{"id":25829,"date":"2023-05-06T22:54:41","date_gmt":"2023-05-06T15:54:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25829"},"modified":"2023-05-14T00:08:50","modified_gmt":"2023-05-13T17:08:50","slug":"tiep-can-chan-doan-va-xu-tri-kho-tho-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/tiep-can-chan-doan-va-xu-tri-kho-tho-o-tre-em\/","title":{"rendered":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed kh\u00f3 th\u1edf \u1edf tr\u1ebb em"},"content":{"rendered":"

Kh\u00f3 th\u1edf l\u00e0 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p trong c\u1ea5p c\u1ee9u nhi khoa, nguy\u00ean nh\u00e2n g\u00e2y ra kh\u00f3 th\u1edf g\u1ed3m 3 lo\u1ea1i ch\u00ednh: Kh\u00f3 th\u1edf do t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf, kh\u00f3 th\u1edf do b\u1ec7nh tim ph\u1ed5i v\u00e0 kh\u00f3 th\u1edf do b\u1ec7nh l\u00fd ngo\u00e0i tim ph\u1ed5i (th\u1ea7n kinh, chuy\u1ec3n ho\u00e1\u2026.). Vi\u1ec7c ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed b\u1ec7nh nhi kh\u00f3 th\u1edf l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u00ednh m\u1ea1ng v\u00e0 s\u1ee9c kh\u1ecfe c\u1ee7a tr\u1ebb. Tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf \u1edf tr\u1ebb c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a nhi\u1ec1u b\u1ec7nh l\u00fd, t\u1eeb nh\u1eb9 \u0111\u1ebfn nghi\u00eam tr\u1ecdng. Do \u0111\u00f3, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed ch\u00ednh x\u00e1c l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u01b0a ra ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p cho tr\u1ebb em.<\/strong><\/p>\n

1.\u0110\u00e1nh gi\u00e1 v\u00e0 c\u1ea5p c\u1ee9u ban \u0111\u1ea7u kh\u00f3 th\u1edf \u1edf tr\u1ebb:<\/h2>\n

Vi\u1ec7c \u0111\u00e1nh gi\u00e1 v\u00e0 x\u1eed l\u00fd \u01b0u ti\u00ean theo th\u1ee9 t\u1ef1 A, B, C, D, E<\/strong>:<\/p>\n

1.1.\u0110\u01b0\u1eddng th\u1edf: (A)<\/h3>\n

1.1.1. \u0110\u00e1nh gi\u00e1<\/h4>\n

S\u1eed d\u1ee5ng k\u1ef9 n\u0103ng “Nh\u00ecn – Nghe – C\u1ea3m nh\u1eadn” \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 th\u00f4ng tho\u00e1ng c\u1ee7a \u0111\u01b0\u1eddng th\u1edf. B\u1eb1ng c\u00e1ch nh\u00ecn s\u1ef1 di chuy\u1ec3n c\u1ee7a l\u1ed3ng ng\u1ef1c v\u00e0 b\u1ee5ng, nghe ti\u1ebfng th\u1edf v\u00e0 c\u1ea3m nh\u1eadn h\u01a1i th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

N\u1ebfu tr\u1ebb c\u00f2n c\u00f3 th\u1ec3 n\u00f3i chuy\u1ec7n ho\u1eb7c kh\u00f3c r\u00f5 r\u00e0ng, th\u00ec \u0111\u01b0\u1eddng th\u1edf th\u00f4ng tho\u00e1ng.<\/p>\n

N\u1ebfu l\u1ed3ng ng\u1ef1c di chuy\u1ec3n k\u00e9m, kh\u00f4ng c\u00f3 kh\u00ed l\u01b0u th\u00f4ng, ch\u1ee9ng t\u1ecf \u0111\u01b0\u1eddng th\u1edf b\u1ecb t\u1eafc ho\u1eb7c tr\u1ebb suy th\u1edf n\u1eb7ng.<\/p>\n

