{"id":25833,"date":"2023-05-06T15:56:26","date_gmt":"2023-05-06T08:56:26","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25833"},"modified":"2023-05-06T15:56:26","modified_gmt":"2023-05-06T08:56:26","slug":"ngung-tho-ngung-tim-o-tre-em","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/06\/ngung-tho-ngung-tim-o-tre-em\/","title":{"rendered":"Ng\u01b0ng th\u1edf ng\u01b0ng tim \u1edf tr\u1ebb em"},"content":{"rendered":"<p><strong>Ng\u01b0ng th\u1edf \u1edf tr\u1ebb em th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p c\u1ea5p. Ng\u01b0ng tim th\u01b0\u1eddng sau ng\u01b0ng th\u1edf. N\u00e3o s\u1ebd b\u1ecb t\u1ed5n th\u01b0\u01a1ng khi ng\u01b0ng th\u1edf ng\u01b0ng tim tr\u00ean 4 ph\u00fat v\u00e0 n\u1ebfu tr\u00ean 10 ph\u00fat th\u01b0\u1eddng t\u1eed vong, n\u1ebfu s\u1ed1ng s\u1ebd \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng n\u00e3o n\u1eb7ng n\u1ec1. V\u00ec th\u1ebf khi ng\u01b0ng th\u1edf ng\u01b0ng tim c\u1ea7n nhanh ch\u00f3ng x\u1eed tr\u00ed \u0111\u1ec3 cung c\u1ea5p oxy v\u00e0 m\u00e1u cho n\u00e3o.<\/strong><\/p>\n<h2>1. \u0110\u1ea1i c\u01b0\u01a1ng ng\u01b0ng th\u1edf ng\u01b0ng tim:<\/h2>\n<p>Ng\u01b0ng th\u1edf \u1edf tr\u1ebb em th\u01b0\u1eddng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a suy h\u00f4 h\u1ea5p c\u1ea5p. Th\u01b0\u1eddng sau \u0111\u00f3 l\u00e0 ng\u01b0ng tim.<\/p>\n<p>N\u1ebfu ng\u01b0ng th\u1edf v\u00e0 ng\u01b0ng tim k\u00e9o d\u00e0i tr\u00ean 4 ph\u00fat, n\u00e3o s\u1ebd b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong s\u1ebd cao h\u01a1n khi k\u00e9o d\u00e0i tr\u00ean 10 ph\u00fat. N\u1ebfu s\u1ed1ng s\u00f3t, tr\u1ebb c\u00f3 th\u1ec3 \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng n\u00e3o n\u1eb7ng n\u1ec1. V\u00ec v\u1eady, c\u1ea7n cung c\u1ea5p oxy v\u00e0 m\u00e1u cho n\u00e3o nhanh ch\u00f3ng trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y.<\/p>\n<p>C\u00f3 hai lo\u1ea1i h\u1ed3i s\u1ee9c:<\/p>\n<ul>\n<li><strong>H\u1ed3i s\u1ee9c c\u01a1 b\u1ea3n:<\/strong> th\u1ef1c hi\u1ec7n t\u1ea1i hi\u1ec7n tr\u01b0\u1eddng v\u00e0 kh\u00f4ng s\u1eed d\u1ee5ng d\u1ee5ng c\u1ee5.<\/li>\n<li><strong>H\u1ed3i s\u1ee9c ti\u1ebfn b\u1ed9<\/strong>: th\u1ef1c hi\u1ec7n t\u1ea1i c\u00e1c c\u01a1 s\u1edf y t\u1ebf ho\u1eb7c tr\u00ean xe c\u1ee9u th\u01b0\u01a1ng v\u1edbi s\u1ef1 h\u1ed7 tr\u1ee3 c\u1ee7a d\u1ee5ng c\u1ee5 v\u00e0 thu\u1ed1c c\u1ea5p c\u1ee9u.