{"id":4408,"date":"2024-12-24T10:22:20","date_gmt":"2024-12-24T03:22:20","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=bai-giang&p=4408"},"modified":"2024-12-24T10:22:20","modified_gmt":"2024-12-24T03:22:20","slug":"benh-an-ngoai-khoa-3","status":"publish","type":"bai-giang","link":"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-an-ngoai-khoa-3\/","title":{"rendered":"B\u1ec6NH \u00c1N NGO\u1ea0I KHOA"},"content":{"rendered":"

TR\u01af\u1edcNG Y D\u01af\u1ee2C TR\u00c0 VINH
\nL\u1edaP Y6 – NH\u00d3M 05
\nSinh vi\u00ean th\u1ef1c hi\u1ec7n:
\n1. NGUY\u1ec4N TH\u1eca ANH TH\u01af 116019240
\n2. NGUY\u1ec4N NG\u1eccC TI\u1ec0N 116019253<\/p>\n

B\u1ec6NH \u00c1N NGO\u1ea0I KHOA<\/strong><\/p>\n

(Ti\u1ec1n ph\u1eabu)<\/strong><\/p>\n

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

    \n
  1. H\u1ecd v\u00e0 t\u00ean: NGUY\u1ec4N V\u0102N L.<\/li>\n
  2. Gi\u1edbi: Nam<\/li>\n
  3. Sinh n\u0103m: 1972 (52 tu\u1ed5i)<\/li>\n
  4. Ngh\u1ec1 nghi\u1ec7p: t\u1ef1 do<\/li>\n
  5. Thu\u1eadn tay v\u00e0 ch\u00e2n (P)<\/li>\n
  6. \u0110\u1ecba ch\u1ec9: 74\/12\/12 -Ph\u01b0\u1eddng S\u01a1n K\u1ef3 – Qu\u1eadn T\u00e2n Ph\u00fa – TP HCM<\/li>\n
  7. Ng\u00e0y, gi\u1edd nh\u1eadp C\u1ea5p c\u1ee9u: 05 gi\u1edd 35 ph\u00fat, ng\u00e0y 29 th\u00e1ng 10 n\u0103m 2024<\/li>\n
  8. Ng\u00e0y, gi\u1edd nh\u1eadp Khoa Ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh: 06 gi\u1edd 19 ph\u00fat, ng\u00e0y 29\/10\/2024<\/li>\n
  9. Ng\u00e0y, gi\u1edd l\u00e0m b\u1ec7nh \u00e1n: 11 gi\u1edd 00 ph\u00fat, ng\u00e0y 29 th\u00e1ng 10 n\u0103m 2024<\/li>\n<\/ol>\n

    II. L\u00dd DO NH\u1eacP VI\u1ec6N<\/strong><\/p>\n

    \u0110au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp vai (P)<\/p>\n

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

    B\u1ec7nh nh\u00e2n khai: C\u00e1ch nh\u1eadp vi\u1ec7n 01 gi\u1edd, b\u1ec7nh nh\u00e2n \u0111ang l\u00e1i xe m\u00e1y t\u1ed1c \u0111\u1ed9 30km\/h kh\u00f4ng say r\u01b0\u1ee3u, c\u00f3 \u0111\u1ed9i n\u00f3n b\u1ea3o hi\u1ec3m, do tr\u1eddi t\u1ed1i b\u1ec7nh nh\u00e2n ch\u1ea1y v\u00e0o l\u1ed7 h\u1ecfng tr\u00ean \u0111\u01b0\u1eddng n\u00ean m\u1ea5t l\u00e1i ng\u00e3 xe v\u1ec1 ph\u00eda b\u00ean (P), \u0111\u1eadp m\u1eb7t ngo\u00e0i vai (P) xu\u1ed1ng n\u1ec1n c\u1ee9ng, trong t\u01b0 th\u1ebf vai kh\u00e9p khu\u1ef7u g\u1ea5p, kh\u00f4ng \u0111\u1eadp \u0111\u1ea7u ng\u1ef1c b\u1ee5ng. Sau t\u00e9 b\u1ec7nh nh\u00e2n t\u1ec9nh, th\u1ea5y \u0111au nh\u00f3i vai (P), v\u1eadn \u0111\u1ed9ng n\u00e2ng tay (P) b\u1ecb h\u1ea1n ch\u1ebf, kh\u00f4ng t\u00ea tay, kh\u00f4ng m\u1ea5t c\u1ea3m gi\u00e1c tay (P), c\u1eed \u0111\u1ed9ng khu\u1ef7u tay b\u00ecnh th\u01b0\u1eddng, b\u1ec7nh nh\u00e2n kh\u00f4ng x\u1eed tr\u00ed kh\u00f4ng c\u1ed1 \u0111\u1ecbnh \u0111\u1ec3 tay (P) \u1edf t\u01b0 th\u1ebf g\u1ea5p khu\u1ef7u tay tr\u00e1i \u00f4m tay (P) v\u00e0o c\u1ea5p c\u1ee9u b\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t.<\/p>\n

    Trong qu\u00e1 tr\u00ecnh b\u1ec7nh, b\u1ec7nh nh\u00e2n kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng \u0111au ng\u1ef1c-b\u1ee5ng, kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng ch\u00f3ng m\u1eb7t, kh\u00f4ng bu\u1ed3n n\u00f4n.<\/p>\n

    *T\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp Khoa C\u1ea5p c\u1ee9u:<\/strong><\/p>\n

    – Sinh hi\u1ec7u:<\/p>\n

    + M\u1ea1ch 80 l\u1ea7n\/ph\u00fat<\/p>\n

    + Huy\u1ebft \u00e1p 160\/90 mmHg<\/p>\n

    + Nhi\u1ec7t \u0111\u1ed9 37\u00b0C<\/p>\n

    + Nh\u1ecbp th\u1edf 20 l\u1ea7n\/ph\u00fat<\/p>\n

    – SpO2 96%\/kh\u00ed tr\u1eddi<\/p>\n

    – C\u00e2n n\u1eb7ng 55 kg; Chi\u1ec1u cao 165 cm<\/p>\n

    – B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/p>\n

    – Da, ni\u00eam m\u1ea1c h\u1ed3ng<\/p>\n

    – \u0110au v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng vai (P)<\/p>\n

