cap cuu noi khoa thuong gap

Chy mu tiu ha trn

1. Nguyn nhn: - Vim lot d dy, hnh t rng, ung th d dy. - Do thuc: Aspirin, phenylbutazon, corticoid - V gin tnh mch thc qun bnh nhn x gan. - Chy mu ng mt. - Mt s bnh mu. 2. Triu chng: - Nn ra mu thng c ln thc n; mu c th en ln ti hoc mu cc. - i tin phn en nh nha ng, b caph, thnh khun hay nho lng. - Ton thn: da nht nht, v m hi, hoa mt chng mt, c th ngt, mch nhanh nh, huyt p gim, c th tru tim mch. - Xt nghim: Hng cu v huyt sc t gim, hematocrit gim. 3. X tr: - Bnh nhn nm u thp, bt ng, chm lnh vng thng v. - Cho th xy 2 4 lt/pht. - Theo di huyt p, mch, lng nc tiu, tnh cht phn. - Xt nghim mu thng quy, hematocrit v th nhm mu ngay. - t dy truyn dch b sung ngay lng dch mt: Dung dch glucose 5% hoc Natriclorua 9%0, Dextran Trng hp mt mu nhiu, nu truyn c mu cng nhm th rt tt nhng phi bo m cc quy nh v k thut truyn lng dch hoc mu truyn ph thuc vo lng mu mt i. - Thuc cn dng: - Vitamin K 0,005g x 4 ng/ngy tim bp tht. - Transamin 0,25 g x 4 ng/ngy pha trong dch truyn. - Glanduitrin 10 15 n v pha vo dch truyn. - Nu do nguyn nhn thuc gy chy mu: ngng ngay thuc . 4. iu kin chuyn tuyn sau: - Bnh nhn tm thi n nh: mch u r, huyt p ti a 90mmHg c th chuyn bnh nhn v tuyn sau. Bt ng tt, va hi sc chuyn, iu kin kh khn phi mi tuyn sau ln chi vin.
http://www.benhhoc.com/post/1454/

Cn hen ph qun cp

1. Triu chng: - Cn kh th ra chm, rt, c c ko di 30 pht n vi gi, tc ngc, ho t m trng, dnh, qunh. Thng xut hin v m gn sng, khi thay i thi tit. - Cn c th t ct hoc ct sau dng Theophyllin, Salbutamol. - C bnh s mn tnh ti din nhiu ln, lin quan vi thi tit, d nguyn. Khng c bnh s hoc tin s suy tim tri v hp van hai l. - Khm phi c nhiu ran rt hoc ran ngy, g vang. 2. X tr: - Nu nh: Cho ung Salbutamol 4mg hoc Theophyllin 0,10g x1 3 vin/ngy. C th xt vo hng Ventolin (Salbutamol) hoc Bricanyl (Terbutalin) mi ln 1 - 2 nht, 6 gi sau c th xt li, mt ngy khng qu 3 ln. - Nu nng: + Aminophyllin: Tim tnh mch rt chm trong 20 pht 1 ng 0,24g pha trong 20ml dung dch glucose 5%. C th tim 2-3 ln mi ngy. + Corticoid: Prednisolon 5mg x 6 vin, ung ngay sau khi n, liu gim dn trong nhng ngy sau. Hoc Depersolon 30mgx1 ng tim bp tht. Cc thuc ny ct c cn nhanh song phi thn trng v bnh nhn s b quen vi thuc, dng lu di c nhiu tc dng ph phc tp. Ch dng trong cn hen cp tnh nng, khi cc thuc khc khng ct c cn. - Cc bin php phi hp: Th oxy 2 4 lt/pht, nu nng cho th oxy lin tc. Dng khng sinh khi c nhim khun. Khng dng loi khng sinh c th gy d ng lm cho cn hen nng thm nh penicillin Thn trng khi dng Erythromycin v thucny lm tng nng Theophyllin, Aminophyllin trong mu, nu nng cc thuc ny cao d gy ng c. Tr tim mch. Khi c du hiu cn hen c tnh: Cn nng ko di > 24 gi, c suy h hp rt nng, bnh nhn kh th nhiu, tm ti, mch nhanh, dng cc thuc ct cn khng th phi chuyn sm i bnh vin. Trn ng vn chuyn, cho th oxy lin tc. 3. iu kin chuyn tuyn sau: - Bnh nhn tm thi n nh; ht cn kh th, mch u r, huyt p ti a >90mmHg c th chuyn bnh nhn v tuyn sau. - Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Cn nhp nhanh kch pht trn tht

1. Triu chng: - Cn xy ra t ngt, bnh nhn cm thy tim p nhanh, bn chn, hi hp, c th chng mt, bun nn, kh th, tc ngc. - Mch quay kh bt, tn s 150 180 ck/pht hoc hn, u. Cn c th ko di vi giy, vi pht hay vi gi, him gp ko di hn v kt thc cng t ngt. - Ghi in tm trong cn: nhp nhanh u, cc phc b QRS u, sng P thng khng nhn thy v nhp qu nhanh, on ST h thp. 2.X tr: - Lm ln lt cc bin php sau kch thch dy X cho n khi thy c hiu qu: . Nut mt ming bnh. . Ht vo, th ra mnh. - Ngi gp mnh ra trc, u ci vo gia hai gi. . Nghim php Valsalva: bnh nhn th ra ht - ht vo tht su - nhn hi ri rn th. Lm 3 - 4 ln khng kt qa ngng. . Xoa xoang cnh: lm tng bn 10 - 20 giy, lm li vi ln nu khng thy c tt huyt p, do ngt (khng c xoa c 2 bn mt ln). C ngi theo di mch ca bnh nhn khng cho tn s tim qu thp, di mc bnh thng. - Nu khng hiu qu: . An thn: Seduxen 5 mg x 1 vin. . Propranolol 40 mg x1 - 2 vin hoc Amiodaron (Cordarone) 200 mg x 2-3 vin/ngy. . C th dng Digoxin 0,5 mg hoc Isolanid 0,4 mg tim tnh mch. Nu sau 6 gi, nhp khng gim th tim 1 ng na. 3. iu kin chuyn tuyn sau: Khi mch tr li bnh thng, huyt p n nh th chuyn v bnh vin xc nh chn on v iu tr tip.

Cn tng huyt p kch pht

1.Triu chng: - Cn xy ra t ngt, sau gng sc hoc stress, khi thay i thi tit, b nhim

lnh - Huyt p tng cao 200/120mmHg, c khi tng rt cao 260/140mmHg. C

th ch c tng huyt p tm thu n thun. - Bnh nhn au u, mt bng, chng mt, chunh chong, c th c bun

nn, nn, c khi gim th lc, ln ln 2. X tr:

Mc tiu l dng cc bin php khn trng a huyt p xung di mc nguy him, thng thng ch ti 170 180/110mmHg, sau huyt p s dn tr v mc c.

