentially due to coronary artery disease (myocardial infarction, unstable or stable angina pectoris). A number of models for the investigation and treatment of these patients have been employed over the last five to ten years. This paper describes the evolution of a model for managing ischaemic chest pain that aims to avoid potentially preventable deaths from undiagnosed myocardial infarction, to admit to hospital patients who could benefit from inpatient treatment, to admit to a coronary care unit patients at significant risk of complications, and to avoid inter-hospital transfer of patients. Introduction of the model has led to an increase in the appropriate hospital admission of patients with ischaemic chest pain, a marked reduction in inter-hospital transfers, and better utilisation of coronary care beds. Unmonitored, general ward management of low risk patients with clinical unstable angina has not resulted in compromised outcomes.
在澳大利亚，患者前往急诊科就诊的最常见原因之一是胸痛，这可能是由冠状动脉疾病（心肌梗死、不稳定型或稳定型心绞痛）引起的。在过去五到十年间，已经采用了多种针对这些患者的调查和治疗模式。本文描述了一种用于管理缺血性胸痛的模式的演变，该模式旨在避免因未确诊的心肌梗死导致潜在可预防的死亡，收治可从住院治疗中获益的患者，收治有严重并发症风险的患者进入冠心病监护病房，并避免患者在医院间转运。该模式的引入使得缺血性胸痛患者的适当住院率有所提高，医院间转运显著减少，冠心病监护病床得到了更好的利用。对临床不稳定型心绞痛低风险患者进行无监测的普通病房管理并未导致治疗结果受损。