    – M\u1ea1ch quay r\u00f5<\/p>\n

    – Kh\u00f4ng t\u00ea tay (P)<\/p>\n

    – S\u00e2y s\u00e1t da tay (P)<\/p>\n

    – Tim \u0111\u1ec1u, th\u1edf \u00eam, ph\u1ed5i kh\u00f4ng ran, b\u1ee5ng m\u1ec1m<\/p>\n

    – X\u1eed tr\u00ed t\u1ea1i Khoa C\u1ea5p c\u1ee9u:<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 + Diclofenac 75mg\/3ml: 01 \u1ed1ng TB<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 + \u0110eo \u0111ai x\u01b0\u01a1ng \u0111\u00f2n s\u1ed1 8<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 + C\u1eadn l\u00e2m s\u00e0ng: X-quang x\u01b0\u01a1ng \u0111\u00f2n th\u1eb3ng, si\u00eau \u00e2m c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng<\/p>\n

    \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 + Ch\u01b0a \u0111\u01b0\u1ee3c \u0111o n\u1ed3ng \u0111\u1ed9 Ethanol m\u00e1u<\/p>\n

    *Nh\u1eadp khoa CTCH<\/strong> l\u00fac 06 gi\u1edd 19 ph\u00fat, ng\u00e0y 29\/10\/2024<\/p>\n

    – B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/p>\n

    – Sinh hi\u1ec7u \u1ed5n<\/p>\n

    – \u0110au v\u00e0 s\u01b0ng vai (P)<\/p>\n

    – H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng vai (P)<\/p>\n

    – M\u1ea1ch quay r\u00f5<\/p>\n

    – S\u00e2y s\u00e1t da khu\u1ef7u tay (P)<\/p>\n

    * Di\u1ebfn ti\u1ebfn t\u1eeb l\u00fac v\u00e0o khoa \u0111\u1ebfn l\u00fac th\u0103m kh\u00e1m:<\/strong><\/p>\n

    – B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/p>\n

    – Sinh hi\u1ec7u \u1ed5n<\/p>\n

    – \u0110au gi\u1ea3m \u0111au vai (P)<\/p>\n

    – S\u01b0ng n\u1ec1 vai (P)<\/p>\n

    – H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng vai (P)<\/p>\n

    – M\u1ea1ch quay r\u00f5<\/p>\n

    – S\u00e2y s\u00e1t da khu\u1ef7u tay (P)<\/p>\n

    – B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u00e0m b\u1ed9 x\u00e9t nghi\u1ec7m ti\u1ec1n ph\u1eabu<\/p>\n

     <\/p>\n

      \n
    1. TI\u1ec0N C\u0102N<\/strong><\/li>\n
    2. B\u1ea3n th\u00e2n:<\/em><\/strong><\/li>\n<\/ol>\n

      – N\u1ed9i khoa: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n

      – Ngo\u1ea1i khoa: ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n

      – D\u1ecb \u1ee9ng: ch\u01b0a ghi nh\u1eadn d\u1ecb \u1ee9ng thu\u1ed1c v\u00e0 th\u1ee9c \u0103n<\/p>\n

      – Th\u00f3i quen: h\u00fat thu\u1ed1c l\u00e1 20 g\u00f3i.n\u0103m, kh\u00f4ng u\u1ed1ng r\u01b0\u1ee3u bia<\/p>\n

        \n
      1. Gia \u0111\u00ecnh:<\/em><\/strong> ch\u01b0a ghi nh\u1eadn b\u1ec7nh l\u00fd li\u00ean quan<\/li>\n<\/ol>\n

         <\/p>\n

          \n
        1. KH\u00c1M L\u00c2M S\u00c0NG (11 gi\u1edd 00 ph\u00fat 29\/10\/2024)<\/strong><\/li>\n
        2. T\u1ed5ng tr\u1ea1ng:<\/em><\/strong><\/li>\n<\/ol>\n

          – B\u1ec7nh nh\u00e2n t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t<\/p>\n

          – Th\u1edf d\u1ec5<\/p>\n

          – Da, ni\u00eam m\u1ea1c h\u1ed3ng<\/p>\n

          – Tuy\u1ebfn gi\u00e1p kh\u00f4ng to<\/p>\n

          – H\u1ea1ch ngo\u1ea1i vi kh\u00f4ng s\u1edd ch\u1ea1m<\/p>\n

          – Kh\u00f4ng ph\u00f9<\/p>\n

          – Sinh hi\u1ec7u:<\/p>\n

          M\u1ea1ch 80 l\u1ea7n\/ph\u00fat<\/p>\n

          Huy\u1ebft \u00e1p 120\/70 mmHg<\/p>\n

          Nhi\u1ec7t \u0111\u1ed9 37\u00b0C<\/p>\n

          Nh\u1ecbp th\u1edf 20 l\u1ea7n\/ph\u00fat<\/p>\n

          – SpO2 99%\/kh\u00ed tr\u1eddi<\/p>\n

          – Chi\u1ec1u cao 165 cm; C\u00e2n n\u1eb7ng 55 kg. BMI 20,2 kg\/m2 (b\u00ecnh th\u01b0\u1eddng theo IDI8&WPRO)<\/p>\n

            \n
          1. Tim m\u1ea1ch:<\/em><\/strong><\/li>\n<\/ol>\n

            – L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng \u0111\u1ec1u theo nh\u1ecbp th\u1edf, kh\u00f4ng sao m\u1ea1ch.<\/p>\n

            – Kh\u00f4ng rung mi\u00eau, kh\u00f4ng \u1ed5 \u0111\u1eadp b\u1ea5t th\u01b0\u1eddng.<\/p>\n

            – Di\u1ec7n \u0111\u1eadp m\u1ecfm tim 1×1 cm, KLS 5, \u0111\u01b0\u1eddng trung \u0111\u00f2n tr\u00e1i<\/p>\n

            – T1,T2 \u0111\u1ec1u, r\u00f5, kh\u00f4ng \u00e2m th\u1ed5i<\/p>\n

            – T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i (-)<\/p>\n

            – M\u1ea1ch ngo\u1ea1i bi\u00ean b\u1eaft \u0111\u01b0\u1ee3c \u0111\u1ec1u r\u00f5 hai b\u00ean<\/p>\n

              \n
            1. H\u00f4 h\u1ea5p:<\/em><\/strong><\/li>\n<\/ol>\n

              – L\u1ed3ng ng\u1ef1c c\u00e2n \u0111\u1ed1i, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf, kh\u00f4ng co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, kh\u00f4ng g\u00f9 v\u1eb9o c\u1ed9t s\u1ed1ng.<\/p>\n

