{"id":4311,"date":"2024-12-01T18:30:07","date_gmt":"2024-12-01T11:30:07","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=4311"},"modified":"2024-12-01T18:30:19","modified_gmt":"2024-12-01T11:30:19","slug":"benh-an-ngoai-khoa-tien-phau-5","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-an-ngoai-khoa-tien-phau-5\/","title":{"rendered":"B\u1ec6NH \u00c1N NGO\u1ea0I KHOA (TI\u1ec0N PH\u1eaaU)"},"content":{"rendered":"
Sinh vi\u00ean th\u1ef1c hi\u1ec7n:<\/div>\n
Hu\u1ef3nh Thanh T\u00f9ng\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 MSSV:116019287<\/div>\n
Nguy\u1ec5n Ho\u00e0ng Kh\u00e1nh Uy\u00ean\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 MSSV:116019290<\/div>\n
\u0110I\u1ec2M NH\u1eacN X\u00c9T CH\u1eee K\u00dd<\/div>\n
\n

I. H\u00c0NH CH\u00cdNH<\/strong><\/p>\n<\/div>\n

1.\u00a0 \u00a0 H\u1ecd v\u00e0 t\u00ean: \u0110\u1eb6NG QUANG H<\/div>\n
2. Tu\u1ed5i: 28 (Sinh n\u0103m: 1996)<\/div>\n
3. Gi\u1edbi t\u00ednh: Nam<\/div>\n
4. \u0110\u1ecba ch\u1ec9: Khu ph\u1ed1 4, \u0110\u00f4 Vinh, Phan rang-Th\u00e1p ch\u00e0m, t\u1ec9nh Ninh Thu\u1eadn<\/div>\n
5. Ngh\u1ec1 nghi\u1ec7p: Xe \u00f4m c\u00f4ng ngh\u1ec7<\/div>\n
6. Chi thu\u1eadn: Tay (P) – Ch\u00e2n (P)<\/div>\n
7. Ng\u00e0y gi\u1edd v\u00e0o vi\u1ec7n: 19h15p ng\u00e0y 17\/9\/2024<\/div>\n
8.\u00a0 \u00a0 Ng\u00e0y gi\u1edd l\u00e0m b\u1ec7nh \u00e1n:\u00a0 21h00 – ng\u00e0y 17\/09\/2024<\/div>\n
\n