<\/li>\n<\/ul>\n<h2>2. H\u1ed3i s\u1ee9c c\u01a1 b\u1ea3n ng\u01b0ng th\u1edf ng\u01b0ng tim<\/h2>\n<h3>2.1 Ch\u1ea9n \u0111o\u00e1n ng\u01b0ng th\u1edf ng\u01b0ng tim<\/h3>\n<p>&#8211; H\u00f4n m\u00ea: lay g\u1ecdi kh\u00f4ng t\u1ec9nh<\/p>\n<p>&#8211; L\u1ed3ng ng\u1ef1c kh\u00f4ng di \u0111\u1ed9ng<\/p>\n<p>&#8211; Kh\u00f4ng c\u00f3 m\u1ea1ch trung t\u00e2m<\/p>\n<h3>2.2 H\u1ed3i s\u1ee9c c\u01a1 b\u1ea3n<\/h3>\n<p>Th\u1ef1c hi\u1ec7n t\u1ea1i n\u01a1i x\u1ea3y ra tai n\u1ea1n ngo\u00e0i b\u1ec7nh vi\u1ec7n<\/p>\n<p><strong>Nguy\u00ean t\u1eafc:<\/strong> nhanh v\u00e0 theo th\u1ee9 t\u1ef1 A, B, C<\/p>\n<ul>\n<li>Th\u00f4ng \u0111\u01b0\u1eddng th\u1edf (Airway)<\/li>\n<li>Th\u1ed5i ng\u1ea1t (Breathing)<\/li>\n<li>\u1ea4n tim ngo\u00e0i l\u1ed3ng ng\u1ef1c (Circulation)<\/li>\n<\/ul>\n<p>C\u00e1c b\u01b0\u1edbc th\u1ef1c hi\u1ec7n theo th\u1ee9 t\u1ef1 \u01b0u ti\u00ean:<\/p>\n<h4>2.2.1. Lay g\u1ecdi, k\u00eau gi\u00fap \u0111\u1ee1<\/h4>\n<p>&#8211; Lay g\u1ecdi b\u1ec7nh nh\u00e2n<\/p>\n<p>&#8211; N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng l\u00e0 h\u00f4n m\u00ea, nghi ng\u1edd ng\u01b0ng th\u1edf ng\u01b0ng tim khi h\u00f4n m\u00ea v\u00e0 k\u00eau g\u1ecdi ng\u01b0\u1eddi gi\u00fap \u0111\u1ee1<\/p>\n<h4>2.2.2. Th\u00f4ng \u0111\u01b0\u1eddng th\u1edf<\/h4>\n<p>&#8211; Ng\u1eeda \u0111\u1ea7u n\u00e2ng c\u1eb1m, n\u1ebfu nghi ch\u1ea5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng c\u1ed5 th\u00ec d\u00f9ng ph\u01b0\u01a1ng ph\u00e1p \u1ea5n h\u00e0m v\u00e0 c\u1ed1 \u0111\u1ecbnh c\u1ed5 \u0111\u1ec3 tr\u00e1nh di l\u1ec7ch c\u1ed9t s\u1ed1ng c\u1ed5<\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p h\u00f4n m\u00ea th\u00ec c\u00e1c c\u01a1 v\u00f9ng c\u1ed5 m\u1ea5t tr\u01b0\u01a1ng l\u1ef1c g\u00e2y ch\u00e8n \u00e9p t\u1eafc \u0111\u01b0\u1eddng th\u1edf<\/p>\n<p>&#8211; L\u1ea5y d\u1ecb v\u1eadt n\u1ebfu c\u00f3:<\/p>\n<p>+ Th\u1ee7 thu\u1eadt v\u1ed7 l\u01b0ng \u1ea5n ng\u1ef1c: s\u01a1 sinh, nh\u0169 nhi<\/p>\n<p>+ Th\u1ee7 thu\u1eadt v\u1ed7 l\u01b0ng: tr\u1ebb l\u1edbn<\/p>\n<p>Kh\u00f4ng d\u00f9ng tay m\u00f3c m\u00f9 d\u1ecb v\u1eadt v\u00ec c\u00f3 th\u1ec3 \u0111\u1ea9y d\u1ecb v\u1eadt v\u00e0o s\u00e2u h\u01a1n v\u00e0 l\u00e0m t\u1ed5n th\u01b0\u01a1ng ni\u00eam m\u1ea1c mi\u1ec7ng h\u1ea7u<\/p>\n<h4>2.2.3. Quan s\u00e1t di \u0111\u1ed9ng l\u1ed3ng ng\u1ef1c v\u00e0 nghe c\u1ea3m nh\u1eadn h\u01a1i th\u1edf<\/h4>\n<p>N\u1ebfu l\u1ed3ng ng\u1ef1c kh\u00f4ng c\u00f3 chuy\u1ec3n \u0111\u1ed9ng<\/p>\n<p>N\u1ebfu kh\u00f4ng c\u1ea3m nh\u1eadn \u0111\u01b0\u1ee3c h\u01a1i th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n<\/p>\n<p>=&gt; C\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a ng\u01b0ng th\u1edf.<\/p>\n<h4>2.2.4. Th\u1ed5i ng\u1ea1t<\/h4>\n<ul>\n<li>Th\u1ed5i ng\u1ea1t 5 l\u1ea7n \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c 2 nh\u1ecbp c\u00f3 hi\u1ec7u qu\u1ea3<\/li>\n<li>Th\u1ed5i c\u00f3 hi\u1ec7u qu\u1ea3 khi th\u1ea5y l\u1ed3ng ng\u1ef1c nh\u00f4 l\u00ean khi th\u1ed5i<\/li>\n<\/ul>\n<h4>2.2.5. B\u1eaft m\u1ea1ch trung t\u00e2m<\/h4>\n<p>\u0110\u1ec3 b\u1eaft m\u1ea1ch trung t\u00e2m, c\u1ea7n th\u1ef1c hi\u1ec7n nh\u01b0 sau:<\/p>\n<ul>\n<li>V\u1edbi s\u01a1 sinh v\u00e0 tr\u1ebb nh\u1ecf, c\u00f3 th\u1ec3 b\u1eaft m\u1ea1ch \u1edf c\u00e1nh tay ho\u1eb7c b\u1eb9n.