{"id":25827,"date":"2023-05-06T15:24:04","date_gmt":"2023-05-06T08:24:04","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25827"},"modified":"2023-05-06T15:24:04","modified_gmt":"2023-05-06T08:24:04","slug":"cach-tiep-can-va-xu-tri-tre-co-dau-hieu-de-doa-tinh-mang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/cach-tiep-can-va-xu-tri-tre-co-dau-hieu-de-doa-tinh-mang\/","title":{"rendered":"C\u00e1ch ti\u1ebfp c\u1eadn v\u00e0 x\u1eed tr\u00ed tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u \u0111e do\u1ea1 t\u00ednh m\u1ea1ng"},"content":{"rendered":"<p><strong>C\u00e1ch ti\u1ebfp c\u1eadn v\u00e0 x\u1eed tr\u00ed tr\u1ebb c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng cho ph\u00e9p th\u1ea7y thu\u1ed1c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh c\u1ee7a tr\u1ebb trong nh\u1eefng gi\u1edd \u0111\u1ea7u m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p. \u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u v\u00e0 h\u1ed3i s\u1ee9c nh\u1eb1m duy tr\u00ec ch\u1ee9c n\u0103ng s\u1ed1ng c\u01a1 b\u1ea3n, \u0111\u00e1nh gi\u00e1 b\u01b0\u1edbc hai v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u cho ph\u00e9p \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u h\u01a1n. Giai \u0111o\u1ea1n \u0111i\u1ec1u tr\u1ecb x\u00e1c \u0111\u1ecbnh \u0111\u00f2i h\u1ecfi ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c ph\u1ea3i l\u00e0m t\u1eebng b\u01b0\u1edbc, c\u00f3 h\u1ec7 th\u1ed1ng \u0111\u1ec3 tr\u00e1nh b\u1ecf s\u00f3t nh\u1eefng d\u1ea5u hi\u1ec7u thay \u0111\u1ed5i tr\u00ean l\u00e2m s\u00e0ng.<\/strong><\/p>\n<h2>1. T\u1ed5ng quan v\u1ec1 <strong>ti\u1ebfp c\u1eadn v\u00e0 x\u1eed tr\u00ed tr\u1ebb c\u00f3 <\/strong><strong>d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng<\/strong>:<\/h2>\n<p>\u0110\u1ec3 x\u1eed tr\u00ed c\u1ea5p c\u1ee9u m\u1ed9t tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng, c\u1ea7n \u0111\u00e1nh gi\u00e1 nhanh v\u00e0 can thi\u1ec7p k\u1ecbp th\u1eddi. Qu\u00e1 tr\u00ecnh ti\u1ebfp c\u1eadn bao g\u1ed3m c\u00e1c b\u01b0\u1edbc sau:<\/p>\n<ol>\n<li>\u0110\u00e1nh gi\u00e1 s\u01a1 b\u1ed9 t\u00ecnh tr\u1ea1ng c\u1ee7a tr\u1ebb \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00f3 d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng hay kh\u00f4ng.<\/li>\n<li>Th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed3i s\u1ee9c \u0111\u1ec3 c\u1ee9u s\u1ed1ng tr\u1ebb, bao g\u1ed3m th\u1edf oxy, th\u1edf m\u00e1y, th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt CPR ho\u1eb7c s\u1eed d\u1ee5ng c\u00e1c m\u00e1y t\u1ea1o nh\u1ecbp tim.<\/li>\n<li>\u0110\u00e1nh gi\u00e1 k\u1ef9 h\u01a1n \u0111\u1ec3 t\u00ecm ra nh\u1eefng v\u1ea5n \u0111\u1ec1 ch\u00ednh trong t\u00ecnh tr\u1ea1ng c\u1ee7a tr\u1ebb, bao g\u1ed3m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n, nhi\u1ec5m tr\u00f9ng v\u00e0 ch\u1ea5n th\u01b0\u01a1ng.<\/li>\n<li>Th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p x\u1eed tr\u00ed c\u1ea5p c\u1ee9u ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng c\u1ee7a tr\u1ebb, bao g\u1ed3m s\u1eed d\u1ee5ng thu\u1ed1c, ti\u00eam vaccin, truy\u1ec1n d\u1ecbch ho\u1eb7c th\u1ef1c hi\u1ec7n c\u00e1c th\u1ee7 thu\u1eadt ph\u1eabu thu\u1eadt.