{"id":22292,"date":"2023-04-16T15:35:34","date_gmt":"2023-04-16T08:35:34","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22292"},"modified":"2023-04-17T14:13:16","modified_gmt":"2023-04-17T07:13:16","slug":"hon-me-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/16\/hon-me-o-tre-em\/","title":{"rendered":"Ti\u1ebfp c\u1eadn h\u00f4n m\u00ea \u1edf tr\u1ebb em"},"content":{"rendered":"

H\u00f4n m\u00ea \u1edf tr\u1ebb em<\/a> l\u00e0 s\u1ef1 suy gi\u1ea3m \u00fd th\u1ee9c do t\u1ed5n th\u01b0\u01a1ng b\u00e1n c\u1ea7u \u0111\u1ea1i n\u00e3o ho\u1eb7c h\u1ec7 th\u1ed1ng l\u01b0\u1edbi. H\u00f4n m\u00ea l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng ch\u1ee9 kh\u00f4ng ph\u1ea3i m\u1ed9t b\u1ec7nh. L\u00e0 \u00a0khi b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3n h\u1ed3i l\u1ea1i b\u1ea5t k\u1ef3 m\u1ed9t k\u00edch th\u00edch n\u00e0o. H\u00f4n m\u00ea \u1edf tr\u1ebb em th\u01b0\u1eddng g\u1eb7p trong c\u1ea5p c\u1ee9u nhi, bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m l\u00e0 t\u1eafc \u0111\u01b0\u1eddng th\u1edf v\u00e0 ng\u01b0ng th\u1edf.<\/strong><\/p>\n

\u00dd th\u1ee9c suy y\u1ebfu \u0111\u1ec1 c\u1eadp \u0111\u1ebfn nh\u1eefng r\u1ed1i lo\u1ea1n t\u01b0\u01a1ng t\u1ef1, \u00edt nghi\u00eam tr\u1ecdng c\u1ee7a \u00fd th\u1ee9c; nh\u1eefng r\u1ed1i lo\u1ea1n n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 h\u00f4n m\u00ea.\u00a0 C\u01a1 ch\u1ebf h\u00f4n m\u00ea ho\u1eb7c \u00fd th\u1ee9c suy gi\u1ea3m li\u00ean quan \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ee7a c\u1ea3 hai b\u00e1n c\u1ea7u n\u00e3o ho\u1eb7c c\u1ee7a h\u1ec7 th\u1ed1ng k\u00edch ho\u1ea1t l\u01b0\u1edbi (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u1ec7 th\u1ed1ng k\u00edch th\u00edch t\u0103ng d\u1ea7n).<\/strong><\/p>\n

1. B\u1ec7nh sinh h\u00f4n m\u00ea \u1edf tr\u1ebb em:<\/strong><\/h2>\n

\u00dd th\u1ee9c bao g\u1ed3m 2 ch\u1ee9c n\u0103ng l\u00e0 ch\u1ee9c n\u0103ng th\u1ee9c t\u1ec9nh v\u00e0 ch\u1ee9c n\u0103ng n\u1ed9i dung. C\u1ea3 hai th\u00e0nh ph\u1ea7n n\u00e0y \u0111\u01b0\u1ee3c quy \u0111\u1ecbnh b\u1edfi nh\u1eefng c\u01a1 s\u1edf gi\u1ea3i ph\u1eabu nh\u1ea5t \u0111\u1ecbnh trong n\u00e3o b\u1ed9. Ch\u1ee9c n\u0103ng th\u1ee9c t\u1ec9nh do h\u1ec7 l\u01b0\u1edbi ho\u1ea1t h\u00f3a l\u00ean \u0111i su\u1ed1t th\u00e2n n\u00e3o tr\u00ean, d\u01b0\u1edbi \u0111\u1ed3i v\u00e0 v\u00f9ng \u0111\u1ed3i th\u1ecb quy\u1ebft \u0111\u1ecbnh. Ch\u1ee9c n\u0103ng n\u1ed9i dung c\u1ee7a \u00fd th\u1ee9c bao g\u1ed3m nh\u1eefng kh\u1ea3 n\u0103ng thu\u1ed9c v\u1ec1 l\u0129nh v\u1ef1c tr\u00ed tu\u1ec7 v\u00e0 c\u1ea3m x\u00fac, v\u1edbi c\u01a1 s\u1edf gi\u1ea3i ph\u1eabu l\u00e0 hai b\u00e1n c\u1ea7u \u0111\u1ea1i n\u00e3o v\u00e0 s\u1ef1 t\u01b0\u01a1ng t\u00e1c gi\u1eefa c\u00e1c v\u00f9ng trong hai b\u00e1n c\u1ea7u n\u00e0y.<\/p>\n