              – Rung thanh \u0111\u1ec1u hai b\u00ean, g\u00f5 trong<\/p>\n

              – R\u00ec r\u00e0o ph\u1ebf nang \u00eam d\u1ecbu hai ph\u1ebf tr\u01b0\u1eddng, kh\u00f4ng ran<\/p>\n

                \n
              1. Ti\u00eau h\u00f3a:<\/em><\/strong><\/li>\n<\/ol>\n

                – B\u1ee5ng kh\u00f4ng to b\u00e8, kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169, kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7<\/p>\n

                – Nhu \u0111\u1ed9ng ru\u00f4t 8 l\u1ea7n\/ph\u00fat. Kh\u00f4ng \u00e2m th\u1ed5i \u0111\u1ed9ng m\u1ea1ch<\/p>\n

                – B\u1ee5ng g\u00f5 trong<\/p>\n

                – B\u1ee5ng m\u1ec1m, \u1ea5n kh\u00f4ng \u0111au. Gan, l\u00e1ch s\u1edd kh\u00f4ng ch\u1ea1m<\/p>\n

                  \n
                1. C\u01a1 – X\u01b0\u01a1ng – Kh\u1edbp:<\/em><\/strong><\/li>\n<\/ol>\n

                  \u00a0\u00a0\u00a0\u00a0\u00a0 *NH\u00ccN (<\/strong>B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c kh\u00e1m \u1edf t\u01b0 th\u1ebf ng\u1ed3i, th\u00e1o \u0111ai vai s\u1ed1 8 \u0111\u1ec3 kh\u00e1m)<\/p>\n

                  – Bi\u1ebfn d\u1ea1ng b\u1eadc thang v\u1ecb tr\u00ed 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                  – Vai (P) th\u1ea5p h\u01a1n vai (T)<\/p>\n

                  – Kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng v\u00f9ng ng\u1ef1c v\u00e0 vai (P)<\/p>\n

                  – S\u01b0ng, v\u1ebft b\u1ea7m t\u00edm 1×0,5 cm gi\u1eefa vai (P), s\u00e2y s\u00e1t da c\u00f9ng khu\u1ef7u tay (P)<\/p>\n

                  – Kh\u00f4ng m\u1ea5t r\u00e3nh delta – ng\u1ef1c<\/p>\n

                  – C\u00e1c \u0111\u1ea7u ng\u00f3n tay h\u1ed3ng<\/p>\n

                  – Kh\u00f4ng c\u00f3 b\u00e0n tay vu\u1ed1t tr\u1ee5, b\u00e0n tay r\u0169<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0\u00a0 *S\u1edc<\/strong><\/p>\n

                  – Chi \u1ea5m, CRT <2 gi\u00e2y<\/p>\n

                  – S\u1edd \u0111\u01b0\u1ee3c c\u00e1c m\u00f3c x\u01b0\u01a1ng v\u00f9ng vai: m\u1ecfm c\u00f9ng vai, m\u1ecfm qu\u1ea1, m\u1ea5u chuy\u1ec3n l\u1edbn x\u01b0\u01a1ng c\u00e1nh tay<\/p>\n

                  – \u1ea4n kh\u00f4ng \u0111au kh\u1edbp vai v\u00e0 d\u1ecdc x\u01b0\u01a1ng c\u00e1nh tay (P)<\/p>\n

                  – S\u1edd 2 x\u01b0\u01a1ng b\u1ea3 vai ph\u00eda sau c\u1ea7n x\u1ee9ng, kh\u00f4ng \u0111au<\/p>\n

                  – \u1ea4n \u0111au ch\u00f3i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                  – D\u1ea5u m\u1ea5t li\u00ean t\u1ee5c t\u1ea1i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P) (+)<\/p>\n

                  – D\u1ea5u l\u1ea1o x\u1ea1o x\u01b0\u01a1ng t\u1ea1i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P) (+)<\/p>\n

                  – D\u1ea5u ph\u00edm \u0111\u00e0n (-)<\/p>\n

                  – D\u1ea5u \u1ed5 kh\u1edbp r\u1ed7ng (-)<\/p>\n

                  – M\u1ea1ch quay, tr\u1ee5 (+)<\/p>\n

                  – Tr\u01b0\u01a1ng l\u1ef1c c\u01a1: kh\u00f4ng t\u0103ng, kh\u00f4ng gi\u1ea3m<\/p>\n

                  – Kh\u00f4ng t\u00ea tay, kh\u00f4ng d\u1ecb c\u1ea3m<\/p>\n

                  – Kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng l\u1ed1i tho\u00e1t ng\u1ef1c<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0\u00a0 *\u0110O<\/strong><\/p>\n

                  – Chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i x\u01b0\u01a1ng \u0111\u00f2n (\u0111\u1ea7u \u1ee9c – \u0111\u1ea7u c\u00f9ng vai x\u01b0\u01a1ng \u0111\u00f2n):<\/p>\n

                  (P): 12 cm<\/p>\n

                  (T): 14 cm<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0\u00a0 *V\u1eacN \u0110\u1ed8NG<\/strong><\/p>\n

                  – S\u1ee9c c\u01a1 tay (P) 4\/5, tay (T) 5\/5<\/p>\n

                  – \u0110\u1ed9ng t\u00e1c ra tr\u01b0\u1edbc-ra sau, d\u1ea1ng-kh\u00e9p, xoay trong-xoay ngo\u00e0i vai (P) h\u1ea1n ch\u1ebf<\/p>\n

                  – V\u1eadn \u0111\u1ed9ng c\u00e1c kh\u1edbp khu\u1ef7u, c\u1ed5 tay, b\u00e0n ng\u00f3n c\u1ee7a tay (P) ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n

                  – Kh\u00e1m c\u00e1c nghi\u1ec7m ph\u00e1p:<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 + Nghi\u1ec7m ph\u00e1p c\u00e1nh tay r\u01a1i (-)<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 + Nghi\u1ec7m ph\u00e1p Yergason (-)<\/p>\n

                  \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 + Nghi\u1ec7m ph\u00e1p e s\u1ee3 (-)<\/p>\n

                  + Nghi\u1ec7m ph\u00e1p Froment (-)<\/p>\n

                  *Kh\u00e1m tay (T) v\u00e0 hai chi d\u01b0\u1edbi ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng.<\/p>\n

                    \n
                  1. Kh\u00e1m th\u1ea7n kinh:<\/em><\/strong><\/li>\n<\/ol>\n