<\/li>\n<li>Sau khi \u1ed5n \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng c\u1ee7a tr\u1ebb, c\u1ea7n v\u1eadn chuy\u1ec3n tr\u1ebb \u0111\u1ebfn b\u1ec7nh vi\u1ec7n ho\u1eb7c \u0111\u01a1n v\u1ecb \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 ti\u1ebfp t\u1ee5c qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u0103m s\u00f3c<\/li>\n<\/ol>\n<figure id=\"attachment_28725\" aria-describedby=\"caption-attachment-28725\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-28725 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dh-300x214.jpg\" alt=\"d\u1ea5u hi\u1ec7u de do\u1ea1 t\u00ednh m\u1ea1ng\" width=\"300\" height=\"214\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dh-300x214.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dh.jpg 600w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-28725\" class=\"wp-caption-text\">d\u1ea5u hi\u1ec7u de do\u1ea1 t\u00ednh m\u1ea1ng<\/figcaption><\/figure>\n<h2>2. \u0110\u00e1nh gi\u00e1 b\u01b0\u1edbc \u0111\u1ea7u v\u00e0 h\u1ed3i s\u1ee9c <strong>tr\u1ebb c\u00f3 <\/strong><strong>d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng:<\/strong><\/h2>\n<h3><b>2.1. \u0110\u00e1nh gi\u00e1 \u0111\u01b0\u1eddng th\u1edf \u1edf tr\u1ebb c\u00f3 d\u1ea5u hi\u1ec7u \u0111e do\u1ea1 t\u00ednh m\u1ea1ng:<\/b><\/h3>\n<p><strong><i>\u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u<\/i>:<\/strong><\/p>\n<ul>\n<li>Nh\u00ecn di \u0111\u1ed9ng l\u1ed3ng ng\u1ef1c v\u00e0 b\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng \u0111\u01b0\u1eddng th\u1edf c\u1ee7a tr\u1ebb.<\/li>\n<li>Nghe th\u00f4ng kh\u00ed ph\u1ed5i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p c\u1ee7a tr\u1ebb.<\/li>\n<li>C\u1ea3m nh\u1eadn lu\u1ed3ng kh\u00ed th\u1edf ch\u1ec9 c\u00f3 hi\u1ec7u qu\u1ea3 khi b\u1ec7nh nh\u00e2n th\u1edf t\u1ef1 nhi\u00ean. N\u1ebfu tr\u1ebb n\u00f3i \u0111\u01b0\u1ee3c ho\u1eb7c kh\u00f3c \u0111\u01b0\u1ee3c, ch\u1ee9ng t\u1ecf \u0111\u01b0\u1eddng th\u1edf th\u00f4ng tho\u00e1ng, h\u00f4 h\u1ea5p \u0111\u1ea3m b\u1ea3o.<\/li>\n<li>N\u1ebfu tr\u1ebb t\u1ef1 th\u1edf, ch\u00fa \u00fd \u0111\u1ebfn c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u00f3 th\u1ec3 g\u1ee3i \u00fd t\u1eafc \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean nh\u01b0 ti\u1ebfng th\u1edf r\u00edt hay c\u00e1c d\u1ea5u hi\u1ec7u co k\u00e9o.<\/li>\n<li>N\u1ebfu kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng ch\u1eafc ch\u1eafn v\u1ec1 s\u1ef1 l\u01b0u th\u00f4ng c\u1ee7a \u0111\u01b0\u1eddng th\u1edf, ta c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh k\u1ef9 thu\u1eadt \u1ea5n h\u00e0m v\u00e0 n\u00e2ng c\u1eb1m, sau \u0111\u00f3 \u0111\u00e1nh gi\u00e1 l\u1ea1i. N\u1ebfu \u0111\u01b0\u1eddng th\u1edf v\u1eabn ch\u01b0a l\u01b0u th\u00f4ng, ta c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh m\u1edf mi\u1ec7ng b\u1ec7nh nh\u00e2n v\u00e0 th\u1ed5i ng\u1ea1t \u0111\u1ec3 t\u1ea1o ra \u00e1p su\u1ea5t \u0111\u1ec3 th\u00f4ng tho\u00e1ng \u0111\u01b0\u1eddng th\u1edf.