{"id":29309,"date":"2023-04-29T22:06:02","date_gmt":"2023-04-29T15:06:02","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29309"},"modified":"2023-04-29T22:06:02","modified_gmt":"2023-04-29T15:06:02","slug":"thong-khi-co-hoc-trong-hoi-sinh-tim-phoi","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/thong-khi-co-hoc-trong-hoi-sinh-tim-phoi\/","title":{"rendered":"Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc trong h\u1ed3i sinh tim ph\u1ed5i"},"content":{"rendered":"

H\u1ed3i sinh tim ph\u1ed5i k\u1ebft h\u1ee3p v\u1edbi s\u1ed1c \u0111i\u1ec7n s\u1edbm trong v\u00f2ng 3 \u0111\u1ebfn 5 ph\u00fat \u0111\u1ea7u ti\u00ean sau khi ng\u1eebng tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 \u0111\u1ea1t t\u1ef7 l\u1ec7 c\u1ee9u s\u1ed1ng l\u00ean \u0111\u1ebfn 50% -75% . Ng\u1eebng tu\u1ea7n ho\u00e0n h\u00f4 h\u1ea5p<\/a> l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng tim ng\u1eebng ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c c\u00f2n ho\u1ea1t \u0111\u1ed9ng nh\u01b0ng kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 t\u1ed1ng m\u00e1u. L\u00e0 m\u1ed9t t\u1ed1i c\u1ea5p c\u1ee9u v\u00ec NB \u0111ang \u1edf ranh gi\u1edbi gi\u1eefa s\u1ed1ng v\u00e0 ch\u1ebft.<\/strong><\/p>\n

1.\u00a0\u00a0\u00a0\u00a0 T\u1ed5ng quan th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc trong h\u1ed3i sinh tim ph\u1ed5i<\/strong><\/h2>\n
    \n
  • M\u1ee5c \u0111\u00edch ch\u00ednh c\u1ee7a th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc l\u00e0 \u0111\u1ec3 duy tr\u00ec n\u1ed3ng \u0111\u1ed9 oxy trong m\u00e1u \u0111\u1ec3 nu\u00f4i s\u1ed1ng m\u00f4 v\u00e0 lo\u1ea1i b\u1ecf kh\u00ed CO2 hi\u1ec7u qu\u1ea3. Tuy nhi\u00ean c\u00e1c nghi\u00ean c\u1ee9u hi\u1ec7n t\u1ea1i ch\u01b0a \u0111\u01b0a ra dung t\u00edch s\u1ed1ng, t\u1ea7n s\u1ed1 th\u1edf v\u00e0 n\u1ed3ng \u0111\u1ed9 oxy t\u1ed1i \u01b0u trong h\u1ed3i sinh tim ph\u1ed5i.<\/li>\n
  • Vi\u1ec7c th\u00f4ng kh\u00ed v\u00e0 \u1ea5n tim l\u00e0 r\u1ea5t quan tr\u1ecdng \u1edf b\u1ec7nh nh\u00e2n ng\u01b0ng tim c\u00f3 rung th\u1ea5t k\u00e9o d\u00e0i v\u00e0 v\u1edbi t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp kh\u00e1c. Do qu\u00e1 tr\u00ecnh t\u01b0\u1edbi m\u00e1u h\u1ec7 th\u1ed1ng v\u00e0 tu\u1ea7n ho\u00e0n ph\u1ed5i \u0111\u1ec1u b\u1ecb gi\u1ea3m \u0111\u00e1ng k\u1ec3 khi CPR, m\u1ed1i li\u00ean quan gi\u1eefa th\u00f4ng kh\u00ed – t\u01b0\u1edbi m\u00e1u th\u1ea5p h\u01a1n so v\u1edbi b\u00ecnh th\u01b0\u1eddng. Trong khi CPR v\u1edbi \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao, t\u1ea7n s\u1ed1 nh\u1ecbp th\u1edf \u0111\u01b0\u1ee3c cung c\u1ea5p th\u01b0\u1eddng th\u1ea5p h\u01a1n \u0111\u1ec3 tr\u00e1nh th\u00f4ng kh\u00ed qu\u00e1 m\u1ee9c.<\/li>\n<\/ul>\n

