{"id":4299,"date":"2024-12-01T17:35:39","date_gmt":"2024-12-01T10:35:39","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=4299"},"modified":"2024-12-01T17:35:53","modified_gmt":"2024-12-01T10:35:53","slug":"benh-an-ngoai-khoa-tien-phau-4","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-an-ngoai-khoa-tien-phau-4\/","title":{"rendered":"B\u1ec6NH \u00c1N NGO\u1ea0I KHOA (TI\u1ec0N PH\u1eaaU)\u00a0"},"content":{"rendered":"
I. H\u00c0NH CH\u00cdNH<\/strong><\/div>\n
\u00a0<\/div>\n
1. H\u1ecd v\u00e0 t\u00ean: NG\u00d4 H\u00c0O Q<\/div>\n
2. N\u0103m sinh: 1968 ( 56 tu\u1ed5i)<\/div>\n
3. Gi\u1edbi t\u00ednh: Nam<\/div>\n
4. \u0110\u1ecba ch\u1ec9:32\/35 Quang Trung, ph\u01b0\u1eddng 13\u00a0 Qu\u1eadn T\u00e2n B\u00ecnh, TP H\u1ed3 Ch\u00ed Minh.<\/div>\n
5. Ngh\u1ec1 nghi\u1ec7p: c\u00f4ng nh\u00e2n\u00a0 (x\u01b0\u1edfng n\u01b0\u1edbc \u0111\u00e1)<\/div>\n
6. Ng\u00e0y gi\u1edd v\u00e0o vi\u1ec7n: 14h31ph\u00fat – ng\u00e0y 11\/09\/2024<\/div>\n
7. Ng\u00e0y gi\u1edd l\u00e0m b\u1ec7nh \u00e1n: 19h30ph\u00fat – ng\u00e0y 11\/09\/2024<\/div>\n
II. L\u00dd DO V\u00c0O VI\u1ec6N: \u0111au g\u00f3t ch\u00e2n (T)<\/strong><\/div>\n
\u00a0<\/div>\n
\n