<\/li>\n<\/ul>\n<p><strong><i>H\u1ed3i s\u1ee9c: <\/i><\/strong><em>B\u1eb1ng c\u00e1c k\u1ef9 thu\u1eadt:<\/em> nh\u00ecn, nghe v\u00e0 c\u1ea3m nh\u1eadn m\u00e0 th\u1ea5y \u0111\u01b0\u1eddng th\u1edf kh\u00f4ng th\u00f4ng tho\u00e1ng th\u00ec c\u00f3 th\u1ec3 m\u1edf th\u00f4ng \u0111\u01b0\u1eddng th\u1edf b\u1eb1ng:<\/p>\n<ul>\n<li>K\u1ef9 thu\u1eadt n\u00e2ng c\u1eb1m v\u00e0 \u1ea5n h\u00e0m<\/li>\n<li>\u0110i\u1ec1u ch\u1ec9nh t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 th\u00f4ng tho\u00e1ng<\/li>\n<li>C\u00f3 th\u1ec3 \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n (NKQ) n\u1ebfu th\u1ea5y c\u1ea7n thi\u1ebft.<\/li>\n<\/ul>\n<h3><b>2.2. \u0110\u00e1nh gi\u00e1 h\u00f4 h\u1ea5p:<\/b><\/h3>\n<p><strong><i>\u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u<\/i><\/strong><\/p>\n<p>\u0110\u01b0\u1eddng th\u1edf th\u00f4ng tho\u00e1ng ch\u01b0a ch\u1eafc th\u00f4ng kh\u00ed \u0111\u00e3 \u0111\u1ea7y \u0111\u1ee7. Th\u00f4ng kh\u00ed ch\u1ec9 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 khi c\u00f3 s\u1ef1 ph\u1ed1i h\u1ee3p c\u1ee7a trung t\u00e2m h\u00f4 h\u1ea5p, ph\u1ed5i, c\u01a1 ho\u00e0nh v\u00e0 c\u00e1c c\u01a1 l\u1ed3ng ng\u1ef1c.<\/p>\n<p><strong><i>H\u1ed3i s\u1ee9c<\/i><\/strong><\/p>\n<p>S\u1eed d\u1ee5ng oxy l\u01b0u l\u01b0\u1ee3ng cao (15 l\u00edt\/ph\u00fat) cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p ho\u1eb7c thi\u1ebfu oxy t\u1ed5 ch\u1ee9c<i>.\u00a0<\/i>Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 suy h\u00f4 h\u1ea5p c\u1ea7n \u0111\u01b0\u1ee3c th\u00f4ng kh\u00ed v\u1edbi oxy qua m\u1eb7t n\u1ea1 c\u00f3 van v\u00e0 t\u00fai ho\u1eb7c \u0111\u1eb7t \u1ed1ng NKQ v\u00e0 cho th\u1edf \u00e1p l\u1ef1c d\u01b0\u01a1ng ng\u1eaft qu\u00e3ng.<\/p>\n<h3><b>2.3. \u0110\u00e1nh gi\u00e1 tu\u1ea7n ho\u00e0n:<\/b><\/h3>\n<p><strong><i>\u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u<\/i><\/strong><\/p>\n<p>C\u00e1c b\u01b0\u1edbc \u0111\u00e1nh gi\u00e1 tu\u1ea7n ho\u00e0n \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3.<\/p>\n<p><strong><i>H\u1ed3i s\u1ee9c<\/i><\/strong><\/p>\n<p>T\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy tu\u1ea7n ho\u00e0n (s\u1ed1c) n\u00ean \u0111\u01b0\u1ee3c cho th\u1edf oxy qua m\u1eb7t n\u1ea1, ho\u1eb7c qua \u1ed1ng NKQ.<\/p>\n<p>S\u1eed d\u1ee5ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u01b0\u1eddng truy\u1ec1n trong x\u01b0\u01a1ng \u0111\u1ec3 truy\u1ec1n ngay dung d\u1ecbch \u0111i\u1ec7n gi\u1ea3i ho\u1eb7c dung d\u1ecbch keo v\u1edbi l\u01b0\u1ee3ng d\u1ecbch l\u00e0 20ml\/kg v\u00e0 l\u1ea5y c\u00e1c m\u1eabu m\u00e1u x\u00e9t nghi\u1ec7m ngay th\u1eddi \u0111i\u1ec3m n\u00e0y.<\/p>\n<h3><b>2.4. \u0110\u00e1nh gi\u00e1 th\u1ea7n kinh:<\/b><\/h3>\n<p><strong><i>\u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u<\/i><\/strong><\/p>\n<p>Tr\u01b0\u1edbc khi xem x\u00e9t c\u00e1c r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c c\u00f3 nguy\u00ean nh\u00e2n th\u1ea7n kinh, c\u1ea7n \u0111\u00e1nh gi\u00e1 theo ABC \u0111\u1ec3 ki\u1ec3m tra c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c nh\u01b0 thi\u1ebfu oxy t\u1ed5 ch\u1ee9c ho\u1eb7c s\u1ed1c c\u00f3 th\u1ec3 g\u00e2y