{"id":2187,"date":"2023-08-04T19:00:13","date_gmt":"2023-08-04T12:00:13","guid":{"rendered":"https:\/\/bsvothanhtoan.com\/?post_type=chuyen-de&#038;p=2187"},"modified":"2024-03-20T16:10:03","modified_gmt":"2024-03-20T09:10:03","slug":"benh-an-gay-xuong-ho-2","status":"publish","type":"chuyen-de","link":"https:\/\/bsvothanhtoan.com\/en\/chuyen-de\/benh-an-gay-xuong-ho-2\/","title":{"rendered":"B\u1ec7nh \u00e1n g\u00e3y x\u01b0\u01a1ng h\u1edf 2"},"content":{"rendered":"<h2><span style=\"font-size: 16px;\">V\u1ebft th\u01b0\u01a1ng kh\u00e2u k\u00edn nhi\u1ec5m tr\u00f9ng v\u1ecb tr\u00ed \u2153 d\u01b0\u1edbi c\u1eb3ng ch\u00e2n sau tai n\u1ea1n giao th\u00f4ng ng\u00e0y 3 ch\u01b0a bi\u1ebfn ch\u1ee9ng\/ THA \u0111\u1ed9 I theo ESC 2018, R\u1ed1i lo\u1ea1n lipid m\u00e1u, Thi\u1ebfu m\u00e1u c\u01a1 tim.<\/span><br \/>\n<span style=\"font-size: 16px;\">Differential diagnosis:<\/span><br \/>\n<span style=\"font-size: 16px;\">G\u00e3y x\u01b0\u01a1ng h\u1edf c\u1eb3ng ch\u00e2n tr\u00e1i (T) \u0111\u1ed9 IIIA &#8211; Nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng \u0111\u00e3 \u0111\u01b0\u1ee3c kh\u00e2u kin sau tai n\u1ea1n giao th\u00f4ng ng\u00e0y 3 TD bi\u1ebfn ch\u1ee9ng vi\u00eam x\u01b0\u01a1ng\/ THA \u0111\u1ed9 I theo ESC 2018, R\u1ed1i lo\u1ea1n lipid m\u00e1u, Thi\u1ebfu m\u00e1u c\u01a1 tim<\/span><\/h2>\n<h2><strong>I. H\u00e0nh ch\u00ednh:<\/strong><\/h2>\n<ol>\n<li>T\u00ean b\u1ec7nh nh\u00e2n: NG\u00d4 V\u0102N T.<\/li>\n<li>Sinh n\u0103m: 1952 (71 tu\u1ed5i)<\/li>\n<li>Ngh\u1ec1 nghi\u1ec7p: H\u01b0u tr\u00ed<\/li>\n<li>Gi\u1edbi t\u00ednh: Nam<\/li>\n<li>\u0110\u1ecba ch\u1ec9: TPHCM<\/li>\n<li>Nh\u1eadp vi\u1ec7n v\u00e0o: Khoa c\u1ea5p c\u1ee9u 18h50 ng\u00e0y 12\/05\/2023<\/li>\n<li>Chi thu\u1eadn: Ch\u00e2n (P), Tay (P)<\/li>\n<li>\u00a0Ng\u00e0y, gi\u1edd nh\u1eadp khoa Ngo\u1ea1i CTCH: 20h, ng\u00e0y 12\/05\/2023<\/li>\n<li>Ng\u00e0y l\u00e0m b\u1ec7nh \u00e1n: 20h, ng\u00e0y 12\/05\/2023 \u2013 ng\u00e0y th\u1ee9 3 c\u1ee7a b\u1ec7nh<\/li>\n<\/ol>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\"wp-image-2114 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/luu-y.png\" alt=\"Luu-y\" width=\"820\" height=\"462\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/luu-y.png 820w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/luu-y-300x169.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/luu-y-768x433.png 768w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/luu-y-18x10.png 18w\" sizes=\"(max-width: 820px) 100vw, 820px\" \/><\/p>\n<p>Tr\u01b0\u1edbc khi xem h\u00e3y \u0111\u1ecdc c\u00e1c b\u00e0i gi\u1ea3ng sau:<\/p>\n<p><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ho\/\">B\u00e0i gi\u1ea3ng G\u00e3y x\u01b0\u01a1ng h\u1edf<\/a><\/p>\n<p><a href=\"https:\/\/bsvothanhtoan.com\/en\/chuyen-de\/slide-bai-giang-gay-xuong-ho\/\">Lecture slides Open fractures<\/a><\/p>\n<h2><strong>II. L\u00fd do v\u00e0o vi\u1ec7n:<\/strong><\/h2>\n<p>\u0110au c\u1eb3ng ch\u00e2n tr\u00e1i (T)<\/p>\n<h2><strong>III. B\u1ec7nh s\u1eed: <\/strong><\/h2>\n<pre><a href=\"https:\/\/vi.wikipedia.org\/wiki\/B%E1%BB%87nh_nh%C3%A2n\" target=\"_blank\" rel=\"noopener\">BN<\/a> khai:<\/pre>\n<p><strong>Tr\u01b0\u1edbc ph\u1eabu thu\u1eadt:<\/strong><\/p>\n<ul>\n<li>C\u00e1ch nh\u1eadp vi\u1ec7n 3 ng\u00e0y (15h ng\u00e0y 9\/5\/2023), b\u1ec7nh nh\u00e2n (BN) \u0111ang di chuy\u1ec3n b\u1eb1ng xe m\u00e1y, b\u1ecb m\u1ed9t xe m\u00e1y kh\u00e1c \u0111ang di chuy\u1ec3n theo h\u01b0\u1edbng vu\u00f4ng g\u00f3c va ch\u1ea1m tr\u1ef1c ti\u1ebfp v\u00e0o ch\u00e2n (T), sau va ch\u1ea1m BN ng\u00e3 c\u1ea3 ng\u01b0\u1eddi v\u1ec1 ph\u00eda b\u00ean tr\u00e1i, BN ch\u1ea1m \u0111\u1ea5t b\u1eb1ng m\u00f4ng (T) v\u00e0 ch\u00e2n (T) trong t\u01b0 th\u1ebf ng\u1ed3i, kh\u00f4ng k\u1ecbp ch\u1ed1ng tay, xe kh\u00f4ng \u0111\u00e8 l\u00ean ng\u01b0\u1eddi. BN kh\u00f4ng \u0111\u1eadp \u0111\u1ea7u v\u00e0 t\u1ec9nh trong l\u00fac ch\u1ea5n th\u01b0\u01a1ng. Sau ng\u00e3 BN c\u1ea3m th\u1ea5y \u0111au ch\u00f3i v\u00f9ng c\u1eb3ng ch\u00e2n (T) \u0111\u1ed3ng th\u1eddi kh\u00f4ng ch\u1ecbu l\u1ef1c v\u00e0 c\u00f3 v\u1ebft th\u01b0\u01a1ng h\u1edf \u1edf 1\/3 d\u01b0\u1edbi ngo\u00e0i c\u1eb3ng ch\u00e2n (T), v\u1ebft th\u01b0\u01a1ng h\u1edf k\u00edch th\u01b0\u1edbc 7x4cm, ch\u1ea3y nhi\u1ec1u m\u00e1u d\u1ea1ng tr\u00e0n ra b\u1ec1 m\u1eb7t da. T\u1ea1i hi\u1ec7n tr\u01b0\u1eddng, BN \u0111\u01b0\u1ee3c b\u0103ng qu\u1ea5n v\u1ebft th\u01b0\u01a1ng b\u1eb1ng v\u1ea3i, kh\u00f4ng \u0111\u01b0\u1ee3c n\u1eb9p c\u1ed1 \u0111\u1ecbnh v\u00e0 \u0111\u01b0a v\u00e0o BV V\u0169ng T\u00e0u. Tr\u01b0\u1edbc khi t\u00e9, BN v\u1eeba \u0103n tr\u01b0a c\u00e1ch \u0111\u00f3 1h, v\u00e0 kh\u00f4ng ghi nh\u1eadn s\u1eed d\u1ee5ng ch\u1ea5t k\u00edch th\u00edch.