II. L\u00dd DO V\u00c0O VI\u1ec6N: \u0111au khu\u1ef7u tay (T)<\/strong><\/p>\n<\/div>\n

\n

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

B\u1ec7nh nh\u00e2n khai:<\/div>\n
\u00a0 C\u00e1ch nh\u1eadp vi\u1ec7n # 30 ph\u00fat, b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u khi\u1ec3n xe m\u00e1y tr\u00ean \u0111\u01b0\u1eddng va ch\u1ea1m v\u1edbi 1 xe m\u00e1y \u0111i ng\u01b0\u1ee3c chi\u1ec1u t\u00f4ng tr\u1ef1c di\u1ec7n. B\u1ec7nh nh\u00e2n ng\u00e3 xu\u1ed1ng \u0111\u01b0\u1eddng ng\u00e3 ng\u01b0\u1eddi v\u1ec1 b\u00ean (T), Khu\u1ef7u tay (T) ti\u1ebfp \u0111\u1ea5t tr\u1ef1c ti\u1ebfp trong t\u01b0 th\u1ebf g\u1ea5p khu\u1ef7u, sau ng\u00e3 b\u1ec7nh nh\u00e2n than \u0111au nhi\u1ec1u v\u00f9ng khu\u1ef7u tay (T), \u0111au t\u0103ng khi c\u1eed \u0111\u1ed9ng khu\u1ef7u tay (T), s\u01b0ng n\u1ec1 v\u00e0 x\u00e2y x\u00e1t khu\u1ef7u tay (T), kh\u00f4ng va ch\u1ea1m v\u00f9ng \u0111\u1ea7u. B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c x\u1eed tr\u00ed g\u00ec v\u00e0 \u0111\u01b0\u1ee3c ng\u01b0\u1eddi d\u00e2n \u0111\u01b0a \u0111\u1ebfn kh\u00e1m t\u1ea1i b\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t.<\/div>\n
\u00a0 Trong qu\u00e1 tr\u00ecnh di\u1ec5n ti\u1ebfn b\u1ec7nh, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au \u0111\u1ea7u hay ch\u00f3ng m\u1eb7t, kh\u00f4ng bu\u1ed3n n\u00f4n, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng \u0111au ng\u1ef1c, ti\u00eau ti\u1ec3u t\u1ef1 ch\u1ee7.<\/div>\n
T\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp vi\u1ec7n:<\/div>\n
–\u00a0 \u00a0 B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/div>\n
–\u00a0 \u00a0 Kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng bu\u1ed3n n\u00f4n<\/div>\n
–\u00a0 \u00a0 \u0110au nhi\u1ec1u v\u00f9ng khu\u1ef7u tay (T), c\u01b0\u1eddng \u0111\u1ed9 \u0111au 6\/10 (theo thang \u0111i\u1ec3m VAS)<\/div>\n
–\u00a0 \u00a0 H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng Khu\u1ef7u tay (T)<\/div>\n
–\u00a0 \u00a0 D\u1ea5u hi\u1ec7u sinh t\u1ed3n:<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 M\u1ea1ch: 75 l\u1ea7n\/ph\u00fat<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Huy\u1ebft \u00e1p: 140\/ 80 mmHg<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Nhi\u1ec7t \u0111\u1ed9: 37 0C<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Nh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 SpO2: 98%<\/div>\n
C\u1eadn l\u00e2m s\u00e0ng c\u1ea5p c\u1ee9u: Ch\u1ee5p X Quang ng\u1ef1c th\u1eb3ng; Ghi \u0111i\u1ec7n tim c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng; Ch\u1ee5p Xquang kh\u1edbp khu\u1ef7u tay (T)<\/div>\n
X\u1eed tr\u00ed \u1edf c\u1ea5p c\u1ee9u:\u00a0 Paracetamol 01 chai (TTM) C g\/ph\u00fat<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 N\u1eb9p c\u1ed1 \u0111\u1ecbnh c\u00e1nh – c\u1eb3ng – b\u00e0n tay<\/div>\n
T\u00ecnh tr\u1ea1ng hi\u1ec7n t\u1ea1i: B\u1ec7nh nh\u00e2n t\u1ec9nh, gi\u1ea3m \u0111au, c\u01b0\u1eddng \u0111\u1ed9 \u0111au 4\/10, c\u00f2n s\u01b0ng n\u1ec1 khu\u1ef7u tay (T), h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng khu\u1ef7u tay (T), kh\u00f4ng t\u00ea tay, kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng v\u00f9ng khu\u1ef7u<\/div>\n
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IV. TI\u1ec0N S\u1eec<\/strong><\/p>\n<\/div>\n

1.\u00a0 \u00a0 B\u1ea3n th\u00e2n<\/div>\n
a\/ N\u1ed9i khoa<\/div>\n
Ch\u01b0a ghi nh\u1eadn b\u1ec7nh l\u00fd n\u1ed9i khoa<\/div>\n
\u00a0 b\/ Ngo\u1ea1i khoa:\u00a0 Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n ph\u1eabu thu\u1eadt hay ch\u1ea5n th\u01b0\u01a1ng tr\u01b0\u1edbc \u0111\u00e2y.<\/div>\n
c\/ D\u1ecb \u1ee9ng: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n s\u1eed d\u1ecb \u1ee9ng.<\/div>\n
\u00a0 d\/ Th\u00f3i quen: kh\u00f4ng h\u00fat thu\u1ed1c l\u00e1, u\u1ed1ng r\u01b0\u1ee3u bia<\/div>\n
2. Gia \u0111\u00ecnh: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd li\u00ean quan.<\/div>\n
\n