ra r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c. Ngo\u00e0i ra, c\u1ea7n th\u1ef1c hi\u1ec7n ki\u1ec3m tra \u0111\u01b0\u1eddng m\u00e1u tr\u01b0\u1edbc khi x\u1eed l\u00fd c\u00e1c tr\u01b0\u1eddng h\u1ee3p tr\u1ebb suy gi\u1ea3m tri gi\u00e1c ho\u1eb7c co gi\u1eadt<\/p>\n<p><strong><i>H\u1ed3i s\u1ee9c<\/i><\/strong><\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c \u1edf m\u1ee9c \u0111\u1ed9 P ho\u1eb7c U (ch\u1ec9 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111au ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng), c\u1ea7n \u0111\u1eb7t \u1ed1ng NKQ \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng th\u1edf.<\/p>\n<p>\u0110\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, c\u1ea7n s\u1eed d\u1ee5ng dung d\u1ecbch glucoza 10% v\u1edbi li\u1ec1u 2ml\/kg. Tr\u01b0\u1edbc khi truy\u1ec1n dung d\u1ecbch, c\u1ea7n l\u1ea5y m\u1eabu m\u00e1u \u0111\u1ec3 x\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 c\u00e1c ch\u1ec9 s\u1ed1 kh\u00e1c.<\/p>\n<h2>3. \u0110\u00e1nh gi\u00e1 b\u01b0\u1edbc hai v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u <strong>tr\u1ebb c\u00f3 <\/strong><strong>d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng:<\/strong><\/h2>\n<p>Sau khi \u0111\u00e3 ti\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng, ta c\u00f3 th\u1ec3 ti\u1ebfp c\u1eadn \u0111\u1ebfn b\u01b0\u1edbc \u0111\u00e1nh gi\u00e1 b\u01b0\u1edbc hai. \u0110\u00e1nh gi\u00e1 b\u01b0\u1edbc hai bao g\u1ed3m h\u1ecfi b\u1ec7nh s\u1eed, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng v\u00e0 l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1eb7c hi\u1ec7u \u0111\u1ec3 hi\u1ec3u r\u00f5 h\u01a1n v\u1ec1 b\u1ec7nh c\u1ee7a tr\u1ebb v\u00e0 c\u00f3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t. Tuy nhi\u00ean, v\u00ec th\u1eddi gian c\u00f3 h\u1ea1n, vi\u1ec7c ti\u1ebfp c\u1eadn ph\u1ea3i t\u1eadp trung v\u00e0o nh\u1eefng v\u1ea5n \u0111\u1ec1 thi\u1ebft y\u1ebfu nh\u1ea5t.<\/p>\n<h3><b>3.1. H\u00f4 h\u1ea5p:<\/b><\/h3>\n<p><b> <\/b><i>\u0110\u00e1nh gi\u00e1 b\u01b0\u1edbc hai<\/i><\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p th\u01b0\u1eddng g\u1eb7p:<\/p>\n<table style=\"height: 716px;\" border=\"0\" width=\"561\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"284\"><b>Tri\u1ec7u ch\u1ee9ng<\/b><\/td>\n<td valign=\"top\" width=\"284\"><b>D\u1ea5u hi\u1ec7u<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"284\">Kh\u00f3 th\u1edf<\/p>\n<p>S\u1ed5 m\u0169i<\/p>\n<p>Ho<\/p>\n<p>Th\u1edf \u1ed3n \u00e0o (th\u1edf r\u00ean, th\u1edf r\u00edt, kh\u00f2 kh\u00e8&#8230;)<\/p>\n<p>Kh\u00e0n ti\u1ebfng<\/p>\n<p>Kh\u00f4ng u\u1ed1ng \u0111\u01b0\u1ee3c<\/p>\n<p>\u0110au b\u1ee5ng<\/p>\n<p>T\u00edm t\u00e1i<\/p>\n<p>Co r\u00fat l\u1ed3ng ng\u1ef1c<\/p>\n<p>\u0110au ng\u1ef1c<\/p>\n<p>Ng\u1eebng th\u1edf<\/p>\n<p>Kh\u00f4ng \u0103n \u0111\u01b0\u1ee3c<\/p>\n<p>Nh\u1ecbp th\u1edf nhi\u1ec5m toan<\/td>\n<td valign=\"top\" width=\"284\">Nh\u1ecbp th\u1edf nhanh<\/p>\n<p>Co r\u00fat l\u1ed3ng ng\u1ef1c<\/p>\n<p>Th\u1edf r\u00ean<\/p>\n<p>C\u00e1nh m\u0169i ph\u1eadp ph\u1ed3ng<\/p>\n<p>Th\u1edf r\u00edt<\/p>\n<p>Kh\u00f2 