<\/li>\n<li>V\u1edbi tr\u1ebb l\u1edbn, c\u00f3 th\u1ec3 b\u1eaft m\u1ea1ch \u1edf c\u1ed5 ho\u1eb7c b\u1eb9n.<\/li>\n<\/ul>\n<p>N\u1ebfu c\u00f3 m\u1ea1ch trung t\u00e2m, ti\u1ebfp t\u1ee5c t\u1ed5i ng\u1ea1t cho b\u1ec7nh nh\u00e2n.<\/p>\n<p>N\u1ebfu kh\u00f4ng t\u00ecm th\u1ea5y m\u1ea1ch trung t\u00e2m trong v\u00f2ng 10 gi\u00e2y, \u0111\u00f3 c\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a ng\u01b0ng tim. Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, c\u1ea7n th\u1ef1c hi\u1ec7n \u1ea5n tim ngo\u00e0i l\u1ed3ng ng\u1ef1c.<\/p>\n<h4>2.2.6. \u1ea4n tim ngo\u00e0i l\u1ed3ng ng\u1ef1c<\/h4>\n<p>\u0110\u1ec3 th\u1ef1c hi\u1ec7n \u1ea5n tim ngo\u00e0i l\u1ed3ng ng\u1ef1c, c\u1ea7n tu\u00e2n th\u1ee7 c\u00e1c nguy\u00ean t\u1eafc sau:<\/p>\n<ul>\n<li>V\u1ecb tr\u00ed \u1ea5n tim ph\u00f9 h\u1ee3p cho m\u1ecdi l\u1ee9a tu\u1ed5i l\u00e0 \u1edf gi\u1eefa l\u1ed3ng ng\u1ef1c, k\u1ebf ph\u1ea7n d\u01b0\u1edbi c\u1ee7a x\u01b0\u01a1ng \u1ee9c.<\/li>\n<li>C\u1ea7n \u1ea5n s\u00e2u v\u00e0o kho\u1ea3ng 1\/3 b\u1ec1 d\u00e0y c\u1ee7a l\u1ed3ng ng\u1ef1c.<\/li>\n<li>\u0110\u1ed1i v\u1edbi tr\u1ebb s\u01a1 sinh nh\u0169 nhi (d\u01b0\u1edbi 1 tu\u1ed5i), c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng hai ng\u00f3n c\u00e1i ho\u1eb7c hai ng\u00f3n tay \u0111\u1ec3 th\u1ef1c hi\u1ec7n k\u1ef9 thu\u1eadt \u1ea5n tim ngo\u00e0i l\u1ed3ng ng\u1ef1c<\/li>\n<\/ul>\n<figure id=\"attachment_28669\" aria-describedby=\"caption-attachment-28669\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-28669 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cpr-300x171.jpg\" alt=\"H\u00ecnh 1: \u1ea4n tim 2 ng\u00f3n tay\" width=\"300\" height=\"171\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cpr-300x171.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cpr-768x439.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/cpr.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-28669\" class=\"wp-caption-text\">H\u00ecnh 1: \u1ea4n tim 2 ng\u00f3n tay<\/figcaption><\/figure>\n<p>&#8211; Tr\u1ebb l\u1edbn (Tr\u00ean 1 tu\u1ed5i):<\/p>\n<p>&#8211; K\u1ef9 thu\u1eadt:<\/p>\n<ul>\n<li>1 b\u00e0n tay ( 1- 8 tu\u1ed5i)<\/li>\n<li>2 b\u00e0n tay (&gt; 8 tu\u1ed5i)<\/li>\n<\/ul>\n<figure id=\"attachment_28671\" aria-describedby=\"caption-attachment-28671\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-28671 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Realistic-child-cpr-training-300x261.jpg\" alt=\"H\u00ecnh 2: \u1ea4n tim 1 b\u00e0n tay\" width=\"300\" height=\"261\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Realistic-child-cpr-training-300x261.