<\/li>\n<li>Trong qu\u00e1 tr\u00ecnh b\u1ec7nh, BN kh\u00f4ng nh\u1ee9c \u0111\u1ea7u, kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng ho, kh\u00f4ng s\u1ed1t, kh\u00f4ng co gi\u1eadt, kh\u00f4ng \u0111au ng\u1ef1c, kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng ph\u00f9.<\/li>\n<\/ul>\n<p><strong>Qu\u00e1 tr\u00ecnh ph\u1eabu thu\u1eadt<\/strong>:<\/p>\n<p>T\u1ea1i BV V\u0169ng T\u00e0u, BN \u0111\u01b0\u1ee3c ch\u1ee5p film XQ v\u00e0 ch\u1ea9n \u0111o\u00e1n: <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ho\/\">Open fracture<\/a> 1\/3 d\u01b0\u1edbi x\u01b0\u01a1ng m\u00e1c (T). \u0110\u01b0\u1ee3c x\u1eed tr\u00ed:<\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul style=\"list-style-type: circle;\">\n<li>C\u1eaft l\u1ecdc, kh\u00e2u v\u1ebft th\u01b0\u01a1ng v\u00e0 n\u1eb9p b\u1ed9t,<\/li>\n<li>\u0110i\u1ec1u tr\u1ecb thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 kh\u00e1ng sinh (kh\u00f4ng r\u00f5 lo\u1ea1i). BN kh\u00f4ng mang theo film XQ v\u00e0 HSBA.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Sau ph\u1eabu thu\u1eadt:<\/strong><\/p>\n<ul>\n<li>1h sau ph\u1eabu thu\u1eadt, BN \u0111\u1ee1 \u0111au ch\u1ed7 x\u01b0\u01a1ng g\u00e3y, ch\u00e2n (T) \u0111\u01b0\u1ee3c n\u1eb9p b\u1ed9t t\u1eeb \u0111\u1ea7u g\u1ed1i \u0111\u1ebfn h\u1ebft b\u00e0n ch\u00e2n (T), sinh hi\u1ec7u \u1ed5n. \u0110\u01b0\u1ee3c truy\u1ec1n gi\u1ea3m \u0111au v\u00e0 kh\u00e1ng sinh, Ch\u0103m s\u00f3c c\u1ea5p 2.<\/li>\n<li>12h sau ph\u1eabu thu\u1eadt, BN b\u1eaft \u0111\u1ea7u c\u1ea3m th\u1ea5y n\u00f3ng r\u00e1t v\u00f9ng mu ch\u00e2n v\u00e0 c\u1ed5 ch\u00e2n b\u00ean (T), \u0111au t\u0103ng \u1edf 1\/3 d\u01b0\u1edbi c\u1eb3ng ch\u00e2n (T), sinh hi\u1ec7u \u1ed5n, v\u1ebft m\u1ed5<\/li>\n<li>1 ng\u00e0y sau ph\u1eabu thu\u1eadt,<\/li>\n<li>2 ng\u00e0y sau ph\u1eabu thu\u1eadt,<\/li>\n<li>3 ng\u00e0y sau ph\u1eabu thu\u1eadt, BN c\u1ea3m th\u1ea5y \u0111au t\u0103ng nhi\u1ec1u h\u01a1n k\u00e8m theo s\u01b0ng n\u00f3ng \u0111\u1ecf \u1edf v\u1ebft th\u01b0\u01a1ng \u0111\u1ed3ng th\u1eddi k\u00e8m t\u00ecnh tr\u1ea1ng s\u1ed1t nh\u1eb9. B\u1ec7nh nh\u00e2n (BN) lo l\u1eafng n\u00ean xin chuy\u1ec3n l\u00ean BVTN.<\/li>\n<\/ul>\n<p><strong>X\u1eed tr\u00ed t\u1ea1i ph\u00f2ng c\u1ea5p c\u1ee9u<\/strong><strong> BV Th\u1ed1ng Nh\u1ea5t:<\/strong><\/p>\n<ul>\n<li>BN t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t, GCS 15\u0111, da ni\u00eam m\u1ea1c h\u1ed3ng, th\u1edf kh\u00f4ng co k\u00e9o.<\/li>\n<li>Sinh hi\u1ec7u: M\u1ea1ch: 78 l\u1ea7n\/ph\u00fat<\/li>\n<\/ul>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nhi\u1ec7t \u0111\u1ed9: 38.5 \u0111\u1ed9 C<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 HA: 150\/70 mmHg<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nh\u1ecbp th\u1edf: 18 l\u1ea7n\/ph\u00fat<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SpO2: 99% kh\u00ed tr\u1eddi<\/p>\n<ul>\n<li>Tim \u0111\u1ec1u, ph\u1ed5i kh\u00f4ng ran, b\u1ee5ng m\u1ec1m, c\u1ed5 m\u1ec1m, s\u1ee9c c\u01a1 hai tay v\u00e0 ch\u00e2n ph\u1ea3i (P) 5\/5. S\u01b0ng n\u00f3ng \u0111\u1ecf \u0111au v\u1ebft th\u01b0\u01a1ng c\u1eb3ng ch\u00e2n (T)<\/li>\n<li>\u0110\u1ec1 ngh\u1ecb CLS: C\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, \u0111\u01b0\u1eddng huy\u1ebft mao m\u1ea1ch t\u1ea1i gi\u01b0\u1eddng, XQ c\u1eb3ng ch\u00e2n (T) b\u00ecnh di\u1ec7n th\u1eb3ng v\u00e0 nghi\u00eang. Ch\u1ee5p XQ x\u01b0\u01a1ng b\u00e0n, ng\u00f3n ch\u00e2n th\u1eb3ng nghi\u00eang ho\u1eb7c ch\u1ebfch.<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n t\u1ea1i CC: Ch\u1ea5n th\u01b0\u01a1ng c\u1eb3ng b\u00e0n ch\u00e2n (T) do TNGT ng\u00e0y 3<\/li>\n<li>X\u1eed tr\u00ed: \u0110eo n\u1eb9p \u0111\u00f9i ch\u1ed1ng xoay (T) v\u00e0 b\u0103ng v\u1ebft th\u01b0\u01a1ng b\u1eb1ng g\u1ea1c v\u00f4 khu\u1ea9n, ch\u0103m s\u00f3c c\u1ea5p 2<\/li>\n<\/ul>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nh\u1eadp v\u00e0o <a href=\"https:\/\/bsvothanhtoan.com\/en\/\">khoa Ngo\u1ea1i<\/a> CTCH l\u00fac 20h c\u00f9ng ng\u00e0y.<\/p>\n<h2><strong>IV. Ti\u1ec1n c\u0103n:<\/strong><\/h2>\n<h3>1. B\u1ea3n th\u00e2n:<\/h3>\n<p><strong>N\u1ed9i khoa: <\/strong>N\u0103m 2016 (c\u00e1ch \u0111\u00e2y 7 n\u0103m):<\/p>\n<ul>\n<li>\u0110\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n THA t\u1ea1i BV Th\u1ed1ng Nh\u1ea5t, BN \u0111i\u1ec1u tr\u1ecb Losartan 50mg\/1 vi\u00ean\/ng\u00e0y, Bisoprolol 2.5mg\/vi\u00ean\/ng\u00e0y. HA cao nh\u1ea5t 150\/80 mmHg, th\u01b0\u1eddng xuy\u00ean \u0111o HA t\u1ea1i nh\u00e0, HA th\u00edch nghi: 130\/80 mmHg. Ch\u01b0a ghi nh\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a THA.