{"id":4403,"date":"2024-12-24T10:13:13","date_gmt":"2024-12-24T03:13:13","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&#038;p=4403"},"modified":"2024-12-24T10:13:13","modified_gmt":"2024-12-24T03:13:13","slug":"benh-an-ngoai-khoa-2","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-an-ngoai-khoa-2\/","title":{"rendered":"B\u1ec6NH \u00c1N NGO\u1ea0I KHOA"},"content":{"rendered":"<p>TR\u01af\u1edcNG Y D\u01af\u1ee2C TR\u00c0 VINH<br \/>\nL\u1edaP Y6 &#8211; NH\u00d3M 05<br \/>\nSinh vi\u00ean th\u1ef1c hi\u1ec7n:<br \/>\nNGUY\u1ec4N TH\u1eca KIM THU 116019231<br \/>\nHU\u1ef2NH TRUNG T\u00cdNH 116019255<\/p>\n<p><strong>B\u1ec6NH \u00c1N NGO\u1ea0I KHOA<\/strong><\/p>\n<p><strong>(Ti\u1ec1n ph\u1eabu)<\/strong><\/p>\n<ol>\n<li><strong>H\u00c0NH CH\u00c1NH<\/strong><\/li>\n<li>H\u1ecd v\u00e0 t\u00ean: NGUY\u1ec4N V\u0102N L\u1ee2I<\/li>\n<li>Sinh n\u0103m: 1972 (52 tu\u1ed5i)<\/li>\n<li>Gi\u1edbi t\u00ednh: Nam<\/li>\n<li>\u0110\u1ecba ch\u1ec9: 74\/12\/12, Ph\u01b0\u1eddng S\u01a1n K\u1ef3,Qu\u1eadn T\u00e2n Ph\u00fa,TP. H\u1ed3 Ch\u00ed Minh, Vi\u1ec7t Nam<\/li>\n<li>D\u00e2n t\u1ed9c: Kinh<\/li>\n<li>Thu\u1eadn tay: Ph\u1ea3i<\/li>\n<li>Ng\u00e0y gi\u1edd nh\u1eadp c\u1ea5p c\u1ee9u: 5g35 ph\u00fat, ng\u00e0y 29\/10\/2024<\/li>\n<li>Ng\u00e0y gi\u1edd nh\u1eadp khoa ngo\u1ea1i ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh: 6 gi\u1edd 19 ph\u00fat, ng\u00e0y 29\/10\/2024<\/li>\n<li>Ng\u00e0y l\u00e0m b\u1ec7nh \u00e1n: 6 gi\u1edd 30 ph\u00fat ng\u00e0y 29\/10\/2024<\/li>\n<li><strong> L\u00dd DO V\u00c0O VI\u1ec6N<\/strong>: \u0110au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp vai ph\u1ea3i<\/li>\n<\/ol>\n<p><strong>III. B\u1ec6NH S\u1eec <\/strong><\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n khai: C\u00e1ch nh\u1eadp vi\u1ec7n 1 gi\u1edd 40 ph\u00fat b\u1ec7nh nh\u00e2n ch\u1ea1y xe m\u00e1y t\u1ed1c \u0111\u1ed9 40km\/h c\u00f3 \u0111\u1ed9i m\u0169 b\u1ea3o hi\u1ec3m th\u00ec va ch\u1ea1m v\u00e0o bi\u1ec3n b\u00e1o thi c\u00f4ng v\u00e0 t\u00e9 v\u1ec1 ph\u00eda b\u00ean ph\u1ea3i, \u0111\u1eadp vai ph\u1ea3i xu\u1ed1ng m\u1eb7t \u0111\u01b0\u1eddng trong t\u01b0 th\u1ebf vai kh\u00e9p, kh\u1ee7y g\u1ea5p, kh\u00f4ng va ch\u1ea1m v\u00f9ng \u0111\u1ea7u. Sau t\u00e9 b\u1ec7nh nh\u00e2n v\u1eabn t\u1ec9nh nh\u01b0ng th\u1ea5y \u0111au ch\u00f3i vai ph\u1ea3i, th\u1ea5y s\u01b0ng v\u00f9ng gi\u1eefa vai ph\u1ea3i, vai ph\u1ea3i kh\u00f4ng d\u1ea1ng \u0111\u01b0\u1ee3c, kh\u00f4ng gi\u01a1 tay l\u00ean cao \u0111\u01b0\u1ee3c, b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c x\u1eed tr\u00ed g\u00ec, gi\u1eef vai \u1edf t\u01b0 th\u1ebf vai kh\u00e9p, khu\u1ef7u g\u1eadp s\u00e1t ng\u1ef1c v\u00e0 chuy\u1ec3n \u0111\u1ebfn BV Th\u1ed1ng Nh\u1ea5t b\u1eb1ng xe m\u00e1y. Trong c\u1ea3 qu\u00e1 tr\u00ecnh t\u00e9 b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng kh\u00f3 th\u1edf.