V. L\u01af\u1ee2C QUA C\u00c1C C\u01a0 QUAN<\/strong><\/p>\n<\/div>\n

\u2022 Tim m\u1ea1ch: kh\u00f4ng h\u1ed3i h\u1ed9p, kh\u00f4ng \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, kh\u00f4ng \u0111au ng\u1ef1c<\/div>\n
\u2022 H\u00f4 h\u1ea5p: kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng ho<\/div>\n
\u2022 Ti\u00eau ho\u00e1: kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng bu\u1ed3n n\u00f4n, kh\u00f4ng n\u00f4n<\/div>\n
\u2022 Ti\u1ebft ni\u1ec7u: kh\u00f4ng ti\u1ec3u g\u1eaft bu\u1ed1t, n\u01b0\u1edbc ti\u1ec3u v\u00e0ng trong<\/div>\n
\u2022 C\u01a1 x\u01b0\u01a1ng kh\u1edbp: s\u01b0ng n\u1ec1, \u0111au khu\u1ef7u tay (T)<\/div>\n
\u2022 Th\u1ea7n kinh: kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa<\/div>\n
\n

VI. KH\u00c1M L\u00c2M S\u00c0NG 21h 00′, ng\u00e0y 17\/09\/2024)<\/strong><\/p>\n<\/div>\n

\u00a0 \u00a0 A\/ Kh\u00e1m t\u1ed5ng tr\u1ea1ng<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/div>\n
–\u00a0 \u00a0 D\u1ea5u hi\u1ec7u sinh t\u1ed3n:<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 M\u1ea1ch: 75 l\u1ea7n\/ph\u00fat,<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Huy\u1ebft \u00e1p: 130\/ 80 mmHg<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Nhi\u1ec7t \u0111\u1ed9: 37 0C<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Nh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 SpO2: 98%\u00a0<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0Da, ni\u00eam m\u1ea1c h\u1ed3ng<\/div>\n
–\u00a0 \u00a0 Chi \u1ea5m, m\u1ea1ch quay r\u00f5, CRT < 2s<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0Kh\u00f4ng ph\u00f9<\/div>\n
–\u00a0 \u00a0 Th\u1ec3 tr\u1ea1ng: Ti\u1ec1n b\u00e9o ph\u00ec, BMI= 23,7 kg\/m2 theo IDI & WPRO<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0 (C\u00e2n n\u1eb7ng: 70 kg, Chi\u1ec1u cao: 1,72 m)<\/div>\n
–\u00a0 \u00a0 D\u1ea5u v\u00e9o da m\u1ea5t nhanh<\/div>\n
–\u00a0 \u00a0 Tuy\u1ebfn gi\u00e1p kh\u00f4ng to<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0H\u1ea1ch ngo\u1ea1i vi s\u1edd kh\u00f4ng ch\u1ea1m.<\/div>\n
B\/ Kh\u00e1m c\u00e1c c\u01a1 quan<\/div>\n
1.\u00a0 \u00a0 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 \u0111\u01b0\u1eddng trung \u0111\u00f2n (T), rung mi\u00eau (-), Harzer (-)<\/div>\n
– Ti\u1ebfng tim T1, T2 \u0111\u1ec1u, r\u00f5<\/div>\n
– Nh\u1ecbp tim 75 l\u1ea7n\/ph\u00fat, \u0111\u1ec1u, kh\u00f4ng ph\u00e1t hi\u1ec7n \u00e2m th\u1ed5i b\u1ea5t th\u01b0\u1eddng.<\/div>\n
2.\u00a0 \u00a0 Kh\u00e1m h\u00f4 h\u1ea5p<\/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, ph\u1ed5i kh\u00f4ng ran<\/div>\n