III. B\u1ec6NH S\u1eec:<\/strong><\/p>\n<\/div>\n

B\u1ec7nh nh\u00e2n khai:\u00a0<\/div>\n
C\u00e1ch nh\u1eadp vi\u1ec7n 4 ng\u00e0y b\u1ec7nh nh\u00e2n \u0111ang l\u00e0m vi\u1ec7c th\u00ec \u0111\u1ed9t ng\u1ed9t tr\u01b0\u1ee3t ch\u00e2n t\u00e9 t\u1eeb c\u1ea7u thang v\u1edbi chi\u1ec1u cao 1.5m, v\u1edbi t\u01b0 th\u1ebf ng\u1ed3i, hai b\u00e0n tay ch\u1ed1ng, g\u00f3t ch\u00e2n tr\u00e1i ch\u1ea1m n\u1ec1n c\u1ee9ng tr\u01b0\u1edbc, sau t\u00e9 b\u1ec7nh nh\u00e2n \u0111au \u00e2m \u1ec9 v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i \u0111au t\u0103ng l\u00ean khi \u0111i l\u1ea1i v\u00e0 \u0111\u1ee9ng, gi\u1ea3m \u0111au khi ngh\u1ec9 ng\u01a1i sau \u0111\u00f3 b\u1ec7nh nh\u00e2n x\u1eed tr\u00ed b\u1eb1ng c\u00e1ch xoa b\u00f3p d\u1ea7u kho\u1ea3ng 30 ph\u00fat nh\u01b0ng kh\u00f4ng gi\u1ea3m, n\u00ean b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ng\u01b0\u1eddi xung quanh \u0111\u01b0a v\u00e0o b\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t,t\u1ea1i \u0111\u00e2y b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng n\u1eb9p \u0111\u1ec3 c\u1ed1 \u0111\u1ecbnh g\u00f3t ch\u00e2n tr\u00e1i, u\u1ed1ng v\u00e0 ti\u00eam thu\u1ed1c ( kh\u00f4ng r\u00f5 t\u00ean lo\u1ea1i thu\u1ed1c) v\u00e0 ch\u1ee5p x quang v\u1edbi k\u1ebft qu\u1ea3 g\u00e3y x\u01b0\u01a1ng g\u00f3t n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh nh\u1eadp vi\u1ec7n nh\u01b0ng b\u1ec7nh nh\u00e2n\u00a0 xin v\u1ec1 s\u1eafp x\u1ebfp c\u00f4ng vi\u1ec7c. Sau khi v\u1ec1 nh\u00e0 b\u1ec7nh nh\u00e2n v\u1eabn ti\u1ebfp t\u1ee5c c\u00f4ng vi\u1ec7c.<\/div>\n
C\u00e1ch nh\u1eadp vi\u1ec7n # 04 gi\u1edd b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y s\u1ed1t v\u00e0 \u0111au g\u00f3t ch\u00e2n tr\u00e1i v\u1edbi t\u00ednh ch\u1ea5t nh\u01b0 tr\u00ean nh\u01b0ng v\u1edbi m\u1ee9c \u0111\u1ed9 nhi\u1ec1u h\u01a1n n\u00ean b\u1ec7nh nh\u00e2n c\u00f3 t\u1ef1\u00a0 mua thu\u1ed1c u\u1ed1ng (kh\u00f4ng r\u00f5 lo\u1ea1i), c\u00f3 gi\u1ea3m s\u1ed1t v\u00e0 gi\u1ea3m \u0111au nh\u01b0ng v\u1eabn t\u00e1i l\u1ea1i\u00a0 n\u00ean b\u1ec7nh nh\u00e2n\u00a0 \u0111\u1ebfn BV th\u1ed1ng nh\u1ea5t \u0111\u1ec3 nh\u1eadp vi\u1ec7n\u00a0<\/div>\n
Trong qu\u00e1 tr\u00ecnh b\u1ec7nh, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng ch\u00f3ng m\u1eb7t, kh\u00f4ng kh\u00f3 th\u1edf.<\/div>\n
T\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp vi\u1ec7n:<\/div>\n
– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/div>\n
– \u0110au v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
– H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng g\u00f3t tr\u00e1i<\/div>\n
– S\u01b0ng n\u1ec1 v\u00e0 b\u1ea7m t\u00edm v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
– D\u1ea5u hi\u1ec7u sinh t\u1ed3n:\u00a0<\/div>\n
– M\u1ea1ch: 82 l\u1ea7n\/ph\u00fat<\/div>\n
– Huy\u1ebft \u00e1p: 120\/ 80 mmHg<\/div>\n
– Nhi\u1ec7t \u0111\u1ed9: 37 0C<\/div>\n
– Nh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat<\/div>\n
– SPO2:99%<\/div>\n
X\u1eed tr\u00ed l\u00fac nh\u1eadp vi\u1ec7n<\/div>\n
Paracetamol 500mg 1 vi\u00ean(u)<\/div>\n
N\u1eb9p c\u1ed1 \u0111\u1ecbnh c\u1eb3ng b\u00e0n ch\u00e2n tr\u00e1i (\u0111\u00e3 c\u00f3)<\/div>\n
X- Quang kh\u1edbp c\u1ed5 ch\u00e2n tr\u00e1i th\u1eb3ng v\u00e0 nghi\u00eang ( \u0111\u00e3 c\u00f3)<\/div>\n
\u00a0Di\u1ec5n bi\u1ebfn b\u1ec7nh t\u1eeb l\u00fac v\u00e0o vi\u1ec7n \u0111\u1ebfn l\u00fac kh\u00e1m,ghi nh\u1eadn: b\u1ec7nh nh\u00e2n t\u1ec9nh, b\u1ec7nh nh\u00e2n gi\u1ea3m \u0111au g\u00f3t ch\u00e2n tr\u00e1i, nh\u01b0ng c\u00f2n \u0111au khi \u0111\u1ee9ng l\u00ean v\u00e0 \u0111i l\u1ea1i,c\u00f2n s\u01b0ng n\u1ec1 v\u00e0 b\u1ea7m t\u00edm v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
\n