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/Realistic-child-cpr-training.jpg 720w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-28671\" class=\"wp-caption-text\">H\u00ecnh 2: \u1ea4n tim 1 b\u00e0n tay<\/figcaption><\/figure>\n<p>T\u1ea7n s\u1ed1 \u1ea5n tim cho t\u1ea5t c\u1ea3 c\u00e1c l\u1ee9a tu\u1ed5i: 100 l\u1ea7n\/ph\u00fat<\/p>\n<p><em><b>\u1ea4n tim \u0111\u00fang: m\u1ea1ch trung t\u00e2m c\u00f3 khi \u1ea5n<\/b><\/em><\/p>\n<p>&#8211; Ng\u01b0ng th\u1edf ng\u01b0ng tim: T\u1ec9 l\u1ec7 \u1ea5n tim\/ th\u1ed5i ng\u1ea1t: 15\/2 cho 2 c\u1ea5p c\u1ee9u vi\u00ean, 30\/2 cho 1 c\u1ea5p c\u1ee9u vi\u00ean<\/p>\n<h2>3. H\u1ed3i s\u1ee9c n\u00e2ng cao ng\u01b0ng th\u1edf ng\u01b0ng tim<\/h2>\n<p>Th\u1ef1c hi\u1ec7n t\u1ea1i c\u01a1 s\u1edf y t\u1ebf, b\u1ec7nh vi\u1ec7n c\u00f3 \u0111\u1ee7 y d\u1ee5ng c\u1ee5 v\u00e0 thu\u1ed1c c\u1ea5p c\u1ee9u<\/p>\n<h3>3.1. Lay g\u1ecdi, k\u00eau gi\u00fap \u0111\u1ee1<\/h3>\n<p>&#8211; Lay g\u1ecdi b\u1ec7nh nh\u00e2n<\/p>\n<p>&#8211; N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng, h\u00f4n m\u00ea, k\u00eau g\u1ecdi BS, \u0110D gi\u00fap \u0111\u1ee1<\/p>\n<h3>3.2. Th\u00f4ng \u0111\u01b0\u1eddng th\u1edf<\/h3>\n<p>\u0110\u1ec3 th\u00f4ng \u0111\u01b0\u1eddng th\u1edf, c\u1ea7n th\u1ef1c hi\u1ec7n c\u00e1c b\u01b0\u1edbc sau:<\/p>\n<ul>\n<li>Ng\u1eeda \u0111\u1ea7u v\u00e0 n\u00e2ng c\u1eb1m \u0111\u1ec3 m\u1edf \u0111\u01b0\u1eddng th\u1edf. N\u1ebfu c\u00f3 nghi ng\u1edd v\u1ec1 ch\u1ea5n th\u01b0\u01a1ng c\u1ed9t s\u1ed1ng c\u1ed5, c\u1ea7n \u1ea5n h\u00e0m v\u00e0 c\u1ed1 \u0111\u1ecbnh c\u1ed5.<\/li>\n<li>H\u00fat \u0111\u00e0m n\u1ebfu c\u00f3.<\/li>\n<li>N\u1ebfu c\u00f3 d\u1ecb v\u1eadt, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt v\u1ed7 l\u01b0ng ho\u1eb7c \u1ea5n ng\u1ef1c \u0111\u1ec3 l\u1ea5y d\u1ecb v\u1eadt. V\u1edbi tr\u1ebb s\u01a1 sinh v\u00e0 nh\u0169 nhi, n\u00ean s\u1eed d\u1ee5ng th\u1ee7 thu\u1eadt v\u1ed7 l\u01b0ng v\u00e0 \u1ea5n ng\u1ef1c.<\/li>\n<li>N\u1ebfu c\u00e1c th\u1ee7 thu\u1eadt tr\u00ean kh\u00f4ng th\u00e0nh c\u00f4ng, c\u1ea7n \u0111\u1eb7t \u1ed1ng th\u00f4ng mi\u1ec7ng h\u1ea7u \u0111\u1ec3 th\u00f4ng \u0111\u01b0\u1eddng th\u1edf.<\/li>\n<\/ul>\n<h3>3.3. Quan s\u00e1t di \u0111\u1ed9ng l\u1ed3ng ng\u1ef1c v\u00e0 c\u1ea3m nh\u1eadn h\u01a1i th\u1edf<\/h3>\n<p>N\u1ebfu l\u1ed3ng ng\u1ef1c kh\u00f4ng c\u00f3 chuy\u1ec3n \u0111\u1ed9ng<\/p>\n<p>N\u1ebfu kh\u00f4ng c\u1ea3m nh\u1eadn \u0111\u01b0\u1ee3c h\u01a1i th\u1edf c\u1ee7a b\u1ec7nh nh\u00e2n<\/p>\n<p>=&gt; C\u00f3 th\u1ec3 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a ng\u01b0ng th\u1edf.