N\u1ebfu c\u00f3 ti\u1ebfng r\u00edt thanh qu\u1ea3n (Stridor), c\u1ea7n ngh\u0129 \u0111\u1ebfn kh\u1ea3 n\u0103ng t\u1eafc \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean.<\/p>\n

1.1.2. X\u1eed l\u00fd<\/h4>\n
    \n
  • N\u1ebfu \u0111\u01b0\u1eddng th\u1edf b\u1ecb t\u1eafc, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt m\u1edf th\u00f4ng \u0111\u01b0\u1eddng th\u1edf b\u1eb1ng c\u00e1ch ng\u1eeda \u0111\u1ea7u, n\u00e2ng c\u1eb1m ho\u1eb7c \u1ea5n-n\u00e2ng g\u00f3c h\u00e0m.<\/li>\n
  • N\u1ebfu c\u1ea7n thi\u1ebft, \u0111\u1eb7t canuyn mi\u1ec7ng-h\u1ecdng ho\u1eb7c m\u0169i-h\u1ecdng.<\/li>\n
  • Trong tr\u01b0\u1eddng h\u1ee3p c\u00e1c bi\u1ec7n ph\u00e1p tr\u00ean kh\u00f4ng th\u00e0nh c\u00f4ng, c\u00f3 th\u1ec3 \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n (NKQ).<\/li>\n
  • \u0110\u00f4i khi, \u0111\u1ec3 c\u1ee9u s\u1ed1ng b\u1ec7nh nh\u00e2n, ph\u1ea3i th\u1ef1c hi\u1ec7n ch\u1ecdc catheter qua s\u1ee5n nh\u1eabn gi\u00e1p ho\u1eb7c m\u1edf kh\u00ed qu\u1ea3n<\/li>\n<\/ul>\n
    \"Kh\u00f3
    Kh\u00f3 th\u1edf \u1edf tr\u1ebb<\/figcaption><\/figure>\n

    1.2. Th\u1edf: (B)<\/h3>\n

    1.2.1. \u0110\u00e1nh gi\u00e1: \u0111\u00e1nh gi\u00e1 xem b\u1ec7nh nh\u00e2n th\u1edf c\u00f3 \u0111\u1ea3m b\u1ea3o kh\u00f4ng d\u1ef1a v\u00e0o:<\/h4>\n

    \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 xem b\u1ec7nh nh\u00e2n th\u1edf c\u00f3 \u0111\u1ea3m b\u1ea3o kh\u00f4ng, c\u1ea7n quan s\u00e1t c\u00e1c ch\u1ec9 s\u1ed1 sau:<\/p>\n