<\/li>\n<li><strong>T\u00ecnh tr\u1ea1ng nh\u1eadp vi\u1ec7n: <\/strong><\/li>\n<li><strong><em>T\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n c\u1ea5p c\u1ee9u<\/em><\/strong><\/li>\n<\/ul>\n<p>&#8211; Sinh hi\u1ec7u:<\/p>\n<ul>\n<li>M\u1ea1ch: 83 l\u1ea7n\/ph\u00fat<\/li>\n<li>Huy\u1ebft \u00e1p: 160\/90 mmHg<\/li>\n<li>Nhi\u1ec7t \u0111\u1ed9: 37 \u00b0C<\/li>\n<li>Nh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat<\/li>\n<li>SPO2: 96 %<\/li>\n<\/ul>\n<p>&#8211; N\u1eb7ng 60kg, Cao 162cm<\/p>\n<p>&#8211; B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/p>\n<ul>\n<li><strong><em>X\u1eed tr\u00ed t\u1ea1i khoa c\u1ea5p c\u1ee9u:<\/em><\/strong><\/li>\n<li>Diclofenac 75mg\/3ml 1 \u1ed1ng TB<\/li>\n<li>\u0110ai x\u01b0\u01a1ng \u0111\u00f2n s\u1ed1 8<\/li>\n<li>XN: Ch\u1ee5p Xquang x\u01b0\u01a1ng \u0111\u00f2n th\u1eb3ng ho\u1eb7c ch\u1ebfch (P); Si\u00eau \u00e2m c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng<\/li>\n<li>Chuy\u1ec3n khoa CTCH<\/li>\n<li><strong><em>T\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp khoa CTCH: <\/em><\/strong><\/li>\n<li>B\u00eanh nh\u00e2n t\u1ec9nh, Sinh hi\u1ec7u \u1ed5n<\/li>\n<li>Mang \u0111ai vai s\u1ed1 8<\/li>\n<li>Gi\u1ea3m \u0111au vai ph\u1ea3i so v\u1edbi th\u1eddi \u0111i\u1ec3m \u1edf c\u1ea5p c\u1ee9u<\/li>\n<li>Vai ph\u1ea3i h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng<\/li>\n<\/ul>\n<ol>\n<li><strong> TI\u1ec0N C\u0102N<\/strong><\/li>\n<li><strong>B\u1ea3n Th\u00e2n:<\/strong><\/li>\n<li>N\u1ed9i khoa: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n b\u1ec7nh l\u00fd nh\u01b0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u0103ng huy\u1ebft \u00e1p<\/li>\n<li>Ngo\u1ea1i khoa: Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n ch\u1ea5n th\u01b0\u01a1ng, ph\u1eabu thu\u1eadt.<\/li>\n<li>Th\u00f3i quen sinh ho\u1ea1t: H\u00fat thu\u1ed1c l\u00e1 20 g\u00f3i.n\u0103m. S\u1eed d\u1ee5ng r\u01b0\u1ee3u bia kh\u00f4ng th\u01b0\u1eddng xuy\u00ean, ch\u1ec9 d\u00f9ng khi c\u00f3 \u0111\u00e1m ti\u1ec7c.<\/li>\n<li>D\u1ecb \u1ee9ng: ch\u01b0a ghi nh\u1eadn d\u1ecb \u1ee9ng thu\u1ed1c th\u1ee9c \u0103n.<\/li>\n<li><strong> Gia \u0111\u00ecnh: <\/strong>Ch\u01b0a ghi nh\u1eadn ti\u1ec1n c\u0103n gia \u0111\u00ecnh m\u1eafc b\u1ec7nh l\u00fd li\u00ean quan<\/li>\n<li><strong> KH\u00c1M L\u00c2M S\u00c0NG ( 6 GI\u1edc 30 PH\u00daT c\u00f9ng ng\u00e0y)<\/strong><\/li>\n<li><strong><em>KH\u00c1M T\u1ed4NG TR\u1ea0NG <\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>Sinh hi\u1ec7u:<\/li>\n<li>M\u1ea1ch 80 l\u1ea7n\/ph\u00fat<\/li>\n<li>Nh\u1ecbp th\u1edf 18 l\u1ea7n\/ ph\u00fat<\/li>\n<li>Nhi\u1ec7t \u0111\u1ed9 37oC<\/li>\n<li>Huy\u1ebft \u00e1p 140\/90 mmHg<\/li>\n<li>B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/li>\n<li>Da ni\u00eam h\u1ed3ng,kh\u00f4ng xu\u1ea5t huy\u1ebft d\u01b0\u1edbi da<\/li>\n<li>CRT &lt;2s<\/li>\n<li>Tuy\u1ebfn gi\u00e1p kh\u00f4ng to, h\u1ea1ch ngo\u1ea1i vi s\u1edd kh\u00f4ng ch\u1ea1m.<\/li>\n<li>Kh\u00f4ng ph\u00f9<\/li>\n<li>C\u00e2n n\u1eb7ng: 60 kg, chi\u1ec1u cao: 165 cm, BMI= 22.03 kg\/m2 &#8211;&gt; Th\u1ec3 tr\u1ea1ng b\u1ec7nh nh\u00e2n trung b\u00ecnh theo IDI &amp; WPRO<\/li>\n<\/ul>\n<ol start=\"2\">\n<li><strong><em>KH\u00c1M TU\u1ea6N HO\u00c0N<\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, kh\u00f4ng v\u1ebft th\u01b0\u01a1ng, kh\u00f4ng x\u00e2y x\u00e1t<\/li>\n<li>M\u1ecfm tim \u1edf khoang li\u00ean s\u01b0\u1eddn IV \u0111\u01b0\u1eddng trung \u0111\u00f2n tr\u00e1i<\/li>\n<li>Harzer (-)<\/li>\n<li>Nh\u1ecbp tim \u0111\u1ec1u, r\u00f5 T1,T2, t\u1ea7n s\u1ed1 80 l\u1ea7n\/ph\u00fat, kh\u00f4ng nghe th\u1ea5y \u00e2m th\u1ed5i<\/li>\n<li>M\u1ea1ch t\u1ee9 chi \u0111\u1ec1u hai b\u00ean.