Khi h\u1ec7 th\u1ed1ng l\u01b0\u1edbi ho\u1ea1t h\u00f3a l\u00ean b\u1ecb t\u1ed5n th\u01b0\u01a1ng, ch\u1ee9c n\u0103ng th\u1ee9c t\u1ec9nh b\u1ecb t\u00e1c \u0111\u1ed9ng, d\u1eabn \u0111\u1ebfn c\u00e1c tr\u1ea1ng th\u00e1i kh\u00e1c nhau c\u1ee7a \u00fd th\u1ee9c, theo chi\u1ec1u h\u01b0\u1edbng x\u1ea5u d\u1ea7n, t\u1eeb ng\u1ee7 g\u00e0, l\u01a1 m\u01a1 \u0111\u1ebfn n\u1eb7ng nh\u1ea5t l\u00e0 h\u00f4n m\u00ea. Khi c\u00e1c v\u00f9ng \u0111\u1eb7c bi\u1ec7t trong hai b\u00e1n c\u1ea7u n\u00e3o b\u1ecb t\u1ed5n th\u01b0\u01a1ng, n\u1ed9i dung c\u1ee7a \u00fd th\u1ee9c s\u1ebd th\u1ec3 hi\u1ec7n ra kh\u00f4ng b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Ch\u1ee9c n\u0103ng n\u1ed9i dung c\u1ee7a \u00fd th\u1ee9c c\u00f3 th\u1ec3 b\u1ecb thay \u0111\u1ed5i m\u00e0 kh\u00f4ng \u1ea3nh h\u01b0\u1edfng g\u00ec \u0111\u1ebfn ch\u1ee9c n\u0103ng th\u1ee9c t\u1ec9nh. Nh\u01b0ng ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu ch\u1ee9c n\u0103ng th\u1ee9c t\u1ec9nh b\u1ecb t\u00e1c \u0111\u1ed9ng, th\u00ec n\u1ed9i dung c\u1ee7a \u00fd th\u1ee9c c\u0169ng s\u1ebd b\u1ecb t\u00e1c \u0111\u1ed9ng.<\/p>\n

Khi ch\u1ee9c n\u0103ng th\u1ee9c t\u1ec9nh b\u1ecb t\u1ed5n th\u01b0\u01a1ng, \u00fd th\u1ee9c s\u1ebd suy gi\u1ea3m v\u00e0 bi\u1ec3u hi\u1ec7n ra ngo\u00e0i theo nhi\u1ec1u m\u1ee9c \u0111\u1ed9. C\u00e1c m\u1ee9c \u0111\u1ed9 n\u00e0y kh\u00f4ng th\u1ed1ng nh\u1ea5t v\u1ec1 c\u00e1ch g\u1ecdi t\u00ean theo c\u00e1ch \u0111\u00e1nh gi\u00e1 c\u1ee7a nhi\u1ec1u b\u00e1c s\u0129 nhi khoa tr\u00ean th\u1ebf gi\u1edbi v\u00ec c\u00f2n t\u00f9y v\u00e0o s\u1ef1 quan s\u00e1t c\u1ee7a m\u1ed7i ng\u01b0\u1eddi. Tuy ch\u01b0a th\u1eadt s\u1ef1 \u0111\u01b0\u1ee3c th\u1ed1ng nh\u1ea5t, nh\u01b0ng v\u1ec1 c\u01a1 b\u1ea3n c\u00f3 c\u00e1c m\u1ee9c \u0111\u1ed9 sau:<\/p>\n

    \n
  • Ng\u1ee7 g\u00e0: b\u1ec7nh nh\u00e2n h\u1ea7u h\u1ebft l\u00fac n\u00e0o c\u0169ng ng\u1ee7. Khi c\u00f3 k\u00edch th\u00edch t\u1eeb nh\u1eb9 \u0111\u1ebfn v\u1eeba, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 t\u1ec9nh nh\u01b0ng l\u1ea1i ng\u1ee7 ngay khi kh\u00f4ng c\u00f2n k\u00edch th\u00edch.<\/li>\n
  • L\u01a1 m\u01a1: c\u0169ng gi\u1ed1ng ng\u1ee7 g\u00e0, nh\u01b0ng m\u1ee9c \u0111\u1ed9 k\u00edch th\u00edch ph\u1ea3i m\u1ea1nh v\u00e0 l\u1eb7p \u0111i l\u1eb7p l\u1ea1i b\u1ec7nh nh\u00e2n m\u1edbi th\u1ee9c \u0111\u01b0\u1ee3c.<\/li>\n
  • H\u00f4n m\u00ea: gi\u1ed1ng nh\u01b0 ng\u1ee7, m\u1ea5t kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi m\u1ecdi k\u00edch th\u00edch.<\/li>\n<\/ul>\n