kh\u00e8<\/p>\n<p>L\u00e9p b\u00e9p th\u00e0nh ng\u1ef1c<\/p>\n<p>Kh\u00ed qu\u1ea3n b\u1ecb \u0111\u1ea9y l\u1ec7ch<\/p>\n<p>Ti\u1ebfng g\u00f5 b\u1ea5t th\u01b0\u1eddng<\/p>\n<p>Nghe ti\u1ebfng ran n\u1ed5<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"top\" width=\"568\"><b>X\u00e9t nghi\u1ec7m<\/b><\/p>\n<p>\u0110o l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh n\u1ebfu nghi ng\u1edd hen, ch\u1ee5p XQ ph\u1ed5i, kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch, \u0111\u1ed9 b\u00e3o ho\u00e0 oxy.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><i>\u0110i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u<\/i><\/strong><\/p>\n<p>Khi ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u, c\u00e1c bi\u1ec7n ph\u00e1p c\u1ea7n th\u1ef1c hi\u1ec7n ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a tr\u1ebb. C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u c\u00f3 th\u1ec3 bao g\u1ed3m:<\/p>\n<ul>\n<li>N\u1ebfu nghe th\u1ea5y ti\u1ebfng l\u1ecdc s\u1ecdc do \u0111\u01b0\u1eddng th\u1edf c\u00f3 nhi\u1ec1u d\u1ecbch th\u00ec ph\u1ea3i th\u1ef1c hi\u1ec7n h\u00fat \u0111\u1eddm d\u00e3i.<\/li>\n<li>Khi c\u00f3 ti\u1ebfng th\u1edf r\u00edt k\u1ebft h\u1ee3p v\u1edbi ho \u00f4ng \u1ed5ng v\u00e0 kh\u00f3 th\u1edf n\u1eb7ng th\u00ec ngh\u0129 \u0111\u1ebfn vi\u00eam t\u1eafc thanh qu\u1ea3n n\u1eb7ng, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00ed dung adrenalin 1\u2030 5ml v\u00e0 oxy.<\/li>\n<li>N\u1ebfu c\u00f3 ti\u1ebfng r\u00edt nh\u1eb9 v\u00e0 tr\u1ebb m\u1ec7t th\u00ec xem c\u00f3 vi\u00eam n\u1eafp thanh m\u00f4n kh\u00f4ng, tuy nhi\u00ean b\u1ec7nh n\u00e0y hi\u1ebfm g\u1eb7p. C\u00f3 th\u1ec3 li\u00ean h\u1ec7 b\u00e1c s\u1ef9 g\u00e2y m\u00ea \u0111\u1ec3 tr\u1ee3 gi\u00fap. Kh\u00f4ng n\u00ean c\u00f3 c\u00e1c can thi\u1ec7p th\u00f4 b\u1ea1o v\u00e0o \u0111\u01b0\u1eddng th\u1edf.<\/li>\n<li>N\u1ebfu b\u1ec7nh c\u1ee7a tr\u1ebb kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t v\u00e0 c\u00f3 ti\u1ec1n s\u1eed s\u1eb7c r\u00f5 th\u00ec ngh\u0129 \u0111\u1ebfn d\u1ecb v\u1eadt thanh qu\u1ea3n. Th\u1ef1c hi\u1ec7n c\u00e1c bi\u1ec7n ph\u00e1p \u0111\u1ec3 t\u1ed1ng d\u1ecb v\u1eadt ra ngo\u00e0i, n\u1ebfu kh\u00f4ng th\u00e0nh c\u00f4ng th\u00ec c\u1ea7n \u0111\u1ebfn b\u00e1c s\u1ef9 \u0111\u1ec3 soi thanh qu\u1ea3n g\u1eafp d\u1ecb v\u1eadt. Kh\u00f4ng \u0111\u01b0\u1ee3c can thi\u1ec7p th\u00f4 b\u1ea1o v\u00e0o \u0111\u01b0\u1eddng th\u1edf.<\/li>\n<li>N\u1ebfu ti\u1ebfng th\u1edf r\u00edt x\u1ea3y ra sau khi tr\u1ebb ti\u00eam ho\u1eb7c \u0103n ph\u1ea3i d\u1ecb nguy\u00ean th\u00ec ngh\u0129 \u0111\u1ebfn ph\u1ea3n v\u1ec7. C\u1ea7n th\u1ef1c hi\u1ec7n cho adrenalin 1\u2030 10mg\/kg, ti\u00eam b\u1eafp.<\/li>\n<li>\u0110\u1ed1i v\u1edbi tr\u1ebb b\u1ecb hen ph\u1ebf qu\u1ea3n, th\u1edf kh\u00f2 kh\u00e8, suy h\u00f4 h\u1ea5p n\u1eb7ng, l\u01b0u l\u01b0\u1ee3ng \u0111\u1ec9nh gi\u1ea3m ho\u1eb7c thi\u1ebfu oxy t\u1ed5 ch\u1ee9c th\u00ec ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00ed dung c\u00e1c thu\u1ed1c ch\u1ee7 v\u1eadn b2 v\u00e0 ipratropium v\u1edbi O2.