<\/li>\n<\/ul>\n<ol start=\"3\">\n<li><strong><em>KH\u00c1M H\u00d4 H\u1ea4P <\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>Kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5<\/li>\n<li>Rung thanh \u0111\u1ec1u hai b\u00ean, kh\u00f4ng tr\u00e0n kh\u00ed d\u01b0\u1edbi da<\/li>\n<li>G\u00f5 trong kh\u1eafp ph\u1ed5i<\/li>\n<li>Ph\u1ed5i kh\u00f4ng rale.<\/li>\n<\/ul>\n<ol start=\"4\">\n<li><strong><em>KH\u00c1M TI\u00caU H\u00d3A<\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>Th\u00e0nh b\u1ee5ng c\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169<\/li>\n<li>Nhu \u0111\u1ed9ng ru\u1ed9t 8 l\u1ea7n\/ph\u00fat<\/li>\n<li>B\u1ee5ng m\u1ec1m, kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa<\/li>\n<li>Gan, l\u00e1ch kh\u00f4ng to, s\u1edd kh\u00f4ng ch\u1ea1m.<\/li>\n<\/ul>\n<ol start=\"5\">\n<li><strong><em>KH\u00c1M TH\u1eacN NI\u1ec6U<\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>H\u1ed1 th\u1eaft l\u01b0ng c\u00e2n \u0111\u1ed1i hai b\u00ean, kh\u00f4ng s\u01b0ng b\u1ea7m<\/li>\n<li>Cham th\u1eadn (-)<\/li>\n<li>C\u1ea7u b\u00e0ng quang (-)<\/li>\n<\/ul>\n<ol start=\"6\">\n<li><strong><em>KH\u00c1M TH\u1ea6N KINH <\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>C\u1ea3m gi\u00e1c n\u00f4ng s\u00e2u c\u00f2n t\u1ed1t<\/li>\n<li>C\u1ed5m m\u1ec1m<\/li>\n<li>Kh\u00f4ng d\u1ea5u th\u1ea7n kinh khu tr\u00fa<\/li>\n<\/ul>\n<ol start=\"7\">\n<li><strong><em>KH\u00c1M C\u01a0 X\u01af\u01a0NG KH\u1edaP <\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>NH\u00ccN:<\/li>\n<li>B\u1ec7nh nh\u00e2n n\u1eb1m tr\u00ean gi\u01b0\u1eddng mang \u0111ai x\u01b0\u01a1ng \u0111\u00f2n s\u1ed1 8<\/li>\n<li>Kh\u00f4ng v\u1ebft th\u01b0\u01a1ng, kh\u00f4ng v\u1ebft b\u1ea7m v\u00f9ng vai v\u00f9ng ng\u1ef1c, b\u1ee5ng<\/li>\n<li>Vai ph\u1ea3i bi\u1ebfn d\u1ea1ng c\u00f3 kh\u1ed1i g\u1ed3 \u1edf 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i<\/li>\n<li>Kh\u00f4ng m\u1ea5t r\u00e3nh delta ng\u1ef1c<\/li>\n<li>S\u1edc<\/li>\n<li>Chi \u1ea5m<\/li>\n<li>S\u1ee9c c\u01a1 5\/5 \u0111\u1ec1u hai b\u00ean<\/li>\n<li>C\u00e1c m\u1ed1c x\u01b0\u01a1ng: m\u1ecfm c\u00f9ng vai; m\u1ecfm qu\u1ea1, m\u1ea5u \u0111\u1ed9ng l\u1edbn x\u01b0\u01a1ng c\u00e1nh tay<\/li>\n<li>D\u1ea5u m\u1ea5t li\u00ean t\u1ee5c \u1edf 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i<\/li>\n<li>D\u1ea5u l\u1ea1o x\u1ea1o x\u01b0\u01a1ng (+) \u1edf 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i<\/li>\n<li>\u1ea4n \u0111au ch\u00f3i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i<\/li>\n<li>\u1ea4n kh\u00f4ng \u0111au kh\u1edbp vai v\u00e0 d\u1ecdc x\u01b0\u01a1ng c\u00e1nh tay tr\u00e1i<\/li>\n<li>D\u1ea5u hi\u1ec7u \u1ed5 kh\u1edbp r\u1ed7ng (-)<\/li>\n<li>D\u1ea5u ph\u00edm \u0111\u00e0n (-)<\/li>\n<li>S\u1edd c\u1ea3m gi\u00e1c