    \"minh-hoa-hon-me-o-tre-em\"<\/p>\n

    2. Ph\u00e2n lo\u1ea1i h\u00f4n m\u00ea \u1edf tr\u1ebb em theo nguy\u00ean nh\u00e2n:<\/strong><\/h2>\n

    + Ch\u1ea5n th\u01b0\u01a1ng: xu\u1ea5t huy\u1ebft n\u00e3o, d\u1eadp n\u00e3o.<\/p>\n

    + Kh\u00f4ng do ch\u1ea5n th\u01b0\u01a1ng:<\/p>\n

      \n
    • Tai bi\u1ebfn m\u1ea1ch m\u00e1u n\u00e3o: nh\u0169n n\u00e3o, xu\u1ea5t huy\u1ebft n\u00e3o kh\u00f4ng do ch\u1ea5n th\u01b0\u01a1ng.<\/li>\n
    • Nhi\u1ec5m tr\u00f9ng: vi\u00eam n\u00e3o, m\u00e0ng n\u00e3o, s\u1ed1t r\u00e9t th\u1ec3 n\u00e3o.<\/li>\n
    • Chuy\u1ec3n h\u00f3a: r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, suy gan, suy th\u1eadn.<\/li>\n
    • Ng\u1ed9 \u0111\u1ed9c: thu\u1ed1c ng\u1ee7, Morphin v\u00e0 d\u1eabn xu\u1ea5t, phospho h\u1eefu c\u01a1.<\/li>\n
    • Thi\u1ebfu m\u00e1u n\u00e3o (shock), thi\u1ebfu oxy n\u00e3o (suy h\u00f4 h\u1ea5p).<\/li>\n
    • \u0110\u1ed9ng kinh.<\/li>\n<\/ul>\n

      3. Ch\u1ea9n \u0111o\u00e1n h\u00f4n m\u00ea \u1edf tr\u1ebb em:<\/strong><\/h2>\n

      3.1 C\u00f4ng vi\u1ec7c ch\u1ea9n \u0111o\u00e1n:<\/strong><\/h3>\n

      H\u1ecfi b\u1ec7nh s\u1eed nhanh, c\u1ea7n ch\u00fa \u00fd:<\/strong><\/p>\n

        \n
      • Ch\u1ea5n th\u01b0\u01a1ng.<\/li>\n
      • S\u1ed1t.<\/li>\n
      • Co gi\u1eadt.<\/li>\n
      • Ti\u1ebfp x\u00fac thu\u1ed1c, \u0111\u1ed9c ch\u1ea5t, r\u01b0\u1ee3u.<\/li>\n
      • Ti\u1ec1n c\u0103n: \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, \u0111\u1ed9ng kinh, b\u1ec7nh gan th\u1eadn.<\/li>\n<\/ul>\n