    2.\u00a0\u00a0\u00a0\u00a0 Th\u00f4ng kh\u00ed v\u00e0 oxy li\u1ec7u ph\u00e1p trong h\u1ed3i sinh tim ph\u1ed5i<\/h2>\n
      \n
    • Khi l\u01b0u l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n th\u1ea5p nh\u01b0 trong CPR, qu\u00e1 tr\u00ecnh cung c\u1ea5p oxy \u0111\u1ebfn tim v\u00e0 n\u00e3o b\u1ecb gi\u1edbi h\u1ea1n b\u1edfi l\u01b0u l\u01b0\u1ee3ng d\u00f2ng m\u00e1u h\u01a1n l\u00e0 n\u1ed3ng \u0111\u1ed9 b\u00e3o h\u00f2a oxy trong m\u00e1u. V\u00ec v\u1eady, vi\u1ec7c th\u1ed5i ng\u1ea1t kh\u00f4ng \u01b0u ti\u00ean b\u1eb1ng \u0111\u1ed9ng t\u00e1c \u00e9p tim ngo\u00e0i l\u1ed3ng ng\u1ef1c trong v\u00e0i ph\u00fat \u0111\u1ea7u n\u1ebfu ch\u1ee9ng ki\u1ebfn b\u1ec7nh nh\u00e2n ng\u01b0ng tim c\u00f3 rung th\u1ea5t v\u00e0 c\u00f3 th\u1ec3 gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng CPR do gi\u00e1n \u0111o\u1ea1n \u00e9p tim v\u00e0 t\u0103ng \u00e1p su\u1ea5t trong l\u1ed3ng ng\u1ef1c d\u1eabn \u0111\u1ebfn th\u00f4ng kh\u00ed \u00e1p l\u1ef1c d\u01b0\u01a1ng.<\/li>\n
    • Trong v\u00e0i ph\u00fat \u0111\u1ea7u n\u1ebfu ch\u1ee9ng ki\u1ebfn b\u1ec7nh nh\u00e2n ng\u01b0ng tim, ng\u01b0\u1eddi c\u1ea5p c\u1ee9u ch\u1ec9 c\u00f3 m\u1ed9t m\u00ecnh kh\u00f4ng n\u00ean gi\u00e1n \u0111o\u1ea1n \u00e9p tim \u0111\u1ec3 th\u1ed5i ng\u1ea1t. Thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao kh\u00f4ng n\u00ean l\u00e0m ch\u1eadm tr\u1ec5 vi\u1ec7c \u00e9p tim v\u00e0 kh\u1eed rung cho b\u1ec7nh nh\u00e2n ng\u01b0ng tim c\u00f3 rung th\u1ea5t.<\/strong><\/li>\n<\/ul>\n