ng\u00f3n 4,5 b\u00ecnh th\u01b0\u1eddng c\u1ea3 hai b\u00ean<\/li>\n<li>\u0110O:<\/li>\n<\/ul>\n<p>Chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i: (t\u1eeb \u0111\u1ea7u \u1ee9c \u0111\u00f2n b\u00ean tr\u00e1i \u0111\u1ebfn \u0111\u1ea7u c\u00f9ng vai)<\/p>\n<ul>\n<li>X\u01b0\u01a1ng \u0111\u00f2n tr\u00e1i: 14 cm<\/li>\n<li>X\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i: 12 cm<\/li>\n<li>NGHI\u1ec6M PH\u00c1P:<\/li>\n<li>Drop arm test (-)<\/li>\n<li>Apprehension test (-)<\/li>\n<\/ul>\n<ol start=\"8\">\n<li><strong><em>C\u00c1C C\u01a0 QUAN KH\u00c1C:<\/em><\/strong> Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng t\u1ea1i th\u1eddi \u0111i\u1ec3m kh\u00e1m<\/li>\n<\/ol>\n<p><strong>VII. T\u00d3M T\u1eaeT B\u1ec6NH \u00c1N<\/strong><\/p>\n<p>B\u1ec7nh nh\u00e2n nam, 52 tu\u1ed5i v\u00e0o vi\u1ec7n v\u00ec \u0111au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng v\u00f9ng kh\u1edbp vai (P), qua h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m ghi nh\u1eadn:<\/p>\n<ul>\n<li>Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/li>\n<li>\u0110au ch\u00f3i vai ph\u1ea3i<\/li>\n<li>Kh\u00f4ng d\u1ea1ng, kh\u00f4ng gi\u01a1 tay ph\u1ea3i l\u00ean \u0111\u01b0\u1ee3c<\/li>\n<li>Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/li>\n<li>D\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: D\u1ea5u m\u1ea5t li\u00ean t\u1ee5c \u1edf 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i, d\u1ea5u l\u1ea1o x\u1ea1o x\u01b0\u01a1ng (+)<\/li>\n<li>D\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng: \u1ea4n \u0111au ch\u00f3i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i, gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u1edbp vai ph\u1ea3i<\/li>\n<\/ul>\n<p>Chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i: X\u01b0\u01a1ng \u0111\u00f2n tr\u00e1i: 14cm, x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i:<\/p>\n<p><strong>VIII. \u0110\u1eb6T V\u1ea4N \u0110\u1ec0<\/strong><\/p>\n<ol>\n<li>D\u1ea5u hi\u1ec7u g\u00e3y x\u01b0\u01a1ng ph\u1ea3i<\/li>\n<li><strong> DIAGNOSE <\/strong><\/li>\n<\/ol>\n<p>G\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i gi\u1edd th\u1ee9 2 do tai n\u1ea1n giao th\u00f4ng ch\u01b0a bi\u1ebfn ch\u1ee9ng<\/p>\n<ol>\n<li><strong> BI\u1ec6N LU\u1eacN <\/strong><\/li>\n<\/ol>\n<p>B\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u1edbi t\u00ecnh tr\u1ea1ng \u0111au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp vai ph\u1ea3i sau tai n\u1ea1n giao th\u00f4ng, ngh\u0129 \u0111\u1ebfn c\u00e1c nguy\u00ean nh\u00e2n:<\/p>\n<ul>\n<li>G\u00e3y k\u00edn \u2153 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i: ngh\u0129 nhi\u1ec1u nh\u1ea5t v\u00ec: nh\u00ecn kh\u00f4ng th\u1ea5y v\u1ebft th\u01b0\u01a1ng v\u00f9ng vai ph\u1ea3i, v\u00f9ng \u2153 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n c\u00f3 kh\u1ed1i g\u1ed3 l\u00ean nh\u1eb9, s\u1edd m\u1ea5t li\u00ean t\u1ee5c v\u00e0 \u1ea5n \u0111au ch\u00f3i t\u1ea1i \u2153 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n, d\u1ea5u l\u1ea1o x\u1ea1o x\u01b0\u01a1ng (+), chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i &lt; tr\u00e1i.