        3.2 Kh\u00e1m l\u00e2m s\u00e0ng:<\/strong><\/h3>\n
          \n
        • T\u00ecm d\u1ea5u hi\u1ec7u c\u1ea5p c\u1ee9u v\u00e0 x\u1eed tr\u00ed c\u1ea5p c\u1ee9u ngay khi tr\u1ebb c\u00f3 m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau: c\u01a1n ng\u1eebng th\u1edf, t\u00edm t\u00e1i, shock, co gi\u1eadt.<\/li>\n
        • \u0110\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 tri gi\u00e1c theo thang \u0111i\u1ec3m AVPU:<\/li>\n
        • A (Alert): tr\u1ebb t\u1ec9nh.<\/li>\n
        • V (Voice): \u0111\u00e1p \u1ee9ng v\u1edbi l\u1eddi n\u00f3i.<\/li>\n
        • P (Pain): \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch \u0111au.<\/li>\n
        • U (Unconscious): h\u00f4n m\u00ea.<\/li>\n
        • Ho\u1eb7c d\u1ef1a v\u00e0o thang \u0111i\u1ec3m Glasgow \u1edf tr\u1ebb em. Tr\u1ebb h\u00f4n m\u00ea khi thang \u0111i\u1ec3m t\u1ed5ng c\u1ed9ng theo thang \u0111i\u1ec3m Glasgow \u00a3 10 \u0111i\u1ec3m; Glasgow <8 \u0111i\u1ec3m th\u01b0\u1eddng n\u1eb7ng, t\u1eed vong cao.<\/li>\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
          Tr\u1ebb tr\u00ean 2 tu\u1ed5i<\/td>\nTr\u1ebb d\u01b0\u1edbi 2 tu\u1ed5i<\/td>\n\u0110i\u1ec3m<\/td>\n<\/tr>\n
          Tr\u1ea1ng th\u00e1i m\u1eaft<\/strong><\/td>\n<\/tr>\n
          M\u1edf t\u1ef1 nhi\u00ean<\/td>\nM\u1edf t\u1ef1 nhi\u00ean<\/td>\n4<\/td>\n<\/tr>\n
          M\u1edf khi g\u1ecdi<\/td>\nPh\u1ea3n \u1ee9ng v\u1edbi l\u1eddi n\u00f3i<\/td>\n3<\/td>\n<\/tr>\n
          M\u1edf khi \u0111au<\/td>\nPh\u1ea3n \u1ee9ng v\u1edbi k\u00edch th\u00edch \u0111au<\/td>\n2<\/td>\n<\/tr>\n
          Kh\u00f4ng \u0111\u00e1p \u1ee9ng<\/td>\nKh\u00f4ng \u0111\u00e1p \u1ee9ng<\/td>\n1<\/td>\n<\/tr>\n
          \u0110\u00e1p \u1ee9ng v\u1eadn \u0111\u1ed9ng t\u1ed1t nh\u1ea5t<\/strong><\/td>\n<\/tr>\n
          L\u00e0m theo y\u00eau c\u1ea7u<\/td>\nTheo nhu c\u1ea7u<\/td>\n6<\/td>\n<\/tr>\n
          \u0110\u1ecbnh v\u1ecb \u0111\u01b0\u1ee3c n\u01a1i \u0111au<\/td>\n\u0110\u1ecbnh v\u1ecb \u0111\u01b0\u1ee3c n\u01a1i \u0111au<\/td>\n5<\/td>\n<\/tr>\n
          T\u01b0 th\u1ebf c\u00f3 khi k\u00edch th\u00edch \u0111au<\/td>\nCo tay \u0111\u00e1p \u1ee9ng k\u00edch th\u00edch \u0111au<\/td>\n4<\/td>\n<\/tr>\n
          T\u01b0 th\u1ebf co b\u1ea5t th\u01b0\u1eddng<\/td>\nT\u01b0 th\u1ebf m\u1ea5t v\u1ecf khi \u0111au<\/td>\n3<\/td>\n<\/tr>\n
          T\u01b0 th\u1ebf du\u1ed7i b\u1ea5t th\u01b0\u1eddng<\/td>\nT\u01b0 th\u1ebf m\u1ea5t n\u00e3o khi \u0111au<\/td>\n2<\/td>\n<\/tr>\n
          Kh\u00f4ng \u0111\u00e1p \u1ee9ng<\/td>\nKh\u00f4ng \u0111\u00e1p \u1ee9ng<\/td>\n1<\/td>\n<\/tr>\n
          \u0110\u00e1p \u1ee9ng ng\u00f4n ng\u1eef t\u1ed1t nh\u1ea5t<\/strong><\/td>\n<\/tr>\n
          \u0110\u1ecbnh h\u01b0\u1edbng v\u00e0 tr\u1ea3 l\u1eddi \u0111\u00fang<\/td>\nM\u1ec9m c\u01b0\u1eddi, n\u00f3i b\u1eadp b\u1eb9<\/td>\n5<\/td>\n<\/tr>\n
          M\u1ea5t \u0111\u1ecbnh h\u01b0\u1edbng v\u00e0 tr\u1ebb l\u1eddi sai<\/td>\nQu\u1ea5y kh\u00f3c<\/td>\n4<\/td>\n<\/tr>\n
          D\u00f9ng t\u1eeb kh\u00f4ng th\u00edch h\u1ee3p<\/td>\nQu\u1ea5y kh\u00f3c khi \u0111au<\/td>\n3<\/td>\n<\/tr>\n
          \u00c2m thanh v\u00f4 ngh\u0129a<\/td>\nR\u00ean r\u1ec9 khi \u0111au<\/td>\n2<\/td>\n<\/tr>\n
          Kh\u00f4ng \u0111\u00e1p \u1ee9ng<\/td>\nKh\u00f4ng \u0111\u00e1p \u1ee9ng<\/td>\n1<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
            \n
          • Kh\u00e1m \u0111\u1ea7u c\u1ed5 v\u00e0 th\u1ea7n kinh:<\/li>\n
          • D\u1ea5u hi\u1ec7u ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u.<\/li>\n
          • C\u1ed5 c\u1ee9ng, th\u00f3p ph\u1ed3ng.<\/li>\n
          • K\u00edch th\u01b0\u1edbc \u0111\u1ed3ng t\u1eed v\u00e0 ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng.<\/li>\n
          • D\u1ea5u th\u1ea7n kinh khu tr\u00fa.<\/li>\n
          • T\u01b0 th\u1ebf g\u1ed3ng c\u1ee9ng m\u1ea5t v\u1ecf, m\u1ea5t n\u00e3o.<\/li>\n
          • D\u1ea5u hi\u1ec7u t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd: \u0111\u1ed3ng t\u1eed kh\u00f4ng \u0111\u1ec1u, g\u1ed3ng c\u1ee9ng, tam ch\u1ee9ng Cushing (m\u1ea1ch ch\u1eadm, huy\u1ebft \u00e1p t\u0103ng, nh\u1ecbp th\u1edf b\u1ea5t th\u01b0\u1eddng), ph\u00f9 gai th\u1ecb.<\/li>\n
          • Kh\u00e1m to\u00e0n di\u1ec7n:<\/li>\n
          • L\u1ea5y d\u1ea5u hi\u1ec7u sinh t\u1ed3n, \u0111o \u0111\u1ed9 b\u00e3o h\u00f2a oxy SpO<\/li>\n
          • V\u00e0ng da, t\u1eed ban d\u1ea1ng b\u1ea3n \u0111\u1ed3, thi\u1ebfu m\u00e1u, gan l\u00e1ch to, ph\u00f9.<\/li>\n<\/ul>\n

