The First Affiliated Hospital of Henan College of Traditional Chinese Medicine Author: Care Min Zhu Mingjun Chest pain, which can be understood as a feeling of discomfort in the chest and its surrounding areas, occurs in everyone and most people do not care about it; acute chest pain, which can be caused by a variety of diseases or even fatal diseases, can seriously endanger patients’ lives if it is not recognized and treated early. Certain serious diseases that cause chest pain are particularly dependent on resuscitation time, and the first few hours are particularly critical, so the earlier the diagnosis and the more timely the treatment for chest pain, the better the patient’s treatment outcome. For doctors, when they encounter a patient with acute chest pain, they will ask about the condition with extra care and also need to make a rapid assessment to rule out life-threatening diseases. The First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Department of Cardiology, Care Min1 Background and significance of the establishment of Chest Pain Center “Acute chest pain” is a common symptom in emergency medicine, which can involve acute coronary syndrome (ACS), pulmonary embolism, aortic coarctation, tension pneumothorax and other fatal diseases. Among them, ACS accounts for a high percentage, but still about 70% belong to non-ischemic chest pain. How to quickly and accurately diagnose and identify the causes of ACS and other fatal chest pains has become a difficult and important point in emergency management. The “Chest pain center CPC” (Chest pain center CPC) is a concept proposed to reduce the morbidity and mortality of acute myocardial infarction by providing rapid and accurate diagnosis, risk assessment and appropriate treatment, effective classification of patients with chest pain, thus improving the ability to diagnose and treat ACS early, reducing the likelihood of myocardial infarction or avoiding it, and accurately screening patients at low risk for myocardial ischemia, with the goal of reducing misdiagnosis and underdiagnosis and overtreatment, as well as improving patients’ clinical prognosis. Chest pain centers have been established in hospitals in many countries around the world. The establishment of chest pain centers has significantly reduced the time to diagnosis of chest pain, the time to STEMI reperfusion treatment, the length of hospital stay, the number of re-visits and re-hospitalizations, the cost of unnecessary tests, and the quality of health-related life and satisfaction of patients with their visit. Compared to traditional hospitalization, chest pain centers using rapid, standardized diagnostic protocols can provide faster and more accurate evaluation of patients with chest pain at 20% and 50% of the cost of a traditional 1 to 3 day hospitalization. In China, the morbidity and mortality of ACS are increasing year by year, and the trend is younger, becoming an important cause of death, disability and leading to the loss of labor force in our population. At present, there are many problems in the treatment process of acute chest pain and ACS in China, which are mainly reflected in four aspects: (1) there is a significant delay in patients seeking treatment; (2) the diagnosis process is not standardized, and 20% of patients may have wrong diagnosis at discharge; (3) the treatment is not standardized, and 2/3 of high-risk ACS patients do not receive interventional treatment; (4) the prognosis of ACS patients is poor, especially the high incidence of heart failure. The “chest pain center” is designed to improve the shortcomings of the treatment process and optimize the treatment process, and it is necessary to promote the concept of “chest pain center” in China. With the care and support of Prof. Hu Dayi, our hospital was the first hospital in Henan Province to be officially opened on October 9, 2012.2 Operation Mechanism of Chest Pain Center 2.1 Triage Process of Patients with Chest Pain-Related Diseases The source of patients mainly includes 120 transfer, pre-hospital consultation, outpatient registration office and all patients with chest pain-related diseases attending outpatient clinics are timely triaged to the “Chest Pain Center”. Chest Pain Center”. The “Chest Pain Center” is responsible for receiving all patients with chest pain symptoms. The definition of chest pain is broad, including chest tightness, stuffy discomfort, choking, pressure or compression, heaviness, heartburn, blockage, neck tightness and other sensations; patients with traumatic chest pain are excluded. 2.2 Workflow of “Chest Pain Center” Patients with chest pain are admitted to “Chest Pain Center”. After being admitted to the “Chest Pain Center”, patients can be monitored on the monitoring bed in the observation room with continuous 24 ECG and blood pressure monitoring, ECG, chest X-ray, blood sampling for cardiac enzymes, D-dimer and other examinations, and special examinations such as cardiac and macrovascular ultrasound as well as dual-source spiral CT and MRI are feasible according to the situation. Focus on three acute and critical conditions with high mortality: acute heart attack, acute pulmonary embolism, and acute aortic coarctation. According to ECG, cardiac enzyme test – acute heart attack – send to catheterization laboratory for PCI; according to chest X-ray, D-dimer – further chest CT scan –Diagnosis of aortic coarctation or pulmonary embolism – treat accordingly. If interventional treatment is required, the second line shift and the catheterization laboratory can be contacted quickly to prepare for emergency interventional treatment. The “Chest Pain Center” is responsible for training physicians at all levels of the hospital on emergency and critical care related to chest pain. Patients with other system diseases clearly diagnosed by the “Chest Pain Center” are referred to the corresponding departments for treatment; for patients with low-risk chest pain, the doctors of the “Chest Pain Center” are responsible for contacting consultation matters.3 “Chest Pain Center “The “Chest Pain Center” sets up a permanent unit in the “Emergency Center”, with a special chest pain consultation room (24-hour duty) and a temporary observation room. It is administratively managed by the emergency center and operationally managed by the heart center, while the emergency center is still responsible for related nursing work. The outgoing emergency outpatient clinic is under the responsibility of the emergency center and keeps in touch with the chest pain center at all times. After the patients are handed over to the chest pain center, those with clear diagnosis are escorted to the catheterization room or CCU or cardiac ward. Patients with cardiac arrest received by the emergency department are resuscitated by the emergency physicians, and the physicians on duty at the chest pain center assist in