- Cho bnh nhn nm ngh ni yn tnh. - Nu huyt p tng rt cao 200/120mmHg: Lasix 20mg x 1 ng tim tnh mch. Chc thng vin nang Adalate 10mg, nh III git vo di li, thuc c tc dng

ngay sau 3 - 5 pht, t mc ti a sau 15 - 20 pht, ko di 4 -5 gi. Theo di huyt p, nu vn cn cao 200/120mmHg th sau 30 pht li nh thm III git na. Ch nh nhiu Adalate th huyt p gim rt nhanh nguy him!

Hoc Captopril 25mg x 1 vin nhai v ngm trong ming, thuc c tc dng sau 15 - 20 pht, ko di 60 pht.

An thn: Seduxen 5mg x 1 vin. Tip tc dng liu thuc h p trong ngy. Vi bnh nhn cha dng thuc: Cho thuc c ch men chuyn nh Enalapril

(Renitec, Ednyt) 5mg x 1 vin/ ngy hoc Perindopril (Coversyl) 4mg cng c th dng thuc c ch th th bta nh Propranolol 40mg x 1 - 2 vin/ ngy chia 2 ln (nu khng c phn ch nh nh suy tim, mch chm, hen ph qun).

Ch n gim mui. Khi huyt p n nh, tip tc dng cc thuc iu tr bnh tng huyt p

a huyt p xung dn ti

Cn au tht ngc

1- Triu chng: - Hon cnh xut hin: Thng xy ra khi gng sc, khi c stress, sau tm lnh, n qu nhiu. C mt th t pht, cn au t nhin xy ra khng lin quan n hon cnh trn. - Cn au in hnh: au t ngt thng sau xng c, v tr 1/3 trn hay 1/3 gia, cng c th au vng trc tim, tnh cht au nh co tht tim hoc au c, nn buc bnh nhn phi ngng cc hot ng, thm ch ngng th. au c th lan ra cnh tay tri hoc c 2 tay, 2 vai, ln c, ln hm, ra sau lng, km theo v m hi, lo lng. Cn au mt i nhanh chng sau khi ngm Nitroglycerin hoc ngng vn ng. Trn thc t, cn lu c nhng trng hp khng in hnh v tnh cht au, v tr au, cng c nhng trng hp bnh nhn khng au (suy vnh thm lng). - Mch, huyt p bnh thng, c th tng nh. - in tm trong cn thy on ST chnh xung, sng T dng, nhn, i xng (tn thng v thiu mu di ni tm mc) hoc on ST chnh ln, sng T m, nhn, i xng (tn thng v thiu mu di thng tm mc). Ngoi cn au, cc sng bnh l ch thy khong 30% s bnh nhn. 2- X tr: -Cho bnh nhn ngng vn ng, nm ngh ni yn tnh, thong, th nh nhng, gii thch cho bnh nhn trnh lo lng. - Ct cn au: ngm di li 1 vin Nitroglycerin 0,5 - 0,75mg, thuc ct cn au t 30 giy n 1 - 2 pht, ko di 30 pht. C th xt Nitromint sprey vo ming 1 - 2 ln. Nu c iu kin ghi in tm ngay. Theo di huyt p, mch, cn au. Sau 10 -20 pht, nu vn cn au ngc th cho ngm li 1 vin Nitroglycerin 0,5mg hoc xt Nitromint sprey, thng th vi liu ny l c kt qu. Nu cn au ko di trn 20 pht mc d dng Nitroglycerin th phi lu n kh nng nhi mu c tim, bnh nhn cn c chuyn ngay ln tuyn trn. Trong ngy c th dng thuc nhiu ln nu cn au li ti din v bnh nhn khng b au u, h huyt p. Chng ch nh dng Nitroglycerin khi huyt o tm thu

Ng c barbituric

C 2 loi barbituric thng dng: loi c tc dng di nh Phenobarbital, Veronal, loi c tc dng nhanh nh Thiopenthal 1.Triu chng: Thuc ch yu gy c ch thn kinh trung ng. -Ng c nh: bnh nhn cha hon ton mt tr gic nhng ln tinh thn, cn phn ng li khi gy au hoc khi tim. i khi c trng thi kch ng ging nh say ru. H hp cn gi c bnh thng. Phn x gic mc v phn x gn xng vn cn nhng gim, i khi c rung git nhn cu v ni kh. -Ng c nng: ng lm ri i vo hn m su dn. Mch nhanh, huyt p h, th nng v chm, c lc ngng th. ng t thng co li v ch gin ra giai on cui cng , phn ng yu t hoc khng phn ng vi nh sng. Phn x gic mc, phn x gn xng, phn x ho gim, thn nhit gim. -Kim tra ng c qu nng, t vong do lit trung tm h hp hoc do ngng tim phi, do suy thn, c th do n tc cc cht tit ng th gy suy h hp cp hoc bnh nhn nn v ht vo ng th. 2.X tr: -Ra d dy, d bnh nhn n mun sau 12 gi: +Bnh nhn cn tnh: t ng thng qua mi bm ra d dy. +Bnh nhn hn m: t ng ni kh qun, bm phng bng chn ri mi c xng ra d dy qua mm trnh tro ngc nc ra vo ng h hp. Ra bng dung dch Natri clorua 9% 5 10 lt, ra xong bm qua xng d dy dung dch cha 30g MgSO4. -Than hot hp thu tt cc barbituric, nn cho lin tc khi ra d dy. -Tng o thi thuc qua nc tiu v kim ho nc tiu. +Lasix 20mg tim tnh mch, tim nhc li 6 gi 1 ln. +Truyn tnh mch dung dch Natri clorua 9% v glucose 5% ngy 3 4 lt, dung dch Natri bicarbonat 8,4% 200ml. B sung 2 3 g Kaliclorua trong dch truyn. -Chng ri lon h hp: ht m ri, th xy. -Tr tim mch: nu huyt p tt, dng Noradrenalin hoc Dopamin vo trong dung dch truyn tnh mch nng huyt p ln. -Khng sinh chng bi nhim. Vi nhng bnh nhn nng, nht l nhng bnh nhn suy h hp, bnh nhn s cn din bin phc tp, sau khi ra d dy v hi sc tim mch, cn chuyn di bnh vin sm c iu kin x l tip theo kp thi v tt hn. 3.iu kin chuyn tuyn sau: -Bnh nhn tm thi n nh: t th, mch u r, huyt p ti a >90mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc v chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Ng c cc cht tr su c Clo hu c