IV. TI\u1ec0N S\u1eec<\/strong><\/p>\n<\/div>\n

1. B\u1ea3n th\u00e2n<\/div>\n
– N\u1ed9i khoa: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd<\/div>\n
– Ngo\u1ea1i khoa: Ch\u01b0a nh\u1eadn ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng, ph\u1eabu thu\u1eadt.<\/div>\n
– D\u1ecb \u1ee9ng: ch\u01b0a ghi nh\u1eadn ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng<\/div>\n
– Th\u00f3i quen: kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1, u\u1ed1ng r\u01b0\u1ee3u bia( kho\u1ea3ng 1 \u0111\u01a1n v\u1ecb c\u1ed3n\/ ng\u00e0y)<\/div>\n
2. Gia \u0111\u00ecnh: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd li\u00ean quan.<\/div>\n
\u00a0<\/div>\n
V. KH\u00c1M L\u00c2M S\u00c0NG<\/strong> (19h30\u2019, ng\u00e0y 11\/09\/2024)\u00a0<\/div>\n
\u00a0<\/div>\n
1. Kh\u00e1m t\u1ed5ng tr\u1ea1ng<\/div>\n
– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/div>\n
– Da, ni\u00eam m\u1ea1c h\u1ed3ng\u00a0<\/div>\n
– Chi \u1ea5m, m\u1ea1ch quay r\u00f5, CRT < 2cm<\/div>\n
– Kh\u00f4ng ph\u00f9<\/div>\n
– D\u1ea5u v\u00e9o da m\u1ea5t nhanh<\/div>\n
– Tuy\u1ebfn gi\u00e1p kh\u00f4ng to<\/div>\n
– H\u1ea1ch ngo\u1ea1i vi s\u1edd kh\u00f4ng ch\u1ea1m.<\/div>\n
– Sinh hi\u1ec7u:\u00a0<\/div>\n
– M\u1ea1ch: 82 l\u1ea7n\/ph\u00fat,\u00a0<\/div>\n
– Huy\u1ebft \u00e1p: 120\/ 80 mmHg<\/div>\n
– Nhi\u1ec7t \u0111\u1ed9: 37.5 0C<\/div>\n
-Nh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat<\/div>\n
– C\u00e2n n\u1eb7ng:\u00a0 65kg. Chi\u1ec1u cao:\u00a0 170cm. BMI =\u00a0 22.5kg\/m2. Th\u1ec3 tr\u1ea1ng b\u00ecnh th\u01b0\u1eddng theo IDI & WPRO<\/div>\n
\u00a0<\/div>\n
2. Kh\u00e1m tu\u1ea7n ho\u00e0n<\/div>\n
– L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, kh\u00f4ng c\u00f3 \u1ed5 \u0111\u1eadp b\u1ea5t th\u01b0\u1eddng, di\u1ec7n \u0111\u1eadp m\u1ecfm tim #2cm.<\/div>\n
– V\u1ecb tr\u00ed m\u1ecfm tim khoang li\u00ean s\u01b0\u1eddn IV\u00a0 \u0111\u01b0\u1eddng trung \u0111\u00f2n (T), rung miu (-), Harzer(-)<\/div>\n
– Ti\u1ebfng tim T1,T2 \u0111\u1ec1u r\u00f5 t\u1ea7n s\u1ed1 82l\/p<\/div>\n
3. Kh\u00e1m h\u00f4 h\u1ea5p\u00a0<\/div>\n
– L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf.<\/div>\n
– Rung thanh \u0111\u1ec1u 2 b\u00ean ph\u1ebf tr\u01b0\u1eddng.<\/div>\n
– G\u00f5 ph\u1ed5i trong.<\/div>\n
– R\u00ec r\u00e0o ph\u1ebf nang \u00eam d\u1ecbu 2 ph\u1ebf tr\u01b0\u1eddng,\u00a0 ph\u1ed5i kh\u00f4ng ran\u00a0<\/div>\n
4. Kh\u00e1m ti\u00eau ho\u00e1<\/div>\n
– B\u1ee5ng m\u1ec1m c\u00e2n \u0111\u1ed1i , kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7, kh\u00f4ng v\u1ebft m\u1ed5 c\u0169, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf.<\/div>\n
– Nhu \u0111\u1ed9ng ru\u1ed9t 12 l\u1ea7n\/ 2 ph\u00fat, kh\u00f4ng \u00e2m th\u1ed5i b\u1ea5t th\u01b0\u1eddng.<\/div>\n
– B\u1ee5ng m\u1ec1m, kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa<\/div>\n
– Gan kh\u00f4ng to, l\u00e1ch s\u1edd kh\u00f4ng ch\u1ea1m<\/div>\n
5. Kh\u00e1m th\u1eadn – ti\u1ebft ni\u1ec7u<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – H\u1ed1 th\u1eaft l\u01b0ng kh\u00f4ng s\u01b0ng n\u1ec1, u c\u1ee5c, xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169.<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – Ch\u1ea1m th\u1eadn (-)<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 – \u0110i\u1ec3m \u0111au ni\u1ec7u qu\u1ea3n tr\u00ean, ni\u1ec7u qu\u1ea3n gi\u1eefa 2 b\u00ean (-)<\/div>\n
6. Kh\u00e1m c\u01a1 x\u01b0\u01a1ng kh\u1edbp:\u00a0<\/div>\n
B\u1ec7nh nh\u00e2n n\u1eb1m tr\u00ean gi\u01b0\u1eddng, k\u00ea cao ch\u00e2n, b\u1ec7nh nh\u00e2n \u0111ang n\u1eb9p c\u1ed1 \u0111\u1ecbnh c\u1eb3ng b\u00e0n ch\u00e2n, th\u00e1o n\u1eb9p \u0111\u00e1nh gi\u00e1:<\/div>\n
NH\u00ccN:\u00a0<\/div>\n
– Kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng<\/div>\n
– Kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169<\/div>\n
– C\u00f3 v\u1ebft b\u1ea7m t\u00edm v\u00e0 s\u01b0ng n\u1ec1 v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
– \u0110\u1ea7u c\u00e1c ng\u00f3n ch\u00e2n h\u1ed3ng<\/div>\n
– B\u00e0n ch\u00e2n tr\u00e1i b\u1eb9t<\/div>\n
S\u1edc:<\/div>\n
– Chi \u1ea5m.<\/div>\n
– S\u1ee9c c\u01a1 ch\u00e2n (P) 5\/5 ch\u00e2n (T) 5\/5<\/div>\n
– Tr\u01b0\u01a1ng l\u1ef1c c\u01a1:\u00a0<\/div>\n
+ \u0110\u1ed9 ch\u1eafc \u0111\u1ec1u hai b\u00ean\u00a0<\/div>\n
+ \u0110\u1ed9 ve v\u1eaby, \u0111\u1ed9 do\u00e3i\u00a0 ch\u00e2n tr\u00e1i kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c do b\u1ec7nh nh\u00e2n \u0111au<\/div>\n
– T\u00ecm c\u00e1c m\u1ed1c x\u01b0\u01a1ng: m\u1eaft c\u00e1 ngo\u00e0i, m\u1eaft c\u00e1 trong, c\u1ee7 l\u1edbn x\u01b0\u01a1ng g\u00f3t.<\/div>\n
– \u1ea4n \u0111au ch\u00f3i v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
– M\u1ea1ch mu ch\u00e2n 2 b\u00ean: \u0111\u1ec1u, r\u00f5<\/div>\n
– M\u1ea1ch ch\u00e0y sau 2 b\u00ean: \u0111\u1ec1u, r\u00f5\u00a0<\/div>\n
V\u1eacN \u0110\u1ed8NG:<\/div>\n
– V\u1eadn \u0111\u1ed9ng g\u1eadp l\u01b0ng \u2013 g\u1eadp l\u00f2ng, d\u1ea1ng- kh\u00e9p b\u00e0n ch\u00e2n kh\u00f4ng h\u1ea1n ch\u1ebf<\/div>\n
– V\u1eadn \u0111\u1ed9ng l\u1eadt s\u1ea5p, l\u1eadt ng\u1eeda h\u1ea1n ch\u1ebf<\/div>\n
– C\u00e1c ng\u00f3n ch\u00e2n 2 b\u00ean c\u1eed \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng<\/div>\n
– B\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb m\u1ea5t c\u1ea3m gi\u00e1c v\u00e0 kh\u00f4ng t\u00ea b\u00ec \u1edf v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i.<\/div>\n
NGHI\u1ec6M PH\u00c1P\u00a0<\/div>\n
Nghi\u1ec7m ph\u00e1p Thompson(-)<\/div>\n
7. Kh\u00e1m th\u1ea7n kinh: B\u1ec7nh nh\u00e2n t\u1ec9nh, c\u1ed5 m\u1ec1m, kernig (-), brudzinski (-), kh\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa<\/div>\n
8. Kh\u00e1m c\u00e1c c\u01a1 quan kh\u00e1c: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng.<\/div>\n
\n