      \n
    • Th\u1edf g\u1eafng s\u1ee9c.<\/li>\n
    • S\u1ef1 co r\u00fat: d\u1ea5u hi\u1ec7u th\u01b0\u1eddng g\u1eb7p trong kh\u00f3 th\u1edf, khi c\u00f3 bi\u1ec3u hi\u1ec7n s\u1ef1 r\u00fat l\u00f5m tr\u00ean x\u01b0\u01a1ng \u1ee9c th\u00ec th\u01b0\u1eddng c\u00f3 t\u1eafc ngh\u1ebdn c\u1ee7a \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean.<\/li>\n
    • T\u1ea7n s\u1ed1 th\u1edf: t\u0103ng khi c\u00f3 kh\u00f3 th\u1edf, nh\u01b0ng khi t\u1ea7n s\u1ed1 th\u1edf gi\u1ea3m xu\u1ed1ng r\u1ed3i ch\u1eadm l\u1ea1i l\u00e0 d\u1ea5u hi\u1ec7u n\u1eb7ng l\u00ean.<\/li>\n
    • Ti\u1ebfng th\u1edf r\u00edt trong th\u00ec th\u1edf v\u00e0o (Stridor) – bi\u1ec3u hi\u1ec7n t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, ti\u1ebfng kh\u00f2 kh\u00e8 trong th\u00ec th\u1edf ra bi\u1ec3u hi\u1ec7n trong t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p d\u01b0\u1edbi (hen, vi\u00ean ti\u1ec3u ph\u1ebf qu\u1ea3n).<\/li>\n
    • Th\u1edf r\u00ean: th\u01b0\u1eddng g\u1eb7p trong kh\u00f3 th\u1edf \u1edf tr\u1ebb s\u01a1 sinh.<\/li>\n
    • S\u1eed d\u1ee5ng c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5 m\u1ed7i l\u1ea7n th\u1edf.<\/li>\n
    • C\u00e1nh m\u0169i ph\u1eadp ph\u1ed3ng.<\/li>\n
    • T\u01b0 th\u1ebf c\u1ee7a tr\u1ebb: khi b\u1ecb kh\u00f3 th\u1edf tr\u1ebb th\u01b0\u1eddng t\u00ecm m\u1ed9t t\u01b0 th\u1ebf th\u00edch h\u1ee3p \u0111\u1ec3 l\u00e0m gi\u1ea3m s\u1ef1 kh\u00f3 th\u1edf – nh\u1ea5t l\u00e0 trong khi kh\u00f3 th\u1edf do t\u1eafc ngh\u1ebdn (d\u1ecb t\u1eadt, vi\u00eam thanh qu\u1ea3n, hen, vi\u00eam n\u1eafp thanh m\u00f4n).<\/li>\n
    • Khi b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n ki\u1ec7t s\u1ee9c, (gi\u1ea3m s\u1ef1 g\u1eafng s\u1ee9c, t\u1ea7n s\u1ed1 th\u1edf gi\u1ea3m, gi\u1ea3m th\u00f4ng kh\u00ed hai ph\u1ed5i) b\u00e1o hi\u1ec7u b\u1ec7nh nhi \u0111ang trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch.<\/li>\n<\/ul>\n

      Hi\u1ec7u qu\u1ea3 c\u1ee7a th\u1edf:<\/strong>
      \n\u0110\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a th\u1edf, c\u1ea7n quan s\u00e1t c\u00e1c ch\u1ec9 s\u1ed1 sau:<\/p>\n

        \n
      • Nghe ti\u1ebfng th\u1edf: \u0111\u00e1nh gi\u00e1 th\u00f4ng kh\u00ed c\u1ee7a hai b\u00ean ph\u1ed5i v\u00e0 \u0111\u01b0\u1eddng th\u1edf.<\/li>\n
      • S\u1ef1 d\u00e3n n\u1edf c\u1ee7a l\u1ed3ng ng\u1ef1c v\u00e0 di \u0111\u1ed9ng c\u1ee7a b\u1ee5ng (nh\u1ea5t l\u00e0 \u1edf tr\u1ebb nh\u1ecf).<\/li>\n
      • \u0110\u1ed9 b\u00e3o ho\u00e0 oxy m\u1ea1ch m\u00e1u (s\u1eed d\u1ee5ng pulse oximeter).<\/li>\n
      • Bi\u1ec3u hi\u1ec7n ph\u1ed5i c\u00e2m (gi\u1ea3m, m\u1ea5t r\u00ec r\u00e0o ph\u1ebf nang, di \u0111\u1ed9ng l\u1ed3ng ng\u1ef1c gi\u1ea3m ho\u1eb7c kh\u00f4ng di \u0111\u1ed9ng). \u0110\u1ed9 b\u00e3o ho\u00e0 oxy < 85% khi th\u1edf kh\u00ed tr\u1eddi, b\u00e1o hi\u1ec7u b\u1ec7nh nh\u00e2n trong t\u00ecnh tr\u1ea1ng nguy k\u1ecbch.<\/li>\n<\/ul>\n