<\/li>\n<li>\u0110\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n r\u1ed1i lo\u1ea1i lipid m\u00e1u t\u1ea1i BV Th\u1ed1ng Nh\u1ea5t, \u0111i\u1ec1u tr\u1ecb Atorvastatin 40mg\/vi\u00ean\/ng\u00e0y.<\/li>\n<li>\u0110\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n thi\u1ebfu m\u00e1u c\u01a1 tim t\u1ea1i BV Th\u1ed1ng Nh\u1ea5t, \u0111i\u1ec1u tr\u1ecb Clopidogrel 75mg\/vi\u00ean\/ng\u00e0y.\n<ul>\n<li>Kh\u00f4ng ghi nh\u1eadn ti\u1ec1n c\u0103n ng\u1ea5t, b\u1ec7nh l\u00fd u b\u01b0\u1edbu, b\u1ec7nh l\u00fd <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/benh-ly-ban-chan-dai-thao-duong\/\">\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a>, lo\u00e3ng x\u01b0\u01a1ng.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Ngo\u1ea1i khoa:<\/strong><\/p>\n<ul>\n<li>Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/li>\n<\/ul>\n<p><strong>Allergy<\/strong>: Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng<\/p>\n<p><strong>Habit<\/strong>: Kh\u00f4ng thu\u1ed1c l\u00e1, r\u01b0\u1ee3u bia.<\/p>\n<h3>2. Gia \u0111\u00ecnh:\u00a0<\/h3>\n<pre>Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng.<\/pre>\n<h2><strong>V. Kh\u00e1m <\/strong>(20h ng\u00e0y 12\/05\/2023 \u2013 ng\u00e0y th\u1ee9 3 c\u1ee7a b\u1ec7nh)<strong>:<\/strong><\/h2>\n<h3><strong>1. T\u1ed5ng tr\u1ea1ng:<\/strong><\/h3>\n<ul>\n<li>BN t\u1ec9nh, ti\u1ebfp x\u00fac t\u1ed1t, da, ni\u00eam m\u1ea1c h\u1ed3ng, c\u1ee7ng m\u1ea1c m\u1eaft kh\u00f4ng v\u00e0ng v\u00e0 kh\u00f4ng d\u1ea5u xu\u1ea5t huy\u1ebft, Glasgow 15 (m\u1edf m\u1eaft: 4, tr\u1ea3 l\u1eddi: 5, v\u1eadn \u0111\u1ed9ng: 6)<\/li>\n<li>D\u1ea5u m\u1ea5t n\u01b0\u1edbc (-), l\u01b0\u1ee1i kh\u00f4ng d\u01a1.<\/li>\n<li>Chi \u1ea5m, l\u00f2ng b\u00e0n tay h\u1ed3ng, m\u00f3ng tay kh\u00f4ng m\u1ea5t b\u00f3ng<\/li>\n<li>Tuy\u1ebfn gi\u00e1p kh\u00f4ng to<\/li>\n<li>H\u1ea1ch ngo\u1ea1i vi kh\u00f4ng s\u1edd ch\u1ea1m.<\/li>\n<li>(CRT) &lt; 2 gi\u00e2y<\/li>\n<li>Sinh<strong> hi\u1ec7u<\/strong><\/li>\n<\/ul>\n<p>M\u1ea1ch: 98 l\u1ea7n\/ph\u00fat\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 HA: 140\/90 mmHg<\/p>\n<p>Nh\u1ecbp th\u1edf: 20 l\u1ea7n\/ph\u00fat\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nhi\u1ec7t \u0111\u1ed9: 38.5 \u00b0C<\/p>\n<p>SpO2: 98% th\u1edf kh\u00ed tr\u1eddi<\/p>\n<p>HA t\u00e2m thu =140 mmHg &gt;100 mmHg, m\u1ea1ch: 98 l\u1ea7n\/ph\u00fat \ud83e\udc6a Ch\u1ec9 s\u1ed1 s\u1ed1c\u00a0 = 0.7 &lt;1<\/p>\n<p>C\u00e2n n\u1eb7ng: #60kg, chi\u1ec1u cao: 1m65. BMI: 22.0 kg\/m2 \ud83e\udc6a Th\u1ec3 tr\u1ea1ng trung b\u00ecnh theo IDI &amp; WPRO<\/p>\n<p>CRT (d\u1ea5u hi\u1ec7u b\u1ea5m m\u00f3ng tay) =1s &lt;2s<\/p>\n<h3><strong>2. H\u1ec7 tim m\u1ea1ch:<\/strong><\/h3>\n<ul>\n<li>M\u1ecfm tim n\u1eb1m \u1edf \u0111\u01b0\u1eddng trung \u0111\u00f2n tr\u00e1i, kho\u1ea3ng li\u00ean s\u01b0\u1eddn V.<\/li>\n<li>L\u1ed3ng ng\u1ef1c kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169, kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf \u0111\u1ec1u 2 b\u00ean.<\/li>\n<li>Ti\u1ebfng tim: T1, T2 \u0111\u1ec1u r\u00f5, kh\u00f4ng nghe \u00e2m th\u1ed5i b\u1ec7nh l\u00fd<\/li>\n<\/ul>\n<h3><strong>3. H\u1ec7 h\u00f4 h\u1ea5p:<\/strong><\/h3>\n<ul>\n<li>R\u00ec r\u00e0o ph\u1ebf nang \u00eam d\u1ecbu, kh\u00f4ng ti\u1ebfng rale, kho\u1ea3ng gian s\u01b0\u1eddn #1cm<\/li>\n<li>G\u00f5 trong<\/li>\n<li>Rung thanh \u0111\u1ec1u 2 ph\u1ebf tr\u01b0\u1eddng<\/li>\n<\/ul>\n<h3><strong>4. H\u1ec7 ti\u00eau h\u00f3a:<\/strong><\/h3>\n<ul>\n<li>Th\u00e0nh b\u1ee5ng kh\u00f4ng s\u1eb9o m\u1ed5 c\u0169, kh\u00f4ng tu\u1ea7n ho\u00e0n b\u00e0ng h\u1ec7, kh\u00f4ng d\u1ea5u sao m\u1ea1ch, di \u0111\u1ed9ng theo nh\u1ecbp th\u1edf.<\/li>\n<li>Nhu \u0111\u1ed9ng ru\u1ed9t: 5 l\u1ea7n\/ph\u00fat<\/li>\n<li>G\u00f5 trong<\/li>\n<li>S\u1edd b\u1ee5ng m\u1ec1m, kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa, kh\u00f4ng s\u1edd th\u1ea5y kh\u1ed1i u b\u1ea5t th\u01b0\u1eddng<\/li>\n<li>Gan l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m.<\/li>\n<\/ul>\n<h3><strong>5. H\u1ec7 th\u1eadn &#8211; ti\u1ebft ni\u1ec7u &#8211; sinh d\u1ee5c:<\/strong><\/h3>\n<ul>\n<li>C\u1ea7u b\u00e0ng quang (-)<\/li>\n<li>Ch\u1ea1m th\u1eadn (-)<\/li>\n<li>Rung th\u1eadn (-)<\/li>\n<\/ul>\n<h3><strong>6. H\u1ec7 th\u1ea7n kinh:<\/strong><\/h3>\n<ul>\n<li>C\u1ed5 m\u1ec1m<\/li>\n<li>Babinski (-)<\/li>\n<li>Nystagmus (-)<\/li>\n<\/ul>\n<h3><strong>7. C\u01a1 x\u01b0\u01a1ng kh\u1edbp:<\/strong><\/h3>\n<p>&#8211; BN n\u1eb1m tr\u00ean gi\u01b0\u1eddng \u0111ang n\u1eb9p \u0111\u00f9i c\u1eb3ng ch\u00e2n ch\u1ed1ng xoay ch\u00e2n (T), th\u00e1o n\u1eb9p v\u00e0 \u0111\u00e1nh gi\u00e1:<\/p>\n<p><strong><u>Kh\u00e1m chi d\u01b0\u1edbi:<\/u><\/strong><\/p>\n<p>NH\u00ccN<\/p>\n<ul>\n<li>V\u1ebft th\u01b0\u01a1ng: k\u00edch th\u01b0\u1edbc d#7x4cm, v\u00f9ng \u2153 d\u01b0\u1edbi ch\u00e2n tr\u00e1i, \u0111\u00e3 \u0111\u01b0\u1ee3c kh\u00e2u k\u00edn. M\u00e9p v\u1ebft th\u01b0\u01a1ng c\u00f2n nhi\u1ec1u gi\u1ea3 m\u1ea1c, d\u1ecbch v\u00e0ng th\u1ea5m b\u0103ng, s\u01b0ng \u0111\u1ecf b\u1ea7m t\u00edm xung quanh.