<\/li>\n<li>Tr\u1eadt kh\u1edbp vai: \u00edt ngh\u0129 tr\u1eadt kh\u1edbp vai v\u00ec kh\u00e1m d\u1ea5u hi\u1ec7u \u1ed5 kh\u1edbp r\u1ed7ng (-)<\/li>\n<li>Tr\u1eadt kh\u1edbp c\u00f9ng \u0111\u00f2n: \u00edt ngh\u0129 v\u00ec v\u00f9ng kh\u1edbp vai c\u00f9ng \u0111\u00f2n kh\u00f4ng bi\u1ebfn d\u1ea1ng, \u1ea5n t\u1ea1i kh\u1edbp vai c\u00f9ng \u0111\u00f2n b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au.<\/li>\n<li>R\u00e1ch ch\u00f3p xoay: \u00edt ngh\u0129 v\u00ec th\u0103m kh\u00e1m l\u00e2m s\u00e0ng Drop arm test (-)<\/li>\n<li>R\u00e1ch s\u1ee5n vi\u1ec1n: \u00edt ngh\u0129 v\u00ec th\u0103m kh\u00e1m ghi nh\u1eadn nghi\u1ec7m ph\u00e1p Apprehension test (-)<\/li>\n<\/ul>\n<p>Bi\u1ec7n lu\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a g\u00e3y x\u01b0\u01a1ng:<\/p>\n<ul>\n<li>G\u00e3y k\u00edn sang g\u00e3y h\u1edf: b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 x\u00e2y x\u00e1t hay v\u1ebft th\u01b0\u01a1ng v\u00f9ng ng\u1ef1c v\u00e0 vai ph\u1ea3i, kh\u00f4ng th\u1ea5y c\u0103ng da v\u00f9ng ch\u1ea5n th\u01b0\u01a1ng th\u00ec kh\u00f4ng ngh\u0129 \u0111\u1ebfn<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh: b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea3m gi\u00e1c n\u00f4ng v\u00e0 s\u00e2u b\u00ecnh th\u01b0\u1eddng, gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u1edbp vai do \u0111au, s\u1edd c\u1ea3m gi\u00e1c chi ph\u1ed1i d\u00e2y th\u1ea7n kinh tr\u1ee5 b\u00ecnh th\u01b0\u1eddng, v\u1eadn \u0111\u1ed9ng c\u00e1c kh\u1edbp kh\u00e1c c\u1ee7a tay tr\u00e1i b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng y\u1ebfu li\u1ec7t c\u01a1 v\u00f9ng c\u00e1nh v\u00e0 c\u1eb3ng tay ph\u1ea3i th\u00ec kh\u00f4ng ngh\u0129 \u0111\u1ebfn.<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u: b\u1ec7nh nh\u00e2n c\u00f3 sinh hi\u1ec7u \u1ed5n, chi \u1ea5m, \u0111\u1ea7u c\u00e1c ng\u00f3n h\u1ed3ng, CRT &lt;2 gi\u00e2y, m\u1ea1ch quay (+), kh\u00f4ng th\u1ea5y kh\u1ed1i m\u00e1u t\u1ee5 v\u00f9ng ng\u1ef1c v\u00e0 vai ph\u1ea3i n\u00ean kh\u00f4ng ngh\u0129 \u0111\u1ebfn.<\/li>\n<li>T\u1ed5n th\u01b0\u01a1ng \u0111\u1ec9nh ph\u1ed5i: b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au, kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng hay b\u1ea7m t\u00edm v\u00f9ng ng\u1ef1c ph\u1ea3i, kh\u00e1m kh\u00f4ng th\u1ea5y tr\u00e0n kh\u00ed d\u01b0\u1edbi da, rung thanh \u0111\u1ec1u 2 b\u00ean, g\u00f5 trong n\u00ean \u00edt ngh\u0129.<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<ol>\n<li><strong> \u0110\u1ec0 NGH\u1eca C\u1eacN L\u00c2M S\u00c0NG <\/strong><\/li>\n<li>C\u1eadn l\u00e2m s\u00e0ng ch\u1ea9n \u0111o\u00e1n v\u00e0 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/li>\n<\/ol>\n<ul>\n<li>Xquang x\u01b0\u01a1ng \u0111\u00f2n th\u1eb3ng<\/li>\n<\/ul>\n<ol start=\"2\">\n<li>C\u1eadn l\u00e2m s\u00e0ng ti\u1ec1n ph\u1eabu<\/li>\n<\/ol>\n<ul>\n<li>C\u00f4ng th\u1ee9c m\u00e1u, nh\u00f3m m\u00e1u, \u0111\u00f4ng c\u1ea7m m\u00e1u<\/li>\n<li>Sinh h\u00f3a m\u00e1u: Glucose, Ure, Creatinin, AST, ALT, ion \u0111\u1ed3<\/li>\n<li>ECG<\/li>\n<li>Xquang