      3.\u00a0\u00a0\u00a0\u00a0 Th\u00f4ng kh\u00ed qua b\u00f3ng \u2013 mask<\/h2>\n

      \"hoi-sinh-tim-phoi\"<\/p>\n

        \n
      • B\u00f3p b\u00f3ng qua mask l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn \u0111\u1ec3 th\u00f4ng kh\u00ed v\u00e0 cung c\u1ea5p oxy trong qu\u00e1 tr\u00ecnh CPR nh\u01b0ng l\u1ea1i l\u00e0 k\u1ef9 n\u0103ng c\u1ea7n \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n v\u00e0 th\u1ef1c h\u00e0nh th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 duy tr\u00ec hi\u1ec7u qu\u1ea3. N\u1ebfu ch\u1ec9 c\u00f3 m\u1ed9t c\u1ea5p c\u1ee9u vi\u00ean t\u1ea1i hi\u1ec7n tr\u01b0\u1eddng, th\u00f4ng kh\u00ed qua mi\u1ec7ng-mi\u1ec7ng ho\u1eb7c mi\u1ec7ng-mask s\u1ebd hi\u1ec7u qu\u1ea3 h\u01a1n. Khi c\u00f3 tr\u00ean 2 c\u1ea5p c\u1ee9u vi\u00ean, m\u1ed9t ng\u01b0\u1eddi khai th\u00f4ng \u0111\u01b0\u1eddng th\u1edf v\u00e0 gi\u1eef k\u00edn mask, ng\u01b0\u1eddi c\u00f2n l\u1ea1i b\u00f3p b\u00f3ng l\u00e0 t\u1ed1t nh\u1ea5t.<\/li>\n
      • \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn n\u00ean ch\u1ecdn c\u1ee1 mask v\u00e0 b\u00f3ng ph\u00f9 h\u1ee3p (1-2 l\u00edt) v\u00e0 cung c\u1ea5p \u00edt nh\u1ea5t dung t\u00edch 600ml m\u1ed7i nh\u00e1t b\u00f3p \u0111\u1ec3 b\u01a1m l\u1ed3ng ng\u1ef1c b\u1ec7nh nh\u00e2n l\u1edbn h\u01a1n 1 gi\u00e2y. Dung t\u00edch n\u00e0y \u0111\u1ee7 \u0111\u1ec3 th\u00f4ng kh\u00ed v\u00e0 gi\u1ea3m t\u1ed1i thi\u1ec3u nguy c\u01a1 b\u01a1m h\u01a1i v\u00e0o d\u1ea1 d\u00e0y. Khi th\u00f4ng kh\u00ed qua mask hay th\u1ed5i ng\u1ea1t, th\u1ed5i ng\u1ea1t ho\u1eb7c b\u00f3p b\u00f3ng 2 l\u1ea7n (m\u1ed7i l\u1ea7n h\u01a1n 1 gi\u00e2y), c\u1ea7n ng\u01b0ng \u00e9p tim (3-4 gi\u00e2y) m\u1ed7i 30 l\u1ea7n \u00e9p.<\/li>\n
      • B\u00f3p b\u00f3ng qua mask c\u00f3 th\u1ec3 b\u01a1m h\u01a1i v\u00e0o d\u1ea1 d\u00e0y v\u00e0 d\u1eabn \u0111\u1ebfn nh\u1eefng bi\u1ebfn ch\u1ee9ng kh\u00e1c nh\u01b0 tr\u00e0o ng\u01b0\u1ee3c, h\u00edt s\u1eb7c v\u00e0 vi\u00eam ph\u1ed5i. Vi\u1ec7c b\u01a1m h\u01a1i v\u00e0o d\u1ea1 d\u00e0y c\u0169ng c\u00f3 th\u1ec3 n\u00e2ng c\u01a1 ho\u00e0nh l\u00ean cao, c\u1ea3n tr\u1edf s\u1ef1 gi\u00e3n n\u1edf c\u1ee7a ph\u1ed5i, v\u00e0 gi\u1ea3m hi\u1ec7u qu\u1ea3 th\u00f4ng kh\u00ed sau \u0111\u00f3.<\/li>\n
      • So s\u00e1nh v\u1edbi nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p n\u00e2ng cao, b\u00f3ng-mask l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u01b0\u1eddng s\u1eed d\u1ee5ng v\u00e0 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng. Trong \u0111\u00f3, nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p n\u00e2ng cao bao g\u1ed3m n\u1ed9i kh\u00ed qu\u1ea3n, Supraglottic Advanced Airway (mask thanh qu\u1ea3n, combitube\u2026).<\/li>\n<\/ul>\n