            3.4 C\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/h3>\n
              \n
            • C\u00f4ng th\u1ee9c m\u00e1u, K\u00fd sinh tr\u00f9ng s\u1ed1t r\u00e9t.<\/li>\n
            • Dextrostix, \u0111\u01b0\u1eddng huy\u1ebft, ion \u0111\u1ed3, TPTNT.<\/li>\n
            • Ch\u1ecdc d\u00f2 th\u1eaft l\u01b0ng (ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh khi suy h\u00f4 h\u1ea5p, shock, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd).<\/li>\n
            • Si\u00eau \u00e2m n\u00e3o xuy\u00ean th\u00f3p (u n\u00e3o, xu\u1ea5t huy\u1ebft n\u00e3o).<\/li>\n
            • Ch\u1ee9c n\u0103ng \u0111\u00f4ng m\u00e1u (xu\u1ea5t huy\u1ebft n\u00e3o-m\u00e0ng n\u00e3o, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u).<\/li>\n
            • Ch\u1ee9c n\u0103ng gan, th\u1eadn (b\u1ec7nh l\u00fd gan th\u1eadn).<\/li>\n
            • XQ tim ph\u1ed5i (b\u1ec7nh l\u00fd tim ph\u1ed5i).<\/li>\n
            • T\u00ecm \u0111\u1ed9c ch\u1ea5t trong d\u1ecbch d\u1ea1 d\u00e0y, m\u00e1u, n\u01b0\u1edbc ti\u1ec3u (ng\u1ed9 \u0111\u1ed9c).<\/li>\n
            • CT-scan n\u00e3o (t\u1ee5 m\u00e1u, u n\u00e3o, abc\u00e8ss n\u00e3o).<\/li>\n
            • EEG (\u0111\u1ed9ng kinh, vi\u00eam n\u00e3o Herpes).<\/li>\n<\/ul>\n
                \n
              1. Ch\u1ea9n \u0111o\u00e1n:<\/strong><\/li>\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                Ch\u1ea9n \u0111o\u00e1n<\/td>\nL\u00e2m s\u00e0ng \u2013 C\u1eadn l\u00e2m s\u00e0ng<\/td>\n<\/tr>\n
                Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/td>\nB\u1ec7nh s\u1eed ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u<\/p>\n

                D\u1ea5u hi\u1ec7u th\u1ea7n kinh khu tr\u00fa<\/td>\n<\/tr>\n

                H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/td>\nDextrostix gi\u1ea3m, \u0111\u00e1p \u1ee9ng v\u1edbi Glucose 10% TMC<\/td>\n<\/tr>\n
                Co gi\u1eadt do s\u1ed1t<\/td>\nTi\u1ec1n s\u1eed co gi\u1eadt<\/p>\n

