**Question:** All are included in Manning Score except:

A. Age
B. Heart Rate
C. Respiratory Rate
D. Blood Pressure

**Core Concept:**
The Manning Score is a clinical scoring system used to assess the probability of a patient having acute myocardial infarction (AMI) based on their symptoms and vital signs. This score helps in differentiating between AMI and non-AMI patients and aids in patient triage. The score includes several parameters, such as age, heart rate, respiratory rate, and blood pressure.

**Why the Correct Answer is Right:**
Option D, Blood Pressure, is excluded from the Manning Score because the score focuses on symptoms and vital signs that directly contribute to the diagnosis of AMI. Blood pressure may not be significantly altered in the early phase of AMI, unlike other parameters like heart rate, respiratory rate, and age.

**Why Each Wrong Option is Incorrect:**
Option A, Age, is considered in the Manning Score to identify older patients who are more likely to have AMI due to the higher prevalence of risk factors and comorbidities in the elderly population.

Option B, Blood Pressure, is incorrect because it is not as crucial as other parameters in diagnosing AMI in the early phase. The score focuses on symptoms and vital signs that directly contribute to the diagnosis.

Option C, Blood Pressure, is incorrect for the same reasons mentioned for option D. Blood pressure alterations may not be as evident in the early phase of AMI compared to other parameters.

**Clinical Pearl:**
The Manning Score is a helpful tool for emergency physicians to assess the probability of AMI in patients presenting with chest pain. However, it is essential to consider the patient's clinical presentation, risk factors, and other diagnostic tests when making a definitive diagnosis.

**Correct Answer:** .