<\/p>\n<h3>3.4. B\u00f3p b\u00f3ng qua mask<\/h3>\n<p>&#8211; B\u00f3p b\u00f3ng qua mask 2 nh\u1ecbp c\u00f3 hi\u1ec7u qu\u1ea3 v\u1edbi FiO2 100%<\/p>\n<p><em><b>B\u00f3p b\u00f3ng c\u00f3 hi\u1ec7u qu\u1ea3: l\u1ed3ng ng\u1ef1c nh\u00f4 khi b\u00f3p<\/b><\/em><\/p>\n<p>N\u1ebfu b\u00f3p b\u00f3ng m\u00e0 l\u1ed3ng ng\u1ef1c kh\u00f4ng nh\u00f4 l\u00ean, c\u00f3 th\u1ec3 do m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n sau:<\/p>\n<ul>\n<li>\u0110\u01b0\u1eddng th\u1edf ch\u01b0a th\u00f4ng: c\u1ea7n ki\u1ec3m tra l\u1ea1i v\u00e0 ng\u1eeda \u0111\u1ea7u c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<li>M\u1eb7t n\u1ea1 kh\u00f4ng k\u00edn: c\u1ea7n ki\u1ec3m tra l\u1ea1i v\u1ecb tr\u00ed v\u00e0 \u0111\u1ed9 k\u00edn c\u1ee7a m\u1eb7t n\u1ea1.<\/li>\n<li>C\u1ee1 b\u00f3ng nh\u1ecf so v\u1edbi k\u00edch th\u01b0\u1edbc c\u1ee7a tr\u1ebb: c\u1ea7n s\u1eed d\u1ee5ng b\u00f3ng ph\u00f9 h\u1ee3p v\u1edbi k\u00edch th\u01b0\u1edbc c\u1ee7a tr\u1ebb.<\/li>\n<li>B\u00f3p b\u00f3ng qu\u00e1 m\u1ea1nh: c\u1ea7n b\u00f3p nh\u1eb9 tay \u0111\u1ec3 tr\u00e1nh g\u00e2y ra s\u1ef1 kh\u00f3 ch\u1ecbu cho b\u1ec7nh nh\u00e2n.<\/li>\n<\/ul>\n<p>N\u1ebfu v\u1eabn kh\u00f4ng t\u1ea1o ra s\u1ef1 nh\u00f4 l\u00ean c\u1ee7a l\u1ed3ng ng\u1ef1c, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n th\u1ee7 thu\u1eadt Sellick b\u1eb1ng c\u00e1ch \u1ea5n nh\u1eb9 l\u00ean s\u1ee5n nh\u1eabn. Th\u1ee7 thu\u1eadt n\u00e0y gi\u00fap tr\u00e1nh h\u01a1i v\u00e0o d\u1ea1 d\u00e0y, gi\u1ea3m ch\u01b0\u1edbng b\u1ee5ng v\u00e0 gi\u1ea3m nguy c\u01a1 h\u00edt s\u1eb7c<\/p>\n<h3>3.5. B\u1eaft m\u1ea1ch trung t\u00e2m<\/h3>\n<p>Kh\u00f4ng c\u00f3 m\u1ea1ch trung t\u00e2m trong v\u00f2ng 10 gi\u00e2y=&gt;\u00a0 Ng\u01b0ng tim<\/p>\n<h3>3.6. \u1ea4n tim ngo\u00e0i l\u1ed3ng ng\u1ef1c<\/h3>\n<p>T\u1ec9 l\u1ec7 b\u00f3p b\u00f3ng v\u00e0 \u1ea5n tim ph\u00f9 h\u1ee3p cho t\u1eebng \u0111\u1ed9 tu\u1ed5i nh\u01b0 sau:<\/p>\n<ul>\n<li>S\u01a1 sinh: 3 l\u1ea7n \u1ea5n tim cho m\u1ed7i l\u1ea7n b\u00f3p b\u00f3ng.<\/li>\n<li>Tr\u1ebb ngo\u00e0i tu\u1ed5i s\u01a1 sinh: 15 l\u1ea7n \u1ea5n tim cho m\u1ed7i 2 l\u1ea7n b\u00f3p b\u00f3ng.<\/li>\n<\/ul>\n<p>N\u1ebfu c\u00f3 hai ng\u01b0\u1eddi th\u1ef1c hi\u1ec7n, ng\u01b0\u1eddi \u1ea5n tim n\u00ean \u0111\u1ebfm to \u0111\u1ec3 ng\u01b0\u1eddi b\u00f3p b\u00f3ng c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p th\u00edch h\u1ee3p.<\/p>\n<p>C\u1ea7n ti\u1ebfp t\u1ee5c b\u00f3p b\u00f3ng v\u00e0 \u1ea5n tim trong v\u00f2ng 2 ph\u00fat, sau \u0111\u00f3 \u0111\u00e1nh gi\u00e1 l\u1ea1i t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng t\u1ef1 th\u1edf l\u1ea1i sau khi \u0111\u01b0\u1ee3c b\u00f3p b\u00f3ng qua m\u1eb7t n\u1ea1 trong kho\u1ea3ng th\u1eddi gian t\u1eeb 1 \u0111\u1ebfn 5 ph\u00fat, c\u1ea7n \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 ti\u1ebfp t\u1ee5c b\u00f3p b\u00f3ng qua n\u1ed9i kh\u00ed qu\u1ea3n.