VI. T\u00d3M T\u1eaeT B\u1ec6NH \u00c1N<\/strong><\/p>\n<\/div>\n

B\u1ec7nh nh\u00e2n nam, 56 tu\u1ed5i v\u00e0o vi\u1ec7n v\u00ec \u0111au g\u00f3t ch\u00e2n tr\u00e1i sau tai n\u1ea1n sinh ho\u1ea1t ng\u00e0y th\u1ee9 4. Qua h\u1ecfi\u00a0 b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng ghi nh\u1eadn:<\/div>\n
* Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/div>\n
– \u0110au v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
– H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
*Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/div>\n
– \u1ea4n \u0111au ch\u00f3i g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
– Sung n\u1ec1 v\u00e0 b\u1ea7m t\u00edm v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
– V\u1eadn \u0111\u1ed9ng l\u1eadt s\u1ea5p, l\u1eadt ng\u1eeda h\u1ea1n ch\u1ebf.<\/div>\n
– B\u00e0n ch\u00e2n tr\u00e1i b\u1eb9t<\/div>\n
\n

VII. \u0110\u1eb6T V\u1ea4N \u0110\u1ec0<\/strong><\/p>\n<\/div>\n

D\u1ea5u hi\u1ec7u g\u00e3y x\u01b0\u01a1ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
\n

VIII. CH\u1ea8N \u0110O\u00c1N S\u01a0 B\u1ed8:<\/strong><\/p>\n<\/div>\n

G\u00e3y k\u00edn x\u01b0\u01a1ng g\u00f3t ch\u00e2n tr\u00e1i do tai n\u1ea1n sinh ho\u1ea1t ng\u00e0y 4, hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng<\/div>\n
\n

IX. CH\u1ea8N \u0110O\u00c1N PH\u00c2N BI\u1ec6T<\/strong><\/p>\n<\/div>\n

Ch\u1ea5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m v\u00f9ng g\u00f3t ch\u00e2n tr\u00e1i do tai n\u1ea1n sinh ho\u1ea1t ng\u00e0y 4<\/div>\n
\n