Cc cht tr su c clo hu c bao gm: DDT, cc dn cht ca cyclo - hexan (666). Cc cht ny thm qua da, phi ng tiu ho, gy tn thng tiu no, v no vng vn ng. 1. Triu chng: -Nn ma, a chy. -Run c bt u mt ri n cc u chi, sau co git rung, co git ton thn ri i vo hn m. - Th nhanh sau ri lon h hp, dn dn lit h hp, ch lit c h hp c th xut hin nhiu gi sau nhim c. 2. X tr: - Nu cht c thm qua da, cn ra sch da, thay qun o nhim DDT. - Nu do ung th ra d dy cng sm cng tt, vi nhiu nc sau cho du Paraffin 200ml. - Tng o thi thuc qua nc tiu. + Lasix 20 mg tim tnh mch, nhc li 6 gi 1 ln. + Truyn tnh mch dung dch Natriclorua 5%0 hoc glucose 5% ngy 3 4 lt. - Chng co git: gardenal 0,10g hoc Seduxen 10mg tim bt tht. -Hi sc h hp l c bn: h hp nhn to iu khin. -Tr tim mch. -Truyn dch, chng sc nu c. 3. iu kin chuyn tuyn sau: - Bnh nhn tm thi n nh: t th, mch u r, huyt p ti a >90mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Ng c cc cht tr su c phospho hu c

Cc cht tr su c phospho hu c vo ngi thm qua da, ht vo phi hoc vo ng tiu ho (ung nhm, tay dnh hoc n dnh, t t ). Vo trong c th, phospho hu c gy c bng cch c ch men Cholinesterase lm cho Acetycholin ng trong cc sinap thn kinh c gy nn cc du hiu bnh l lit cc c vn. 1.Triu chng: cc triu chng xut hin vi gi sau khi ng c. -Cng ph v: nn, au bng, v m hi, tng tit nc bt, co ng t, a i khng ch ng, mch chm, huyt p h, co tht ph qun, tng tit dch ph qun, ho, i khi ph phi, ngng th. -V thn kinh vn ng: co git m mt, c mt, rt li, co c c v lng c khi cng ton thn. -V thn kinh trung ng: hoa mt, chng mt, run, vt v, cn co git, ni kh, ln ln, c khi b hn m. Nu b nh, cc triu chng gim dn sau 2 3 ngy, n khi ti 2 3 tun l. Nhng trng hp rt nng cht rt nhanh, c trng hp trong vng 30 pht n 1 2 gi do tng tit ph qun, lit c h hp. -Tstatropin: tim tnh mch 2 mg Atropin: +ng t t thay i, khng gin to, mch khng nhanh ln hoc nhanh t: ngh n ng c do phospho hu c. +ng t gin to ngay, mch nhanh ngay, da nng, nu bnh nhn tnh s vt v, kch thch: khng ngh n ng c do phospho hu c. 2.X tr: X tr ngay ti bnh x: -Nu cht c vo qua ng tiu ho, phi ra d dy bng dung dch Natri bicarbonat. Ra nhiu nc cho n khi ht cht c trong nc ra d dy (c khi ti 40 60 lt), nc m. Ung than hot lng trng trng. -Nu cht c da, phi ra da bng nc x phng. -Dng Atropin liu cao: tim tnh mch 0,5 2 mg, c 2 gi 1 ln c th nh, c 15 pht 1 ln vi th nng cho n khi da nng, ng t gin 5 mm (tnh trng thm Atropin). Theo di ng t, v d sau 20 pht, ng t co li 90mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Ng c thuc an thn

Cc loi an thn bao gm diazepam (Seduxen, Valium), nitrazepam (Mogadon) 1.Triu chng: -Lc u bnh nhn ng g, c th c trng thi chunh chong, gim trng lc c, gim cc phn x gn xng. Sau i vo hn m, thng ko di trung bnh t 18 40 gi, trong hn m su d c gin ng t hai bn nht l khi c h thn nhit. -Ri lon huyt ng d xy ra: h huyt p nh n thun, hoc tru tim mch vi nhng biu hin lm sng phc tp nh nhp tim nhanh, tm ti, lnh cc u chi, thiu niu ri v niu. -Cc thuc an thn ch gy c ch h hp nh. 2.X tr: -Ra d dy nh vi ng c Barbituric. -H l thch hp i vi bnh nhn hn m, theo di cc du hiu sinh tn. -Tng o thi thuc qua nc tiu: +Lasix 20 mg tim tnh mch, nhc li 6 gi 1 ln +Truyn tnh mch dung dch Natri clorua 9%0 hoc glucose 5% ngy 3 n 4 lt. -Tr tim mch: ouabain; nu c tru tim mch, truyn tnh mch Noradenalin hoc Dopamin nng huyt p ln. -Th oxy khi c suy h hp. Vi bnh nhn hn m, sau khi ra d dy, nu mch v huyt p n nh th chuyn i bnh vin x l tip. 3.iu kin chuyn sau: -Bnh nhn tm thi n nh t th, mch u r, huyt p ti a >90mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Ngng tun hon

1. Triu chng: - Ngng tun hoan, Hn m t ngt. - Mch c, mch bn khng c. - Ngng th. - ng t gin (sau 30 giy). 2. X tr: Phi x tr cp cu ti ch ht sc khn trng, c gng phc hi tun hon, h hp ca bnh nhn trong vng 2 - 5 pht u. Theo phc hi sinh tim v h hp: - t bnh nhn nm nga trn mt mt phng cng (c th ngay di t). - p mnh vo vng trc tim 2- 3 ci, ng thi xem mch bn.
http://www.benhhoc.com/post/1463/http://www.benhhoc.com/post/1448/

- Nu tim khng p li, tin hnh ngay p tim ngoi lng ngc: ly ci bn tay phi t trc tip vo v tr 1/3 di xng c nhng cch mm c 2 khot ngn tay ( trnh lm gip gan khi p), cc ngn tay song song vi xng sn bnh nhn nhng khng c st lng ngc, cn ci bn tay tri t ln mu bn tay phi, dng sc c ngi dn thng gc qua cnh tay lm ln xng c xung khong 3- 5 cm to mt lc p vo tim, p vo khong 60 ln trong 1 pht, phi p lin tc khng ngng d ch chc lt. - ng thi vi p tim ngoi lng ngc, phi lm h hp h tr bng phng php thi ngt mm qua mm hoc mm qua mi: kim tra ng th, ly d vt, lau m ri trong mm, nhanh chng bnh nhn nm nga u, nng hm di ln, n trn ra sau, ri ht mt hi tht su v thi vo phi ca h qua mm hoc mi lm cng lng ngc. Thi nh th 3 ln lin ri tip tc p tim 15 ln (t l 1/5). Nu ch c mt ngi lm th phi hp nhp nhng gia p tim v h hp h tr, c 5 ln p tim th 1 ln thi. Nu c 2 ngi cp cu th sau ln p tim th 5 th ngi th hai thi ngt 1 ln. Nu c bng Ambu th ngi th 2 tin hnh bp bng h tr h hp. - Tim vo trong bung tht tri Adrenalin 0,5 - 1mg pha trong 10ml dung dch Natriclorua 9%o, Calicclorua 0,5 - 1g. C th tim nhc li sau 3- 5 pht. - Trong khi hi sc, nu c th lm c th t dy chuyn tnh mch a c cc dch v thuc cn thit. * chng nhim toan: Dung dch NatriNoradrenalin 4mg pha trong 500ml dung dch glucose 5% truyn tnh mch. C th truyn Dopamin 200mg pha trong 250 ml dung dch glucose 5%, hoc Isuprel 1 mg phng n trong 250 ml dung dch glucose 5% truyn tnh mch. * chng nhim toan: Dung dch bicarbonat 8,4% truyn tnh mch liu 1 2ml/kg. - Nu ghi c in tm th bit c nguyn nhn c bin php x tr thch hp: 1. Rung tht: Ph rung bng in ngoi lng ngc vi in nng 200 300 jun, dng loi khng dng nhp. 2. V tm thu: p tim ngoi lng ngc v dng thuc nh trn. 3. Phn li din c: cng dng thuc nh trn, p tim ngoi lng ngc, tim Calciclorua 10% 0,5 1g tnh mch, Atropin 0,5 mg tnh mch. - Nu bnh nhn tnh li, tip tc hi sc cho n khi mch, huyt p v nhp th tr li bnh thng, ch chm dt vic cp cu khi du hiu cht r rng: tim vn khng p li, mch bn, mch c khng bt c, ng t hai bn gin hon ton. 3. iu kin chuyn tuyn sau: -Bnh nhn tm thi n ch: Tim p tr li, t th, huyt p ti a >90mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyt sau ln chi vin.

