急诊科低危胸痛患者的伦理困境。
The ethical dilemma of emergency department patients with low-risk chest pain.
机构信息
Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
出版信息
Emerg Med J. 2021 Nov;38(11):851-854. doi: 10.1136/emermed-2020-209900. Epub 2021 Mar 9.
Abstract
Millions of patients present to US EDs each year with symptoms concerning for acute coronary syndrome (ACS), but fewer than 10% are ultimately diagnosed with ACS. Well-tested and externally validated accelerated diagnostic protocols were developed to aid providers in risk stratifying patients with possible ACS and have become central components of current ED practice guidelines. Nevertheless, the fear of missing ACS continues to be a strong motivator for ED providers to pursue further testing for their patients. An ethical dilemma arises when the provider must balance the risk of ACS if the patient is discharged compared with the potential harms caused by a cardiac workup. Providers should be familiar with the ethical principles relevant to this dilemma in order to determine what is in the best interests of the patient.
摘要
每年都有数百万患者因疑似急性冠状动脉综合征（ACS）的症状前往美国急诊科就诊，但最终被诊断为 ACS 的患者不到 10%。为了帮助医生对可能患有 ACS 的患者进行风险分层，已经开发出经过充分测试和外部验证的加速诊断方案，并且这些方案已经成为当前急诊科实践指南的核心组成部分。然而，担心漏诊 ACS 仍然是急诊科医生为其患者进行进一步检查的主要动机。当医生必须权衡患者出院时 ACS 的风险与心脏检查可能造成的潜在危害时，就会出现伦理困境。医生应该熟悉与这一困境相关的伦理原则，以便确定什么是符合患者最佳利益的。
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