                Tr\u1ebb 6 th\u00e1ng \u2013 5 tu\u1ed5i<\/p>\n

                Ti\u1ec1n s\u1eed co gi\u1eadt do s\u1ed1t<\/p>\n

                S\u1ed1t, co gi\u1eadt to\u00e0n th\u00e2n v\u00e0 ng\u1eafn, t\u1ec9nh t\u00e1o sau co gi\u1eadt<\/td>\n<\/tr>\n

                S\u1ed1t r\u00e9t th\u1ec3 n\u00e3o<\/td>\nV\u00f9ng d\u1ecbch t\u1ec5 s\u1ed1t r\u00e9t<\/p>\n

                Thi\u1ebfu m\u00e1u, gan l\u00e1ch to, v\u00e0ng da<\/p>\n

                Ph\u1ebft m\u00e1u ngo\u1ea1i bi\u00ean t\u00ecm th\u1ea5y KSTSR<\/td>\n<\/tr>\n

                Vi\u00eam m\u00e0ng n\u00e3o m\u1ee7<\/td>\nS\u1ed1t, n\u00f4n \u00f3i<\/p>\n

                C\u1ed5 c\u1ee9ng, th\u00f3p ph\u1ed3ng<\/p>\n

                T\u1eed ban d\u1ea1ng b\u1ea3n \u0111\u1ed3 trong nhi\u1ec5m n\u00e3o m\u00f4 c\u1ea7u<\/p>\n

                D\u1ecbch n\u00e3o t\u1ee7y \u0111\u1ee5c, \u0111\u1ea1m t\u0103ng (>0,48 g\/l), \u0111\u01b0\u1eddng gi\u1ea3m (< \u00bd \u0111\u01b0\u1eddng huy\u1ebft c\u00f9ng th\u1eddi \u0111i\u1ec3m, t\u1ebf b\u00e0o t\u0103ng \u0111a s\u1ed1 b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n)<\/td>\n<\/tr>\n

                Vi\u00eam n\u00e3o<\/td>\nS\u1ed1t, th\u01b0\u1eddng k\u00e8m co gi\u1eadt<\/p>\n

                \u0110\u01b0\u1eddng huy\u1ebft, ion \u0111\u1ed3 b\u00ecnh th\u01b0\u1eddng<\/p>\n

                D\u1ecbch n\u00e3o t\u1ee7y: trong, \u0111\u1ea1m, \u0111\u01b0\u1eddng v\u00e0 t\u1ebf b\u00e0o th\u01b0\u1eddng trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng<\/td>\n<\/tr>\n

                Ng\u1ed9 \u0111\u1ed9c<\/td>\nTi\u1ec1n s\u1eed c\u00f3 u\u1ed1ng thu\u1ed1c, h\u00f3a ch\u1ea5t<\/p>\n

                D\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng \u0111\u1eb7c hi\u1ec7u c\u1ee7a t\u1eebng lo\u1ea1i ng\u1ed9 \u0111\u1ed9c<\/td>\n<\/tr>\n

                Shock<\/td>\nM\u1ea1ch nhanh, nh\u1eb9, huy\u1ebft \u00e1p k\u00e9p (\u00a325 mmHg) ho\u1eb7c t\u1ee5t (theo tu\u1ed5i), CRT > 3\u201d<\/p>\n

                Shock k\u00e9o d\u00e0i<\/td>\n<\/tr>\n

                Vi\u00eam c\u1ea7u th\u1eadn c\u1ea5p<\/td>\nHuy\u1ebft \u00e1p cao<\/p>\n

                Ph\u00f9 m\u1eb7t chi, ti\u1ec3u \u00edt<\/p>\n

                N\u01b0\u1edbc ti\u1ec3u: h\u1ed3ng c\u1ea7u (+)<\/td>\n<\/tr>\n

                \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n

                t\u0103ng Keton-acid<\/td>\n

                		\u0110\u01b0\u1eddng huy\u1ebft cao<\/p>\n

                Ti\u1ec1n s\u1eed \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c u\u1ed1ng nhi\u1ec1u, ti\u1ec3u nhi\u1ec1u<\/p>\n

                D\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc, th\u1edf nhanh s\u00e2u<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                4. \u0110i\u1ec1u tr\u1ecb h\u00f4n m\u00ea \u1edf tr\u1ebb em:<\/strong><\/h2>\n

                4.1 Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:<\/strong><\/h3>\n
                  \n
                • B\u1ea3o \u0111\u1ea3m th\u00f4ng kh\u00ed v\u00e0 tu\u1ea7n ho\u00e0n.<\/li>\n
                • Ph\u00e1t hi\u1ec7n c\u00e1c b\u1ec7nh l\u00fd ngo\u1ea1i th\u1ea7n kinh.<\/li>\n
                • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n.<\/li>\n
                • \u0110i\u1ec1u tr\u1ecb n\u00e2ng \u0111\u1ee1 v\u00e0 ph\u00f2ng ng\u1eeba bi\u1ebfn ch\u1ee9ng.<\/li>\n<\/ul>\n