                    –<\/strong> B\u1ec7nh nh\u00e2n t\u1ec9nh<\/p>\n

                    – Kh\u00f4ng th\u1ea7n kinh khu tr\u00fa<\/p>\n

                    – Kh\u00f4ng d\u1ea5u m\u00e0ng n\u00e3o<\/p>\n

                      \n
                    1. Kh\u00e1m c\u01a1 quan kh\u00e1c<\/em><\/strong>:<\/strong> ch\u01b0a ghi nh\u00e2n b\u1ea5t th\u01b0\u1eddng t\u1ea1i th\u1eddi \u0111i\u1ec3m th\u0103m kh\u00e1m.<\/li>\n<\/ol>\n
                        \n
                      1. T\u00d3M T\u1ea4T B\u1ec6NH \u00c1N<\/strong><\/li>\n<\/ol>\n

                        B\u1ec7nh nh\u00e2n nam, 52 tu\u1ed5i, nh\u1eadp vi\u1ec7n v\u00ec \u0111au v\u00e0 gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u1edbp vai (P) gi\u1edd th\u1ee9 6 sau tai n\u1ea1n giao th\u00f4ng. Qua h\u1ecfi b\u1ec7nh v\u00e0 th\u0103m kh\u00e1m ghi nh\u1eadn:<\/p>\n\n\n\n\n
                        \n

                        Physical symptoms<\/strong><\/p>\n<\/td>\n

                        		\n

                        – \u0110au, s\u01b0ng n\u1ec1 v\u00e0 b\u1ea7m t\u00edm vai (P)<\/p>\n

                        – H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp vai (P)<\/p>\n<\/td>\n<\/tr>\n

                        \n

                        Physical symptoms<\/strong><\/p>\n<\/td>\n

                        		\n

                        – \u1ea4n \u0111au ch\u00f3i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                        – Bi\u1ebfn d\u1ea1ng 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                        – D\u1ea5u m\u1ea5t li\u00ean t\u1ee5c t\u1ea1i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P) (+)<\/p>\n

                        – D\u1ea5u l\u1ea1o x\u1ea1o x\u01b0\u01a1ng t\u1ea1i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P) (+)<\/p>\n

                        – Kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng v\u00f9ng ng\u1ef1c v\u00e0 vai (P)<\/p>\n

                        – Vai (P) th\u1ea5p h\u01a1n vai (T)<\/p>\n

                        – Chi\u1ec1u d\u00e0i x\u01b0\u01a1ng \u0111\u00f2n b\u00ean (P) ng\u1eafn h\u01a1n b\u00ean (T)<\/p>\n

                        – V\u1eadn \u0111\u1ed9ng g\u1ea5p-du\u1ed7i, d\u1ea1ng-kh\u00e9p kh\u1edbp vai (P) h\u1ea1n ch\u1ebf<\/p>\n

                        – Kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng l\u1ed1i tho\u00e1t ng\u1ef1c<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                        \u00a0<\/strong><\/p>\n

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

                        D\u1ea5u hi\u1ec7u g\u00e3y x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                        \u00a0<\/strong><\/p>\n

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

                        G\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P) ch\u01b0a bi\u1ebfn ch\u1ee9ng gi\u1edd th\u1ee9 6 sau tai n\u1ea1n giao th\u00f4ng<\/p>\n

                        \u00a0<\/strong><\/p>\n

                          \n
                        1. BI\u1ec6N LU\u1eacN L\u00c2M S\u00c0NG<\/strong><\/li>\n<\/ol>\n

                          B\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u00ec \u0111au v\u00e0 gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u1edbp vai (P) gi\u1edd th\u1ee9 6 sau tai n\u1ea1n giao th\u00f4ng c\u00f3 c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng r\u00f5 r\u00e0ng l\u00e0 \u0111\u1eadp m\u1eb7t ngo\u00e0i vai P xu\u1ed1ng n\u1ec1n c\u1ee9ng. V\u1edbi tri\u1ec7u ch\u1ee9ng nh\u01b0 tr\u00ean th\u00ec c\u00f3 th\u1ec3 g\u1eb7p c\u00e1c t\u1ed5n th\u01b0\u01a1ng nh\u01b0:<\/p>\n

                          *G\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P):<\/strong><\/p>\n

                          – B\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng \u0111\u00f2n (P) bao g\u1ed3m: bi\u1ebfn d\u1ea1ng b\u1eadc thang, d\u1ea5u m\u1ea5t li\u00ean t\u1ee5c v\u00e0 d\u1ea5u l\u1ea1o x\u1ea1o x\u01b0\u01a1ng 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P), chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i x\u01b0\u01a1ng \u0111\u00f2n (P) < (T). K\u00e8m c\u00e1c d\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng \u0111\u00f2n (P) bao g\u1ed3m: \u1ea5n \u0111au ch\u00f3i 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P), gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u1edbp vai (P), s\u01b0ng n\u1ec1 v\u00e0 b\u1ea7m t\u00edm v\u00f9ng vai (P).<\/p>\n

                          – B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng v\u00f9ng ng\u1ef1c v\u00e0 vai (P) \u2192 g\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P).<\/p>\n

                          – Bi\u1ec7n lu\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng s\u1edbm c\u1ee7a g\u00e3y x\u01b0\u01a1ng \u0111\u00f2n (P):<\/p>\n

                          + G\u00e3y k\u00edn sang g\u00e3y h\u1edf<\/em>: 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 tr\u00e1i, kh\u00f4ng th\u1ea5y c\u0103ng ch\u1ed7 \u0111\u1ea7u x\u01b0\u01a1ng g\u00e3y \u2192 kh\u00f4ng ngh\u0129.<\/p>\n

                          + Nerve damage:<\/em> b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 h\u1ed9i ch\u1ee9ng l\u1ed1i tho\u00e1t ng\u1ef1c nh\u01b0 kh\u00f4ng t\u00ea tay, kh\u00f4ng d\u1ecb c\u1ea3m, kh\u00f4ng c\u00f3 b\u00e0n tay vu\u1ed1t tr\u1ee5, Froment (-), s\u1ee9c c\u01a1 tay (P) 4\/5 v\u00e0 gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u1edbp vai do \u0111au, v\u1eadn \u0111\u1ed9ng c\u00e1c kh\u1edbp kh\u00e1c c\u1ee7a tay (P) b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng y\u1ebfu li\u1ec7t c\u01a1 v\u00f9ng c\u00e1nh v\u00e0 c\u1eb3ng tay (P) \u2192 kh\u00f4ng ngh\u0129 c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1m r\u1ed1i th\u1ea7n kinh c\u00e1nh tay.<\/p>\n