X. BI\u1ec6N LU\u1eacN L\u00c2M S\u00c0NG<\/strong><\/p>\n<\/div>\n

B\u1ec7nh nh\u00e2n nam, 56 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u00ec \u0111au g\u00f3t ch\u00e2n tr\u00e1i sau tai n\u1ea1n sinh ho\u1ea1t ng\u00e0y 4 v\u1edbi c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp (\u0111\u1eadp g\u00f3t ch\u00e2n xu\u1ed1ng n\u1ec1n c\u1ee9ng)<\/div>\n
– Ngh\u0129 nhi\u1ec1u \u0111\u1ebfn b\u00eanh nh\u00e2n c\u00f3 g\u00e3y x\u01b0\u01a1ng k\u00edn v\u00ec th\u0103m kh\u00e1m kh\u00f4ng ph\u00e1t hi\u1ec7n v\u1ebft th\u01b0\u01a1ng t\u1ea1i v\u1ecb tr\u00ed ch\u1ea5n th\u01b0\u01a1ng.<\/div>\n
– Ngh\u0129 nhi\u1ec1u b\u1ec7nh nh\u00e2n g\u00e3y x\u01b0\u01a1ng g\u00f3t ch\u00e2n tr\u00e1i v\u00ec th\u0103m kh\u00e1m ghi nh\u1eadn c\u00e1c tri\u1ec7u ch\u1ee9ng g\u00e3y x\u01b0\u01a1ng g\u00f3t ch\u00e2n tr\u00e1i nh\u01b0 \u0111au g\u00f3t ch\u00e2n tr\u00e1i, s\u01b0ng n\u1ec1 v\u00e0 b\u1ea7m t\u00edm v\u00f9ng g\u00f3t ch\u00e2n, \u1ea5n \u0111au ch\u00f3i, v\u1eadn \u0111\u1ed9ng l\u1eadt s\u1ea5p, l\u1eadt ng\u1eeda h\u1ea1n ch\u1ebf, b\u00e0n ch\u00e2n tr\u00e1i b\u1eb9t.<\/div>\n
– Ngh\u0129 \u00edt \u0111\u1ebfn ch\u1ea5n th\u01b0\u01a1ng ph\u1ea7n m\u1ec1m do tr\u00ean l\u00e2m s\u00e0ng ghi nh\u1eadn b\u1ec7nh \u1ea5n \u0111au ch\u00f3i, v\u1eadn \u0111\u1ed9ng l\u1eadt s\u1ea5p, l\u1eadt ng\u1eeda h\u1ea1n ch\u1ebf, b\u00e0n ch\u00e2n tr\u00e1i b\u1eb9t nh\u01b0ng c\u00f3 s\u01b0ng n\u1ec1 b\u1ea7m t\u00edm n\u00ean c\u1ea7n \u0111\u1ec1 ngh\u1ecb x- quang kh\u1edbp c\u1ed5 ch\u00e2n th\u1eb3ng v\u00e0 nghi\u00eang, CT \u2013scan kh\u1edbp c\u1ed5 ch\u00e2n<\/div>\n
– Hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0<\/div>\n
+ Cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng: l\u00e2m s\u00e0ng ghi nh\u1eadn b\u1ec7nh t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t, sinh hi\u1ec7u \u1ed5n, chi \u1ea9m, CRT <2s, m\u1ee9c \u0111\u1ed9 \u0111au gi\u1ea3m d\u1ea7n, ch\u1ecbu \u0111\u1ef1ng \u0111\u01b0\u1ee3c, ch\u1ec9 s\u1ed1 s\u1ed1c 0,68 (<1). Ngh\u0129 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 cho\u00e1ng ch\u1ea5n th\u01b0\u01a1ng.<\/div>\n
+ Ch\u00e8n \u00e9p khoang do hi\u1ec7n t\u1ea1i b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng thu\u1ed1c gi\u1ea3m \u0111au sau khi th\u0103m ghi nh\u1eadn m\u1ea1ch mu ch\u00e2n v\u00e0 m\u1ea1ch ch\u00e0y sau r\u00f5, \u0111\u1ea7u c\u00e1c ng\u00f3n ch\u00e2n h\u1ed3ng, b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb m\u1ea5t c\u1ea3m gi\u00e1c v\u00e0 t\u00ea b\u00ec nh\u01b0ng v\u1eabn c\u1ea7n theo d\u00f5i th\u00eam v\u00ec bi\u1ebfn ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra k\u00e9o d\u00e0i \u0111\u1ebfn 6 ng\u00e0y sau ch\u1ea5n th\u01b0\u01a1ng.<\/div>\n
+ Ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh m\u1ea1ch m\u00e1u do kh\u00e1m th\u1ea5y \u0111\u1ea7u c\u00e1c ng\u00f3n ch\u00e2n h\u1ed3ng, b\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch mu ch\u00e2n 2 b\u00ean, m\u1ea1ch ch\u00e0y sau 2 b\u00ean .<\/div>\n
\n