3. Kh\u00e1m c\u01a1 x\u01b0\u01a1ng kh\u1edbp:<\/div>\n
NH\u00ccN: b\u1ec7nh nh\u00e2n t\u01b0 th\u1ebf ng\u1ed3i \u0111\u01b0\u1ee3c th\u00e1o n\u1eb9p c\u00e1nh tay – c\u1eb3ng – b\u00e0n tay T, khu\u1ef7u g\u1ea5p 80 \u0111\u1ed9<\/div>\n
Tay tr\u00e1i: S\u01b0ng n\u1ec1, c\u00f3 v\u1ebft th\u01b0\u01a1ng x\u00e2y x\u00e1t 1\/3 d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay(T), kh\u00f4ng bi\u1ebfn d\u1ea1ng, \u0111\u1ea7u ng\u00f3n tay h\u1ed3ng. Kh\u00f4ng u c\u1ee5c, kh\u00f4ng c\u00f3 s\u1eb9o m\u1ed5 c\u0169.<\/div>\n
S\u1edc:<\/div>\n
– Tay (T):<\/div>\n
+Chi \u1ea5m, CRT < 2s<\/div>\n
+ S\u1ee9c c\u01a1 tay 2 tay 5\/5<\/div>\n
+\u1ea4n \u0111au ch\u00f3i v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T)<\/div>\n
+ M\u1ea5t li\u00ean t\u1ee5c \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T)<\/div>\n
+ \u0110M quay, \u0110M tr\u1ee5 b\u1eaft \u0111\u01b0\u1ee3c \u0111\u1ec1u, r\u00f5<\/div>\n
+ Khi g\u1ea5p khu\u1ef7u 3 \u0111i\u1ec3m g\u1ed3m 2 l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay v\u00e0 m\u1ecfm khu\u1ef7u kh\u00f4ng t\u1ea1o \u0111\u01b0\u1ee3c tam gi\u00e1c khu\u1ef7u<\/div>\n
G\u00d5: Kh\u00f4ng l\u00e0m nghi\u1ec7m ph\u00e1p g\u00f5 do b\u1ec7nh nh\u00e2n \u0111au nhi\u1ec1u<\/div>\n
\u0110O:<\/div>\n
– Tay (P): Chi\u1ec1u d\u00e0i c\u00e1nh tay tuy\u1ec7t \u0111\u1ed1i – t\u01b0\u01a1ng \u0111\u1ed1i: 28-30<\/div>\n
– Tay (T): Chi\u1ec1u d\u00e0i c\u00e1nh tay tuy\u1ec7t \u0111\u1ed1i- t\u01b0\u01a1ng \u0111\u1ed1i: 26-28<\/div>\n
– V\u00f2ng chi (T): 31cm (P): 30cm<\/div>\n
V\u1eacN \u0110\u1ed8NG:<\/div>\n
+ Kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c v\u1eadn \u0111\u1ed9ng v\u00f9ng khu\u1ef7u v\u00e0 c\u00e1nh tay (T) \u0111\u01b0\u1ee3c v\u00ec b\u1ec7nh nh\u00e2n \u0111au<\/div>\n
+ Nghi\u1ec7m ph\u00e1p froment (-)<\/div>\n
C\u1ea2M GI\u00c1C: Kh\u00f4ng t\u00ea ng\u00f3n IV, V<\/div>\n
4.\u00a0 \u00a0 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, r\u1ed1n l\u00f5m.<\/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 – 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 – Ch\u1ea1m th\u1eadn (-)<\/div>\n
\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 th\u1ea7n kinh:<\/div>\n
– B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/div>\n
– C\u1ed5 m\u1ec1m, Kernig (-), Brudzinski (-)<\/div>\n
– Kh\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa<\/div>\n
7.\u00a0 \u00a0 Kh\u00e1m c\u00e1c c\u01a1 quan kh\u00e1c: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/div>\n
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VII. T\u00d3M T\u1eaeT B\u1ec6NH \u00c1N<\/strong><\/p>\n<\/div>\n