Nhim trng nhim c thc n

L mt th vim d dy v rut cp tnh gy nn bi mt s vi khun, ph bin nht l trc khun Salmonella. 1. Triu chng: - Xy ra sau ba n 6 12 gi. - Xut hin t ngt vi cc triu chng: + St cao 38 390c, rt run, au mi ton thn. + y bng, au qun bng, au thng v ri i ngoi, phn lng, nhiu nc ln nhn thc n cha tiu, ngy i 3 10 ln hoc hn. + Nn sau 1 2 ln a lng; nn thc, nn tho nhng thc n cha xung rut, chua, nhiu nc, ngy 2 3 ln hoc hn lm bnh nhn cng b mt nc v in gii. Ch c mt s bnh nhn ch c nn m khng c a lng. + Vi th nng, mt nc nhiu: Huyt p thp, mch nhanh, d c tru tim mch. 2. X tr: - Cch ly bnh nhn, dng c n ung ring. - Ty u phn, cht nn trc khi vo h x. - B sung nc v in gii ngay: + Ung dung dch in gii 1 2 lt/ngy. + Ung nc go rang + mui n hoc ORESOL (gm mui n 3,5g + Natri bicarbonat 2,5 g + Kaliclorua 1,5g + glucose 20g) pha trong 1 lt nc m. + Truyn dch nu bnh nhn nn nhiu, ung c rt t hoc khi mt nc nhiu. Truyn tnh mch dung dch Natri clorua 9%o hoc dung dch ringer, dung dch glucose 5%x0,5-1lt/ngy. + Nu bnh nhn mt nc nng (mt 10% trng lng c th, tc l tng ng vi > 100ml/kg), huyt p c th = 0, cn phi b nhanh mt lng dch ln trong thi gian ngn. C th trong 30 pht u cn t c 30ml/kg; sau khi kt thc nu mch quay bt c th chuyn sang 70ml/kg trong 2,5 gi, nu sau 30 pht u truyn 30ml/kg m vn khng bt c mch quay th phi nhc li ln 2 cng nh vy; cng vi truyn dch, khi bnh nhn bt u ung c, cho dng dung dch ORESOL t mt v dn n. - Nu c tru tim mch cho Noradrenalin hoc Dopamin vo trong dung dch truyn nng huyt p ln (nhng phi bo m lng dch truyn l tng i y ). - Khng sinh chng nhim khun: + Amoxicillin vin 0,25g, cho 1,5 2g/ngy, chia 3 4 ln. + Hoc Co-trimoxasol (biseptol, Bactrim) vin 0,48g x 4 vin/ngy chia 2 ln, dng trong 5 ngy. + Nu 2 thuc trn khng c hiu qu, c th dng nhm Quinolon (Ofloxacin, Pefloxacin ) - Nhn n ngy u, thay bng nc ch c pha t glucose v vi ming bnh m nng. Ngy th hai n cho, ngy th ba n c dn. - C th dng thm: + Chng au bng: tim Atropin. + Cm a chy: Loperamid 2mg 2 vin/ln u, sau ung 1 vin sau mi ln i ngoi, ti a 6 vin/24 gi. + Cc Vitamin nhm B, C.

3. iu kin chuyn tuyn sau: - Bnh nhn tm thi n nh: mch u r, huyt p ti a >90mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. - Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Nhi mu c tim

1. Triu chng: - au d di vng sau xng c 1/3 trn hoc vng trc tim, cm gic nh dao m, nh x, nh b bp nght tim; au lan ra cnh tay tri hoc 2 tay, ln c, ln hm hoc ra sau lng, ko di trn 20 pht, c khi nhiu gi, ngm Nitrolycerin khng c kt qu. C trng hp bnh nhn au vng thng v, mt s trng hp au t hn, thm ch khng au. - Bnh nhn ti mt, chn tay lnh, c th c kh th, bun nn hoc nn, v m hi. Mch c th chm trong nhng gi u nhng thng nhanh v nh. Huyt p gim, d c tru mch. - Ting tim m, c th thy ngoi tm thu hoc cc ri lon v nhp tim khc. - in tm : trong nhng gi u, on ST chnh ln trn ng ng in trm ln sng T ln to thnh hnh vm (sng Pardee), sau xut hin sng Q (sng hoi t). 2. X tr: V nguyn tc, phi chuyn bnh nhn ln ngay tuyn bnh vin c iu kin hi sc tch cc, cp cu bnh nhn. Khi vn chuyn phi ht sc nh nhng, gi bnh nhn bt ng trn cng v sn sng cp cu dc ng. Nu bnh vin qu xa, i li kh khn th gi li v mi tuyn bnh vin n h tr, ch o cch iu tr ri chuyn khi tnh hnh bnh tt cho php. Cc bin php x tr trc mt tuyn bnh x: - Bt ng tuyt i trn ging, khng cho bnh nhn t vn ng d ch vn ng nh. Trn tnh bnh nhn. Cho th xy. - Chng au: c th dng Morphin 0,01g tim di da (khng ch nh khi c bnh phi - ph qun mn tnh, suy h hp, tt huyt p), hoc 1 ng Dolargan 0,10g + 10ml nc ct tim bp tht ml/ln. Tim li sau 3 -4 gi nu cn au vn ko di. Cho thm Seduxen 5 mg ung. - Chng ng: Aspirin ngy u 325mg, cc ngy sao 100mg/ ngy, ung sau n (khng ch nh nu c lot d dy, t trng). - Nu nhp tim qu chm