IX. \u0110\u1ec0 NGH\u1eca C\u1eacN L\u00c2M S\u00c0NG V\u00c0 K\u1ebeT QU\u1ea2 \u0110\u00c3 C\u00d3<\/strong><\/p>\n<\/div>\n

1. \u0110\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng:<\/div>\n
– C\u1eadn l\u00e2m s\u00e0ng h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n:<\/div>\n
+ X quang kh\u1edbp c\u1ed5 ch\u00e2n tr\u00e1i th\u1eb3ng, nghi\u00eang (\u0111\u00e3 c\u00f3)<\/div>\n
+ CT-scan kh\u1edbp c\u1ed5 ch\u00e2n tr\u00e1i<\/div>\n
– C\u1eadn l\u00e2m s\u00e0ng th\u01b0\u1eddng quy\/ti\u1ec1n ph\u1eabu<\/div>\n
+ C\u00f4ng th\u1ee9c m\u00e1u<\/div>\n
+ Sinh h\u00f3a m\u00e1u(glucose, ure, creatinin, eGFR, AST, AGT)\u00a0<\/div>\n
+ ECG<\/div>\n
+ X quang ng\u1ef1c th\u1eb3ng<\/div>\n
+ Bilan \u0111\u00f4ng c\u1ea7m m\u00e1u<\/div>\n
+ T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u<\/div>\n
2. K\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng \u0111\u00e3 c\u00f3:<\/div>\n
a\/ T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi<\/div>\n
\u00a0<\/div>\n
Ng\u00e0y 11\/9\/2024Gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng\u0110\u01a1n v\u1ecb<\/div>\n
WBC 8.43 4.01 \u2013 11.42 K\/Ul<\/div>\n
NEU% 84.2 40 – 74 %<\/div>\n
LYM% 4.9 19 \u2013 48 %<\/div>\n
MONO% 10.4 3.4-9.0 %<\/div>\n
EOS% 0.3 0.0-7.0 %<\/div>\n
BASO% 0.2 0.0-1.5 %<\/div>\n
NEU# 7.09 1.7-7.5 K\/Ul<\/div>\n
LYM# 0.42 1.2-4.0 K\/Ul<\/div>\n
MONO# 0.88 0.2-0.8 K\/Ul<\/div>\n
EOS# 0.02 0.0-0.6 K\/Ul<\/div>\n
BASO#0.020.0-0.1<\/div>\n
RBC 4.66 4.01 \u2013 5.79 M\/Ul<\/div>\n
HGB 11.3 11.5 – 15 g\/Dl<\/div>\n
HCT 33.4 34.4 \u2013 48.6 %<\/div>\n
MCV 71.5 80-99 Fl<\/div>\n
MCH 24.2 27-33 Pg<\/div>\n
MCHC 33.8 32-36 g\/dl<\/div>\n
RDW 14.9 11.5-15.5 %<\/div>\n
PLT 263.0 150 – 450 K\/Ul<\/div>\n
\u00a0<\/div>\n
C\u00f4ng th\u1ee9c m\u00e1u: thi\u1ebfu m\u00e1u m\u1ee9c \u0111\u1ed9 nh\u1eb9 h\u1ed3ng c\u1ea7u nh\u1ecf nh\u01b0\u1ee3c s\u1eaft, b\u1ea1ch c\u1ea7u \u01b0u th\u1ebf d\u00f2ng NEU n\u00ean ngh\u0129 nhi\u1ec1u b\u1ec7nh nh\u00e2n b\u1ecb nhi\u1ec5m tr\u00f9ng nh\u01b0ng tr\u00ean l\u00e2m s\u00e0ng ch\u01b0a ghi nh\u1eadn tri\u1ec7u ch\u1ee9ng nhi\u1ec5m tr\u00f9ng \u1edf b\u1ec7nh nh\u00e2n n\u00e0y n\u00ean c\u1ea7n theo d\u00f5i th\u00eam.<\/div>\n
b\/ \u0110\u00f4ng c\u1ea7m m\u00e1u: c\u00e1c ch\u1ec9 s\u1ed1 n\u1eb1m trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng<\/div>\n
c\/ Sinh ho\u00e1 m\u00e1u<\/div>\n
11\/09\/2024Gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng<\/div>\n
Glucose 6.66 4.1 \u2013 5.9 mmol\/l<\/div>\n
Ure 5.92 2.8 \u2013 7.2 mmol\/l<\/div>\n
Creatinine 86.7 58 \u2013 96 umol\/l<\/div>\n