<\/li>\n<li>Kh\u00f4ng quan s\u00e1t th\u1ea5y c\u00e1c bi\u1ebfn d\u1ea1ng nh\u01b0: xoay trong, xoay ngo\u00e0i, ng\u1eafn chi, g\u1eadp g\u00f3c.<\/li>\n<li>Kh\u00f4ng quan s\u00e1t th\u1ea5y: \u0111\u1ed1m xu\u1ea5t huy\u1ebft, b\u00f3ng n\u01b0\u1edbc da.<\/li>\n<\/ul>\n<p>S\u1edc<\/p>\n<ul>\n<li>\u1ea4n \u0111au ch\u00f3i \u1edf v\u00f9ng c\u1eb3ng ch\u00e2n tr\u00e1i.<\/li>\n<li>Chi b\u00ean tr\u00e1i n\u00f3ng h\u01a1n so v\u1edbi chi b\u00ean ph\u1ea3i.<\/li>\n<li>Kh\u00f4ng m\u1ea5t tr\u1ee5c c\u1eb3ng ch\u00e2n tr\u00e1i.<\/li>\n<li>BN v\u1eabn c\u00f2n c\u1ea3m gi\u00e1c n\u00f4ng (\u0111au, nhi\u1ec7t) \u1edf mu ch\u00e2n, l\u00f2ng b\u00e0n ch\u00e2n, m\u1eb7t tr\u01b0\u1edbc v\u00e0 sau c\u1eb3ng ch\u00e2n hai b\u00ean, m\u1eb7t trong v\u00e0 m\u1eb7t tr\u01b0\u1edbc \u0111\u00f9i hai b\u00ean, v\u1eabn c\u00f2n c\u1ea3m gi\u00e1c s\u00e2u \u1edf b\u00e0n ch\u00e2n hai b\u00ean.<\/li>\n<li>Kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c d\u1ea5u l\u1ea1o x\u1ea1o x\u01b0\u01a1ng, v\u1eadn \u0111\u1ed9ng b\u1ea5t th\u01b0\u1eddng do BN \u0111au nhi\u1ec1u<\/li>\n<li>B\u1eaft \u0111\u01b0\u1ee3c \u0110M mu ch\u00e2n v\u00e0 \u0110M ch\u00e0y sau.<\/li>\n<\/ul>\n<p>\u0110O<\/p>\n<ul>\n<li>X\u01b0\u01a1ng m\u00e1c:<\/li>\n<li>Chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i (\u0111o t\u1eeb ch\u1ecfm x\u01b0\u01a1ng m\u00e1c \u0111\u1ebfn m\u1eaft c\u00e1 ngo\u00e0i):<\/li>\n<\/ul>\n<p>(T): 38cm &#8211; (P): 38cm<\/p>\n<ul>\n<li>Chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i (\u0111o t\u1eeb l\u1ed3i c\u1ea7u ngo\u00e0i x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ebfn m\u1eaft c\u00e1 ngo\u00e0i):<\/li>\n<\/ul>\n<p>(T): 42cm- (P): 42cm<\/p>\n<ul>\n<li>X\u01b0\u01a1ng ch\u00e0y:<\/li>\n<li>Chi\u1ec1u d\u00e0i tuy\u1ec7t \u0111\u1ed1i (\u0111o t\u1eeb l\u1ed3i c\u1ea7u trong x\u01b0\u01a1ng ch\u00e0y \u0111\u1ebfn m\u1eaft c\u00e1 trong):<\/li>\n<\/ul>\n<p>(T): &#8211; (P):<\/p>\n<ul>\n<li>Chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i (\u0111o t\u1eeb l\u1ed3i c\u1ea7u trong x\u01b0\u01a1ng \u0111\u00f9i \u0111\u1ebfn m\u1eaft c\u00e1 trong):<\/li>\n<\/ul>\n<p>(T): &#8211; (P):<\/p>\n<p>\u2192 So s\u00e1nh chi\u1ec1u d\u00e0i (T) v\u00e0 (P) \u21d2 X\u01b0\u01a1ng 2 b\u00ean b\u1eb1ng nhau<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Chu vi v\u00f2ng chi: \u0111o \u1edf v\u1ebft th\u01b0\u01a1ng v\u1ecb tr\u00ed: \u2153 d\u01b0\u1edbi c\u1eb3ng ch\u00e2n<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u1eb3ng ch\u00e2n (P): 21cm<\/p>\n<p>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u1eb3ng ch\u00e2n (T): 23cm<\/p>\n<p>KH\u00c1M V\u1eacN \u0110\u1ed8NG<\/p>\n<ul>\n<li>GHV\u0110 g\u1eadp du\u1ed7i b\u00e0n v\u00e0 ng\u00f3n ch\u00e2n (T). C\u00e1c \u0111\u1ed9ng t\u00e1c c\u00f2n l\u1ea1i c\u1ee7a <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/trat-khop-vai-khuyu-hang\/\">hip joint<\/a> &amp; <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/khai-thac-benh-su-va-tien-can-benh-ly-ngoai-chan-thuong\/\">knee joint<\/a> (g\u1eadp, du\u1ed7i, xoay trong, xoay ngo\u00e0i) kh\u00f4ng kh\u00e1m \u0111\u01b0\u1ee3c do BN \u0111au nhi\u1ec1u.<\/li>\n<\/ul>\n<h3><strong>8. C\u00e1c c\u01a1 quan kh\u00e1c:<\/strong><\/h3>\n<p>Ch\u01b0a ghi nh\u1eadn b\u1ea5t th\u01b0\u1eddng.<\/p>\n<h2><strong>VI. T\u00f3m t\u1eaft b\u1ec7nh \u00e1n:<\/strong><\/h2>\n<p>BN nam, 71 tu\u1ed5i, nh\u1eadp vi\u1ec7n v\u00ec \u0111au c\u1eb3ng ch\u00e2n (T) sau tai n\u1ea1n giao th\u00f4ng ng\u00e0y th\u1ee9 3.<\/p>\n<p><strong>Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng:<\/strong><\/p>\n<ul>\n<li>\u0110au c\u1eb3ng ch\u00e2n (T)<\/li>\n<li>H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng ch\u00e2n tr\u00e1i (T)<\/li>\n<li>V\u1ebft th\u01b0\u01a1ng kh\u00e2u k\u00edn \u2153 d\u01b0\u1edbi ngo\u00e0i c\u1eb3ng ch\u00e2n tr\u00e1i<\/li>\n<li>BN t\u1ec9nh, kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng co gi\u1eadt, kh\u00f4ng \u0111au ng\u1ef1c, kh\u00f4ng kh\u00f3 th\u1edf, ti\u1ec3u \u0111\u01b0\u1ee3c.<\/li>\n<\/ul>\n<p><strong>Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3:<\/strong><\/p>\n<ul>\n<li>Sinh hi\u1ec7u: Nhi\u1ec7t \u0111\u1ed9: 38.5 \u0111\u1ed9 C, c\u00e1c ch\u1ec9 s\u1ed1 c\u00f2n l\u1ea1i b\u00ecnh th\u01b0\u1eddng.