resuscitation. If the patient has non-traumatic chest pain, the emergency physician will contact the on-call physician of the chest pain center in time to prepare resuscitation and related tests, so as to clarify the diagnosis and perform resuscitation as soon as possible. Patients attending the “chest pain center” should be given priority for examination, and all auxiliary departments should actively cooperate.4 Relationship between the chest pain center and the cardiac center In the establishment of the “cardiac center”, the chest pain center, the catheterization laboratory, the cardiac wards, the CCU (ventilator, monitoring), the cardiac surgery department and the cardiac function department are all subordinate to the chest pain center. The cardiac surgery department and cardiac function department are all subordinate to the cardiac center. The first-line doctors can contact and understand all kinds of information of the patients at any time through the 120 fixed-line telephone or the special cell phone number of China Mobile Telecom; the second-line doctors, i.e. the doctors with senior titles in each ward (including those with seniority); the nurses of the catheterization room; and the nurses of the cardiology department. The second-line physicians, i.e., physicians with senior titles in each ward (including those with seniority in the interventional team); and nurses in the catheterization room are on duty 24 hours a day. First-line physicians perform primary diagnosis and differential diagnosis: bedside X-off machine, bedside ultrasound, ECG machine; rapid chest pain test kits. Second-line on-call physicians of all specialties in the hospital can be requested for priority consultation; biochemistry, blood gas, and imaging (ultrasound X-ray) are on emergency duty. Chest pain center – catheterization room – ward through train, doctors first line and second line follow up the whole process (Chest pain center doctors are all ward doctors rotating every day, both sides are solid). Chest pain center rotating physicians and emergency center nurses are strictly and specially trained to work harmoniously with each other. Rapid classification, risk stratification and accurate assessment of chest pain patients minimizes delays in patient care. Through programmed access, especially for the most common cause of chest pain, acute coronary syndrome (ACS), it should be done to: minimize the morbidity and mortality and complication rate of AMI patients; and to prevent, to the greatest extent possible, UA and NSTEMI patients from developing into STEMI; thus, the main tasks of CPC are focused on The main task of CPC is therefore focused on the “green channel of life”, i.e. rapid and accurate diagnosis and treatment of ACS patients. The catheterization room also implements a 24-hour responsibility system and is equipped with intra-aortic balloon counterpulsation device, large ventilator, OCT, FFR and thrombus aspiration catheter and other related equipment and instruments. There is a special night shift nurse on duty; the doctors are doctors with interventional qualifications on shift; the first-line doctors on duty in the chest pain center, interventional doctors, and second-line doctors on duty in the ward are all doctors in the heart center, and although they rotate in different positions, they all work in the fixed ward, and the duty basically ensures a one-stop service in the same ward, and the ward director is the one on duty in 3 lines, and he is in unified command when needed.5 Prospects for the development of the chest pain center Cardiovascular diseases are The main cause of death that threatens people’s physical and mental health, and the three main life-threatening causes of chest pain, coronary artery disease, aortic coarctation and pulmonary embolism are all cardiovascular diseases, while cardiologists are more likely to identify high-risk diseases in this specialty of emergency care than doctors in other specialties, and are also more likely to grasp the condition and carry out risk stratification, and have a better chance to make further differential diagnosis for patients with low-risk, atypical and chronic chest pain; therefore cardiologists The internist is therefore the most competent. For patients without medical knowledge, a visit with “symptoms” is simple and straightforward, leaving the responsibility of diagnosing the cause of the disease to the physician, while a visit with “disease” can easily lead to misdirection, such as acute inferior wall myocardial infarction mistaken for For example, if an acute inferior myocardial infarction is mistaken for a “stomach disease”, the patient goes to the gastroenterology department because he or she lacks basic medical knowledge and goes to the doctor based on “feelings”. However, one inevitable problem is that the population still lacks a good understanding of the concept of “chest pain” and only understands “pain” as “pain”, not knowing the broad meaning of “chest pain”. They do not know the connotation of “chest pain” in the broad sense, and cannot immediately take the right place. Therefore, further efforts are needed to educate and popularize the knowledge of emergency medicine. At the same time, we should improve the ability of clinicians to diagnose and differential diagnosis of chest pain, promote the integration of multidisciplinary advantages, rationalize the use of medical resources, and improve the status of diagnosis and treatment of acute chest pain. It is necessary to promote the concept of “chest pain center” in China because it has great advantages in shortening the treatment time, improving the prognosis and saving medical resources, and its establishment will also play a positive role in promoting the health education of cardiovascular diseases among Chinese residents. The establishment of the “chest pain center” will also play a positive role in promoting cardiovascular disease health education in China. With the gradual construction and improvement of “chest pain center”, especially the establishment of multi-level chest pain center system of tertiary hospitals, secondary hospitals and community hospitals, the participation of community hospitals and secondary hospitals in the construction of chest pain center system and the degree of their attention to popularization will directly determine the final result of the construction of chest pain center in China. Therefore, besides the hospitals themselves should strengthen the construction and management of chest pain centers, the whole society should pay attention to and pay attention to the popularization of related knowledge. It is believed that with the further exploration and development of the “chest pain center” system in China, it will have far-reaching significance and influence on the diagnosis and treatment of acute chest pain and even the future medical management mode in China.