        4.\u00a0\u00a0\u00a0\u00a0 H\u1ed7 tr\u1ee3 thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf h\u1ed3i sinh tim ph\u1ed5i<\/h2>\n
          \n
        • \u1ea4n s\u1ee5n nh\u1eabn (th\u1ee7 thu\u1eadt Sellick<\/strong>): \u1ea5n s\u1ee5n nh\u1eabn \u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 th\u1ec3 b\u1ea3o v\u1ec7 \u0111\u01b0\u1eddng th\u1edf v\u00e0 tr\u00e1nh tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n. Tuy nhi\u00ean kh\u00f4ng \u0111\u1ee7 nghi\u00ean c\u1ee9u ch\u1ee9ng m\u00ecnh \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng n\u00e0y, ng\u01b0\u1ee3c l\u1ea1i c\u00f2n c\u00f3 th\u1ec3 g\u00e2y c\u1ea3n tr\u1edf vi\u1ec7c thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao. V\u00ec th\u1ebf, kh\u00f4ng khuy\u1ebfn c\u00e1o vi\u1ec7c s\u1eed d\u1ee5ng th\u01b0\u1eddng quy th\u1ee7 thu\u1eadt Sellick.<\/li>\n
        • Airway mi\u1ec7ng h\u1ea7u: khi th\u00f4ng kh\u00ed qua b\u00f3ng mask, airway mi\u1ec7ng h\u1ea7u c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n b\u1ea5t t\u1ec9nh (kh\u00f4ng \u0111\u00e1p \u1ee9ng), kh\u00f4ng c\u00f2n ph\u1ea3n x\u1ea1 ho s\u1eb7c v\u00e0 ch\u1ec9 s\u1eed d\u1ee5ng b\u1edfi c\u1ea5p c\u1ee9u vi\u00ean \u0111\u00e3 \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n.<\/u><\/li>\n
        • Airway m\u0169i h\u1ea7u: thay th\u1ebf cho airway mi\u1ec7ng h\u1ea7u.<\/li>\n
        • \u0110\u01b0\u1eddng th\u1edf n\u00e2ng cao<\/strong>: th\u00f4ng kh\u00ed qua b\u00f3ng mask hay b\u00f3p b\u00f3ng qua \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao \u0111\u1ec1u \u0111\u01b0\u1ee3c ch\u1ea5p nh\u1eadn trong quy tr\u00ecnh CPR. Khi th\u00f4ng kh\u00ed qua b\u00f3ng mask kh\u00f4ng hi\u1ec7u qu\u1ea3, thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao l\u00e0 c\u1ea7n thi\u1ebft. Vi\u1ec7c \u0111\u1eb7t \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao \u0111\u00f2i h\u1ecfi c\u1ea5p c\u1ee9u vi\u00ean ph\u1ea3i \u0111\u01b0\u1ee3c hu\u1ea5n luy\u1ec7n v\u00e0 c\u00f3 kinh nghi\u1ec7m.<\/li>\n
        • C\u1ea5p c\u1ee9u vi\u00ean c\u1ea7n \u0111\u00e1nh gi\u00e1 tr\u01b0\u1edbc nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch c\u1ee7a \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao trong t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3 v\u00e0 \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh ph\u00f9 h\u1ee3p nh\u1ea5t. Kh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u n\u00e0o ch\u1ec9 ra \u0111\u01b0\u1ee3c th\u1eddi gian t\u1ed1t nh\u1ea5t \u0111\u1ec3 thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao gi\u00fap c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng c\u1ee7a b\u1ec7nh nh\u00e2n ng\u01b0ng tim. D\u00f9 vi\u1ec7c \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh trong khi \u00e9p tim, nh\u01b0ng th\u01b0\u1eddng s\u1ebd l\u00e0m gi\u00e1n \u0111o\u1ea1n vi\u1ec7c \u00e9p tim. \u0110i\u1ec1u n\u00e0y l\u00e0m gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng c\u1ee7a quy tr\u00ecnh CPR.<\/li>\n
        • N\u1ebfu thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao l\u00e0m gi\u00e1n \u0111o\u1ea1n \u00e9p tim, c\u1ea5p c\u1ee9u vi\u00ean c\u00f3 th\u1ec3 tr\u00ec ho\u00e3n vi\u1ec7c thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf cho t\u1edbi khi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f2n \u0111\u00e1p \u1ee9ng v\u1edbi nh\u1eefng th\u1ee7 thu\u1eadt CPR ban \u0111\u1ea7u v\u00e0 kh\u1eed rung ho\u1eb7c c\u00f3 bi\u1ec3u hi\u1ec7n ROSC.<\/strong><\/li>\n
        • Trong qu\u00e1 tr\u00ecnh \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n, sinh hi\u1ec7u c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c. C\u00f3 th\u1ec3 t\u1ea1m ng\u1eebng quy tr\u00ecnh \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n \u0111\u1ec3 cung c\u1ea5p oxy cho b\u1ec7nh nh\u00e2n khi c\u1ea7n.<\/li>\n
        • Sau khi thi\u1ebft l\u1eadp \u0111\u01b0\u1eddng th\u1edf n\u00e2ng cao c\u1ea7n ki\u1ec3m tra v\u1ecb tr\u00ed \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o th\u00f4ng kh\u00ed hi\u1ec7u qu\u1ea3 v\u00e0 tr\u00e1nh bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u1ec7c \u0111\u1eb7t sai ch\u1ed7.<\/li>\n<\/ul>\n