B\u1ec7nh nh\u00e2n nam, 28 tu\u1ed5i v\u00e0o vi\u1ec7n v\u00ec \u0111au\u00a0 khu\u1ef7u\u00a0 tay\u00a0 (T) do tai n\u1ea1n giao th\u00f4ng ng\u00e0y th\u1ee9 1. Qua h\u1ecfi 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 nhi\u1ec1u c\u00e1nh tay (T), kh\u00f4ng t\u00ea tay<\/div>\n
*Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Khi g\u1ea5p khu\u1ef7u 3 \u0111i\u1ec3m 2 l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay v\u00e0 m\u1ecfm khu\u1ef7u kh\u00f4ng t\u1ea1o \u0111\u01b0\u1ee3c tam gi\u00e1c khu\u1ef7u<\/div>\n
\u00a0 – \u1ea4n \u0111au ch\u00f3i v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T)<\/div>\n
\u00a0 – S\u01b0ng n\u1ec1, x\u00e2y x\u00e1t \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T)<\/div>\n
\u00a0 – \u0110M quay, tr\u1ee5 b\u1eaft \u0111\u01b0\u1ee3c, \u0111\u1ec1u r\u00f5 2 b\u00ean<\/div>\n
\u00a0 – M\u1ea5t li\u00ean t\u1ee5c \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T)<\/div>\n
\u00a0 – Chi \u1ea5m, CRT<2s, kh\u00f4ng t\u00ea tay<\/div>\n
\u00a0 – Chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i, tuy\u1ec7t \u0111\u1ed1i tay T ng\u1eafn h\u01a1n tay P<\/div>\n
* D\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: S\u01b0ng n\u1ec1, \u0111au v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay, \u1ea5n \u0111au ch\u00f3i v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T)<\/div>\n
* D\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: M\u1ea5t li\u00ean t\u1ee5c \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T), Chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i, tuy\u1ec7t \u0111\u1ed1i tay (T) ng\u1eafn h\u01a1n tay (P)<\/div>\n
\u00a0* Ti\u1ec1n c\u0103n: ch\u01b0a ghi nh\u1eadn b\u1ec7nh l\u00fd<\/div>\n
\n

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

–\u00a0 \u00a0 G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T)<\/div>\n
\n

IX. CH\u1ea8N \u0110O\u00c1N<\/strong><\/p>\n<\/div>\n

–\u00a0 \u00a0 Ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9: G\u00e3y k\u00edn \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T) gi\u1edd th\u1ee9 2 do tai n\u1ea1n giao th\u00f4ng ch\u01b0a ghi nh\u1eadn nh\u00e2n bi\u1ebfn ch\u1ee9ng<\/div>\n
–\u00a0 \u00a0 Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t: Th\u1eadt kh\u1edbp khu\u1ef7u tay T<\/div>\n
\n