                  Tuy\u1ebfn c\u01a1 s\u1edf:<\/strong><\/p>\n

                    \n
                  • Th\u00f4ng \u0111\u01b0\u1eddng th\u1edf: n\u1eb1m nghi\u00eang, h\u00fat \u0111\u00e0m nh\u1edbt, \u0111\u1eb7t \u1ed1ng th\u00f4ng mi\u1ec7ng h\u1ea7u khi th\u1ea5t b\u1ea1i v\u1edbi ng\u1eeda \u0111\u1ea7u n\u00e2ng c\u1eb1m v\u00e0 h\u00fat \u0111\u00e0m nh\u1edbt.<\/li>\n
                  • \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n b\u00f3p b\u00f3ng gi\u00fap th\u1edf n\u1ebfu ng\u1eebng th\u1edf ho\u1eb7c c\u00f3 c\u01a1n ng\u01b0ng th\u1edf.<\/li>\n
                  • Th\u1edf oxy duy tr\u00ec SaO2 <\/sub>92 \u2013 96%.<\/li>\n
                  • N\u1ebfu Dextrostix < 40 mg% ho\u1eb7c nghi ng\u1edd h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft ti\u00eam Glucose 10%:<\/li>\n
                  • Tr\u1ebb s\u01a1 sinh: Dextrose 10% 2 ml\/kg TMC.<\/li>\n
                  • Tr\u1ebb l\u1edbn: Dextrose 30% 2 ml\/kg TMC.<\/li>\n
                  • Co gi\u1eadt: Diazepam b\u01a1m h\u1eadu m\u00f4n 0,1 ml\/kg\/l\u1ea7n v\u1edbi \u1ed1ng ti\u00eam 1ml g\u1ee1 b\u1ecf kim \u0111\u01b0a s\u00e2u v\u00e0o h\u1eadu m\u00f4n 4 cm.<\/li>\n
                  • Chuy\u1ec3n tuy\u1ebfn tr\u00ean n\u1ebfu b\u1ec7nh nh\u00e2n h\u00f4n m\u00ea do ch\u1ea5n th\u01b0\u01a1ng \u0111\u1ea7u, ho\u1eb7c kh\u00f4ng t\u1ec9nh l\u1ea1i sau khi c\u1ea5p c\u1ee9u.<\/li>\n<\/ul>\n

                    Tuy\u1ebfn huy\u1ec7n, tuy\u1ebfn t\u1ec9nh, tuy\u1ebfn trung \u01b0\u01a1ng:<\/strong><\/p>\n