          5.\u00a0\u00a0\u00a0\u00a0 Th\u1ef1c hi\u1ec7n:<\/h2>\n

          5.1 B\u00f3ng-mask:<\/h3>\n
            \n
          • \u0110\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n, ch\u1ecdn c\u1ee1 mask v\u00e0 b\u00f3ng ph\u00f9 h\u1ee3p.<\/li>\n
          • K\u1ef9 thu\u1eadt E-C clamp: d\u00f9ng ng\u00f3n 1 v\u00e0 ng\u00f3n 2 c\u1ee7a m\u1ed9t tay t\u1ea1o th\u00e0nh ch\u1eef C gi\u1eef mask, 3 ng\u00f3n c\u00f2n l\u1ea1i t\u1ea1o th\u00e0nh ch\u1eef E gi\u1eef h\u00e0m d\u01b0\u1edbi c\u1ee7a b\u1ec7nh nh\u00e2n. T\u1ea1o l\u1ef1c si\u1ebft l\u00f2ng b\u00e0n tay \u0111\u1ec3 gi\u1eef mask ti\u1ebfp x\u00fac t\u1ed1t v\u1edbi m\u1eb7t c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 tr\u00e1nh r\u00f2 r\u1ec9 kh\u00ed khi b\u00f3p b\u00f3ng.<\/li>\n
          • Ph\u1ed1i h\u1ee3p v\u1edbi \u00e9p tim: cung c\u1ea5p nh\u00e1t b\u00f3p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 th\u00f4ng kh\u00ed t\u1ed1i \u01b0u v\u00e0 gi\u1ea3m thi\u1ec3u bi\u1ebfn ch\u1ee9ng. \u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn, t\u1ec9 s\u1ed1 \u00e9p tim: th\u1ed5i ng\u1ea1t (b\u00f3p b\u00f3ng) l\u00e0 30:2. \u0110\u1ed1i v\u1edbi tr\u1ebb em, t\u1ec9 l\u1ec7 n\u00e0y l\u00e0 15:2.<\/strong><\/li>\n<\/ul>\n

            5.2 \u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n:<\/h3>\n
              \n
            • \u0110\u00e1nh gi\u00e1 \u0111\u01b0\u1eddng th\u1edf<\/u><\/strong>: \u0111\u01b0\u1eddng th\u1edf \u0111\u00e3 th\u00f4ng tho\u00e1ng, b\u1ec7nh nh\u00e2n c\u00f2n th\u1edf hay th\u1edf c\u00f3 hi\u1ec7u qu\u1ea3 kh\u00f4ng. Ti\u00ean l\u01b0\u1ee3ng \u0111\u01b0\u1eddng th\u1edf kh\u00f3 v\u1edbi LEMON:<\/li>\n
            • Look<\/strong>: nh\u00ecn h\u00ecnh d\u1ea1ng b\u00ean ngo\u00e0i, c\u00f3 b\u1ea5t th\u01b0\u1eddng v\u00f9ng mi\u1ec7ng, h\u1ea7u h\u1ecdng v\u00e0 thanh qu\u1ea3n, b\u00e9o ph\u00ec, c\u1ed5 ng\u1eafn, ch\u1ea5n th\u01b0\u01a1ng v\u00f9ng \u0111\u1ea7u m\u1eb7t c\u1ed5, kh\u1edbp th\u00e1i d\u01b0\u01a1ng h\u00e0m, m\u1ea5t r\u0103ng, \u2026<\/li>\n
            • Evaluate<\/strong>: \u0111\u00e1nh gi\u00e1 3-3-2, h\u00e1 mi\u1ec7ng r\u1ecdng 3 ng\u00f3n tay, kho\u1ea3ng c\u00e1ch c\u1eb1m m\u00f3ng 3 ng\u00f3n tay, kho\u1ea3ng c\u00e1ch h\u00e0m d\u01b0\u1edbi s\u1ee5m gi\u00e1p 2 ng\u00f3n tay.<\/li>\n
            • Mallampati scale: 4 class (nh\u00ecn v\u00f2m h\u1ecdng khi b\u1ec7nh nh\u00e2n h\u00e1 mi\u1ec7ng), class 3 v\u00e0 4 ch\u1ee9ng t\u1ecf \u0111\u1eb7t NKQ kh\u00f3.<\/li>\n
            • Obstruction<\/strong>: \u0111\u00e1nh gi\u00e1 t\u1eafc ngh\u1ebdn, vi\u00eam thanh qu\u1ea3n, \u00e1p xe v\u00f9ng amidan, ch\u1ea5n th\u01b0\u01a1ng, b\u1ecfng\u2026<\/li>\n
            • Neck mobility<\/strong>: \u0111\u00e1nh gi\u00e1 c\u1eed \u0111\u1ed9ng c\u1ed5.<\/li>\n
            • Ph\u01b0\u01a1ng ph\u00e1p Cormack \u2013 Lehane (nh\u00ecn th\u1ea5y thanh m\u00f4n v\u00e0 l\u1ed7 thanh m\u00f4n): grade 3-4 \u0111\u1eb7t NKQ kh\u00f3.<\/li>\n
            • C\u00e1c b\u01b0\u1edbc \u0111\u1eb7t NKQ<\/u><\/strong>: ph\u01b0\u01a1ng ph\u00e1p 7P: Prepare \u2013 Pretreat \u2013 Position \u2013 Preoxygenate \u2013 Paralyze \u2013 Placement \u2013 Position.<\/li>\n<\/ul>\n