<\/p>\n<h3>3.7. Thu\u1ed1c<\/h3>\n<p>\u0110\u1ec3 thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch, c\u1ea7n l\u1ea5y m\u1eabu m\u00e1u t\u1eeb t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean. N\u1ebfu kh\u00f4ng th\u00e0nh c\u00f4ng sau 2 l\u1ea7n l\u1ea5y m\u1eabu, c\u1ea7n ti\u00eam qua x\u01b0\u01a1ng b\u1eb1ng kim 18 v\u1edbi trochar, b\u01a1m 5ml dung d\u1ecbch Epinephrine 1\u2030 TM v\u00e0o m\u1eb7t tr\u01b0\u1edbc c\u1ee7a x\u01b0\u01a1ng, kho\u1ea3ng 2-3 cm d\u01b0\u1edbi mao x\u01b0\u01a1ng ch\u00e0y.<\/p>\n<p>C\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 c\u1ea5p c\u1ee9u ng\u01b0ng tim bao g\u1ed3m:<\/p>\n<ul>\n<li>Epinephrine (Adrenaline) 1\u2030 TM: s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p ng\u01b0ng tim. Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 0,1 ml\/kg dung d\u1ecbch 1% TM. Sau khi b\u01a1m thu\u1ed1c, c\u1ea7n b\u01a1m 2-5 ml dung d\u1ecbch n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd \u0111\u1ec3 \u0111\u1ea9y thu\u1ed1c. N\u1ebfu sau 3-5 ph\u00fat tim ch\u01b0a \u0111\u1eadp l\u1ea1i, c\u1ea7n l\u1eb7p l\u1ea1i li\u1ec1u thu\u1ed1c ho\u1eb7c t\u0103ng li\u1ec1u 10 l\u1ea7n, m\u1ed7i 3-5 ph\u00fat ki\u1ec3m tra l\u1ea1i.<\/li>\n<li>Epinephrine (Adrenaline) 1\u2030 b\u01a1m qua n\u1ed9i kh\u00ed qu\u1ea3n (NKQ): s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 0,1 ml\/kg dung d\u1ecbch Epinephrine 1\u2030 pha v\u1edbi NaCl 9\u2030 \u0111\u1ec3 \u0111\u1ee7 1-2 ml. Sau khi b\u01a1m NKQ, c\u1ea7n b\u00f3p b\u00f3ng \u0111\u1ec3 thu\u1ed1c ph\u00e2n t\u00e1n v\u00e0 h\u1ea5p thu v\u00e0o h\u1ec7 tu\u1ea7n ho\u00e0n.<\/li>\n<li>Bicarbonate: ch\u1ec9 \u0111\u1ecbnh cho tr\u01b0\u1eddng h\u1ee3p toan chuy\u1ec3n h\u00f3a n\u1eb7ng ho\u1eb7c kh\u00f4ng th\u1eed kh\u00ed m\u00e1u \u0111\u01b0\u1ee3c. Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 dung d\u1ecbch bicarbonate 8,4% 1ml\/kg\/l\u1ea7n ho\u1eb7c dung d\u1ecbch 4,2% 2 ml\/kg\/l\u1ea7n TM n\u1ebfu c\u1ea7n. Kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng chung v\u1edbi \u0111\u01b0\u1eddng truy\u1ec1n canxi \u0111\u1ec3 tr\u00e1nh nguy c\u01a1 \u1ee9 CO2 g\u00e2y n\u1eb7ng th\u00eam t\u00ecnh tr\u1ea1ng toan h\u00f4 h\u1ea5p.<\/li>\n<li>Atropine: ch\u1ec9 \u0111\u1ecbnh cho tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp tim ch\u1eadm. Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 0,02 mg\/kg TM, li\u1ec1u t\u1ed1i thi\u1ec3u 0,1 mg, t\u1ed1i \u0111a 0,5 mg\/li\u1ec1u ho\u1eb7c t\u1ed5ng li\u1ec1u kh\u00f4ng qu\u00e1 1mg.<\/li>\n<li>Amiodarone: \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp nhanh tr\u00ean th\u1ea5t, rung th\u1ea5t ho\u1eb7c nh\u1ecbp nhanh th\u1ea5t m\u1ea5t m\u1ea1ch. Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 5 mg\/kg TM b\u01a1m nhanh ho\u1eb7c qua x\u01b0\u01a1ng trong 20-60 ph\u00fat. Li\u1ec1u t\u1ed1i \u0111a l\u00e0 15 mg\/kg\/ng\u00e0y. C\u1ea7n theo d\u00f5i huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00ec thu\u1ed1c c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t huy\u1ebft \u00e1p n\u1ebfu ti\u00eam nhanh. Thu\u1ed1c thay th\u1ebf l\u00e0 Lidocain 2% (0,04g\/2ml), li\u1ec1u 1mg\/kg TM, duy tr\u00ec 20-50 mg\/kg\/ph\u00fat qua b\u01a1m ti\u00eam t\u1ef1 \u0111\u1ed9ng.<\/li>\n<li>Canxi: ch\u1ec9 s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 b\u1eb1ng ch\u1ee9ng h\u1ea1 can xi huy\u1ebft ho\u1eb7c ng\u1ed9 \u0111\u1ed9c thu\u1ed1c \u1ee9c ch\u1ebf canxi. Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 Calcium chloride 10% 0,2ml\/kg TM ch\u1eadm ho\u1eb7c Calcium gluconate 10% 1ml\/kg TM ch\u1eadm.<\/li>\n<li>Glucose: ch\u1ec9 \u0111\u1ecbnh cho tr\u01b0\u1eddng h\u1ee3p h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft. Li\u1ec1u khuy\u1ebfn c\u00e1o l\u00e0 dung d\u1ecbch glucose 30% 2ml\/kg TMC \u0111\u1ed1i v\u1edbi tr\u1ebb l\u1edbn v\u00e0 dung d\u1ecbch glucose 10% 2ml\/kg TMC \u0111\u1ed1i v\u1edbi tr\u1ebb s\u01a1 sinh.<\/li>\n<li>Truy\u1ec1n d\u1ecbch: n\u1ebfu nguy\u00ean nh\u00e2n ng\u01b0ng th\u1edf ng\u01b0ng tim l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch, c\u1ea7n truy\u1ec1n nhanh dung d\u1ecbch Lactate Ringer 20 ml\/kg trong 15 ph\u00fat. N\u1ebfu kh\u00f4ng th\u00e0nh c\u00f4ng, c\u1ea7n d\u00f9ng dung d\u1ecbch cao ph\u00e2n t\u1eed.<\/li>\n<\/ul>\n<p>N\u1ebfu kh\u00f4ng th\u1ec3 c\u00e2n b\u1ec7nh nh\u00e2n trong tr\u01b0\u1eddng h\u1ee3p c\u1ea5p c\u1ee9u, c\u00f3 th\u1ec3 \u01b0\u1edbc l\u01b0\u1ee3ng c\u00e2n n\u1eb7ng theo tu\u1ed5i \u0111\u1ec3 t\u00ednh li\u1ec1u thu\u1ed1c.<\/p>\n<p>&#8211; Tr\u1ebb 0-12 th\u00e1ng : C\u00e2n n\u1eb7ng(kg) = (0,5 x tu\u1ed5i t\u00ednh theo th\u00e1ng) + 4<\/p>\n<p>&#8211; Tr\u1ebb 1-5 tu\u1ed5i : C\u00e2n n\u1eb7ng(kg) = (2 x tu\u1ed5i t\u00ednh theo n\u0103m) + 8<\/p>\n<p>&#8211; Tr\u1ebb 6-12 tu\u1ed5i : C\u00e2n n\u1eb7ng(kg) = (3 x tu\u1ed5i t\u00ednh theo n\u0103m) + 7<\/p>\n<h3>3.8. S\u1ed1c \u0111i\u1ec7n<\/h3>\n<p>C\u00e1c ch\u1ec9 \u0111\u1ecbnh cho s\u1ed1c \u0111i\u1ec7n bao g\u1ed3m:<\/p>\n<ul>\n<li>S\u1ed1c \u0111i\u1ec7n kh\u00f4ng \u0111\u1ed3ng b\u1ed9: s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p rung th\u1ea5t, ng\u01b0ng tim, nh\u1ecbp nhanh th\u1ea5t m\u1ea5t m\u1ea1ch.<\/li>\n<li>S\u1ed1c \u0111i\u1ec7n \u0111\u1ed3ng b\u1ed9: s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp nhanh th\u1ea5t c\u00f3 m\u1ea1ch, nh\u1ecbp nhanh k\u1ecbch ph\u00e1t tr\u00ean th\u1ea5t, ho\u1eb7c sau khi \u0111i\u1ec1u tr\u1ecb thu\u1ed1c th\u1ea5t b\u1ea1i ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng.<\/li>\n<\/ul>\n<p>\u1ede tr\u1ebb nh\u1ecf, n\u00ean s\u1eed d\u1ee5ng b\u1ea3n \u0111i\u1ec7n c\u1ee1 tr\u1ebb em c\u00f3 k\u00edch th\u01b0\u1edbc kho\u1ea3ng 4-5cm. N\u1ebfu kh\u00f4ng c\u00f3 b\u1ea3n nh\u1ecf, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng b\u1ea3n l\u1edbn \u0111\u1eb7t tr\u01b0\u1edbc v\u00e0 sau ng\u1ef1c.