                          + T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u:<\/em> b\u1ec7nh nh\u00e2n c\u00f3 sinh hi\u1ec7u \u1ed5n, chi \u1ea5m, \u0111\u1ea7u c\u00e1c ng\u00f3n h\u1ed3ng, CRT <2 gi\u00e2y, m\u1ea1ch quay (+) \u2192 kh\u00f4ng ngh\u0129 t\u1ed5n th\u01b0\u01a1ng b\u00f3 m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n.<\/p>\n

                          + T\u1ed5n th\u01b0\u01a1ng \u0111\u1ec9nh ph\u1ed5i:<\/em> b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au, kh\u00f4ng c\u00f3 v\u1ebft th\u01b0\u01a1ng hay b\u1ea7m t\u00edm\u00a0 v\u00f9ng ng\u1ef1c (P), nghe ph\u1ed5i kh\u00f4ng ran, r\u00ec r\u00e0o ph\u1ebf nang \u00eam d\u1ecbu hai ph\u1ebf tr\u01b0\u1eddng, rung\u00a0 thanh \u0111\u1ec1u 2 b\u00ean, g\u00f5 trong \u2192 kh\u00f4ng ngh\u0129 c\u00f3 bi\u1ebfn ch\u1ee9ng d\u1eadp ph\u1ed5i, g\u00e3y x\u01b0\u01a1ng s\u01b0\u1eddn \u0111\u1ec9nh ph\u1ed5i hay tr\u00e0n kh\u00ed, tr\u00e0n m\u00e1u m\u00e0ng ph\u1ed5i.<\/p>\n

                          *R\u00e1ch ch\u00f3p xoay:<\/strong> \u00edt ngh\u0129 do b\u1ec7nh nh\u00e2n \u0111au vai kh\u00f4ng lan l\u00ean c\u1ed5 hay lan c\u00e1nh tay, nghi\u1ec7m ph\u00e1p c\u00e1nh tay r\u01a1i (-).<\/p>\n

                          *R\u00e1ch s\u1ee5n vi\u1ec1n:<\/strong> \u00edt ngh\u0129 v\u00ec b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u tr\u1eadt kh\u1edbp vai, kh\u00f4ng c\u1ee9ng kh\u1edbp vai, nghi\u1ec7m ph\u00e1p e s\u1ee3 (-).<\/p>\n

                          *Tr\u1eadt kh\u1edbp vai:<\/strong> B\u1ec7nh nh\u00e2n c\u00f3 gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng kh\u1edbp vai (P) nh\u01b0ng \u1ea5n kh\u1edbp vai (P) kh\u00f4ng \u0111au, d\u1ea5u \u1ed5 kh\u1edbp r\u1ed7ng (-), d\u1ea5u ph\u00edm \u0111\u00e0n (-) \u2192 kh\u00f4ng ngh\u0129 c\u00f3 t\u00ecnh tr\u1ea1ng tr\u1eadt kh\u1edbp vai (P) k\u00e8m theo.<\/p>\n

                          *Tr\u1eadt kh\u1edbp c\u00f9ng \u0111\u00f2n:<\/strong> \u00edt ngh\u0129 do kh\u00e1m d\u1ea5u ph\u00edm \u0111\u00e0n (-).<\/p>\n

                          *G\u00e3y \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng c\u00e1nh tay:<\/strong> Kh\u00e1m th\u1ea5y \u1ea5n kh\u00f4ng \u0111au d\u1ecdc x\u01b0\u01a1ng c\u00e1nh tay n\u00ean kh\u00f4ng ngh\u0129.<\/p>\n

                          *T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng b\u1ea3 vai:<\/strong> Kh\u00e1m th\u1ea5y 2 x\u01b0\u01a1ng b\u1ea3 vai c\u1ee7a b\u1ec7nh nh\u00e2n c\u00e2n x\u1ee9ng, kh\u00f4ng \u0111au n\u00ean kh\u00f4ng ngh\u0129.<\/p>\n

                           <\/p>\n

                          X. \u0110\u1ec0 NGH\u1eca C\u1eacN L\u00c2M S\u00c0NG<\/strong><\/p>\n

                            \n
                          1. C\u1eadn l\u00e2m s\u00e0ng \u0111\u00e3 \u0111\u01b0\u1ee3c l\u00e0m:<\/em><\/strong><\/li>\n<\/ol>\n

                            – X-Quang x\u01b0\u01a1ng \u0111\u00f2n (P) b\u00ecnh di\u1ec7n th\u1eb3ng.<\/p>\n

                            \"1\"
                            1<\/figcaption><\/figure>
                            \"2\"
                            2<\/figcaption><\/figure><\/p>\n

                            – X\u00e9t nghi\u1ec7m ti\u1ec1n ph\u1eabu:<\/p>\n

                            + T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u ngo\u1ea1i vi, nh\u00f3m m\u00e1u, Rh<\/p>\n

                            + \u0110\u00f4ng c\u1ea7m m\u00e1u<\/p>\n

                            + Sinh ho\u00e1: ure, creatinine, eGFR, glucose, AST, ALT<\/p>\n

                            + \u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3<\/p>\n

                            + T\u1ed5ng ph\u00e2n t\u00edch n\u01b0\u1edbc ti\u1ec3u<\/p>\n

                            + X-Quang ng\u1ef1c th\u1eb3ng<\/p>\n

                            + \u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/p>\n

                              \n
                            1. \u0110\u1ecdc k\u1ebft qu\u1ea3 c\u00e2n l\u00e2m s\u00e0ng:<\/strong><\/em><\/li>\n<\/ol>\n
                                \n
                              • X-Quang x\u01b0\u01a1ng \u0111\u00f2n (P) th\u1eb3ng:<\/strong><\/li>\n<\/ul>\n

                                *K\u1ebeT QU\u1ea2:<\/strong><\/p>\n

                                – H\u00e0nh ch\u00ednh: phim X-Quang x\u01b0\u01a1ng \u0111\u00f2n (P) th\u1eb3ng c\u1ee7a b\u1ec7nh nh\u00e2n nam Nguy\u1ec5n V\u0103n L, 52 tu\u1ed5i, ch\u1ee5p ng\u00e0y 29\/10\/2024<\/p>\n