eGFR 84.02 >= 60 mL\/ph\u00fat<\/div>\n
AST 72.9 <35 U\/L<\/div>\n
ALT 32.6 <35 U\/L<\/div>\n
Na+ 135.2 135 \u2013 145 mmol\/l<\/div>\n
K+ 4.25 3.5 \u2013 5.0 mmol\/l<\/div>\n
Cl- 99,2 98 \u2013 106 mmol\/l<\/div>\n
\u0110\u1ecbnh l\u01b0\u1ee3ng Calci 2.3 2.15-2.6 Mmol\/l<\/div>\n
\u00a0<\/div>\n
Glucose m\u00e1u 6.66 mmol\/l\u00a0 t\u0103ng c\u1ea7n l\u00e0m l\u1ea1i x\u00e9t nghi\u1ec7m \u0111\u01b0\u1eddng huy\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type II kh\u00f4ng,AST t\u0103ng ngh\u0129 do b\u1ec7nh nh\u00e2n u\u1ed1ng nhi\u1ec1u r\u01b0\u1ee3u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng gan.<\/div>\n
d \/ \u0110\u1ecbnh nh\u00f3m m\u00e1u h\u1ec7 ABO, Rh (+): B+<\/div>\n
e\/ ECG<\/div>\n
B\u1ec7nh nh\u00e2n nam 56 tu\u1ed5i<\/div>\n
\u00a0Ng\u00e0y \u0111o c\u00f9ng ng\u00e0y nh\u1eadp vi\u1ec7n<\/div>\n
\u00a0Nh\u1ecbp xoang \u0111\u1ec1u, t\u1ea7n s\u1ed1 82ll\/ph<\/div>\n
\u00a0Tr\u1ee5c QRS trung gian<\/div>\n
g\/ X-quang kh\u1edbp c\u1ed5 ch\u00e2n th\u1eb3ng v\u00e0 nghi\u00eang<\/div>\n
\n
\"H\u00ecnh
1<\/figcaption><\/figure>
\"2\"
2<\/figcaption><\/figure>\n<\/div>\n
\u00a0<\/div>\n
+ H\u00e0nh ch\u00ednh:<\/div>\n
T\u00ean b\u1ec7nh nh\u00e2n : Ng\u00f4 H\u00e0o Q<\/div>\n
M\u00e3 s\u1ed1: 24036838<\/div>\n
Gi\u1edbi nam<\/div>\n
Sinh n\u0103m:1968<\/div>\n
Phim ch\u1ee5p ng\u00e0y 8\/9\/2024<\/div>\n
T\u01b0 th\u1ebf phim: th\u1eb3ng v\u00e0 nghi\u00eang<\/div>\n
Ch\u1ea5t l\u01b0\u1ee3ng tia: kh\u00f4ng qu\u00e1 c\u1ee9ng, kh\u00f4ng qu\u00e1 m\u1ec1m<\/div>\n
S\u1ed1 l\u01b0\u1ee3ng phim: \u0111\u1ee7 2 phim th\u1eb3ng v\u00e0 nghi\u00eang<\/div>\n
K\u00edch th\u01b0\u1edbc phim: l\u1ea5y tr\u00ean m\u1ed9t kh\u1edbp v\u00e0 d\u01b0\u1edbi m\u1ed9t kh\u1edbp l\u1ea5y t\u1eeb v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng \u0111\u1ee7 r\u1ed9ng l\u1ea5y \u0111\u1ee7 b\u00f3ng m\u00f4 m\u1ec1m xung quanh t\u1ed5n th\u01b0\u01a1ng.<\/div>\n
+ \u0110\u1ecdc t\u1ed5n th\u01b0\u01a1ng:<\/div>\n
G\u00e3y x\u01b0\u01a1ng g\u00f3t ch\u00e2n tr\u00e1i,<\/div>\n
H\u00ecnh th\u1ee9c g\u00e3y: \u0111\u01a1n gi\u00e3n<\/div>\n
\u0110\u01b0\u1eddng g\u00e3y: ngang<\/div>\n
Di l\u1ec7nh: g\u1eadp g\u00f3c<\/div>\n
Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u1ea5u tr\u00fac x\u01b0\u01a1ng<\/div>\n
K\u1ebft lu\u1eadn: g\u00e3y x\u01b0\u01a1ng g\u00f3t ch\u00e2n tr\u00e1i<\/div>\n
\n

XI. CH\u1ea8N \u0110O\u00c1N X\u00c1C \u0110\u1ecaNH<\/strong><\/p>\n<\/div>\n

G\u00e3y k\u00edn x\u01b0\u01a1ng g\u00f3t ch\u00e2n (T) do tai n\u1ea1n sinh ho\u1ea1t ng\u00e0y 4, hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng<\/div>\n
\n