<\/li>\n<li>Chu vi v\u00f2ng chi (T) &gt; (P): 3cm<\/li>\n<li>\u1ea4n \u0111au ch\u00f3i c\u1eb3ng ch\u00e2n (T),<\/li>\n<li>VT kh\u00e2u k\u00edn d#7x4cm, d\u1ecbch v\u00e0ng th\u1ea5m b\u0103ng, c\u00f3 gi\u1ea3 m\u1ea1c, s\u01b0\u01a1ng n\u00f3ng b\u1ea7m t\u00edm xung quanh<\/li>\n<li>Gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng c\u1eb3ng ch\u00e2n (T)<\/li>\n<li>\u0110\u1ed1m xu\u1ea5t huy\u1ebft, b\u00f3ng n\u01b0\u1edbc da (-)<\/li>\n<li>B\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch mu ch\u00e2n v\u00e0 m\u1ea1ch ch\u00e0y sau, c\u00f2n c\u1ea3m gi\u00e1c n\u00f4ng s\u00e2u v\u00f9ng l\u00f2ng b\u00e0n ch\u00e2n, mu ch\u00e2n, tr\u01b0\u1edbc v\u00e0 sau c\u1eb3ng ch\u00e2n.<\/li>\n<\/ul>\n<p><strong>Ti\u1ec1n c\u0103n:<\/strong><\/p>\n<ul>\n<li>THA \u0111\u1ed9 I theo ESC 2018.<\/li>\n<li>R\u1ed1i lo\u1ea1i lipid m\u00e1u<\/li>\n<li>Thi\u1ebfu m\u00e1u c\u01a1 tim<\/li>\n<\/ul>\n<p>Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, ch\u01b0a ghi nh\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng li\u00ean quan.<\/p>\n<h2><strong>VII. \u0110\u1eb7t v\u1ea5n \u0111\u1ec1:<\/strong><\/h2>\n<ul>\n<li>V\u1ebft th\u01b0\u01a1ng nhi\u1ec5m tr\u00f9ng.<\/li>\n<li>Gi\u1edbi h\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng c\u1eb3ng ch\u00e2n (T).<\/li>\n<li>THA \u0111\u1ed9 I theo ESC 2018, R\u1ed1i lo\u1ea1n lipid m\u00e1u, Thi\u1ebfu m\u00e1u c\u01a1 tim.<\/li>\n<\/ul>\n<h2><strong>VIII. Ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9:<\/strong><\/h2>\n<p><span style=\"font-size: 16px;\">V\u1ebft th\u01b0\u01a1ng kh\u00e2u k\u00edn nhi\u1ec5m tr\u00f9ng v\u1ecb tr\u00ed \u2153 d\u01b0\u1edbi c\u1eb3ng ch\u00e2n sau tai n\u1ea1n giao th\u00f4ng ng\u00e0y 3 ch\u01b0a bi\u1ebfn ch\u1ee9ng\/ THA \u0111\u1ed9 I theo ESC 2018, R\u1ed1i lo\u1ea1n lipid m\u00e1u, Thi\u1ebfu m\u00e1u c\u01a1 tim.<\/span><\/p>\n<p><span style=\"font-size: 16px;\"><strong>\u00a0Differential diagnosis:<\/strong><\/span><\/p>\n<ul>\n<li>\n<p><span style=\"font-size: 16px;\">G\u00e3y h\u1edf x\u01b0\u01a1ng c\u1eb3ng ch\u00e2n tr\u00e1i (T) \u0111\u1ed9 IIIA &#8211; Nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng \u0111\u00e3 \u0111\u01b0\u1ee3c kh\u00e2u kin sau tai n\u1ea1n giao th\u00f4ng ng\u00e0y 3 TD bi\u1ebfn ch\u1ee9ng <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/viem-xuong-tuy\/\">inflammation of the bone<\/a>\/ THA \u0111\u1ed9 I theo ESC 2018, R\u1ed1i lo\u1ea1n lipid m\u00e1u, Thi\u1ebfu m\u00e1u c\u01a1 tim<\/span><\/p>\n<\/li>\n<\/ul>\n<h2><strong>IX.Bi\u1ec7n lu\u1eadn:<\/strong><\/h2>\n<p><strong><u>Bi\u1ec7n lu\u1eadn <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-kin\/\">fracture<\/a>:<\/u><\/strong><\/p>\n<ul>\n<li>BN kh\u00f4ng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn c\u1ee7a g\u00e3y x\u01b0\u01a1ng, tuy nhi\u00ean:<\/li>\n<li>BN c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u g\u00e3y x\u01b0\u01a1ng kh\u00f4ng ch\u1eafc ch\u1eafn \u1edf x\u01b0\u01a1ng c\u1eb3ng ch\u00e2n tr\u00e1i nh\u01b0: \u0111au \u1edf \u1edf c\u1eb3ng ch\u00e2n, s\u01b0ng n\u1ec1 v\u00e0 m\u1ea5t v\u1eadn \u0111\u1ed9ng ch\u00e2n tr\u00e1i; v\u00f2ng chi (T) &gt; (P): 3cm<\/li>\n<li>V\u1ec1 y\u1ebfu t\u1ed1 nguy c\u01a1, \u0111\u00e2y l\u00e0 BN nam, l\u1edbn tu\u1ed5i.<\/li>\n<li>BN c\u00f3 c\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng tr\u1ef1c ti\u1ebfp n\u0103ng l\u01b0\u1ee3ng cao &#8211; t\u00e9 ng\u00e3 trong tai n\u1ea1n giao th\u00f4ng.<\/li>\n<\/ul>\n<p>\u21d2 Nghi ng\u1edd BN c\u00f3 g\u00e3y x\u01b0\u01a1ng c\u1eb3ng ch\u00e2n (T) \u21d2 \u0110\u1ec1 ngh\u1ecb CLS: XQ c\u1eb3ng ch\u00e2n (T) b\u00ecnh di\u1ec7n th\u1eb3ng v\u00e0 nghi\u00eang. Ch\u1ee5p XQ x\u01b0\u01a1ng b\u00e0n, ng\u00f3n ch\u00e2n th\u1eb3ng nghi\u00eang ho\u1eb7c ch\u1ebfch.<\/p>\n<ul>\n<li>Ngo\u00e0i ra, Quan s\u00e1t th\u1ea5y v\u1ebft th\u01b0\u01a1ng kh\u00e2u k\u00edn d#7x4cm, d\u1ecbch v\u00e0ng th\u1ea5m b\u0103ng, c\u00f3 gi\u1ea3 m\u1ea1c, s\u01b0\u01a1ng n\u00f3ng b\u1ea7m t\u00edm xung quanh, nhi\u1ec7t \u0111\u1ed9 to\u00e0n th\u00e2n 38.5 \u0111\u1ed9 C, nhi\u1ec7t \u0111\u1ed9 ch\u00e2n (T) &gt; ch\u00e2n (P).<\/li>\n<\/ul>\n<p>\u21d2 Nghi ng\u1edd BN c\u00f3 nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng \u21d2 \u0110\u1ec1 ngh\u1ecb: CTM, CRP, Procalcitonin, C\u1ea5y m\u00e1u.<\/p>\n<ul>\n<li>T\u1ed5n th\u01b0\u01a1ng c\u01a1 quan k\u00e8m theo: qua th\u0103m h\u1ecfi <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/khai-thac-benh-su-va-tien-can-benh-ly-ngoai-chan-thuong\/\">medical history<\/a>, BN kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng \u0111au h\u00f4ng l\u01b0ng, kh\u00f4ng \u0111au \u0111\u1ea7u, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng cho th\u1ea5y, b\u1ee5ng m\u1ec1m kh\u00f4ng \u0111i\u1ec3m \u0111au khu tr\u00fa, ch\u1ea1m th\u1eadn (-), gan l\u00e1ch kh\u00f4ng s\u1edd ch\u1ea1m, c\u1ea7u b\u00e0ng quang (-), ti\u1ec3u \u0111\u01b0\u1ee3c, kh\u00f4ng \u1ea5n \u0111au g\u00f3c s\u01b0\u1eddn \u2013 s\u1ed1ng \ud83e\udc6a \u00edt ngh\u0129 t\u1ed5n th\u01b0\u01a1ng t\u1ea1ng \u1ed5 b\u1ee5ng (t\u1ea1ng \u0111\u1eb7c, b\u00e0ng quang)<\/li>\n<\/ul>\n<h2><strong>X. \u0110\u1ec1 ngh\u1ecb c\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/h2>\n<ol>\n<li>CLS ch\u1ea9n \u0111o\u00e1n: XQ c\u1eb3ng ch\u00e2n (T) b\u00ecnh di\u1ec7n th\u1eb3ng v\u00e0 nghi\u00eang. Ch\u1ee5p XQ x\u01b0\u01a1ng b\u00e0n, ng\u00f3n ch\u00e2n th\u1eb3ng nghi\u00eang ho\u1eb7c ch\u1ebfch.