              Prepare \u2013<\/strong> Chu\u1ea9n b\u1ecb<\/p>\n

                \n
              • \n
                  \n
                • M\u00e1y h\u00fat \u0111\u00e0m lu\u00f4n s\u1eb5n s\u00e0ng v\u00e0 ho\u1ea1t \u0111\u1ed9ng t\u1ed1t<\/li>\n
                • D\u1ee5ng c\u1ee5 cung c\u1ea5p oxy, b\u00f3ng mask<\/li>\n
                • D\u1ee5ng c\u1ee5 \u0111\u1eb7t NKQ: b\u1ed9 l\u01b0\u1ee1i \u0111\u00e8n \u0111\u00fang k\u00edch c\u1ee1, k\u00edch th\u01b0\u1edbc c\u1ee7a \u1ed1ng NKQ (7-7,5-8), ki\u1ec3m tra b\u00f3ng ch\u00e8n c\u1ee7a NKQ, th\u00f4ng n\u00f2ng NKQ \u0111\u00fang v\u1ecb tr\u00ed, \u1ed1ng ti\u00eam, d\u1ee5ng c\u1ee5 \u0111\u1eb7t NKQ th\u1ea5t b\u1ea1i, \u2026<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                  Pretreat<\/strong> \u2013 Thu\u1ed1c d\u1ef1 ph\u00f2ng<\/p>\n

                    \n
                  • \n
                      \n
                    • Lidocaine: ng\u1eeba co th\u1eaft ph\u1ebf qu\u1ea3n, gi\u1ea3m ph\u1ea3n x\u1ea1 ho v\u00e0 t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd. X\u1ecbt h\u1ea7u h\u1ecdng gi\u00fap gi\u1ea3m ph\u1ea3n x\u1ea1 ho, n\u00f4n \u00f3i, g\u00e2y t\u00ea t\u1ea1i ch\u1ed7. Li\u1ec1u ti\u00eam: 1-1.5mg\/kg IV 2-5 ph\u00fat tr\u01b0\u1edbc khi \u0111\u1eb7t NKQ.<\/li>\n
                    • Atropine: d\u00f9ng cho m\u1ecdi tr\u1ebb <12 tu\u1ed5i, d\u00f9ng cho ng\u01b0\u1eddi l\u1edbn c\u00f3 m\u1ea1ch <100 l\/p, khi d\u00f9ng li\u1ec1u th\u1ee9 2 Succinylcholine (Vecuronium). Li\u1ec1u ng\u01b0\u1eddi l\u1edbn: 0,5-1 mg, tr\u1ebb em: 0,01-0,02 mg\/kg (t\u1ed1i \u0111a 1 mg).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                      Position<\/strong> \u2013 Chu\u1ea9n b\u1ecb t\u01b0 th\u1ebf b\u1ec7nh nh\u00e2n<\/p>\n

                        \n
                      • \n
                          \n
                        • V\u1ecb tr\u00ed gi\u01b0\u1eddng ph\u00f9 h\u1ee3p v\u1edbi chi\u1ec1u cao v\u00e0 t\u01b0 th\u1ebf ng\u01b0\u1eddi \u0111\u1eb7t tho\u1ea3i m\u00e1i.<\/li>\n
                        • G\u1ed1i k\u00ea \u0111\u1ea7u b\u1ec7nh nh\u00e2n, ng\u1eeda \u0111\u1ea7u n\u00e2ng c\u1eb1m (sniffing position), nghi\u1ec7m ph\u00e1p Sellick.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                          Preoxygenate<\/strong> \u2013 Cung c\u1ea5p oxy<\/p>\n