<\/p>\n<p>Sau m\u1ed7i l\u1ea7n th\u1ef1c hi\u1ec7n s\u1ed1c \u0111i\u1ec7n, c\u1ea7n nghe tim v\u00e0 theo d\u00f5i nh\u1ecbp tim qua monitor \u0111\u1ec3 c\u00f3 h\u01b0\u1edbng x\u1eed tr\u00ed ti\u1ebfp theo<\/p>\n<h3>3.9. Theo d\u00f5i sau h\u1ed3i s\u1ee9c ng\u01b0ng th\u1edf ng\u01b0ng tim<\/h3>\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>Sau h\u1ed3i s\u1ee9c ng\u01b0ng th\u1edf ng\u01b0ng tim, c\u1ea7n theo d\u00f5i c\u00e1c th\u00f4ng s\u1ed1 sau:<\/p>\n<ul>\n<li>Nh\u1ecbp th\u1edf, m\u00e0u da, ni\u00eam m\u1ea1c, m\u1ea1ch, huy\u1ebft \u00e1p, tri gi\u00e1c, \u0111\u1ed3ng t\u1eed m\u1ed7i 15 ph\u00fat.<\/li>\n<li>\u0110o \u0111\u1ed9 b\u00e3o h\u00f2a oxy (SaO2).<\/li>\n<li>Theo d\u00f5i nh\u1ecbp tim b\u1eb1ng ECG monitoring.<\/li>\n<li>\u0110o kh\u00ed m\u00e1u, ion \u0111\u1ed3, Dextrostix, v\u00e0 XQ tim ph\u1ed5i.<\/li>\n<li>C\u00e1c d\u1ea5u hi\u1ec7u di\u1ec5n ti\u1ebfn t\u1ed1t bao g\u1ed3m: h\u1ed3ng h\u00e0o, t\u1ef1 th\u1edf, tim \u0111\u1eadp l\u1ea1i, m\u1ea1ch r\u00f5, v\u00e0 t\u1ec9nh t\u00e1o.<\/li>\n<\/ul>\n<p>Vi\u1ec7c quy\u1ebft \u0111\u1ecbnh th\u1eddi \u0111i\u1ec3m ng\u01b0ng h\u1ed3i s\u1ee9c trong tr\u01b0\u1eddng h\u1ee3p ng\u01b0ng th\u1edf ng\u01b0ng tim k\u00e9o d\u00e0i l\u00e0 kh\u00f3 kh\u0103n. Tuy nhi\u00ean, c\u00f3 th\u1ec3 xem x\u00e9t ng\u01b0ng h\u1ed3i s\u1ee9c n\u1ebfu sau 30-60 ph\u00fat m\u00e0 tim v\u1eabn kh\u00f4ng \u0111\u1eadp l\u1ea1i, kh\u00f4ng th\u1edf l\u1ea1i, \u0111\u1ed3ng t\u1eed v\u1eabn gi\u00e3n v\u00e0 sau khi \u0111\u00e3 gi\u1ea3i th\u00edch cho th\u00e2n nh\u00e2n.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<section class=\"ChatMessageFeedbackButtons_feedbackButtonsContainer__0Xd3I\"><\/section>\n","protected":false},"excerpt":{"rendered":"<p>Ng\u01b0ng th\u1edf \u1edf tr\u1ebb em th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng suy h\u00f4 h\u1ea5p c\u1ea5p. Ng\u01b0ng tim th\u01b0\u1eddng sau ng\u01b0ng th\u1edf. N\u00e3o s\u1ebd b\u1ecb t\u1ed5n th\u01b0\u01a1ng khi ng\u01b0ng th\u1edf ng\u01b0ng tim tr\u00ean 4 ph\u00fat v\u00e0 n\u1ebfu tr\u00ean 10 ph\u00fat th\u01b0\u1eddng t\u1eed vong, n\u1ebfu s\u1ed1ng s\u1ebd \u0111\u1ec3 l\u1ea1i di ch\u1ee9ng n\u00e3o n\u1eb7ng n\u1ec1. V\u00ec th\u1ebf [&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 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ng\u01b0ng th\u1edf ng\u01b0ng tim \u1edf tr\u1ebb em - Vinmec<\/title>\n<meta name=\"description\" content=\"Ng\u01b0ng th\u1edf tr\u1ebb em th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a suy h\u00f4 h\u1ea5p c\u1ea5p. Ng\u01b0ng tim th\u01b0\u1eddng sau ng\u01b0ng th\u1edf. 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