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

B\u1ec7nh nh\u00e2n nam, 28 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u00ec l\u00fd do \u0111au khu\u1ef7u tay (T) do tai n\u1ea1n giao th\u00f4ng gi\u1edd th\u1ee9 2. Qua h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m, \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t s\u1ed1 v\u1ea5n \u0111\u1ec1 sau:<\/div>\n
\u00a0 – B\u1ec7nh nh\u00e2n c\u00f3 c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng r\u00f5 r\u00e0ng (do va \u0111\u1eadp tr\u1ef1c ti\u1ebfp v\u00f9ng khu\u1ef7u (T) xu\u1ed1ng \u0111\u01b0\u1eddng t\u01b0 th\u1ebf g\u1ea5p khu\u1ef7u sau tai n\u1ea1n giao th\u00f4ng).Qua th\u0103m kh\u00e1m ghi nh\u1eadn b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: M\u1ea5t li\u00ean t\u1ee5c \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T), Chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i, tuy\u1ec7t \u0111\u1ed1i tay (T) ng\u1eafn h\u01a1n tay (P), bi\u1ebfn d\u1ea1ng x\u01b0\u01a1ng (khi g\u1ea5p khu\u1ef7u 90 \u0111\u1ed9 th\u00ec 3 \u0111i\u1ec3m g\u1ed3m 2 l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay v\u00e0 m\u1ecfm khu\u1ef7u kh\u00f4ng t\u1ea1o \u0111\u01b0\u1ee3c tam gi\u00e1c khu\u1ef7u) v\u00e0 d\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn\u00a0 g\u00e3y x\u01b0\u01a1ng: S\u01b0ng n\u1ec1, \u0111au v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay, \u1ea5n \u0111au ch\u00f3i v\u00f9ng \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay (T). N\u00ean ngh\u0129 nhi\u1ec1u \u0111\u1ebfn b\u1ec7nh nh\u00e2n b\u1ecb G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh (T) do tai n\u1ea1n giao th\u00f4ng–> \u0110\u1ec1 ngh\u1ecb ch\u1ee5p Xquang khu\u1ef7u (T) th\u1eb3ng – nghi\u00eang \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n<\/div>\n
– Ngh\u0129 g\u00e3y k\u00edn v\u00ec th\u0103m kh\u00e1m kh\u00f4ng ph\u00e1t hi\u1ec7n v\u1ebft th\u01b0\u01a1ng h\u1edf th\u00f4ng v\u1edbi \u1ed5 g\u00e3y<\/div>\n
– Ngh\u0129 \u0111\u1ebfn tr\u1eadt kh\u1edbp khu\u1ef7u tay T v\u00ec khi g\u1ea5p khu\u1ef7u 90 \u0111\u1ed9 th\u00ec 3 \u0111i\u1ec3m g\u1ed3m 2 l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay v\u00e0 m\u1ecfm khu\u1ef7u kh\u00f4ng t\u1ea1o \u0111\u01b0\u1ee3c tam gi\u00e1c khu\u1ef7u nh\u01b0ng \u00edt ngh\u0129 h\u01a1n v\u00ec b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: m\u1ea5t li\u00ean t\u1ee5c \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay, chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i – tuy\u1ec7t \u0111\u1ed1i x\u01b0\u01a1ng c\u00e1nh tay T ng\u1eafn h\u01a1n x\u01b0\u01a1ng c\u00e1nh tay P nh\u01b0ng v\u1eabn kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n c\u00f3 tr\u1eadt kh\u1edbp khu\u1ef7u v\u00ec v\u1eady c\u1ea7n \u0111\u1ec1 ngh\u1ecb th\u00eam c\u1ea7n l\u00e2m s\u00e0ng ch\u1ee5p Xquang kh\u1edbp khu\u1ef7u tay T th\u1eb3ng- nghi\u00eang.<\/div>\n
– Hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng:<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Ch\u01b0a ngh\u0129 bi\u1ebfn ch\u1ee9ng cho\u00e1ng: v\u00ec b\u1ec7nh nh\u00e2n t\u1ec9nh, kh\u00f4ng ch\u00f3ng m\u1eb7t, kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng, ni\u00eam h\u1ed3ng nh\u1ea1t, chi \u1ea5m, ch\u1ec9 s\u1ed1 cho\u00e1ng < 1 (khi th\u0103m kh\u00e1m), sinh hi\u1ec7u \u1ed5n, ch\u1ee9c n\u0103ng t\u01b0\u1edbi m\u00e1u ngo\u1ea1i vi t\u1ed1t<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Ch\u01b0a ngh\u0129 bi\u1ebfn ch\u1ee9ng t\u1eafc m\u1ea1ch do m\u1ee1: v\u00ec b\u1ec7nh nh\u00e2n kh\u00f4ng ho, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng n\u1eb7ng ng\u1ef1c, da ni\u00eam h\u1ed3ng, sinh hi\u1ec7u \u1ed5n, nh\u1ecbp tim \u0111\u1ec1u n\u00ean ngh\u0129 ch\u01b0a c\u00f3 bi\u00ean ch\u1ee9ng t\u1eafc m\u1ea1ch ph\u1ed5i do m\u1ee1 \u1edf b\u1ec7nh nh\u00e2n n\u00e0y<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Ch\u01b0a ngh\u0129 bi\u1ebfn ch\u1ee9ng ch\u00e8n \u00e9p khoang: B\u1ec7nh nh\u00e2n gi\u1ea3m \u0111au khi n\u1eb9p c\u1ed1 \u0111\u1ecbnh v\u00e0 u\u1ed1ng gi\u1ea3m \u0111au, kh\u00f4ng \u0111au t\u0103ng d\u1ea7n k\u00e8m theo, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u t\u00ea b\u00ec<\/div>\n
\u00a0 \u00a0 \u00a0 \u00a0Ch\u01b0a ngh\u0129 bi\u1ebfn ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u- th\u1ea7n kinh: chi \u1ea5m, kh\u00f4ng ph\u00e1t hi\u1ec7n v\u1ebft b\u1ea7m, CRT<2s, c\u00e1c \u0111\u1ea7u ng\u00f3n ch\u00e2n h\u1ed3ng, c\u00e1c \u0111\u1ea7u ng\u00f3n tay c\u1eed \u0111\u1ed9ng b\u00ecnh th\u01b0\u1eddng, b\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch mu ch\u00e2n, ch\u00e0y sau ch\u00e2n (T), kh\u00f4ng t\u00ea tay sau ch\u1ea5n th\u01b0\u01a1ng, c\u00f3 th\u1ec3 du\u1ed7i c\u1ed5 tay, b\u00e0n ng\u00f3n tay, ng\u00f3n c\u00e1i, froment (-) ng\u00f3n c\u00e1i\u00a0 kh\u00e9p dang t\u1ed1t<\/div>\n
\u00a0 \u00a0 \u00a0Ch\u01b0a ngh\u0129 bi\u1ebfn ch\u1ee9ng g\u00e3y k\u00edn sang g\u00e3y h\u1edf v\u00ec kh\u00f4ng nh\u00ecn th\u1ea5y v\u00f9ng c\u00e1nh tay tr\u00e1i c\u00f3 v\u1ebft th\u01b0\u01a1ng xuy\u00ean qua da, kh\u00f4ng ch\u1ea3y m\u00e1u<\/div>\n
\n