                                – Ti\u00eau chu\u1ea9n phim: c\u01b0\u1eddng \u0111\u1ed9 tia \u0111\u1ee7 (ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c m\u00f4 m\u1ec1m, v\u1ecf x\u01b0\u01a1ng, v\u00e0 t\u1ee7y x\u01b0\u01a1ng), phim ch\u1ee5p \u0111\u1ee7 hai kh\u1edbp qua hai \u0111\u1ea7u \u1ed5 g\u00e3y, b\u00ecnh di\u1ec7n th\u1eb3ng.<\/p>\n

                                – T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng:<\/p>\n

                                + V\u1ecb tr\u00ed x\u01b0\u01a1ng g\u00e3y l\u00e0 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                                + \u0110\u01b0\u1eddng g\u00e3y ch\u00e9o, g\u00e3y c\u00f3 m\u1ea3nh th\u1ee9 3<\/p>\n

                                + Di l\u1ec7ch ch\u1ed3ng ng\u1eafn 2,1cm v\u00e0 di l\u1ec7ch ra sau xu\u1ed1ng d\u01b0\u1edbi<\/p>\n

                                + Ph\u00e2n lo\u1ea1i nh\u00f3m I theo Allman.<\/p>\n

                                – T\u1ed5n th\u01b0\u01a1ng kh\u1edbp v\u00e0 m\u00f4 m\u1ec1m: kh\u00f4ng ghi nh\u1eadn t\u1ed5n th\u01b0\u01a1ng kh\u1edbp v\u00e0 m\u00f4 m\u1ec1m k\u00e8m theo.<\/p>\n

                                *K\u1ebeT LU\u1eacN: <\/strong>G\u00e3y 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                                  \n
                                • Xquang ng\u1ef1c th\u1eb3ng:<\/strong><\/li>\n<\/ul>\n
                                  \"3\"
                                  3<\/figcaption><\/figure>\n

                                  *K\u1ebeT QU\u1ea2:<\/strong><\/p>\n

                                  – H\u00e0nh ch\u00ednh: phim X-Quang ng\u1ef1c th\u1eb3ng c\u1ee7a b\u1ec7nh nh\u00e2n nam Nguy\u1ec5n V\u0103n L, 52 tu\u1ed5i, ch\u1ee5p ng\u00e0y 29\/10\/2024<\/p>\n

                                  – Ti\u00eau chu\u1ea9n phim: c\u01b0\u1eddng \u0111\u1ed9 tia v\u1eeba, th\u1ea5y \u0111\u01b0\u1ee3c \u0111\u1ed1t s\u1ed1ng sau b\u00f3ng tim, phim ch\u1ee5p \u0111\u1ee9ng (x\u01b0\u01a1ng b\u1ea3 vai n\u1eb1m ngo\u00e0i ph\u1ebf tr\u01b0\u1eddng), \u0111\u1ed1i x\u1ee9ng, h\u00edt \u0111\u1ee7 s\u00e2u, th\u1ea5y \u0111\u01b0\u1ee3c 11 cung s\u01b0\u1eddn sau ph\u00eda tr\u00ean v\u00f2m ho\u00e0nh.<\/p>\n

                                  – T\u1ed5n th\u01b0\u01a1ng:<\/p>\n

                                  + Kh\u00ed qu\u1ea3n kh\u00f4ng l\u1ec7ch<\/p>\n

                                  + G\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P)<\/p>\n

                                  + B\u00f3ng tim kh\u00f4ng to<\/p>\n

                                  + V\u00f2m ho\u00e0nh cong \u0111\u1ec1u 2 b\u00ean, kh\u00f4ng m\u1edd g\u00f3c s\u01b0\u1eddn ho\u00e0nh<\/p>\n

                                  + Kh\u00f4ng th\u00e2m nhi\u00eam nhu m\u00f4 ph\u1ed5i<\/p>\n

                                  + Kh\u00f4ng d\u1ecb v\u1eadt<\/p>\n

                                  *K\u1ebeT LU\u1eacN:<\/strong> Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n

                                    \n
                                  • C\u1eadn l\u00e2m s\u00e0ng ti\u1ec1n ph\u1eabu:<\/strong><\/li>\n<\/ul>\n\n\n\n\n\n\n\n
                                    \n

                                    \u0110\u00f4ng c\u1ea7m m\u00e1u<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    \u00a0<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    \u00a0<\/strong><\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    APTT<\/p>\n<\/td>\n

                                    		\n

                                    33.3<\/p>\n<\/td>\n

                                    		\n

                                    Gi\u00e2y<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    TQ<\/p>\n<\/td>\n

                                    		\n

                                    11.5<\/p>\n<\/td>\n

                                    		\n

                                    Gi\u00e2y<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    TL<\/p>\n<\/td>\n

                                    		\n

                                    94<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    INR<\/p>\n<\/td>\n

                                    		\n

                                    1.04<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                                    *K\u1ebeT LU\u1eacN:<\/strong> Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                                    \n

                                    TPTTBM<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    \u00a0<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    \u00a0<\/strong><\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    WBC<\/p>\n<\/td>\n

                                    		\n

                                    12.28\u00a0 \u2191<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    K\/uL<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    NEU#<\/p>\n<\/td>\n

                                    		\n

                                    9.77\u00a0\u00a0\u00a0 <\/strong>\u2191<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    K\/uL<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    NEU %<\/p>\n<\/td>\n

                                    		\n

                                    80,3\u00a0\u00a0\u00a0 <\/strong>\u2191<\/strong><\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    LYM#<\/p>\n<\/td>\n

                                    		\n

                                    1.07<\/p>\n<\/td>\n

                                    		\n

                                    K\/uL<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    MONO#<\/p>\n<\/td>\n

                                    		\n

                                    0.61<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    EOS#<\/p>\n<\/td>\n

                                    		\n

                                    0.09<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    BASO#<\/p>\n<\/td>\n

                                    		\n

                                    0.0<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    RBC<\/p>\n<\/td>\n

                                    		\n

                                    4.57<\/p>\n<\/td>\n

                                    		\n

                                    M\/uL<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    HGB<\/p>\n<\/td>\n

                                    		\n

                                    13.8<\/p>\n<\/td>\n

                                    		\n

                                    g\/dL<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    HCT<\/p>\n<\/td>\n