        \u1ea2nh h\u01b0\u1edfng c\u1ee7a suy th\u1edf l\u00ean c\u00e1c ch\u1ee9c n\u0103ng kh\u00e1c:<\/strong>
        \nSuy th\u1edf c\u00f2n c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e1c ch\u1ee9c n\u0103ng kh\u00e1c, c\u1ea7n quan s\u00e1t c\u00e1c ch\u1ec9 s\u1ed1 sau:<\/p>\n

          \n
        • \n
            \n
          • T\u1ea7n s\u1ed1 tim: m\u1ea1ch nhanh.<\/li>\n
          • M\u00e0u s\u1eafc da: t\u00edm t\u00e1i.<\/li>\n
          • T\u00ecnh tr\u1ea1ng th\u1ea7n kinh: k\u00edch th\u00edch, v\u1eadt v\u00e3, h\u00f4n m\u00ea – bi\u1ec3u hi\u1ec7n c\u00e1c m\u1ee9c \u0111\u1ed9 thi\u1ebfu oxy n\u00e3o.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

            1.2.2. X\u1eed tr\u00ed kh\u00f3 th\u1edf \u1edf tr\u1ebb<\/strong><\/h4>\n

            T\u1ea5t c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb kh\u00f3 th\u1edf \u0111\u1ec1u ph\u1ea3i \u0111\u01b0\u1ee3c cung c\u1ea5p oxy l\u01b0u l\u01b0\u1ee3ng cao: qua m\u1eb7t n\u1ea1 NCPAP, \u1ed1ng th\u00f4ng m\u0169i, g\u1ecdng oxy..<\/p>\n

            V\u1edbi b\u1ec7nh nh\u00e2n gi\u1ea3m th\u00f4ng kh\u00ed, th\u1edf kh\u00f4ng \u0111\u1ea3m b\u1ea3o th\u00ec ph\u1ea3i \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p b\u1eb1ng b\u00f3p b\u00f3ng qua m\u1eb7t n\u1ea1 ho\u1eb7c qua \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, ho\u1eb7c cho th\u1edf m\u00e1y.<\/p>\n

            1.3. Tu\u1ea7n ho\u00e0n: (C)<\/h3>\n

            1.3.1 \u0110\u00e1nh gi\u00e1:<\/h4>\n

            \u0110\u1ec3 x\u00e1c \u0111\u1ecbnh xem tu\u1ea7n ho\u00e0n c\u00f3 \u0111\u1ea3m b\u1ea3o hay kh\u00f4ng, c\u1ea7n quan s\u00e1t c\u00e1c ch\u1ec9 s\u1ed1 sau:<\/p>\n

            T\u00ecnh tr\u1ea1ng tim m\u1ea1ch:<\/strong><\/p>\n

              \n
            • \n
                \n
              • T\u1ea7n s\u1ed1 v\u00e0 nh\u1ecbp tim.<\/li>\n
              • \u0110\u1ed9 n\u1ea3y c\u1ee7a m\u1ea1ch.<\/li>\n
              • Th\u1eddi gian tr\u1edf v\u1ec1 c\u1ee7a m\u00e1u mao m\u1ea1ch.<\/li>\n
              • Huy\u1ebft \u00e1p. Khi huy\u1ebft \u00e1p h\u1ea1 l\u00e0 d\u1ea5u hi\u1ec7u nguy k\u1ecbch.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                \u1ea2nh h\u01b0\u1edfng c\u1ee7a tu\u1ea7n ho\u00e0n l\u00ean c\u01a1 quan kh\u00e1c:<\/strong><\/p>\n