XI. \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.\u00a0 \u00a0 \u0110\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng:<\/div>\n
–\u00a0 \u00a0 C\u1eadn l\u00e2m s\u00e0ng h\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n<\/div>\n
–\u00a0 \u00a0 X quang kh\u1edbp Khu\u1ef7u tay (T) (th\u1eb3ng – nghi\u00eang)<\/div>\n
–\u00a0 \u00a0 C\u1eadn l\u00e2m s\u00e0ng th\u01b0\u1eddng quy\/ti\u1ec1n ph\u1eabu<\/div>\n
+ C\u00f4ng th\u1ee9c m\u00e1u<\/div>\n
+ \u0110\u1ecbnh danh nh\u00f3m m\u00e1u h\u1ec7 ABO, Rhesus<\/div>\n
+ Sinh h\u00f3a m\u00e1u (glucose, ure, creatinin, eGFR, AST, AGT); \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3: Na+, K+, Cl-, Calci<\/div>\n
+ Si\u00eau \u00e2m \u1ed5 b\u1ee5ng<\/div>\n
+ X quang ng\u1ef1c th\u1eb3ng<\/div>\n
+ Bilan \u0111\u00f4ng c\u1ea7m m\u00e1u (aPTT, TQ, TL, INR)<\/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
\u00a0<\/div>\n
\n
\"1\"
1<\/figcaption><\/figure>
\"2\"
2<\/figcaption><\/figure>\n<\/div>\n
\u00a0<\/div>\n
\u0110\u1ecdc phim<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0H\u00e0nh ch\u00ednh<\/div>\n
\u2022 H\u1ecd v\u00e0 t\u00ean b\u1ec7nh nh\u00e2n: \u0110\u1eb6NG QUANG H. , nam, 28 tu\u1ed5i<\/div>\n
\u2022 Ng\u00e0y th\u00e1ng n\u0103m ch\u1ee5p: 17\/9\/2024<\/div>\n
\u2022 T\u01b0 th\u1ebf ch\u1ee5p: phim th\u1eb3ng – nghi\u00eang<\/div>\n
\u2022 V\u1ecb tr\u00ed: khu\u1ef7u tay (T)<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0Ti\u00eau chu\u1ea9n phim<\/div>\n
\u2022 C\u01b0\u1eddng \u0111\u1ed9 tia \u0111\u1ee7<\/div>\n
\u2022 C\u00f3 \u0111\u1ee7 2 phim Xquang khu\u1ef7u tay T th\u1eb3ng-nghi\u00eang<\/div>\n
–\u00a0 \u00a0 \u0110\u1ecdc phim:<\/div>\n
+S\u01b0ng n\u1ec1 m\u00f4 m\u1ec1m quanh kh\u1edbp khu\u1ef7u<\/div>\n
+ G\u00e3y 1\/3 d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay: \u0111\u01b0\u1eddng g\u00e3y ch\u00e9o, ph\u1ee9c t\u1ea1p, G\u00e3y tr\u00ean li\u00ean l\u1ed3i c\u1ea7u, di l\u1ec7ch sang b\u00ean, g\u1eadp g\u00f3c, ch\u1ed3ng ng\u1eafn c\u00f3 m\u1ea3nh r\u1eddi.<\/div>\n
+ \u0110\u1ea7u tr\u00ean x\u01b0\u01a1ng quay, x\u01b0\u01a1ng tr\u1ee5 b\u1edd x\u01b0\u01a1ng li\u00ean t\u1ee5c, kh\u00f4ng g\u1eadp g\u00f3c, kh\u00f4ng n\u1ee9t g\u00e3y<\/div>\n
K\u1ebft lu\u1eadn: G\u00e3y \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng c\u00e1nh tay T \u0111\u01b0\u1eddng g\u00e3y ch\u00e9o qua li\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay, kh\u00f4ng th\u1ea5y m\u1ea3nh r\u1eddi<\/div>\n
\n