ng\u1ef1c th\u1eb3ng<\/li>\n<li>T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc<\/li>\n<\/ul>\n<p><strong>XII. K\u1ebeT QU\u1ea2 C\u1eacN L\u00c2M S\u00c0NG<\/strong><\/p>\n<ol>\n<li><strong><em>Xquang x\u01b0\u01a1ng \u0111\u00f2n th\u1eb3ng<\/em><\/strong><\/li>\n<\/ol>\n<figure id=\"attachment_4404\" aria-describedby=\"caption-attachment-4404\" style=\"width: 307px\" class=\"wp-caption alignnone\"><img fetchpriority=\"high\" decoding=\"async\" class=\"size-full wp-image-4404\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/1-6.png\" alt=\"1\" width=\"307\" height=\"205\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/1-6.png 307w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/1-6-300x200.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/1-6-18x12.png 18w\" sizes=\"(max-width: 307px) 100vw, 307px\" \/><figcaption id=\"caption-attachment-4404\" class=\"wp-caption-text\">1<\/figcaption><\/figure>\n<p>H\u00e0nh ch\u00ednh: xquang c\u1ee7a b\u1ec7nh nh\u00e2n Nguy\u1ec5n V\u0103n L\u1ee3i, nam, 52 tu\u1ed5i<\/p>\n<p>C\u01b0\u1eddng \u0111\u1ed9 tia: ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c x\u01b0\u01a1ng, m\u00f4 m\u1ec1m<\/p>\n<p>Ch\u1ee5p qua \u0111\u1ee7 hai kh\u1edbp<\/p>\n<p>T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng: g\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i, c\u00f3 m\u1ea3nh r\u1eddi, \u0111\u01b0\u1eddng g\u00e3y ch\u00e9o, di l\u1ec7ch sang b\u00ean, xu\u1ed1ng d\u01b0\u1edbi, ch\u1ed3ng ng\u1eafn &gt;1\/2 th\u00e2n x\u01b0\u01a1ng, .<\/p>\n<p>T\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m: ch\u01b0a ghi nh\u1eadn tr\u00ean xquang<\/p>\n<p>&nbsp;<\/p>\n<ol start=\"2\">\n<li><strong><em>Xquang ng\u1ef1c th\u1eb3ng<\/em><\/strong><\/li>\n<\/ol>\n<figure id=\"attachment_4405\" aria-describedby=\"caption-attachment-4405\" style=\"width: 257px\" class=\"wp-caption alignnone\"><img decoding=\"async\" class=\"size-full wp-image-4405\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/2-6.png\" alt=\"2\" width=\"257\" height=\"240\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/2-6.png 257w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/2-6-13x12.png 13w\" sizes=\"(max-width: 257px) 100vw, 257px\" \/><figcaption id=\"caption-attachment-4405\" class=\"wp-caption-text\">2<\/figcaption><\/figure>\n<p>K\u1ebft lu\u1eadn: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng tr\u00ean phim xquang ng\u1ef1c th\u1eb3ng<\/p>\n<ol start=\"3\">\n<li><strong><em>\u0110\u00f4ng c\u1ea7m m\u00e1u, Nh\u00f3m m\u00e1u<\/em><\/strong><\/li>\n<\/ol>\n<table width=\"649\">\n<tbody>\n<tr>\n<td colspan=\"3\" width=\"649\">\n<p><strong>\u0110\u00d4NG C\u1ea6M M\u00c1U<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"185\">\n<p>&nbsp;<\/p>\n<\/td>\n<td colspan=\"2\" width=\"464\">\n<p><strong>K\u1ebeT QU\u1ea2 <\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"185\">\n<p>APTT<\/p>\n<\/td>\n<td width=\"185\">\n<p>33.3 gi\u00e2y<\/p>\n<\/td>\n<td width=\"279\">\n<p>&nbsp;<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"185\">\n<p>TQ<\/p>\n<\/td>\n<td width=\"185\">\n<p>11.5 gi\u00e2y<\/p>\n<\/td>\n<td