<\/li>\n<li>\u0110\u1ed1i v\u1edbi tr\u1ebb b\u1ecb nhi\u1ec5m toan, c\u1ea7n l\u1ea5y m\u00e1u l\u00e0m kh\u00ed m\u00e1u v\u00e0 \u0111\u01b0\u1eddng m\u00e1u. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m toan do \u0111\u00e1i \u0111\u01b0\u1eddng b\u1eb1ng huy\u1ebft thanh m\u1eb7n 9 \u2030 v\u00e0 insulin.<\/li>\n<\/ul>\n<h3><b>3.2.Tu\u1ea7n ho\u00e0n (Circulation): <\/b><\/h3>\n<p><i>\u0110\u00e1nh gi\u00e1 b\u01b0\u1edbc hai:<\/i><\/p>\n<p>C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p:<\/p>\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"284\"><b>Tri\u1ec7u ch\u1ee9ng<\/b><\/td>\n<td valign=\"top\" width=\"284\"><b>D\u1ea5u hi\u1ec7u<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"284\">Kh\u00f3 th\u1edf<\/p>\n<p>S\u1ed1t<\/p>\n<p>Nh\u1ecbp tim nhanh<\/p>\n<p>\u0102n u\u1ed1ng kh\u00f3<\/p>\n<p>T\u00edm t\u00e1i<\/p>\n<p>Xanh xao<\/p>\n<p>Gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1<\/p>\n<p>T\u00ecnh tr\u1ea1ng ng\u1ee7 g\u00e0<\/p>\n<p>M\u1ea5t d\u1ecbch<\/p>\n<p>Thi\u1ec3u ni\u1ec7u<\/td>\n<td valign=\"top\" width=\"284\">Nh\u1ecbp tim nhanh<\/p>\n<p>Nh\u1ecbp tim ch\u1eadm<\/p>\n<p>R\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 bi\u00ean \u0111\u1ed9 m\u1ea1ch<\/p>\n<p>M\u00e0u s\u1eafc v\u00e0 t\u01b0\u1edbi m\u00e1u da b\u1ea5t th\u01b0\u1eddng<\/p>\n<p>Gi\u1ea3m HA<\/p>\n<p>T\u0103ng HA<\/p>\n<p>R\u1ed1i lo\u1ea1n nh\u1ecbp th\u1edf v\u00e0 bi\u00ean \u0111\u1ed9 th\u1edf<\/p>\n<p>Gan to<\/p>\n<p>Ph\u1ed5i c\u00f3 ran<\/p>\n<p>C\u00e1c ti\u1ebfng th\u1ed5i \u1edf tim<\/p>\n<p>Ph\u00f9 ngo\u1ea1i bi\u00ean<\/p>\n<p>T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"284\"><b>C\u00e1c x\u00e9t nghi\u1ec7m<\/b><\/td>\n<td valign=\"top\" width=\"284\"><b>\u00a0<\/b><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"top\" width=\"568\">Ur\u00ea, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, kh\u00ed m\u00e1u, XQ ph\u1ed5i, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, c\u00f4ng th\u1ee9c m\u00e1u, c\u1ea5y m\u00e1u.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><i>\u0110i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u<\/i><\/strong><\/p>\n<div class=\"ChatMessage_messageRow__7yIr2\">\n<div class=\"ChatMessage_messageWrapper__Zf87D\">\n<div class=\"Message_row___ur0Y\">\n<div class=\"Message_botMessageBubble__CPGMI \">\n<div class=\"Markdown_markdownContainer__UyYrv\">\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb s\u1ed1c v\u00e0 kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi l\u1ea7n b\u01a1m d\u1ecbch \u0111\u1ea7u ti\u00ean, c\u1ea7n th\u1ef1c hi\u1ec7n bolus d\u1ecbch \u0111\u1ec3 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng. N\u1ebfu sau l\u1ea7n b\u01a1m d\u1ecbch th\u1ee9 hai b\u1ec7nh nh\u00e2n v\u1eabn kh\u00f4ng \u0111\u00e1p \u1ee9ng, c\u1ea7n c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 \u0111\u1eb7t NKQ tr\u01b0\u1edbc khi th\u1ef1c hi\u1ec7n l\u1ea7n bolus d\u1ecbch th\u1ee9 ba.<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p tr\u1ebb b\u1ecb s\u1ed1c v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u m\u1ea5t n\u01b0\u1edbc, c\u1ea7n c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n m\u00e1u.