<\/li>\n<li>CLS th\u01b0\u1eddng qui: C\u00f4ng th\u1ee9c m\u00e1u, \u0111\u00f4ng m\u00e1u, nh\u00f3m m\u00e1u, sinh h\u00f3a m\u00e1u, XQ ng\u1ef1c th\u1eb3ng, ECG, TPTNT, Ion \u0111\u1ed3.<\/li>\n<li>CLS h\u1ed7 tr\u1ee3 \u0111i\u1ec1u tr\u1ecb: \u0110o \u0111\u1ed9 lo\u00e3ng x\u01b0\u01a1ng DEXA.<\/li>\n<\/ol>\n<h2><strong>XI. K\u1ebft qu\u1ea3 c\u1eadn l\u00e2m s\u00e0ng:<\/strong><\/h2>\n<figure id=\"attachment_2188\" aria-describedby=\"caption-attachment-2188\" style=\"width: 711px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"wp-image-2188 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-1.png\" alt=\"Gay Xuong Ho 1\" width=\"711\" height=\"332\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-1.png 711w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-1-300x140.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-1-18x8.png 18w\" sizes=\"(max-width: 711px) 100vw, 711px\" \/><figcaption id=\"caption-attachment-2188\" class=\"wp-caption-text\">Gay Xuong Ho 1<\/figcaption><\/figure>\n<p>=&gt; CTM ch\u01b0a ghi nh\u1eadn thi\u1ebfu m\u00e1u, BC, TC trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng.<\/p>\n<p><strong>+ Sinh h\u00f3a m\u00e1u: <\/strong><\/p>\n<figure id=\"attachment_2189\" aria-describedby=\"caption-attachment-2189\" style=\"width: 639px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" class=\"wp-image-2189 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-2.png\" alt=\"Gay Xuong Ho 2\" width=\"639\" height=\"365\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-2.png 639w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-2-300x171.png 300w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-2-18x10.png 18w\" sizes=\"(max-width: 639px) 100vw, 639px\" \/><figcaption id=\"caption-attachment-2189\" class=\"wp-caption-text\">Gay Xuong Ho 2<\/figcaption><\/figure>\n<p><strong>\u0110i\u1ec7n gi\u1ea3i \u0111\u1ed3:<\/strong> c\u00e1c ch\u1ec9 s\u1ed1 trong gi\u1edbi h\u1ea1n b\u00ecnh th\u01b0\u1eddng<\/p>\n<p><strong>+ Xquang:<\/strong><\/p>\n<ol>\n<li>Xquang: XQ c\u1eb3ng ch\u00e2n (T) b\u00ecnh di\u1ec7n th\u1eb3ng v\u00e0 nghi\u00eang<\/li>\n<\/ol>\n<p><figure id=\"attachment_2190\" aria-describedby=\"caption-attachment-2190\" style=\"width: 297px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2190 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-3.png\" alt=\"Gay Xuong Ho 3\" width=\"297\" height=\"367\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-3.png 297w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-3-243x300.png 243w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-3-10x12.png 10w\" sizes=\"(max-width: 297px) 100vw, 297px\" \/><figcaption id=\"caption-attachment-2190\" class=\"wp-caption-text\">Gay Xuong Ho 3<\/figcaption><\/figure> <figure id=\"attachment_2192\" aria-describedby=\"caption-attachment-2192\" style=\"width: 301px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2192 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-4.png\" alt=\"Gay Xuong Ho 4\" width=\"301\" height=\"365\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-4.png 301w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-4-247x300.png 247w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-4-10x12.png 10w\" sizes=\"(max-width: 301px) 100vw, 301px\" \/><figcaption id=\"caption-attachment-2192\" class=\"wp-caption-text\">Gay Xuong Ho 4<\/figcaption><\/figure><\/p>\n<h3>H\u00e0nh ch\u00ednh:<\/h3>\n<ul>\n<li>BN Ng\u00f4 V\u0103n T, nam, 71 tu\u1ed5i. M\u1ed9t x quang c\u1eb3ng ch\u00e2n (T) b\u00ecnh di\u1ec7n th\u1eb3ng v\u00e0 nghi\u00eang, ch\u1ee5p l\u00fac 19h31 ng\u00e0y 13\/05\/2023<\/li>\n<li>MSBN: <strong>15032046<\/strong>, T\u1ec9 l\u1ec7 ch\u1ee5p: 100%. S\u1ed1 l\u01b0\u1ee3ng phim: 02.<\/li>\n<li>T\u01b0 th\u1ebf tr\u01b0\u1edbc sau, ch\u1ea5t l\u01b0\u1ee3ng tia v\u1eeba, kh\u00f4ng xoay<\/li>\n<li>Tr\u01b0\u1eddng ch\u1ee5p: l\u1ea5y \u0111\u1ee7 b\u00f3ng m\u00f4 m\u1ec1m xung quanh t\u1ed5n th\u01b0\u01a1ng, kh\u00f4ng l\u1ea5y \u0111\u1ee7 qua 2 kh\u1edbp tr\u00ean v\u00e0 d\u01b0\u1edbi \u1ed5 g\u00e3y<\/li>\n<li>B\u00ecnh di\u1ec7n: b\u00ecnh di\u1ec7n th\u1eb3ng, b\u00ecnh di\u1ec7n nghi\u00eang.