width=\"279\">\n<p>&nbsp;<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"185\">\n<p>TL Prothrombine<\/p>\n<\/td>\n<td width=\"185\">\n<p>94%<\/p>\n<\/td>\n<td width=\"279\">\n<p>&nbsp;<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"185\">\n<p>INR<\/p>\n<\/td>\n<td width=\"185\">\n<p>1.04<\/p>\n<\/td>\n<td width=\"279\">\n<p>&nbsp;<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" width=\"649\">\n<p><strong>NH\u00d3M M\u00c1U <\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"369\">\n<p>H\u1ec7 ABO<\/p>\n<\/td>\n<td width=\"279\">\n<p>Rh<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" width=\"369\">\n<p>A<\/p>\n<\/td>\n<td width=\"279\">\n<p>D\u01af\u01a0NG<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<ol>\n<li><strong><em>C\u00f4ng th\u1ee9c m\u00e1u<\/em><\/strong><\/li>\n<\/ol>\n<table width=\"554\">\n<tbody>\n<tr>\n<td colspan=\"2\" width=\"554\">\n<p><strong>C\u00d4NG TH\u1ee8C M\u00c1U <\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>CH\u1ec8 S\u1ed0<\/p>\n<\/td>\n<td width=\"277\">\n<p>K\u1ebeT QU\u1ea2<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>WBC<\/p>\n<\/td>\n<td width=\"277\">\n<p>12,28 K\/uL<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>NEU%<\/p>\n<\/td>\n<td width=\"277\">\n<p>80,3%<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>NEU#<\/p>\n<\/td>\n<td width=\"277\">\n<p>9,77 K\/uL<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>LYM%<\/p>\n<\/td>\n<td width=\"277\">\n<p>14%<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>LYM#<\/p>\n<\/td>\n<td width=\"277\">\n<p>1,7 K\/uL<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>RBC<\/p>\n<\/td>\n<td width=\"277\">\n<p>4,57 M\/uLl<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>HGB<\/p>\n<\/td>\n<td width=\"277\">\n<p>13,8 g\/dL<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>HCT<\/p>\n<\/td>\n<td width=\"277\">\n<p>41,2%<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>PLT<\/p>\n<\/td>\n<td width=\"277\">\n<p>223 K\/uL<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ol start=\"2\">\n<li><strong><em>T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u <\/em><\/strong><\/li>\n<\/ol>\n<table width=\"554\">\n<tbody>\n<tr>\n<td colspan=\"2\" width=\"554\">\n<p><strong>T\u1ed4NG PH\u00c2N T\u00cdCH N\u01af\u1edaC TI\u1ec2U <\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>URO<\/p>\n<\/td>\n<td width=\"277\">\n<p>nom<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>GLU<\/p>\n<\/td>\n<td width=\"277\">\n<p>nom<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>BIL<\/p>\n<\/td>\n<td width=\"277\">\n<p>neg<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>SG<\/p>\n<\/td>\n<td width=\"277\">\n<p>1,019<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>pH<\/p>\n<\/td>\n<td width=\"277\">\n<p>7<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>PRO<\/p>\n<\/td>\n<td width=\"277\">\n<p>neg<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"277\">\n<p>&nbsp;<\/p>\n<\/td>\n<td width=\"277\">\n<p>&nbsp;<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ol start=\"3\">\n<li><strong><em>ECG:<\/em><\/strong> nh\u1ecbp