<\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp tim, c\u1ea7n s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 lo\u1ea1n nh\u1ecbp th\u00edch h\u1ee3p \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c ph\u1ea3n v\u1ec7, c\u1ea7n s\u1eed d\u1ee5ng adrenalin TB v\u1edbi li\u1ec1u 10mcg\/kg v\u00e0 tu\u00e2n th\u1ee7 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb s\u1ed1c ph\u1ea3n v\u1ec7.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<h3><b>3.3. Th\u1ea7n kinh (disability)<\/b><\/h3>\n<p><i>\u0110\u00e1nh gi\u00e1 b\u01b0\u1edbc hai:\u00a0<\/i>C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p<\/p>\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"284\"><b>Tri\u1ec7u ch\u1ee9ng<\/b><\/td>\n<td valign=\"top\" width=\"284\"><b>D\u1ea5u hi\u1ec7u<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"284\">\u0110au \u0111\u1ea7u<\/p>\n<p>Co gi\u1eadt<\/p>\n<p>Thay \u0111\u1ed5i h\u00e0nh vi<\/p>\n<p>R\u1ed1i lo\u1ea1n \u00fd th\u1ee9c<\/p>\n<p>Gi\u1ea3m v\u1eadn \u0111\u1ed9ng<\/p>\n<p>R\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c<\/p>\n<p>S\u1ed1t<\/td>\n<td valign=\"top\" width=\"284\">R\u1ed1i lo\u1ea1n \u00fd th\u1ee9c<\/p>\n<p>Co gi\u1eadt<\/p>\n<p>K\u00edch th\u01b0\u1edbc \u0111\u1ed3ng t\u1eed v\u00e0 ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng<\/p>\n<p>thay \u0111\u1ed5i<\/p>\n<p>T\u01b0 th\u1ebf b\u1ea5t th\u01b0\u1eddng<\/p>\n<p>Ph\u1ea3n x\u1ea1 m\u1eaft \u2013 n\u00e3o b\u1ea5t th\u01b0\u1eddng<\/p>\n<p>C\u00e1c d\u1ea5u hi\u1ec7u m\u00e0ng n\u00e3o<\/p>\n<p>Ph\u00f9 gai th\u1ecb v\u00e0 xu\u1ea5t huy\u1ebft v\u00f5ng m\u1ea1c<\/p>\n<p>Ph\u1ea3n x\u1ea1 g\u00e2n x\u01b0\u01a1ng thay \u0111\u1ed5i<\/p>\n<p>T\u0103ng huy\u1ebft \u00e1p<\/p>\n<p>M\u1ea1ch ch\u1eadm<\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"284\"><b>X\u00e9t nghi\u1ec7m<\/b><\/td>\n<td valign=\"top\" width=\"284\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" valign=\"top\" width=\"568\">Ur\u00ea, \u0110G\u0110, \u0111\u01b0\u1eddng m\u00e1u, c\u1ea5y m\u00e1u (c\u00f3 ch\u1ecdn l\u1ecdc)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><i>\u0110i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u<\/i><\/strong><\/p>\n<p>N\u1ebfu tr\u1ebb b\u1ecb co gi\u1eadt k\u00e9o d\u00e0i, c\u1ea7n th\u1ef1c hi\u1ec7n ph\u00e1c \u0111\u1ed3 x\u1eed tr\u00ed tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng.<\/p>\n<p>N\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd nh\u01b0 m\u1ea5t \u00fd th\u1ee9c c\u1ea5p t\u00ednh, t\u01b0 th\u1ebf b\u1ea5t th\u01b0\u1eddng ho\u1eb7c ph\u1ea3n x\u1ea1 v\u1eadn \u0111\u1ed9ng nh\u00e3n c\u1ea7u b\u1ea5t th\u01b0\u1eddng, tr\u1ebb c\u1ea7n \u0111\u01b0\u1ee3c \u0111\u1eb7t \u1ed1ng NKQ v\u00e0 s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o. N\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng manitol v\u1edbi li\u1ec1u 0,5g\/kg t\u0129nh m\u1ea1ch \u0111\u1ec3 gi\u1ea3m \u00e1p l\u1ef1c n\u1ed9i s\u1ecd.