                  \n
                • Nh\u1ecbp th\u1edf v\u00e0 ki\u1ec3u th\u1edf.<\/li>\n
                • M\u00e0u s\u1eafc da v\u00e0 th\u00e2n nhi\u1ec7t: bi\u1ec3u hi\u1ec7n t\u00edm t\u00e1i trung \u01b0\u01a1ng kh\u00f4ng c\u1ea3i thi\u1ec7n khi cho b\u1ec7nh nh\u00e2n th\u1edf oxy l\u01b0u l\u01b0\u1ee3ng cao c\u00f3 th\u1ec3 g\u1ee3i \u00fd b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh tim b\u1ea9m sinh c\u00f3 shunt ph\u1ea3i tr\u00e1i.<\/li>\n
                • T\u00ecnh tr\u1ea1ng tinh th\u1ea7n kinh.<\/li>\n
                • L\u01b0\u1ee3ng b\u00e0i ni\u1ec7u.<\/li>\n
                • D\u1ea5u hi\u1ec7u suy tim: b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f3 th\u1edf do b\u1ec7nh c\u1ee7a tim c\u00f3 suy tim.<\/li>\n
                • T\u1ea7n s\u1ed1 tim nhanh, c\u00f3 th\u1ec3 c\u00f3: nh\u1ecbp ng\u1ef1a phi, nghe tim c\u00f3 ti\u1ebfng th\u1ed5i.<\/li>\n
                • T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i (\u00edt th\u1ea5y \u1edf tr\u1ebb b\u00fa m\u1eb9).<\/li>\n
                • Nghe ph\u1ed5i c\u00f3 ran \u1ea9m.<\/li>\n
                • Gan to.<\/li>\n<\/ul>\n

                  1.3.2 X\u1eed tr\u00ed<\/h4>\n

                  \u0110\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n suy tu\u1ea7n ho\u00e0n (s\u1ed1c), c\u1ea7n cung c\u1ea5p oxy l\u01b0u l\u01b0\u1ee3ng cao b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 m\u0169i, m\u1eb7t n\u1ea1, ho\u1eb7c \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n. Sau \u0111\u00f3, truy\u1ec1n dung d\u1ecbch \u0111i\u1ec7n gi\u1ea3i ho\u1eb7c dung d\u1ecbch cao ph\u00e2n t\u1eed (20ml\/kg) \u0111\u1ec3 h\u1ed3i ph\u1ee5c kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n, tr\u1eeb tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u suy tim. Ngo\u00e0i ra, c\u1ea7n l\u1ea5y m\u1eabu m\u00e1u \u0111\u1ec3 th\u1ef1c hi\u1ec7n m\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m c\u1ea7n thi\u1ebft nh\u01b0 c\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ur\u00ea, creatinin, nh\u00f3m m\u00e1u, kh\u00ed m\u00e1u, c\u1ea5y m\u00e1u…<\/p>\n

                  1.4. Th\u1ea7n kinh: (D)<\/h3>\n

                  1.4.1. \u0110\u00e1nh gi\u00e1<\/h4>\n

                  \u0110\u1ec3 \u0111\u00e1nh gi\u00e1 tri gi\u00e1c c\u1ee7a b\u1ec7nh nh\u00e2n, s\u1eed d\u1ee5ng thang \u0111i\u1ec3m AVPU (t\u1ec9nh – \u0111\u00e1p \u1ee9ng v\u1edbi l\u1eddi n\u00f3i – ch\u1ec9 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111au – kh\u00f4ng \u0111\u00e1p \u1ee9ng). Khi b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch \u0111au, c\u1ea7n c\u00f3 bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p. Trong qu\u00e1 tr\u00ecnh kh\u00e1m, c\u1ea7n \u0111o k\u00edch th\u01b0\u1edbc ph\u1ea3n x\u1ea1 c\u1ee7a \u0111\u1ed3ng t\u1eed v\u00e0 quan s\u00e1t t\u01b0 th\u1ebf n\u1eb1m c\u1ee7a tr\u1ebb \u0111\u1ec3 ph\u00e1t hi\u1ec7n co gi\u1eadt do suy th\u1edf. N\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m tri gi\u00e1c ho\u1eb7c c\u00f3 co gi\u1eadt, c\u1ea7n x\u00e1c \u0111\u1ecbnh n\u1ed3ng \u0111\u1ed9 glucose trong m\u00e1u.<\/p>\n