xoang \u0111\u1ec1u, t\u1ea7n s\u1ed1 # 80 ck\/ph\u00fat, tr\u1ee5c trung gian<\/li>\n<\/ol>\n<p><strong>XIII. CH\u1ea8N \u0110O\u00c1N X\u00c1C \u0110\u1ecaNH<\/strong><\/p>\n<p>G\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n ph\u1ea3i nh\u00f3m 1 theo Allman gi\u1edd th\u1ee9 2 sau tai n\u1ea1n giao th\u00f4ng ch\u01b0a bi\u1ebfn ch\u1ee9ng<\/p>\n<p><strong>XIV. \u0110I\u1ec0U TR\u1eca <\/strong><\/p>\n<ol>\n<li><strong><em>The principles of treatment <\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>N\u1eafn ch\u1ec9nh x\u01b0\u01a1ng \u0111\u00f2n v\u1ec1 v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu<\/li>\n<li>B\u1ea5t \u0111\u1ed9ng t\u1ed1t<\/li>\n<li>T\u1eadp v\u1eadn \u0111\u1ed9ng s\u1edbm<\/li>\n<\/ul>\n<ol start=\"2\">\n<li><strong><em>C\u1ee5 th\u1ec3<\/em><\/strong><\/li>\n<\/ol>\n<ul>\n<li>Paracetamol 500mg 01 vi\u00ean x 3<\/li>\n<li>Meloxicam 7.5mg 02 vi\u00ean x 2<\/li>\n<li>Cephazolin 1g 2 l\u1ecd x1 l\u1ea7n\/ng\u00e0y (TMC) v\u00e0 tr\u01b0\u1edbc r\u1ea1ch da 30 ph\u00fat<\/li>\n<li>L\u00ean l\u1ecbch ph\u1eabu thu\u1eadt ch\u01b0\u01a1ng tr\u00ecnh: M\u1ed5 KHX b\u1eb1ng n\u1eb9p v\u00edt<\/li>\n<li>Trong th\u1eddi gian ch\u1edd ti\u1ebfp t\u1ee5c cho b\u1ec7nh \u0111eo \u0111ai vai s\u1ed1 8 v\u00e0 sau khi m\u1ed5<\/li>\n<li>Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng &#8211; v\u1eadt l\u00fd tr\u1ecb li\u1ec7u cho b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt<\/li>\n<\/ul>\n<ol>\n<li><strong> TI\u00caN L\u01af\u1ee2NG<\/strong><\/li>\n<\/ol>\n<ul>\n<li>G\u1ea7n: t\u1ed1t, b\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh kh\u00f4ng m\u1eafc b\u1ec7nh n\u1ec1n, g\u00e3y k\u00edn x\u01b0\u01a1ng \u0111\u00f2n kh\u1ea3 n\u0103ng li\u1ec1n x\u01b0\u01a1ng t\u1ed1t<\/li>\n<li>Xa: kh\u00e1, c\u00f3 th\u1ec3 g\u1eb7p bi\u1ebfn ch\u1ee9ng sau ph\u1eabu thu\u1eadt nh\u01b0 bi\u1ebfn ch\u1ee9ng v\u00f4 c\u1ea3m, bi\u1ebfn ch\u1ee9ng nhi\u1ec5m tr\u00f9ng, ch\u1ea3y m\u00e1u v\u1ebft m\u1ed5, bi\u1ebfn ch\u1ee9ng th\u1ea7n kinh m\u1ea1ch m\u00e1u trong qu\u00e1 tr\u00ecnh k\u1ebft h\u1ee3p x\u01b0\u01a1ng<\/li>\n<\/ul>\n<p><strong>XVI. D\u1ef0 PH\u00d2NG<\/strong><\/p>\n<ul>\n<li>Ti\u1ebfp t\u1ee5c mang \u0111ai s\u1ed1 8 sau m\u1ed5 6-8 tu\u1ea7n<\/li>\n<li>H\u1ea1n ch\u1ebf khu\u00e2n v\u00e1c, v\u1eadn \u0111\u1ed9ng n\u1eb7ng b\u00ean ch\u1ea5n th\u01b0\u01a1ng<\/li>\n<\/ul>","protected":false},"featured_media":4256,"comment_status":"open","ping_status":"closed","template":"","tags":[],"chuyen-muc":[188],"class_list":["post-4403","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\/4403","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=4403"}],"version-history":[{"count":2,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4403\/revisions"}],"predecessor-version":[{"id":4407,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4403\/revisions\/4407"}],"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=4403"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4403"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=4403"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}