glucose 5%, liu 20- 50 mg/kg/pht. Nu thy ngoi tm thu tht dy, tim tnh mch

chm Lidocain 1 mg/kg ri mi truyn tnh mch. d phng ri lon nhp tim khi vn chuyn, ch x tr khi nh hng n huyt ng: Cordarone vin 200 mg, cho 1 - 2 vin/ngy. - Nu tru mch nng: truyn tnh mch Noradrenalin 4mg pha trong 500ml dung dch glucose 5% nng huyt p ln. Nu c Dopamin th truyn 200 mg pha trong 250 ml dung dch glucose 5% (1ml c 800mg Dopamin), bt u liu 2 - 5 mg/kg/pht ri tng dn ln 10 -15 mg/kg/pht a huyt p tm thu ln 95- 100 mmHg, khi t mc

huyt p ny th gim xung liu duy tr. - Nu c ph phi cp: tim tnh mch Lasix 20mg 1 ng, ngm Nitroglycerin 0,5 mg di li, truyn tnh mch Isolanid 0,4 mg pha trong dung dch glucose 5%. Theo di st huyt p, mch, nhp th v cn au x l kp thi. Hin nay, mt s bnh vin H Ni (trong c BVTQ108), thnh ph HCM, nu c iu kin can thip ti ti mu c tim (nong vnh, t stent, dng thuc tan huyt khi ) iu tr mt cch c bn. V vy, nu bnh nhn c nhng du hiu ngh n nhi mu c tim cp nn sm chuyn bnh nhn v tuyn sau xc nh chn on v quyt nh phng hng x tr cn thit. 3. iu kin chuyn tuyn sau: - Bnh nhn tm n nh: mch u >60 ck/pht, huyt p ti a >90 mmHg, t th, c th chuyn bnh nhn v tuyn sau. Phi m bo tt tun hon v h hp trong qu trnh chuyn bnh nhn. - Nu bn nhn nng, iu kin vn chuyn kh khn, phi mi tuyn sau chi vin.

Ph phi cp

1. Nguyn nhn: C 2 loi: - Ph phi cp do ri lon huyt ng; trong cc bnh tim c suy tim tri nh hp van 2 l, h van ng mch ch, nhi mu c tim, tng huyt p khi truyn dch qu nhiu. - Ph phi cp do tn thng mng ph nang - mao mch; cht c chin tranh, hi c cng nghip nh kh nit, kh sulfuric, ammoniac, carbon oxy, nhim khun nng, bng rng 2. Triu chng: - Kh th t ngt, d i, hai th, nhp th nhanh nng 40 60 ln/pht. Bnh nhn khng th nm c, phi ngi dy cui u ra trc th. Trng thi vt v hong ht, mt ti nht, mi v cc u chi tm, v m hi lnh. - Lc u cn ho khan, khc m trng, sau ho khc nhiu bt mu hng, c khi bt hng tro ra mi v ming. - Mch nhanh nh kh bt, huyt p lc u tng sau gim v kt. Nghe phi lc u c th thy ran rt, ran ngy nhng ch yu l cc ran m, ran n nh ht c 2 bn, tng dn ln khp 2 trng phi nh triu dng. 3. X tr:

-t bnh nhn t th na nm na ngi hoc ngi, hai chn thng xung di gng lm gim trng lng mu tr v tim. C th bng gar tnh mch 2 gc chi di, c 15 pht li tho bng tng chi mt (ch khng phi l gar ng mch). - Ht m di, cho th xy qua cn, lu lng 2 4 lt/pht. - Lm gim p lc tiu tun hon: Lasix 20 mgx1 - 2 ng tnh mch gy li tiu mnh, sau 5-10 pht tim nhc li nu vn cn kh th. Nitroglycerin 0,5mg x 1 vin ngm di li hoc xt Nitromint spray vo ming 1 - 2 nht lm gin tnh mch ngoi vi gim lng mu v tim. -Morphin 0,01g x1 ng tim di da (khng ch nh khi c bnh phi ph qun mn tnh, suy h hp, ri lon thc, tt huyt p) lm gim tnh trng th nhanh, gim hong ht, vt v, ri lon vn mch - Tr tim: Uabain 0,25mg x1 ng hoc Isolanid 0,4 mg x 1 ng tim tnh mch. - Chng co tht ph qun: Aminophyllin 0,24 pha trong 20ml dung dch glucose 5% tim tnh mch rt chm. - Nu huyt p tng qu cao >=200/ >=70mmHg dng vin nang Adalat nh 3 git vo di li. -Nu c tru mch: Truyn tnh mch Noadrenalin 4mg pha trong 500ml dung dch glucoga 5% hoc Dopamin 200mg pha trong 250ml dung dch glucoga 5% a huyt p ln n >= 100/ 70mm Hg. Sau , cn c vo nguyn nhn gy ph phi cp tnh m x tr tip. 4. iu kin chuyn tin sau: - Bnh nhn qua cn cp tnh, tm thi n nh: kh th, mch u r, huyt p ti a >90 mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. - Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Rn c cn

1.Cc loi rn c: Ngi ta chia lm 2 loi: -Rn lc, rn chm qup. -Rn h mang, cp nong, cp nia. Cc loi rn t c hn: Rn go, rn nc. 2.Triu chng: -Rn lc: Ch cn au but, sng ty, ph n nhanh chng, hoi t lan dn xung quanh ch cn v pha gc chi. Tru tim mch nu c nc c nhiu, c th ph phi cp tnh, chy mu cc ph tng, lit h hp, nhng ngy sau c tn thng gan thn -Rn h: Du hiu ti ch khng ng k, t ph, t au nhng sau 30 pht tr i, mt mi r ri, lit cc chi, lit h hp, hn m, tn thng c tim nng nh bloc nh tht hon ton c th lm ngng tim, nhng gi sau d c ri lon ng mu gy ng mu ri rc trong mch.