                  1.4.2. X\u1eed l\u00fd<\/h4>\n
                    \n
                  • B\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m tri gi\u00e1c, kh\u00f4ng ho\u1eb7c ch\u1ec9 \u0111\u00e1p \u1ee9ng v\u1edbi k\u00edch th\u00edch \u0111au c\u1ea7n ph\u1ea3i \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o s\u1ef1 th\u00f4ng su\u1ed1t c\u1ee7a \u0111\u01b0\u1eddng th\u1edf.<\/li>\n
                  • B\u1ec7nh nh\u00e2n nghi ng\u1edd gi\u1ea3m glucose m\u00e1u c\u1ea7n ti\u00eam dung d\u1ecbch glucose 10% ho\u1eb7c 20% v\u1edbi li\u1ec1u l\u01b0\u1ee3ng 0,5 g\/kg (tr\u01b0\u1edbc \u0111\u00f3 ph\u1ea3i l\u1ea5y m\u00e1u \u0111\u1ec3 \u0111\u1ecbnh l\u01b0\u1ee3ng \u0111\u01b0\u1eddng m\u00e1u).<\/li>\n
                  • S\u1eed d\u1ee5ng lorazepam ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c diazepam b\u01a1m, th\u1ee5t h\u1eadu m\u00f4n khi b\u1ec7nh nh\u00e2n b\u1ecb co gi\u1eadt.<\/li>\n<\/ul>\n

                    1.5 Kh\u00e1m to\u00e0n th\u00e2n: (E)<\/h3>\n
                      \n
                    • Ch\u00fa \u00fd l\u1ea5y nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3: n\u1ebfu s\u1ed1t th\u00ec g\u1ee3i \u00fd tr\u1ebb c\u00f3 th\u1ec3 b\u1ecb nhi\u1ec5m khu\u1ea9n (tuy v\u1eady khi kh\u00f4ng b\u1ecb s\u1ed1t c\u0169ng ch\u01b0a lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n n\u00e0y).<\/li>\n
                    • Ph\u00e1t hi\u1ec7n ban tr\u00ean da: n\u1ebfu l\u00e0 ban s\u1ea9n m\u1ec1 \u0111ay ph\u1ea3i nghi ng\u1edd tr\u1ebb b\u1ecb ph\u1ea3n v\u1ec7.<\/li>\n<\/ul>\n

                      2. Ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n g\u00e2y kh\u00f3 th\u1edf \u1edf tr\u1ebb:<\/h2>\n

                      \u0110\u1ed3ng th\u1eddi v\u1edbi vi\u1ec7c \u0111\u00e1nh gi\u00e1 v\u00e0 c\u1ea5p c\u1ee9u ban \u0111\u1ea7u c\u1ea7n ph\u1ea3i h\u1ecfi b\u1ec7nh s\u1eed c\u1ee7a tr\u1ebb, \u00edt nh\u1ea5t l\u00e0 trong 24 gi\u1edd tr\u01b0\u1edbc khi tr\u1ebb \u0111\u01b0\u1ee3c c\u1ea5p c\u1ee9u. K\u1ebft h\u1ee3p v\u1edbi k\u1ebft qu\u1ea3 c\u00e1c x\u00e9t nghi\u1ec7m c\u00f3 \u0111\u01b0\u1ee3c, vi\u1ec7c ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n kh\u00f3 th\u1edf c\u00f3 th\u1ec3 d\u1ef1a v\u00e0o c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a tr\u1ebb.<\/p>\n

                      3. \u0110\u00e1nh gi\u00e1 l\u1ea1i v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u theo nguy\u00ean nh\u00e2n g\u00e2y kh\u00f3 th\u1edf \u1edf tr\u1ebb<\/h2>\n

