加護病房病人常因急性呼吸衰竭或上呼吸道狹窄原因緊急放置氣管插管，大部分的病人可在短期 内訓練脫離呼吸器成功，進而移除氣管内管。但依據國外的文獻研究指出仍有高達5-13%病人會使用呼吸 器大於21天。這些須依賴人工氣道維生的病人，通常重症醫師會建議病人與家屬接受氣管造口術，以利 後續照護及避免長時間放置氣管内管所導致相關的併發症。但對於病人與家屬而言，面對重大醫療處置 的陌生及迷思，常導致決策者處於被動及依賴醫師的角色，而陷入抉擇衝突的情境發生。本案例為一名 67歲男性因慢性呼吸衰竭面對是否執行「氣管造口術」所產生之抉擇衝突。照護過程運用「醫病共享決 策」模式，以傾聽為出發點，系統性的評估病人或家屬是否具備疾病、檢查或治療相關的知識，並使用 問卷表單來探索病人本身的價值觀，找出最適合自己的醫療治療決策，達至醫病溝通雙赢的局面。

Boerhaave's syndrome is spontaneous esophageal rupture resulting from a sudden increase in internal esophageal pressure. The mortality rate is very high and increases when treatments are delayed. However, this disease is not only very rare with atypical clinical manifestations, but also not sensitive enough to be detected by the early chest X-ray, so misdiagnosis or delay diagnosis are quite common. We reported a 85-year-old male who felt chest pain, abdominal pain and dyspnea just after having a big meal. When he visited emergency department 5 hours later, the chest X-ray revealed mild infiltration in left lower lobe. However, there was a significant change in the second chest X-ray 11 hours after onset. Computed tomography of chest revealed significant air bubbles in the mediastinum with fluid accumulation at the surrounding region of the esophagus. The following operation confirmed the diagnosis ultimately. We suggests that patients with unexplained and unimproved chest pain should be followed closely with repeated physical examinations and a series of chest X-rays.