<\/p>\n<p>N\u1ebfu tr\u1ebb c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ea3m tri gi\u00e1c ho\u1eb7c co gi\u1eadt, c\u1ea7n ngh\u0129 \u0111\u1ebfn kh\u1ea3 n\u0103ng b\u1ecb vi\u00eam m\u00e0ng n\u00e3o ho\u1eb7c vi\u00eam n\u00e3o v\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c cefotaxim\/acyclovir \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>N\u1ebfu tr\u1ebb c\u00f3 tri\u1ec7u ch\u1ee9ng l\u01a1 m\u01a1 v\u00e0 th\u1edf y\u1ebfu, c\u1ea7n ki\u1ec3m tra \u0111\u01b0\u1eddng m\u00e1u v\u00e0 l\u01b0\u1ee3ng salicylate trong m\u00e1u. N\u1ebfu ph\u00e1t hi\u1ec7n nhi\u1ec5m toan do \u0111\u00e1i \u0111\u01b0\u1eddng, c\u1ea7n s\u1eed d\u1ee5ng huy\u1ebft thanh m\u1eb7n 9\u2030 v\u00e0 insulin \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>N\u1ebfu tr\u1ebb h\u00f4n m\u00ea v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ed3ng t\u1eed co nh\u1ecf, c\u1ea7n ngh\u0129 \u0111\u1ebfn kh\u1ea3 n\u0103ng ng\u1ed9 \u0111\u1ed9c opiate v\u00e0 c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng naloxone \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng<\/p>\n<h3><b>3.4. Kh\u00e1m to\u00e0n th\u00e2n (exposure)<\/b><\/h3>\n<p><i>\u0110\u00e1nh gi\u00e1 b\u01b0\u1edbc hai<\/i><\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p<\/p>\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"top\" width=\"284\"><b>Tri\u1ec7u ch\u1ee9ng<\/b><\/td>\n<td valign=\"top\" width=\"284\"><b>D\u1ea5u hi\u1ec7u<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"top\" width=\"284\">Ban d\u1ecb \u1ee9ng<\/p>\n<p>S\u01b0ng m\u00f4i, l\u01b0\u1ee1i<\/p>\n<p>S\u1ed1t<\/td>\n<td valign=\"top\" width=\"284\">Ban ho\u1ea1i t\u1eed<\/p>\n<p>M\u00e0y \u0111ay<\/p>\n<p>Ph\u00f9 m\u1ea1ch<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><i>\u0110i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u<\/i><\/strong><\/p>\n<p>N\u1ebfu tr\u1ebb c\u00f3 tri\u1ec7u ch\u1ee9ng r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n v\u00e0 th\u1ea7n kinh, c\u00f3 ban xu\u1ea5t huy\u1ebft th\u00ec g\u1ee3i \u00fd c\u00f3 nhi\u1ec5m khu\u1ea9n huy\u1ebft ho\u1eb7c vi\u00eam m\u00e0ng n\u00e3o m\u1ee7, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng cefotaxim v\u00e0 c\u1ea5y m\u00e1u.<\/p>\n<p>N\u1ebfu tr\u1ebb c\u00f3 tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n, c\u00f3 ban m\u1ec1 \u0111ay ho\u1eb7c ph\u00f9 m\u1ea1ch th\u00ec g\u1ee3i \u00fd c\u00f3 s\u1ed1c ph\u1ea3n v\u1ec7, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng epinephrin 10 mcg\/kg ti\u00eam b\u1eafp.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>C\u00e1ch ti\u1ebfp c\u1eadn v\u00e0 x\u1eed tr\u00ed tr\u1ebb c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u \u0111e d\u1ecda t\u00ednh m\u1ea1ng cho ph\u00e9p th\u1ea7y thu\u1ed1c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh c\u1ee7a tr\u1ebb trong nh\u1eefng gi\u1edd \u0111\u1ea7u m\u1ed9t c\u00e1ch th\u00edch h\u1ee3p. \u0110\u00e1nh gi\u00e1 ban \u0111\u1ea7u v\u00e0 h\u1ed3i s\u1ee9c nh\u1eb1m duy tr\u00ec ch\u1ee9c n\u0103ng s\u1ed1ng c\u01a1 b\u1ea3n, \u0111\u00e1nh gi\u00e1 b\u01b0\u1edbc hai v\u00e0 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[15],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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