3.X tr: -Bt ng bnh nhn ngay. Nu vt cn cc chi, phn chi b cn thp hn ngi. -Bng p cht trn ch b cn 5 10 cm lm ga - r tnh mch bng bng bn rng nu vt cn chi hn ch s lu thng ca mu tnh mch v bch mch. C 10 pht li ni v bng p tip pha trn cho n gc chi. -Dng mi dao sc hoc gc li dao co ru rch rng vng rn cn qua im rng cn (ch rch ht lp da) v nn mu ra hoc dng bu gic ht mu. Ch phi v khun cc dng c khi tin hnh. -Trc khi rch da ht mu c th ra sch vt cn bng nc chanh qu, x phng, phn chua, ru trng hoc Betadin. Nhng ngy sau, ra vt thng bng nc thuc tm long: -Chm ti ch v trn ch rn cn. -C th tim phng b quanh vt cn bng Novocain 2% 10ml. - trung ho c t, tt nht th dng huyt thanh khng nc rn c hiu (nu c), nhng phi tim sm. -Chng d ng: Depersolon 30 mg tim bp tht. Nu au nhiu dng gim au cho bnh nhn. -Nu huyt p gim thp th truyn tnh mch Noradrenalin 4 mg pha trong 500ml dung dch glucose 5 % a huyt p ln. -Th xy: -Nu suy h hp phi bp bng Ambu hoc t ng ni kh qun. -Tim khng sinh chng bi nhim. Nu tin trin nng hn, hoc bit chc chn l b rn h cn, chuyn cng nhanh cng tt v bnh vin tip tc cp cu, phng lit c h hp. iu tr bng y hc dn tc: *Bi 1: Ly ngay trong mt cc loi thuc sau y: -L Kim Vng 20g + phn 5g; gi vt nc ung, b p ti ch. -Rau rm 20g + mui 2g; gi vt nc ung, b p ti ch. -Chanh tri 1 qu + phn 5g; vt ung. -Ru hi: 10ml ung 1 ln, c 15 pht li ung 1 ln, khng qu 5 ln. *Bi 2: Sau khi s tr cp cu theo y hc hin i ri th dng tip n sau: -L tru khng ti 40g, sinh khng 40g, qu chi 80g, phn chua phi 20g, vi ti 20g. Vi, qu, phn phi tn thnh bt mn, gng (sinh khng), tru khng gi vt ly nc ct, trn vi bt trn, em phi kh, tn mn li ln na a vo chai v khun. Cho bnh nhn ung 12g bt ho vi nc un si ngui. Ly 10g bt pha vi nc un si ngui ra vt thng, 10g bt rc vo vt thng bng li. *Bi 3: L phn en cn ti 1 nm ( 5 10g) nhai nt nut nc, b p ln ch rn cn. 4.iu kin chuyn tuyn sau: -Bnh nhn tm thi n nh: Mch u r, huyt p ti a >90 mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Say nng, say nng

* SAY NNG: 1.Nguyn nhn: Do lm vic ngoi nng hoc i di nng lu, nht l vo bui tra, khng c nn m che u, tia nng gt c nhiu tia t ngoi trc tip vo u, vo gy. 2.Triu chng: -au u, chng mt, hoa mt, tai, ngt. -Trng thi thn kinh b kch ng, vt v, bn chn, c khi ni sng, co git. -Tru tim mch: mch nhanh nh, c khi huyt p tt. -St rt cao trn 40 410C ngay t u. *SAY NNG: 1.Nguyn nhn: -Lm vic ni hm l nng bc, ni c nhit cao, khng kh m v t thay i, b ra nhiu m hi. -B i tp ngoi nng, mc o phng v cch nhit nn khng thot khng kh v m hi c, nht l v x chiu c nhiu tia hng ngoi, khng c b sung nc v mui. 2.Triu chng: -Lc u v m hi, au u, mt d, cm gic nght th. Sau chng mt, hoa mt, mt ti nht, mch nhanh, huyt p h, c th ngt lm. -Nhit c th tng cao trn 40 0C, da kh. -Li b, vt v, ln ln, m sng, c th co git, hn m. *X tr: -a ngay bnh nhn ra khi ni nng nng, t nm ngh ni thong mt, yn tnh. Ci bt qun o, ni dy lng. -p khn lnh ln trn, ln mt, vo gy, c th p chn t hoc nc lnh khp ngi. Theo di thn nhit. -Cho ung nc ch pha t mi, cho ung dn t mt. -Nu st vn cao, cho ung thm thuc h nhit Paracetamol -Nu tru tim mch, truyn dung dch Natri chlorua 9 %0 hoc glucose 5%, Ringer lactat, cho thm Ouabain mg; nu huyt p thp (huyt p tm thu

l. Nu ra m hi nhiu, mch kh bt th cu huyt Kh hi (lt gng) Thn khuyt (lt mui) -Bi thuc: C nh ni ti 100g, rau m ti, l ci xay 100g ra sch, gi nh, vt nc ct ung.

Sc

1. Nguyn nhn: -Sc tim: Nhi mu c tim, nghn tc ng mch phi -Sc do gim th tch mu: mt mu, mt nc nhiu. -Sc chn thng. -Sc do ri lon vn mch: Nguyn nhn thn kinh, ng c, d ng lm ri lon tun hon ngoi v. Sc phn v c xp trong loi ny (Xem mc tip theo). -Sc nhim khun. 2.Triu chng: -Da xanh lnh, v m hi, u chi tm ti. -Huyt p thp, c th rt thp thm ch khng o c. -Mch nhanh, nh. -Nhp th nhanh, nng. - thc: Vt v, l m, hn m. -i t. 3.X tr: -t bnh nhn nm u thp, k chn cao 100 200 mu tnh mch d tr v tim; cho m, ung nc ch ng nng nu bnh nhn cn tnh. -Bo m khng kh: u nga, nghing mt bn, ht m ri, cho th xy. -t dy truyn dch, b sung dch thiu bng dung dch Natri chlorua 9%0, dung dch glucose 5% hoc cc dch keo. i vi sc do mt mu, nu c iu kin truyn mu cng nhm th tt nht. -Theo di huyt p, nu b dch m huyt p vn cn thp th truyn tnh mch Noradrenalin 4 mg pha trong 500 ml dung dch glucose 5% hoc Dopamin 200mg pha trong 250 ml dung dch glucose 5%. Khi huyt p tm thu ln >100 mmHg th gim tc truyn gi mc huyt p . -iu tr theo nguyn nhn: .Chng au (nu c): Morphin, Atropin, an thn. .B sung mu, dch trong sc do mt mu, b xung dch trong sc do mt nc .Nu sc do gy xng ln: Phng b Novocain 0,5% gc chi, c nh tt gy. -Thuc khng sinh c hiu, ph rng trong sc nhim khun v khng sinh d phng trong tt c cc loi sc. 4.iu kin chuyn tuyn sau: -Bnh nhn tm thi n nh: t th, mch u r, huyt p ti a >90 mmHg c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