                            \n
                          • \n
                              \n
                            • Cung c\u1ea5p oxy tr\u01b0\u1edbc khi \u0111\u1eb7t NKQ \u0111\u1ec3 t\u0103ng d\u1ef1 tr\u1eef oxy trong l\u00fac \u0111\u1eb7t NKQ cho b\u1ec7nh nh\u00e2n. Cho b\u1ec7nh nh\u00e2n th\u1edf oxy 100% qua mask ho\u1eb7c b\u00f3ng-mask 3-5 ph\u00fat.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                              Paralyze <\/strong>\u2013 G\u00e2y m\u00ea, d\u00e3n c\u01a1<\/p>\n

                                \n
                              • \n
                                  \n
                                • Midazolam (0.1 \u2013 2.5 mg\/kg) ho\u1eb7c Diazepam (2 \u2013 10 mg)<\/li>\n
                                • Morphine (3 \u2013 5 mg) ho\u1eb7c Fentanyl (2 \u2013 3 ug\/kg)<\/li>\n
                                • Vecuronium: 0.08 \u2013 1 mg\/kg. Kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng n\u1ebfu ti\u00ean l\u01b0\u1ee3ng \u0111\u1eb7t NKQ kh\u00f3.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                  Placement<\/strong> \u2013 \u0110\u1eb7t NKQ<\/p>\n

                                    \n
                                  • \n
                                      \n
                                    • Ng\u01b0\u1eddi \u0111\u1eb7t \u0111\u1ee9ng tr\u00ean \u0111\u1ea7u b\u1ec7nh nh\u00e2n, d\u00f9ng tay ph\u1ea3i m\u1edf mi\u1ec7ng b\u1ec7nh nh\u00e2n.<\/li>\n
                                    • X\u1ecbt Xylocaine v\u00e0o v\u00f9ng h\u1ea7u h\u1ecdng tr\u01b0\u1edbc khi \u0111\u01b0a \u0111\u00e8n v\u00e0o mi\u1ec7ng b\u1ec7nh nh\u00e2n.<\/li>\n
                                    • Tay tr\u00e1i c\u1ea7m \u0111\u00e8n, \u0111\u01b0a l\u01b0\u1edfi \u0111\u00e8n v\u00e0o b\u00ean ph\u1ea3i mi\u1ec7ng b\u1ec7nh nh\u00e2n, \u0111i d\u1ecdc \u0111\u1ebfn \u0111\u00e1y l\u01b0\u1ee1i b\u1ec7nh nh\u00e2n v\u00e0 g\u1ea1t l\u01b0\u1ee1i sang tr\u00e1i \u0111\u1ec3 l\u01b0\u1ee1i \u0111\u00e8n v\u00e0o \u0111\u00fang v\u1ecb tr\u00ed.<\/li>\n
                                    • N\u00e2ng l\u01b0\u1ee1i \u0111\u00e8n t\u1ecbnh ti\u1ebfn g\u00f3c 45O <\/sup>\u0111\u1ebfn khi th\u1ea5y d\u00e2y thanh \u00e2m, kh\u00f4ng \u0111\u01b0\u1ee3c xoay c\u1ed5 tay hay t\u1ef1a \u0111\u00e8n v\u00e0o r\u0103ng\/m\u00f4i c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n
                                    • \u0110\u01b0a NKQ v\u00e0o m\u00e9p ph\u1ea3i mi\u1ec7ng b\u1ec7nh nh\u00e2n cho \u0111\u1ebfn khi th\u1ea5y \u0111\u01b0\u1ee3c b\u00f3ng ch\u00e8n qua kh\u1ecfi d\u00e2y thanh \u00e2m t\u1eeb 2-3 cm.<\/li>\n
                                    • R\u00fat \u1ed1ng th\u00f4ng n\u00f2ng, b\u01a1m h\u01a1i b\u00f3ng ch\u00e8n 20-25 mmHg v\u1edbi \u1ed1ng ti\u00eam.<\/li>\n
                                    • B\u00f3p b\u00f3ng qua NKQ v\u1edbi oxy 100%<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                                      Position<\/strong> \u2013 Ki\u1ec3m tra v\u1ecb tr\u00ed \u1ed1ng NKQ<\/p>\n

