ER NOTE
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General ER Note
Sepsis
Trauma
Mammalian Bite
Chest Pain
Abdominal Pain
Eye Injury
HN
ER Note — Chest Pain
1
ประวัติอาการเจ็บหน้าอก (Chest Pain HPI)
การเริ่มและระยะเวลา (Onset & duration)
ระดับความรุนแรง (Severity 0–10)
Mild 0–3
Moderate 4–6
Severe 7–10
ลักษณะของอาการ (Character)
Pressure / squeezing
Tearing / ripping
Pleuritic
Positional / reproducible
Burning
การกระจายของอาการ (Radiation)
Left arm / jaw
Back
Shoulder
None
อาการร่วม (Associated symptoms)
Diaphoresis
Nausea / vomiting
Dyspnea
Syncope / presyncope
Palpitation
2
ปัจจัยเสี่ยงและ ECG (Risk Factors & ECG)
ปัจจัยเสี่ยง (Risk factors)
HTN
DM
HLD
Smoking
Family history
Prior CAD / PCI / CABG
ECG findings
Normal
ST elevation
ST depression
T-wave inversion
New LBBB
Non-specific
Rhythm
Sinus rhythm
Atrial fibrillation
Other
0h troponin
1h / 3h troponin (if serial)
3
HEART Score
History
Slightly suspicious (0)
Moderately suspicious (1)
Highly suspicious (2)
ECG
Normal (0)
Non-specific repolarization (1)
Significant ST deviation (2)
Age
<45 (0)
45–64 (1)
≥65 (2)
Risk factors
None (0)
1–2 risk factors (1)
≥3 or prior atherosclerosis (2)
Troponin
≤ normal limit (0)
1–3× normal (1)
>3× normal (2)
HEART:
0
/10 —
low risk
4
ACS Risk Stratification
Stratification
STEMI → cath lab
NSTEMI
Unstable angina
Non-ACS
Initial management
O₂ only if SpO₂ <90%
Aspirin 162–325 mg
P2Y12 loading
Anticoagulation
Beta-blocker
High-intensity statin
Analgesia
Specific P2Y12 / anticoag
5
Investigations
6
Treatment
7
Disposition
Decision
— select —
Cath lab activation
ICU / CCU
Obs / serial troponin
Ward admission
Discharge with OPD f/u
F/U / consult note
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