\n\u00a0XI. CH\u1ea8N \u0110O\u00c1N X\u00c1C \u0110\u1ecaNH<\/strong><\/p>\n

 <\/p>\n<\/div>\n

G\u00e3y k\u00edn li\u00ean l\u1ed3i c\u1ea7u x\u01b0\u01a1ng c\u00e1nh tay (T) \u0111\u1ed9 C2 theo AO gi\u1edd 2 do tai n\u1ea1n giao th\u00f4ng ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng<\/div>\n
\n

XII.\u00a0 \u0110I\u1ec0U TR\u1eca<\/strong><\/p>\n<\/div>\n

1.\u00a0 \u00a0 H\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb:<\/div>\n
–\u00a0 \u00a0 B\u1ea5t \u0111\u1ed9ng v\u1edbi n\u1eb9p ch\u1ed1ng xoay.<\/div>\n
–\u00a0 \u00a0 Gi\u1ea3m \u0111au.<\/div>\n
–\u00a0 \u00a0 Ch\u1ed1ng ph\u00f9 n\u1ec1.<\/div>\n
–\u00a0 \u00a0 Theo d\u00f5i sinh hi\u1ec7u h\u1eb1ng ng\u00e0y<\/div>\n
–\u00a0 \u00a0 Ph\u1eabu thu\u1eadt<\/div>\n
2. \u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3:<\/div>\n
–\u00a0 \u00a0 \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt: Ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng n\u1eb9p v\u00edt<\/div>\n
\u00a0 \u00a0 \u00a0 Paracetamol 500mg 1v u\u1ed1ng\u00a0<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0CSC III- c\u01a1m<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0Theo d\u00f5i sinh hi\u1ec7u, m\u1ea1ch, nhi\u1ec7t \u0111\u1ed9 huy\u1ebft \u00e1p, nh\u1ecbp th\u1edf\/24h<\/div>\n
\n

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

–\u00a0 \u00a0 \u00a0 \u00a0Ti\u00ean l\u01b0\u1ee3ng g\u1ea7n: Trung b\u00ecnh. Ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0 Ti\u00ean l\u01b0\u1ee3ng xa: trung b\u00ecnh: nguy c\u01a1 bi\u1ebfn ch\u1ee9ng sau ph\u1eabu thu\u1eadt<\/div>\n
\n

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

–\u00a0 \u00a0 \u00a0 \u00a0V\u1ebft th\u01b0\u01a1ng sau m\u1ed5, c\u1eaft ch\u1ec9 sau 10-14 ng\u00e0y<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0D\u1ef1 ph\u00f2ng c\u1ee9ng kh\u1edbp, x\u01a1 h\u00f3a kh\u1edbp khu\u1ef7u d\u00f3 b\u1ea5t \u0111\u1ed9ng l\u00e2u ng\u00e0y<\/div>\n
–\u00a0 \u00a0 T\u1eadp ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau m\u1ed5<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0B\u1ed5 sung th\u1ef1c ph\u1ea9m gi\u00e0u canxi<\/div>\n
–\u00a0 \u00a0 \u00a0 \u00a0T\u00e1i kh\u00e1m\u00a0<\/div>\n
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