                                    		\n

                                    41.2<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    PLT<\/p>\n<\/td>\n

                                    		\n

                                    223.3<\/p>\n<\/td>\n

                                    		\n

                                    K\/uL<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    Nh\u00f3m m\u00e1u<\/p>\n<\/td>\n

                                    		\n

                                    A (+)<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                                    *K\u1ebeT LU\u1eacN:<\/strong> B\u1ea1ch c\u1ea7u t\u0103ng, \u01b0u th\u1ebf NEU ngh\u0129 do ph\u1ea3n \u1ee9ng c\u01a1 th\u1ec3 do tr\u00ean l\u00e2m s\u00e0ng kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng. Tuy nhi\u00ean \u0111\u1ec3 lo\u1ea1i tr\u1eeb em \u0111\u1ec1 ngh\u1ecb th\u00eam CRP \u0111\u1ecbnh l\u01b0\u1ee3ng<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                                    \n

                                    Sinh ho\u00e1<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    \u00a0<\/strong><\/p>\n<\/td>\n

                                    		\n

                                    \u00a0<\/strong><\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    Glucose<\/p>\n<\/td>\n

                                    		\n

                                    9<\/p>\n<\/td>\n

                                    		\n

                                    mmol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    Ure<\/p>\n<\/td>\n

                                    		\n

                                    5.6<\/p>\n<\/td>\n

                                    		\n

                                    mmol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    Creatinin<\/p>\n<\/td>\n

                                    		\n

                                    83<\/p>\n<\/td>\n

                                    		\n

                                    umol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    eGFR<\/p>\n<\/td>\n

                                    		\n

                                    89.69<\/p>\n<\/td>\n

                                    		\n

                                    ml\/ph\u00fat<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    AST<\/p>\n<\/td>\n

                                    		\n

                                    22<\/p>\n<\/td>\n

                                    		\n

                                    U\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    ALT<\/p>\n<\/td>\n

                                    		\n

                                    20<\/p>\n<\/td>\n

                                    		\n

                                    U\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    Na+<\/p>\n<\/td>\n

                                    		\n

                                    139<\/p>\n<\/td>\n

                                    		\n

                                    mmol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    K+<\/p>\n<\/td>\n

                                    		\n

                                    3.8<\/p>\n<\/td>\n

                                    		\n

                                    mmol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    Cl-<\/p>\n<\/td>\n

                                    		\n

                                    103<\/p>\n<\/td>\n

                                    		\n

                                    mmol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    \u0110L calci to\u00e0n ph\u1ea7n<\/p>\n<\/td>\n

                                    		\n

                                    2.22<\/p>\n<\/td>\n

                                    		\n

                                    mmol\/L<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                                    *K\u1ebeT LU\u1eacN:<\/strong> Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
                                    \n

                                    TPT n\u01b0\u1edbc ti\u1ec3u<\/strong><\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    URO<\/p>\n<\/td>\n

                                    		\n

                                    nom<\/p>\n<\/td>\n

                                    		\n

                                    umol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    GLU<\/p>\n<\/td>\n

                                    		\n

                                    nom<\/p>\n<\/td>\n

                                    		\n

                                    mmol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    BIL<\/p>\n<\/td>\n

                                    		\n

                                    (-)<\/p>\n<\/td>\n

                                    		\n

                                    umol\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    KET<\/p>\n<\/td>\n

                                    		\n

                                    (-)<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    S.G<\/p>\n<\/td>\n

                                    		\n

                                    1.019<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    BLD<\/p>\n<\/td>\n

                                    		\n

                                    (-)<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    pH<\/p>\n<\/td>\n

                                    		\n

                                    7<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    PRO<\/p>\n<\/td>\n

                                    		\n

                                    (-)<\/p>\n<\/td>\n

                                    		\n

                                    g\/L<\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    NIT<\/p>\n<\/td>\n

                                    		\n

                                    (-)<\/p>\n<\/td>\n

                                    		\n

                                     <\/p>\n<\/td>\n<\/tr>\n

                                    \n

                                    LEU<\/p>\n<\/td>\n

                                    		\n

                                    (-)<\/p>\n<\/td>\n

                                    		\n

                                    ug\/dl<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

                                    *K\u1ebeT LU\u1eacN:<\/strong>\u00a0 Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n

                                     <\/p>\n

                                      \n
                                    • \u0110i\u1ec7n t\u00e2m \u0111\u1ed3:<\/strong><\/li>\n<\/ul>\n

                                      – Nh\u1ecbp xoang \u0111\u1ec1u, t\u1ea7n s\u1ed1 80 chu k\u1ef3\/ph\u00fat<\/p>\n

                                      – Tr\u1ee5c trung gian<\/p>\n

                                        \n
                                      • Si\u00eau \u00e2m c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng (eFAST): <\/strong>Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng.<\/li>\n<\/ul>\n

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

                                        G\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n (P) nh\u00f3m I theo Allman ch\u01b0a bi\u1ebfn ch\u1ee9ng gi\u1edd th\u1ee9 6 sau tai n\u1ea1n giao th\u00f4ng<\/p>\n

                                        XII. H\u01af\u1edaNG X\u1eec TR\u00cd<\/strong><\/p>\n

                                          \n
                                        1. H\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb:<\/strong><\/li>\n<\/ol>\n

                                          *\u0110i\u1ec1u tr\u1ecb hi\u1ec7n t\u1ea1i:<\/em><\/strong><\/p>\n

                                          – N\u1eafn ch\u1ec9nh x\u01b0\u01a1ng \u0111\u00f2n v\u1ec1 v\u1ecb tr\u00ed gi\u1ea3i ph\u1eabu<\/p>\n

                                          – C\u1ed1 \u0111\u1ecbnh x\u01b0\u01a1ng \u0111\u00f2n b\u1eb1ng \u0111ai s\u1ed1 8<\/p>\n

                                          – Gi\u1ea3m \u0111au, kh\u00e1ng vi\u00eam nonsteroid<\/p>\n

                                          *\u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt:<\/em><\/strong><\/p>\n

                                          – Ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng \u0111\u00f2n (P): ch\u1ec9 \u0111\u1ecbnh l\u00e0 g\u00e3y c\u00f3 ch\u1ed3ng ng\u1eafn >2cm<\/p>\n

                                          – Kh\u00e1ng sinh d\u1ef1 ph\u00f2ng tr\u01b0\u1edbc m\u1ed5<\/p>\n

                                          – Ch\u0103m s\u00f3c v\u1ebft th\u01b0\u01a1ng sau m\u1ed5, c\u1eaft ch\u1ec9 sau 10-14 ng\u00e0y<\/p>\n