                      Sau b\u01b0\u1edbc c\u1ea5p c\u1ee9u v\u00e0 \u0111\u00e1nh gi\u00e1 ban \u0111\u1ea7u, t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n t\u1ea1m \u1ed5n \u0111\u1ecbnh, nguy\u00ean nh\u00e2n kh\u00f3 th\u1edf \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh. B\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c kh\u00e1m, \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u1ec9 m\u1ec9 h\u01a1n. L\u00fac n\u00e0y m\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m m\u00e1u, c\u1eadn l\u00e2m s\u00e0ng (X- quang, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, kh\u00ed m\u00e1u\u2026) c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m th\u00eam \u0111\u1ec3 gi\u00fap cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n, \u0111i\u1ec1u tr\u1ecb v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n theo nguy\u00ean nh\u00e2n.Tuy v\u1eady, trong giai \u0111o\u1ea1n n\u00e0y b\u1ec7nh nhi v\u1eabn lu\u00f4n \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t c\u00e1c ch\u1ee9c n\u0103ng s\u1ed1ng (h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n, tinh th\u1ea7n kinh, th\u00e2n nhi\u1ec7t\u2026) n\u1ebfu c\u00f3 r\u1ed1i lo\u1ea1n n\u00e0o th\u00ec ph\u1ea3i ti\u1ebfn h\u00e0nh \u0111\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u ban \u0111\u1ea7u l\u1ea1i.<\/p>\n

                      3.1 \u0110i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u<\/h3>\n

                      N\u1ebfu nghe th\u1ea5y ti\u1ebfng “l\u1ecdc x\u1ecdc” trong mi\u1ec7ng b\u1ec7nh nh\u00e2n, \u0111\u01b0\u1eddng th\u1edf c\u00f3 nhi\u1ec1u ch\u1ea5t d\u1ecbch ti\u1ebft, c\u1ea7n h\u00fat s\u1ea1ch.<\/p>\n

                      N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 th\u1edf r\u00edt thanh qu\u1ea3n v\u00e0 bi\u1ec3u hi\u1ec7n suy th\u1edf n\u1eb7ng, c\u00f3 th\u1ec3 do vi\u00eam thanh qu\u1ea3n n\u1eb7ng, c\u1ea7n cho b\u1ec7nh nh\u00e2n th\u1edf kh\u00ed dung adrenalin.<\/p>\n

                      N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ebfng th\u1edf r\u00edt thanh qu\u1ea3n nh\u1eb9 nh\u01b0ng t\u00ecnh tr\u1ea1ng chung c\u1ee7a tr\u1ebb r\u1ea5t n\u1eb7ng, c\u00f3 kh\u1ea3 n\u0103ng tr\u1ebb b\u1ecb vi\u00eam n\u1eafp thanh qu\u1ea3n c\u1ea7n cho kh\u00e1ng sinh, corticoid v\u00e0 \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n c\u1ea5p c\u1ee9u.<\/p>\n

                      N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 di\u1ec5n bi\u1ebfn b\u1ec7nh \u0111\u1ed9t ng\u1ed9t ho\u1eb7c th\u1edf r\u00edt thanh qu\u1ea3n sau khi u\u1ed1ng ho\u1eb7c ti\u00eam thu\u1ed1c, c\u1ea7n ngh\u0129 \u0111\u1ebfn nguy\u00ean nh\u00e2n ph\u1ea3n v\u1ec7 v\u00e0 ti\u00eam b\u1eafp adrenalin.<\/p>\n

                      \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed hen ph\u1ebf qu\u1ea3n ho\u1eb7c th\u1edf kh\u00f2 kh\u00e8 c\u00f3 suy th\u1edf n\u1eb7ng, c\u1ea7n cho kh\u00ed dung ventolin v\u00e0 Ipratropium v\u1edbi oxy. \u1ede tr\u1ebb b\u00fa m\u1eb9 c\u00f3 th\u1ec3 do vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n, ch\u1ec9 c\u1ea7n th\u1edf oxy.<\/p>\n