Sc phn v

1.Triu chng: Trong hoc sau khi dng mt s thuc nh Penicillin, Streptomycin, hoc b cn trng t , ngi bnh t nhin hoa mt, chng mt, vt v, mt bng, tm ti, lm i hoc ngt, huyt p tt hoc khng o c, c th kh th do co tht thanh mn 2.X tr: -Nu ang tim thuc th ngng ngay, rt kim tim ra. -Th nh: .Bnh nhn nm u thp, nghing v mt bn, 2 chn hi cao. .Th oxy 4lt/pht. .Tim di da su 0,3 0,5 mg Adrenalin, ri c 15 20 pht/ln tim li cho n khi bnh nhn thot khi tnh trng sc, huyt p tr li mc bnh thng. -Khng histamin tng hp: Pipolphen 0,05g tim bp 1 ng, Periactin 4 mg ung ngy 2 3 vin. -Th nng: Mch nhanh nh kh bt, tt huyt p, mt tri gic. .Th oxy 3 5 lt/pht. .Adrenalin: Tim di da su 1 mg ri dng bm tim ly mu tnh mch trng bm tim v tim li vo trong tnh mch. C th dng Dopamin 200 mg pha trong 250 ml dung dch glucose 5%, truyn tnh mch liu >=20 ug/kg/pht a huyt p ln. .Dng corticoid: Depersolon 30 mg x 1 ng tim tnh mch chm hoc Hydrocortison hemisuccinat 300 500 mg tim tnh mch chm C th dng thuc khng histamin nh Pipolphen 50 mg 1 ng tim bp tht. .Nu c cn kh th: Aminophyllin 0,24g x 1 ng pha trong 10 ml dung dch glucose 30% tim tnh mch chm. .Tr tim mch: Ouabain hoc Isolanid. -Th rt nng: Mt mch, ngng th. .Tin hnh khn trng hi sinh tng hp (xem mc Ngng tun hon). Ch : -Trong khi cp cu, khng c dng bm tim c dnh khng sinh gy sc phn v mc d ra v luc k. -Th phn ng Peicillin cng c khi b sc phn v, v vy trc khi cho th dng phi hi k tin s c b d ng thuc, nht l d ng penicillin khng? Nu c th phi ngng ngay v phi chun b sn hp thuc cp cu sc phn v. 3. iu kin chuyn tuyn sau: -Bnh nhn n nh: gi li iu tr ti bnh x, khng cn chuyn tuyn sau; -Nu bnh nhn vn cn nng, chuyn tuyn sau; iu kin vn chuyn kh khn phi mi tuyn sau ln chi vin.

St rt c tnh

1. Hon cnh xut hin: -C tin s gn y b st rt .. -Cha b st rt nhng ang sng hoc t vng st rt lu hnh ra. Ch nhng ngi mi vo vng st rt, ngi b st rt s nhim. 2.Triu chng: -St km theo nhng cn rt run. -Ri lon thc, m sng, lon thn, co git kiu ng kinh, i vo hn m, khng c hi chng mng no, khng c triu chng thn kinh khu tr. -Kim tra mu thy c k sinh trng st rt. Nu m tnh, vn cha loi tr c v c 15 20 % s trng hp P.falciparum tp trung cc mao mch no, mt s ph tng m khng ra mu ngoi vi hoc ra mun. -Gan lch to (lch c th khng to khi st rt c tnh xut hin ngi b st rt s nhim) hng cu gim nhiu, bch cu khng tng, c th c nhng tn thng ph tng khc suy thn, suy gan, suy tun hon, suy h hp. 3.X tr: Phi pht hin bnh sm, iu tr khn trng. -iu tr c hiu: dng 1 trong cc thuc sau y theo t t u tin: +Artesunat tim, ng 60mg pha vo ng dung mi 0,6ml Bicarbonat 5% sau thm 5,4ml dung dch glucose 5% mi ml nh vy cha 10mg Artesunat, pha xong tim tnh mch ngay, nu vn c khng c dng. Mi ln tim 60 mg (1,2mg/kg) vo cc gi 0, 4, 24, 48 gi. Nu cha tnh, c 24 gi tim nhc li 1 ln. Vi tr di 7 tui, cho liu 1,5mg/kg. Nu bnh nhn n mun, hn m su, ln u c th tim gp i liu. +Artemether ng 80mg ngy u tim bp tht 2 ng, nhng ngy sau tim mi ngy 1 ng cho n khi tnh th thay bng ng Artemisinin. Quinin: Tim ngay Quinin dichlohydrat liu 30 -40 mg/kg trong 24 gi. C 6 gi, truyn tnh mch 0,50 g Quinin pha trong 250 ml dung dch Natrichlorua 9%0 hoc glucose 5%, tt nht dung dch c c Natri chlorua v glucose ng trng, tc 30 git/pht, truyn 2-3 ngy, cho ti khi tnh, khi chuyn sang ung Quinin sulfat 1,50g/24 gi chia 2 ln cho 7 -10 ngy. Nu bnh nhn n mun, hn m su qu 24 gi, cha dng Quinin th nn tim mng 1 ng Quinin 0,50g, sau truyn tnh mch nh trn. Nu khng c iu kin truyn tnh mch th ch tim Quinin vo mng. Artesunat vin 50mg: Ung gi u 2 vin, sau c cch 4 gi cho 1 vin bm qua xng vo d dy, khi tnh cho ung 2 vin/ngy cho 7ngy. Artemisinin n t hu mn, dng cho nhng tuyn khng c thuc tim v khng t c xng d dy, c bit tr em nh tui nn nhiu. C cc loi n 100mg, 200mg, 300mg, liu dng 20mg/kg/24 gi, gi u t 2 n (300mg cho ngi ln, 100mg cho tr em), sau c cch 4 gi t thm 1 n cho ti khi tnh th thay bng ng ung. -iu tr triu chng: .H thn nhit khi st cao: Chm mt trn, nch, bn, i, cho Parace tamol .Chng co git: Seduxen 10mg tim tnh mch, tim nhc li nhiu ln khi cn thit. Gardenal 0,10 0,20g tim bp tht, ngy khng qu 0,50g.

.Chng suy tun hon: B dch bng dung dch Natri chlorua 9%0, dung dch glucose 5%. .Chng suy h hp: Lau, ht m ri, th oxy. .Nu th gp do nhim toan mu: Dung dch Natri bicarbonat 8,4% 100ml ngy 1 -2 ln truyn tnh mch. .Khng sinh khi c bi nhim. .Chng suy thn: cn ch b sung dch, in gii. Truyn dch da vo lng nc tiu hoc p lc tnh mch trung ng. Lasix 20mg tim tnh mch. -Dinh dng: Thc n lng qua ng thng vo d dy. 4.iu kin chuyn tuyn sau: -Bnh nhn tm thi n nh: T th, mch u r, huyt p ti a >90mmHg, khng co git, c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. Qu trnh vn chuyn vn phi iu tr c hiu. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

St rt i huyt cu t

St rt i huyt cu t l th st rt din bin nng, c huyt tn d di, gy thiu mu cp, vng da, vng nim mc, i ra huyt cu t dn ti suy thn cp. Tnh trng ny c lin quan vi vic dng mt s thuc v trong mu c nhiu k sinh trng st rt. 1.Phn loi: C 3 loi st rt i huyt cu t: -Huyt tn cp bnh nhn st rt c tnh cha dng Quinin, do s lng k sinh trng st rt trong mu nhiu, ph hu hng cu t. -Huyt tn cp bnh nhn st rt c lin quan n vic dng mt s thuc nh: Quinin, Plasmoxit, Primaquine, Sulfamid v s lng k sinh trng st rt trong mu nhiu. -St rt i huyt cu t nhng khng c tnh. Bnh nhn b st rt c i ra huyt sc t nhng cha dng cc thuc gy huyt tn cp. 2.Triu chng: -St cao, rt run, au bng, au lng, nc tiu nh nc vi, c th c sc, ri lon tri thc, i t hoc v niu. -Suy thn cp (ch yu l suy thn thc th), nu khng c u tr bnh nhn s cht. Ur, Creatinin, Kali mu cao, Urobilin niu (+). -Thiu mu nng: hng cu v huyt sc t gim, hematocrit gim, vng da, vng nim mc. -K sinh trng st rt trong mu c th dng tnh hoc m tnh. 3.X tr: 3.1. Thuc c hiu: -V nguyn tc: nu i huyt cu t do chnh qa trnh bnh st rt gy ra th phi dng thuc st rt c hiu lc cao; nu l i huyt cu t do thuc st rt th phi