                                          – Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng sau m\u1ed5<\/p>\n

                                          2.\u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3:<\/strong><\/p>\n

                                          – Paracetamol 500mg<\/p>\n

                                          Ng\u00e0y u\u1ed1ng 3 l\u1ea7n, l\u1ea7n 01 vi\u00ean (8h – 14h – 20h)<\/p>\n

                                          – Meloxicam 7,5mg<\/p>\n

                                          U\u1ed1ng ng\u00e0y 2 l\u1ea7n , l\u1ea7n 1 vi\u00ean (8h – 20h)<\/p>\n

                                          – L\u00ean l\u1ecbch ch\u01b0\u01a1ng tr\u00ecnh: ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p x\u01b0\u01a1ng \u0111\u00f2n (P) b\u1eb1ng n\u1eb9p v\u00edt<\/p>\n

                                          – Cefazolin 1g 1 l\u1ecd<\/p>\n

                                          TMC ng\u00e0y 1 l\u1ea7n , l\u1ea7n 2 l\u1ecd, tr\u01b0\u1edbc r\u1ea1ch da 30 ph\u00fat<\/p>\n

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

                                          – G\u1ea7n: T\u1ed1t – b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ec7nh n\u1ec1n, g\u00e3y k\u00edn 1\/3 gi\u1eefa x\u01b0\u01a1ng \u0111\u00f2n, ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng \u2192 kh\u1ea3 n\u0103ng li\u1ec1n x\u01b0\u01a1ng t\u1ed1t<\/p>\n

                                          – Xa: Kh\u00e1, c\u00f3 th\u1ec3 b\u1ecb nh\u1eefng bi\u1ebfn ch\u1ee9ng ph\u1eabu thu\u1eadt (bi\u1ebfn ch\u1ee9ng v\u00f4 c\u1ea3m, t\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh v\u00e0 m\u1ea1ch m\u00e1u trong qu\u00e1 tr\u00ecnh k\u1ebft h\u1ee3p x\u01b0\u01a1ng, nhi\u1ec5m tr\u00f9ng v\u00e0 ch\u1ea3y m\u00e1u v\u1ebft m\u1ed5), ch\u1eadm li\u1ec1n x\u01b0\u01a1ng, can l\u1ec7ch.<\/p>\n

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

                                          – Ti\u1ebfp t\u1ee5c \u0111eo \u0111ai s\u1ed1 8 sau m\u1ed5.<\/p>\n

                                          – T\u1eadp v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng kh\u1edbp khu\u1ef7u v\u00e0 b\u00e0n tay ngay sau m\u1ed5.<\/p>\n

                                          – Sau m\u1ed5 10 ng\u00e0y t\u1eadp v\u1edbi con l\u1eafc Codman, sau m\u1ed5 2 tu\u1ea7n t\u1eadp v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng ho\u1eb7c ch\u1ee7 \u0111\u1ed9ng c\u00f3 tr\u1ee3 gi\u00fap bi\u00ean \u0111\u1ed9 kh\u00f4ng qu\u00e1 90 \u0111\u1ed9<\/p>\n

                                          – T\u00e1i kh\u00e1m sau 1,3,6,12 tu\u1ea7n. Ch\u1ee5p X quang ki\u1ec3m tra t\u1eeb tu\u1ea7n 4-6.<\/p>\n

                                          – T\u1eeb tu\u1ea7n th\u1ee9 6: b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111au, xquang can x\u01b0\u01a1ng t\u1ed1t th\u00ec t\u1eadp v\u1eadn \u0111\u1ed9ng th\u1ee5 \u0111\u1ed9ng ho\u1eb7c ch\u1ee7 \u0111\u1ed9ng c\u00f3 tr\u1ee3 gi\u00fap kh\u1edbp vai kh\u00f4ng gi\u1edbi h\u1ea1n bi\u00ean \u0111\u1ed9, t\u1eadp t\u0103ng d\u1ea7n s\u1ee9c m\u1ea1nh<\/p>\n

                                          – H\u1ea1n ch\u1ebf khu\u00e2n v\u00e1c v\u1eadt n\u1eb7ng b\u00ean vai ch\u1ea5n ch\u01b0\u01a1ng<\/p>\n

                                          REFERENCES<\/strong><\/p>\n

                                            \n
                                          1. PGS.TS.BS. V\u00f5 Th\u00e0nh To\u00e0n (2022). G\u00e3y x\u01b0\u01a1ng chi tr\u00ean. B\u00e0i gi\u1ea3ng Ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh t\u1eadp I <\/em>(\u1ea5n b\u1ea3n l\u1ea7n 2), tr.43\u201345. NXB \u0110\u1ea1i H\u1ecdc Qu\u1ed1c Gia th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh.<\/li>\n
                                          2. PGS.TS. \u0110o\u00e0n Qu\u1ed1c H\u01b0ng, GS.TS. Tr\u1ea7n Trung D\u0169ng (2021). \u0110i\u1ec1u tr\u1ecb g\u00e3y x\u01b0\u01a1ng \u0111\u00f2n. B\u1ec7nh h\u1ecdc ngo\u1ea1i khoa Ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh<\/em>, tr.260-270. NXB Y h\u1ecdc.<\/li>\n
                                          3. TS.BSCKII. Phan Quang Tr\u00ed (2018). Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh vi\u1ec7n Ch\u1ea5n th\u01b0\u01a1ng ch\u1ec9nh h\u00ecnh 2018, ph\u1ea7n 1, <\/em>tr.193-197. NXB Gi\u00e1o d\u1ee5c Vi\u1ec7t Nam.<\/li>\n
                                          4. PGS.TS.BS. L\u00ea \u0110\u00ecnh Thanh, PGS.TS.DS. B\u00f9i Th\u1ecb H\u01b0\u01a1ng Qu\u1ef3nh (2022). H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng kh\u00e1ng sinh<\/em>, tr.142-143. NXB Y h\u1ecdc.<\/li>\n<\/ol>","protected":false},"featured_media":4256,"comment_status":"open","ping_status":"closed","template":"","tags":[],"chuyen-muc":[188],"class_list":["post-4408","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\/4408","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=4408"}],"version-history":[{"count":1,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4408\/revisions"}],"predecessor-version":[{"id":4412,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/4408\/revisions\/4412"}],"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=4408"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4408"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=4408"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}