                      3.2. \u0110i\u1ec1u tr\u1ecb \u1ed5n \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng v\u00e0 v\u1eadn chuy\u1ec3n an to\u00e0n b\u1ec7nh nh\u00e2n<\/h3>\n

                      Sau khi \u0111\u01b0\u1ee3c c\u1ea5p c\u1ee9u, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c gi\u00e1m s\u00e1t th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng. Quy\u1ebft \u0111\u1ecbnh ti\u1ebfp theo nh\u01b0 chuy\u1ec3n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, chuy\u1ec3n \u0111i\u1ec1u tr\u1ecb chuy\u00ean khoa hay chuy\u1ec3n vi\u1ec7n ph\u1ee5 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n v\u00e0 \u0111i\u1ec1u ki\u1ec7n c\u1ee7a c\u01a1 s\u1edf y t\u1ebf ti\u1ebfp nh\u1eadn. Khi chuy\u1ec3n b\u1ec7nh nh\u00e2n, c\u1ea7n \u0111\u1ea3m b\u1ea3o an to\u00e0n cho b\u1ec7nh nh\u00e2n b\u1eb1ng c\u00e1ch \u0111\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh, li\u00ean l\u1ea1c ch\u1eb7t ch\u1ebd v\u1edbi n\u01a1i b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u1ebfn v\u00e0 ti\u1ebfp t\u1ee5c duy tr\u00ec ch\u1ee9c n\u0103ng s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n trong qu\u00e1 tr\u00ecnh v\u1eadn chuy\u1ec3n.<\/p>\n

                      Vi\u1ec7c ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed b\u1ec7nh nhi kh\u00f3 th\u1edf l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o t\u00ednh m\u1ea1ng v\u00e0 s\u1ee9c kh\u1ecfe c\u1ee7a tr\u1ebb. Vi\u1ec7c khuy\u1ebfn kh\u00edch s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a c\u00e1c ph\u01b0\u01a1ng ph\u00e1p m\u1edbi \u0111\u1ec3 c\u1ea3i thi\u1ec7n vi\u1ec7c ti\u1ebfp c\u1eadn v\u00e0 \u0111i\u1ec1u tr\u1ecb cho tr\u1ebb em kh\u00f3 th\u1edf l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 t\u0103ng c\u01b0\u1eddng kh\u1ea3 n\u0103ng ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn tri\u1ec7u ch\u1ee9ng kh\u00f3 th\u1edf \u1edf tr\u1ebb em.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

                      Kh\u00f3 th\u1edf l\u00e0 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p trong c\u1ea5p c\u1ee9u nhi khoa, nguy\u00ean nh\u00e2n g\u00e2y ra kh\u00f3 th\u1edf g\u1ed3m 3 lo\u1ea1i ch\u00ednh: Kh\u00f3 th\u1edf do t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf, kh\u00f3 th\u1edf do b\u1ec7nh tim ph\u1ed5i v\u00e0 kh\u00f3 th\u1edf do b\u1ec7nh l\u00fd ngo\u00e0i tim ph\u1ed5i (th\u1ea7n kinh, chuy\u1ec3n ho\u00e1\u2026.). Vi\u1ec7c ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed […]<\/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":"\nTi\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed kh\u00f3 th\u1edf \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"Kh\u00f3 th\u1edf \u1edf tr\u1ebb l\u00e0 bi\u1ec3u hi\u1ec7n th\u01b0\u1eddng g\u1eb7p trong c\u1ea5p c\u1ee9u, nguy\u00ean nh\u00e2n g\u1ed3m 3 lo\u1ea1i ch\u00ednh: t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng th\u1edf, b\u1ec7nh tim ph\u1ed5i, b\u1ec7nh l\u00fd ngo\u00e0i tim ph\u1ed5i\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u1eed tr\u00ed kh\u00f3 th\u1edf \u1edf tr\u1ebb em - 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