                      \n
                    • \u0110i\u1ec1u tr\u1ecb nh\u01b0 tuy\u1ebfn c\u01a1 s\u1edf.<\/li>\n
                    • Th\u1edf m\u00e1y n\u1ebfu c\u00f3 suy h\u00f4 h\u1ea5p.<\/li>\n
                    • Truy\u1ec1n d\u1ecbch ch\u1ed1ng shock n\u1ebfu c\u00f3:<\/li>\n
                    • Truy\u1ec1n d\u1ecbch Lactate Ringer hay Normal saline 20 ml\/kg\/gi\u1edd v\u00e0 c\u00e1c thu\u1ed1c t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim (Dopamine, Dobutamine) \u0111\u1ec3 duy tr\u00ec huy\u1ebft \u00e1p \u1ed5n \u0111\u1ecbnh.<\/li>\n
                    • Tr\u00e1nh truy\u1ec1n qu\u00e1 nhi\u1ec1u d\u1ecbch c\u00f3 th\u1ec3 g\u00e2y ph\u00f9 n\u00e3o v\u00e0 t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/li>\n
                    • Ch\u1ed1ng ph\u00f9 n\u00e3o n\u1ebfu c\u00f3.<\/li>\n
                    • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n:<\/li>\n
                    • H\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft: dung d\u1ecbch Glucose 10%.<\/li>\n
                    • Ng\u1ed9 \u0111\u1ed9c Morphin: Naloxon 0,1 mg\/kg t\u1ed1i \u0111a 2g TM.<\/li>\n
                    • S\u1ed1t r\u00e9t: Artesunate TM.<\/li>\n
                    • Vi\u00eam m\u00e0ng n\u00e3o kh\u00e1ng sinh t\u0129nh m\u1ea1ch.<\/li>\n
                    • Vi\u00eam n\u00e3o do Herpes: Acyclovir TM.<\/li>\n
                    • Ph\u1eabu thu\u1eadt s\u1ecd n\u00e3o l\u1ea5y kh\u1ed1i m\u00e1u t\u1ee5 khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/li>\n
                    • Truy\u1ec1n d\u1ecbch:<\/li>\n
                    • 2\/3 nhu c\u1ea7u \u0111\u1ec3 tr\u00e1nh ph\u00f9 n\u00e3o do ti\u1ebft ADH kh\u00f4ng th\u00edch h\u1ee3p.<\/li>\n
                    • Natri: 3 mEq\/100 ml d\u1ecbch, Kali 1-2 mEq\/100 ml d\u1ecbch.<\/li>\n
                    • Dung d\u1ecbch th\u01b0\u1eddng ch\u1ecdn l\u00e0 Dextrose 5-10% trong 0,2 \u2013 0,45% saline.<\/li>\n
                    • Dinh d\u01b0\u1ee1ng:<\/li>\n
                    • Trong giai \u0111o\u1ea1n c\u1ea5p khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh nu\u00f4i \u0103n qua sond d\u1ea1 d\u00e0y th\u00ec trong 3 ng\u00e0y \u0111\u1ea7u ch\u1ec9 c\u1ea7n cung c\u1ea5p glucose v\u00e0 \u0111i\u1ec7n gi\u1ea3i.<\/li>\n
                    • C\u1ea7n nhanh ch\u00f3ng nu\u00f4i \u0103n qua sond d\u1ea1 d\u00e0y n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, chia l\u00e0m nhi\u1ec1u b\u1eefa \u0103n nh\u1ecf gi\u1ecdt ch\u1eadm, n\u1ebfu c\u1ea7n nu\u00f4i \u0103n t\u0129nh m\u1ea1ch m\u1ed9t ph\u1ea7n.<\/li>\n
                    • T\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u h\u00f4 h\u1ea5p.<\/li>\n
                    • Theo d\u00f5i: D\u1ea5u hi\u1ec7u sinh t\u1ed3n, m\u1ee9c \u0111\u1ed9 tri gi\u00e1c, k\u00edch th\u01b0\u1edbc \u0111\u1ed3ng t\u1eed m\u1ed7i 3 gi\u1edd trong 24 gi\u1edd \u0111\u1ea7u, sau \u0111\u00f3 m\u1ed7i 6 gi\u1edd.<\/li>\n<\/ul>\n

                       <\/p>\n

                      T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/em><\/strong><\/p>\n

                        \n
                      1. H\u00f4n m\u00ea, ThS.BS. \u0110\u1ed7 Minh H\u00f9ng, B\u1ed9 m\u00f4n Nhi, Khoa Y \u2013 \u0110\u1ea1i h\u1ecdc Qu\u1ed1c Gia TP.HCM<\/em><\/li>\n
                      2. H\u00f4n m\u00ea c\u1ea5p c\u1ee9u r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c v\u00e0 \u0111i\u1ec1u tr\u1ecb _ <\/em>TS V\u0169 Anh Nh\u1ecb 2018.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                        H\u00f4n m\u00ea \u1edf tr\u1ebb em l\u00e0 s\u1ef1 suy gi\u1ea3m \u00fd th\u1ee9c do t\u1ed5n th\u01b0\u01a1ng b\u00e1n c\u1ea7u \u0111\u1ea1i n\u00e3o ho\u1eb7c h\u1ec7 th\u1ed1ng l\u01b0\u1edbi. H\u00f4n m\u00ea l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng ch\u1ee9 kh\u00f4ng ph\u1ea3i m\u1ed9t b\u1ec7nh. L\u00e0 \u00a0khi b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3n h\u1ed3i l\u1ea1i b\u1ea5t k\u1ef3 m\u1ed9t k\u00edch th\u00edch n\u00e0o. H\u00f4n m\u00ea \u1edf tr\u1ebb em th\u01b0\u1eddng g\u1eb7p trong […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15,33],"tags":[3],"yoast_head":"\nTi\u1ebfp c\u1eadn h\u00f4n m\u00ea \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u00f4n m\u00ea \u1edf tr\u1ebb em l\u00e0 s\u1ef1 suy gi\u1ea3m \u00fd th\u1ee9c do t\u1ed5n th\u01b0\u01a1ng b\u00e1n c\u1ea7u \u0111\u1ea1i n\u00e3o ho\u1eb7c h\u1ec7 th\u1ed1ng l\u01b0\u1edbi. 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