ngng ngay loi thuc gy huyt tn cp. -Nu khng xc nh cn nguyn gy huyt tn th: bnh nhn ang dng Quinin b i huyt cu t chuyn sang dng Artemisimin hoc Artesunat; bnh nhn dng thuc st rt khc (khng phi Quinin) c th dng Artemisinin, Artesunat hoc Quinin (dng khi hi sc v bo v bng Corticoid); nu bnh nhn cha dng thuc st rt th c th dng Artemisinin, Artesunat hoc Quinin. -Nu bnh nhn c tin s i huyt cu t do loi thuc st rt no th trnh dng li thuc . -Liu lng thuc: Artemisinin vin 250 mg ung 10 -20 mg/kg/24 gi, 2 4 vin/ngy, cch 6- 8 gi 1 vin, tng liu c t 3 -4 g; Artesunat tim tnh mch dng liu u tin 200mg, 24 gi sau 100mg, tip tc mi ngy 100mg cho 5 ngy hoc Quinin chlorhydrat tim bp tht hoc truyn tnh mch liu trung bnh 30mg/kg/24 gi chia 3 ln, c t khong 7 10 ngy. 3.2.Hi sc: -Dng corticoid, c th dng mt trong cc thuc sau: +Prednisolon hemisuccinat truyn tnh mch 150 180 mg/ngy trong 2 3 ngy. +Dexamethason 12 15 mg/ngy tim tnh mch. +Depersolon 60 90 mg/ngy tim tnh mch. +Prednisolon 40 60 mg/ngy ung tip sau t tim. -Truyn mu nu c iu kin, khi hng cu < 2.10 12/l hoc hematocrit 90mmHg c th chuyn tuyn sau, va hi sc va chuyn. -Nu iu kin chuyn kh khn phi mi tuyn sau ln chi vin.

Tai bin mch mu no

1. Cc loi tai bin: - Tai bin mch mu no lm thi hi phc hon ton trong vng 24 gi khng li di chng nhng d ti pht. - Tai bin mch mu no chnh thc: bao gm chy mu no, chy mu no mng no, nhi mu no, tc mch no. Chn on nguyn nhn ca tai bin trong giai on u ti tuyn bnh x thng rt kh khn. Tin lng bnh d dt nu tn thng ln, qua khi c th thng li di chng. 2. X tr: Phi chuyn ngay bnh nhn ln tuyn bnh vin c iu kin lm chn on v c phng hng cp cu iu tr thch hp vi tng th tai bin. Trong khi vn chuyn phi theo di huyt p, mch, nhp th, trng thi tm thn kinh x tr kp thi. - Bt ng bnh nhn. - Bo m thng kh tt, ht m ri nu c. - t sm dy truyn dch thun li cho vic dng cc thuc cn thit. -Nu huyt p tng rt cao 200/ 120 mmHg: sau tai bin mch mu no, huyt p thng tng phn x; trong trng hp ny ch c dng thuc a huyt p xung di mc nguy him, thng thng vo khong 170 180/100 mmHg, khng c a xung mc ny; nu a nhanh chng huyt p xung

in git

1. Triu chng: - C th gy lit h hp, ngng th. - C th c cn rung tht v ngng tim. - Nn nhn cn c th b bng nu in th cao v thi gian c tip xc di. Ngoi ra cn c th b chn thng nu ng t trn cao. 2. X tr: Tun th nguyn tc cp cu khn trng v ti ch. - Ct ngay ngun in. - Nu khng ct c ngun in hoc nn nhn cn vng vo dy in trn th ngi cp cu phi ng trn tm vn kh hoc trn cc vt cch in khc, dng gy g, tre g tch nn nhn ra khi dng din trc khi s vo ngi nn nhn hoc dng tay eo gng cch in g nn nhn ra. - Nu ngng th: tin hnh h hp nhn to ngay mm - mm hoc mm mi. - Nu ngng tim phi, m mnh vo vng trc tim 2 - 3 ci, nu tim khng p li th tin hnh cp cu va thi ngt (mm - mm hoc mm - mi) va p tim ngoi lng ngc (xem mc ngng tun hon). - Sau khi nn nhn hi phc: theo di huyt p, mch, nu huyt p thp th truyn tnh mch Noradrenalin hoc Dopamin; chng nhim toan chuyn ho bng dung dch Natri bicarbonat 8,4% 200ml. - Sau , nu nh th li bnh x, nu nng hoc c bng phc tp, c chn thng th chuyn v bnh vin tip tc iu tr. - Cn theo di st phng ngng tim tr li. 3. iu kin chuyn tuyn sau: - Bnh nhn tm thi n nh: Tim p tr li, huyt p ti a >90 mmHg, t th c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. - Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

ui nc

1. X tr: -S cu ti ch, tch cc, ng phng php. -Kin tr cp cu trong nhiu gi. -Mc tiu l gii phng ng h hp, em li xy cho nn nhn. -X tr cc ri lon tim mch, h hp, chuyn ho. -Cp cu ngay di nc: Nm tc nn nhn u nh ln khi mt nc, tt 2 - 3 ci tht mnh vo m gy phn x hi tnh v th li, qung tay qua nch nn nhn li vo b hoc ln thuyn cp cu. -Trn b: Cho nn nhn nm sp, vng tay qua bng, nng bng ln ri t xung 10 ln cho nc c ra hoc vc bnh nhn ln vai, bng bnh nhn p vo vai ngi cp cu. Vi tr nh, cm hai chn dc ngc nhng khng ko di qu mt pht. -Nu nn nhn cn th v tim cn p: t nn nhn nm u thp cho nc d tip tc thot ra, ly khn lau v mc ht m di trong mm. Theo di huyt p, mch, dng thuc tr tim mch khi cn. -Nu nn nhn khng th na nhng tim cn p: t nn nhn nm n c, ly khn lau sch mi, ming, hng ri tin hnh h hp h tr bng phng php mm mm. -Nu ngng th v ngng tim: Khn trng lau sch mi, ming, hng, ri x tr nh ngng tun hon: m mnh vo vng trc tim 2 3 ci, nu khng thy tim p li th p tim ngoi lng ngc kt hp h hp nhn to bng phng php mm mm. 2.iu kin chuyn tuyn sau: -Bnh nhn tm thi n nh: Tim p tr li, huyt p ti a >90mm Hg, t th, c th chuyn bnh nhn v tuyn sau. Va hi sc va chuyn. -Nu bnh nhn vn cn nng, iu kin vn chuyn kh khn, phi mi tuyn sau ln chi vin.

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