\nXII. \u0110I\u1ec0U TR\u1eca<\/strong><\/p>\n

 <\/p>\n<\/div>\n

1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb:\u00a0<\/div>\n
– C\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng g\u00e3y<\/div>\n
– Gi\u1ea3m \u0111au<\/div>\n
– Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng<\/div>\n
– B\u1ed5 sung dinh d\u01b0\u1ee1ng,kho\u00e1ng ch\u1ea5t<\/div>\n
2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3:<\/div>\n
– B\u00f3 b\u1ed9t th\u1ee7y tinh c\u1eb3ng -b\u00e0n ch\u00e2n tr\u00e1i<\/div>\n
– Paracetamol 500mg 01 vi\u00ean u\u1ed1ng<\/div>\n
– Caldihasan 1250mg 1 vi\u00ean(u\u1ed1ng)<\/div>\n
\n

XIII. TI\u00caN L\u01af\u1ee2NG<\/strong><\/p>\n<\/div>\n

– Ti\u00ean l\u01b0\u1ee3ng g\u1ea7n:trung b\u00ecnh, do hi\u1ec7n t\u1ea1i b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng nh\u01b0ng b\u00eanh nh\u00e2n c\u00f3 th\u00f3i quen u\u1ed1ng r\u01b0\u1ee3u n\u00ean \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1eddi gian li\u1ec1n x\u01b0\u01a1ng.<\/div>\n
– Ti\u00ean l\u01b0\u1ee3ng xa: Trung b\u00ecnh do t\u00ednh ch\u1ea5t c\u00f4ng vi\u1ec7c c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0m vi\u1ec7c n\u1eb7ng n\u00ean th\u1eddi gian h\u1ed3i ph\u1ee5c x\u01b0\u01a1ng c\u00f3 th\u1ec3 k\u00e9o d\u00e0i l\u00e2u.<\/div>\n
\n

XIV. D\u1ef0 PH\u00d2NG<\/strong><\/p>\n<\/div>\n

– Tr\u00e1nh c\u00e1c b\u1ec1 m\u1eb7t nguy hi\u1ec3m: Khi \u0111i b\u1ed9 ho\u1eb7c tham gia c\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u1ec3 thao, h\u00e3y ch\u00fa \u00fd \u0111\u1ebfn b\u1ec1 m\u1eb7t \u0111\u1ec3 tr\u00e1nh nh\u1eefng c\u00fa tr\u01b0\u1ee3t ho\u1eb7c va ch\u1ea1m g\u00e2y \u00e1p l\u1ef1c qu\u00e1 m\u1ee9c l\u00ean x\u01b0\u01a1ng g\u00f3t.<\/div>\n
– T\u1eadp th\u1ec3 d\u1ee5c \u0111\u1ecbnh k\u1ef3: Duy tr\u00ec s\u1ee9c m\u1ea1nh c\u1ee7a c\u01a1 b\u1eafp v\u00e0 \u0111\u1ed9 linh ho\u1ea1t c\u1ee7a kh\u1edbp th\u00f4ng qua c\u00e1c b\u00e0i t\u1eadp th\u1ec3 d\u1ee5c, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng b\u00e0i t\u1eadp h\u1ed7 tr\u1ee3 x\u01b0\u01a1ng ch\u00e2n v\u00e0 m\u1eaft c\u00e1 ch\u00e2n.<\/div>\n
– Ch\u1ebf \u0111\u1ed9 \u0103n gi\u00e0u canxi, vitamin D v\u00e0 acid folic.<\/div>\n
– H\u1ea1n ch\u1ebf l\u00e0m c\u00e1c c\u00f4ng vi\u1ec7c n\u1eb7ng<\/div>\n
– T\u00e1i kh\u00e1m khi g\u00f3t ch\u00e2n tr\u00e1i v\u1eabn c\u00f2n \u0111au\u00a0<\/div>\n
– H\u1ea1n ch\u1ebf c\u00e1c lo\u1ea1i th\u1ee9c u\u1ed1ng nh\u01b0 c\u00e0 ph\u00ea, n\u01b0\u1edbc ng\u1ecdt c\u00f3 ga, r\u01b0\u1ee3u bia,.. v\u00ec n\u00f3 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i c\u1ee7a x\u01b0\u01a1ng.<\/div>\n
\u00a0<\/div>","protected":false},"featured_media":4256,"comment_status":"open","ping_status":"closed","template":"","tags":[],"chuyen-muc":[188],"class_list":["post-4299","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","chuyen-muc-benh-an-mau"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4299","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/bai-giang"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=4299"}],"version-history":[{"count":2,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4299\/revisions"}],"predecessor-version":[{"id":4303,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4299\/revisions\/4303"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/4256"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=4299"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4299"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=4299"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}