                                        \n
                                      • \n
                                          \n
                                        • Nh\u00ecn: th\u1ea5y \u1ed1ng NKQ \u0111i qua d\u00e2y thanh \u00e2m, h\u01a1i n\u01b0\u1edbc l\u00e0m m\u1edd \u1ed1ng NKQ khi b\u1ec7nh nh\u00e2n th\u1edf ra.<\/li>\n
                                        • Nghe: h\u01a1i kh\u00f4ng v\u00e0o d\u1ea1 d\u00e0y b\u1ec7nh nh\u00e2n, th\u00f4ng kh\u00ed \u0111\u1ec1u 2 b\u00ean ph\u1ebf tr\u01b0\u1eddng. N\u1ebfu m\u1ed9t b\u00ean nh\u1ecf h\u01a1n ho\u1eb7c kh\u00f4ng nghe, x\u1ea3 b\u00f3ng ch\u00e8n, r\u00fat \u1ed1ng NKQ 2-3 cm sau \u0111\u00f3 b\u01a1m b\u00f3ng ch\u00e8n v\u00e0 th\u1eed l\u1ea1i.<\/li>\n
                                        • ETCO2<\/sub> thay \u0111\u1ed5i khi b\u1ec7nh nh\u00e2n th\u1edf ra.<\/li>\n
                                        • Ch\u1ee5p X-quang nh\u00ecn th\u1ea5y \u0111\u1ea7u \u1ed1ng NKQ trong ph\u1ebf qu\u1ea3n g\u1ed1c tr\u00ean g\u00f3c Carina 3-7 cm.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
                                            \n
                                          • \u0110\u1eb7t NKQ th\u1ea5t b\u1ea1i: b\u00f3p b\u00f3ng qua mask, \u0111\u1eb7t mask thanh qu\u1ea3n, \u0111\u1eb7t NKQ ng\u01b0\u1ee3c d\u00f2ng, m\u1edf kh\u00ed qu\u1ea3n.<\/li>\n
                                          • <\/li>\n<\/ul>\n

                                            T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n

                                              \n
                                            1. American Heart Association Guidelines for CPR and ECC (2018), Part 7: Adult Advanced Cardiovascular Life Support.<\/li>\n
                                            2. T\u00e0i li\u1ec7u l\u1edbp h\u1ecdc H\u1ed3i sinh tim ph\u1ed5i c\u01a1 b\u1ea3n, B\u1ec7nh vi\u1ec7n Tr\u01b0ng V\u01b0\u01a1ng.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                                              H\u1ed3i sinh tim ph\u1ed5i k\u1ebft h\u1ee3p v\u1edbi s\u1ed1c \u0111i\u1ec7n s\u1edbm trong v\u00f2ng 3 \u0111\u1ebfn 5 ph\u00fat \u0111\u1ea7u ti\u00ean sau khi ng\u1eebng tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 \u0111\u1ea1t t\u1ef7 l\u1ec7 c\u1ee9u s\u1ed1ng l\u00ean \u0111\u1ebfn 50% -75% . Ng\u1eebng tu\u1ea7n ho\u00e0n h\u00f4 h\u1ea5p l\u00e0 hi\u1ec7n t\u01b0\u1ee3ng tim ng\u1eebng ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c c\u00f2n ho\u1ea1t \u0111\u1ed9ng nh\u01b0ng kh\u00f4ng c\u00f3 hi\u1ec7u […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[],"yoast_head":"\nTh\u00f4ng kh\u00ed c\u01a1 h\u1ecdc trong h\u1ed3i sinh tim ph\u1ed5i - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed3i sinh tim ph\u1ed5i k\u1ebft h\u1ee3p v\u1edbi s\u1ed1c \u0111i\u1ec7n s\u1edbm trong v\u00f2ng 3 \u0111\u1ebfn 5 ph\u00fat \u0111\u1ea7u ti\u00ean sau khi ng\u1eebng tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 \u0111\u1ea1t t\u1ef7 l\u1ec7 s\u1ed1ng l\u00ean \u0111\u1ebfn 50% -75% .\" \/>\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=\"Th\u00f4ng kh\u00ed c\u01a1 h\u1ecdc trong h\u1ed3i sinh tim ph\u1ed5i - 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