<\/li>\n<\/ul>\n<h3>\u0110\u1ecdc phim:<\/h3>\n<ul>\n<li>G\u00e3y \u2153 d\u01b0\u1edbi th\u00e2n x\u01b0\u01a1ng m\u00e1c ch\u00e2n (T)<\/li>\n<li>\u0110\u01b0\u1eddng g\u00e3y ngang, \u0111\u01a1n gi\u1ea3n<\/li>\n<li>Di l\u1ec7ch: ch\u1ed3ng ng\u1eafn v\u00e0 sang b\u00ean 1 v\u1ecf x\u01b0\u01a1ng<\/li>\n<li>Kh\u00f4ng tr\u1eadt kh\u1edbp<\/li>\n<li>Tho\u00e1i h\u00f3a x\u01b0\u01a1ng c\u1eb3ng ch\u00e2n: kh\u00f4ng ghi nh\u1eadn h\u00ecnh \u1ea3nh<\/li>\n<li>Kh\u00f4ng quan s\u00e1t d\u1ecb v\u1eadt b\u1ea5t th\u01b0\u1eddng.<\/li>\n<li>M\u00f4 m\u1ec1m s\u01b0ng n\u1ec1<\/li>\n<\/ul>\n<p>b) Ch\u1ee5p XQ x\u01b0\u01a1ng b\u00e0n, ng\u00f3n ch\u00e2n th\u1eb3ng nghi\u00eang ho\u1eb7c ch\u1ebfch.<\/p>\n<p><figure id=\"attachment_2193\" aria-describedby=\"caption-attachment-2193\" style=\"width: 281px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2193 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-5.png\" alt=\"Gay Xuong Ho 5\" width=\"281\" height=\"403\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-5.png 281w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-5-209x300.png 209w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-5-8x12.png 8w\" sizes=\"(max-width: 281px) 100vw, 281px\" \/><figcaption id=\"caption-attachment-2193\" class=\"wp-caption-text\">Gay Xuong Ho 5<\/figcaption><\/figure> <figure id=\"attachment_2194\" aria-describedby=\"caption-attachment-2194\" style=\"width: 297px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2194 size-full\" src=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-6.png\" alt=\"Gay Xuong Ho 6\" width=\"297\" height=\"396\" title=\"\" srcset=\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-6.png 297w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-6-225x300.png 225w, https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/07\/gay-xuong-ho-6-9x12.png 9w\" sizes=\"(max-width: 297px) 100vw, 297px\" \/><figcaption id=\"caption-attachment-2194\" class=\"wp-caption-text\">Gay Xuong Ho 6<\/figcaption><\/figure><\/p>\n<h3>H\u00e0nh ch\u00ednh:<\/h3>\n<ul>\n<li>BN Ng\u00f4 V\u0103n T, nam, 71 tu\u1ed5i. M\u1ed9t XQ x\u01b0\u01a1ng b\u00e0n, ng\u00f3n ch\u00e2n th\u1eb3ng nghi\u00eang ho\u1eb7c ch\u1ebfch., ch\u1ee5p l\u00fac 19h31 ng\u00e0y 13\/05\/2023<\/li>\n<li>MSBN: <strong>15032046<\/strong>, T\u1ec9 l\u1ec7 ch\u1ee5p: 100%. S\u1ed1 l\u01b0\u1ee3ng phim: 02.<\/li>\n<li>T\u01b0 th\u1ebf tr\u01b0\u1edbc sau, ch\u1ea5t l\u01b0\u1ee3ng tia v\u1eeba, kh\u00f4ng xoay<\/li>\n<li>Tr\u01b0\u1eddng ch\u1ee5p: l\u1ea5y \u0111\u1ee7 b\u00f3ng m\u00f4 m\u1ec1m xung quanh t\u1ed5n th\u01b0\u01a1ng, kh\u00f4ng l\u1ea5y \u0111\u1ee7 qua 2 kh\u1edbp tr\u00ean v\u00e0 d\u01b0\u1edbi \u1ed5 g\u00e3y<\/li>\n<\/ul>\n<ul>\n<li>B\u00ecnh di\u1ec7n: b\u00ecnh di\u1ec7n th\u1eb3ng, b\u00ecnh di\u1ec7n nghi\u00eang.<\/li>\n<\/ul>\n<h3>\u0110\u1ecdc phim:<\/h3>\n<ul>\n<li>Kh\u00f4ng ghi nh\u1eadn h\u00ecnh \u1ea3nh b\u1ea5t th\u01b0\u1eddng<\/li>\n<\/ul>\n<p>\u21d2 K\u1ebft lu\u1eadn: G\u00e3y \u2153 d\u01b0\u1edbi x\u01b0\u01a1ng m\u00e1c, <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/ton-thuong-kin-mo-mem\/\">t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m<\/a> xung quanh.<\/p>\n<h2><strong>XII. Bi\u1ec7n lu\u1eadn CLS: <\/strong><\/h2>\n<ul>\n<li>Tr\u00ean XQ ghi nh\u1eadn h\u00ecnh \u1ea3nh: G\u00e3y \u2153 d\u01b0\u1edbi th\u00e2n x\u01b0\u01a1ng m\u00e1c ch\u00e2n (T). \u0110\u01b0\u1eddng g\u00e3y ngang, \u0111\u01a1n gi\u1ea3n &#8211; Di l\u1ec7ch: ch\u1ed3ng ng\u1eafn v\u00e0 sang b\u00ean 1 v\u1ecf x\u01b0\u01a1ng &#8211; Kh\u00f4ng tr\u1eadt kh\u1edbp, t\u1ed5n th\u01b0\u01a1ng m\u00f4 m\u1ec1m xung quanh.<\/li>\n<li>V\u1ebft th\u01b0\u01a1ng sau khi c\u1eaft l\u1ecdc che ph\u1ee7 \u0111\u01b0\u1ee3c x\u01b0\u01a1ng \u21d2 Ph\u00e2n lo\u1ea1i IIIa theo <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/gay-xuong-ho\/\">Gustilo<\/a><\/li>\n<li>V\u00ec b\u1ec7nh s\u1eed \u0111\u00e3 di\u1ec5n ti\u1ebfn 3 ng\u00e0y, n\u00ean c\u00e1c BC c\u00f3 th\u1ec3 x\u1ea3y ra tr\u00ean BN n\u00e0y l\u00e0:<\/li>\n<li><strong>Early complications:<\/strong>\n<ul>\n<li><strong><u><a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/hoi-chung-chen-ep-khoang\/\">Cavity compression<\/a> (CEK):<\/u><\/strong> Kh\u00f4ng ngh\u0129 do: kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n c\u1ee7a CEK nh\u01b0: \u0111au kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi x\u1eed tr\u00ed, d\u1ecb c\u1ea3m, t\u00ea b\u00ec, kh\u00f4ng n\u1ed5i bong b\u00f3ng n\u01b0\u1edbc.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>+ <u>T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u:<\/u><\/strong> kh\u00f4ng ngh\u0129 do da v\u00f9ng b\u00e0n ch\u00e2n v\u00e0 c\u1eb3ng ch\u00e2n v\u1eabn h\u1ed3ng h\u00e0o v\u00e0 s\u1edd \u1ea5m \u2013 \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u t\u1ed1t, b\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch mu ch\u00e2n v\u00e0 m\u1ea1ch ch\u00e0y sau.<\/p>\n<p><strong>+ <u>Nerve damage:<\/u><\/strong> kh\u00f4ng ngh\u0129 do BN kh\u00f4ng c\u00f3 c\u1ea3m gi\u00e1c n\u00f4ng s\u00e2u v\u1eabn c\u00f2n \u1edf c\u1eb3ng ch\u00e2n v\u00e0 b\u00e0n ch\u00e2n (TK m\u00e1c)<\/p>\n<p>+ <strong><u>R\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng c\u1ea5p t\u00ednh<\/u><\/strong>: kh\u00f4ng c\u00f3 b\u00f3ng n\u01b0\u1edbc da c\u1ea1nh \u1ed5 g\u00e3y<\/p>\n<h2>XIII. Ch\u1ea9n<strong> \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh: <\/strong><\/h2>\n<p>G\u00e3y h\u1edf \u2153 d\u01b0\u1edbi x\u01b0\u01a1ng m\u00e1c ch\u00e2n tr\u00e1i (T) \u0111\u1ed9 IIIA theo Gustilo &#8211; Nhi\u1ec5m tr\u00f9ng v\u1ebft th\u01b0\u01a1ng \u0111\u00e3 \u0111\u01b0\u1ee3c kh\u00e2u k\u00edn sau tai n\u1ea1n giao th\u00f4ng ng\u00e0y 3\/ THA \u0111\u1ed9 I theo ESC 2018, R\u1ed1i lo\u1ea1n lipid m\u00e1u, Thi\u1ebfu m\u00e1u c\u01a1 tim<\/p>\n<h2><strong>\u00a0XIV. <\/strong><strong>Treatment: <\/strong><\/h2>\n<ol>\n<li>Gi\u1ea3m \u0111au:<\/li>\n<\/ol>\n<ul>\n<li>To\u00e0n th\u00e2n: paracetamol u\u1ed1ng ho\u1eb7c truy\u1ec1n<\/li>\n<li>T\u1ea1i ch\u1ed7: <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/so-cuu-bat-dong-gay-xuong\/\">motionless<\/a> t\u1ea1m th\u1eddi: c\u1ed1 \u0111\u1ecbnh t\u1eeb 1\/3 tr\u00ean \u0111\u00f9i t\u1edbi g\u00f3t ch\u00e2n b\u1eb1ng n\u1eb9p eke g\u1ed7 ho\u1eb7c 2 n\u1eb9p tre \u0111\u1eb7t \u1edf m\u1eb7t trong v\u00e0 m\u1eb7t ngo\u00e0i<\/li>\n<\/ul>\n<ol start=\"2\">\n<li>Kh\u00e1ng sinh:<\/li>\n<li>Ch\u1ed1ng u\u1ed1n v\u00e1n : SAT 1500 UI ti\u00eam b\u1eafp<\/li>\n<li>Conservative treatment: <a href=\"https:\/\/bsvothanhtoan.com\/en\/bai-giang\/bo-bot\/\">Bundle of dough<\/a> ngay: \u0111\u1ed1i v\u1edbi g\u00e3y th\u00e2n 2 x\u01b0\u01a1ng c\u1eb3ng ch\u00e2n kh\u00f4ng di l\u1ec7ch ho\u1eb7c \u00edt di l\u1ec7ch, g\u00e3y 2 x\u01b0\u01a1ng c\u1eb3ng ch\u00e2n \u1edf tr\u1ebb em<\/li>\n<\/ol>\n<ul>\n<li>\u0110i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n<\/li>\n<\/ul>\n<h2>\u00a0<strong>XV. Ti\u00ean l\u01b0\u1ee3ng:<\/strong><\/h2>\n<p>&#8211; G\u1ea7n: T\u1ed1t,\u00a0 BN cao tu\u1ed5i nh\u01b0ng ch\u01b0a c\u00f3 ti\u1ec1n c\u0103n lo\u00e3ng x\u01b0\u01a1ng, \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi, hi\u1ec7n t\u1ea1i ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng \u2192 C\u1ea7n \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c ho\u00e0n to\u00e0n trong giai \u0111o\u1ea1n sau m\u1ed5, kh\u00f3 ph\u1ed1i h\u1ee3p t\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u ch\u1ee7 \u0111\u1ed9ng, nguy c\u01a1 m\u1eafc c\u00e1c bi\u1ebfn ch\u1ee9ng do n\u1eb1m m\u1ed9t ch\u1ed7.<\/p>\n<p>&#8211; Xa: T\u1ed1t, kh\u1ea3 n\u0103ng \u0111i l\u1ea1i ph\u1ee5 thu\u1ed9c v\u00e0o vi\u1ec7c tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u1eadp v\u1eadn \u0111\u1ed9ng c\u1ee7a BN.<\/p>\n<h2><strong>XVI. D\u1ef0 PH\u00d2NG:<\/strong><\/h2>\n<p>&#8211; Ch\u0103m s\u00f3c v\u1ebft m\u1ed5<\/p>\n<p>&#8211; S\u1eed d\u1ee5ng kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng<\/p>\n<p>&#8211; C\u1ea5y d\u1ecbch l\u00e0m kh\u00e1ng sinh \u0111\u1ed3 n\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u nhi\u1ec5m tr\u00f9ng<\/p>\n<p>&#8211; Dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7, ph\u00f9 h\u1ee3p<\/p>\n<p>&#8211; T\u1eadp v\u1eadn \u0111\u1ed9ng s\u1edbm tr\u00e1nh teo c\u01a1<\/p>\n<p>&#8211; T\u00e1i kh\u00e1m khi c\u00f3 d\u1ea5u hi\u1ec7u b\u1ea5t th\u01b0\u1eddng<\/p>","protected":false},"featured_media":1480,"comment_status":"open","ping_status":"open","template":"","tags":[207,48],"chuyen-muc":[188],"class_list":["post-2187","chuyen-de","type-chuyen-de","status-publish","has-post-thumbnail","hentry","tag-benh-an-gay-xuong-ho","tag-gay-xuong-ho","chuyen-muc-benh-an-mau"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-de\/2187","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-de"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/chuyen-de"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=2187"}],"version-history":[{"count":2,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-de\/2187\/revisions"}],"predecessor-version":[{"id":2667,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-de\/2187\/revisions\/2667"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/1480"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=2187"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=2187"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=2187"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}