![\"Luu-y\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2024\/12\/luu-y.webp\" "\\"\\"")
<\/p>\n<\/p>\n
Sinh vi\u00ean th\u1ef1c hi\u1ec7n:
\n1. L\u00fd V\u00e2n Anh 116019024
\n2. Ph\u1ea1m Ki\u1ec1u Anh 11601902<\/p>\n
I. H\u00c0NH CH\u00cdNH<\/strong><\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u1ecd v\u00e0 t\u00ean: PHAN THI\u0323 A.<\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sinh n\u0103m: 1936 (88 tu\u1ed5i)<\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u00e2n t\u1ed9c: Kinh<\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gi\u1edbi t\u00ednh: N\u01b0\u0303<\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ngh\u1ec1 nghi\u1ec7p tr\u01b0\u01a1\u0301c \u0111\u00e2y: n\u00f4\u0323i tr\u01a1\u0323<\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110\u1ecba ch\u1ec9: TP H\u00f4\u0300 Chi\u0301 Minh<\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ng\u00e0y, gi\u1edd v\u00e0o vi\u1ec7n: 20 gi\u1edd 47 ph\u00fat, ng\u00e0y 30\/11\/2024\u00a0<\/p>\n –\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ng\u00e0y, gi\u1edd l\u00e0m b\u1ec7nh \u00e1n: 22 gi\u1edd, ng\u00e0y 04\/12\/202<\/p>\n II. L\u00dd DO V\u00c0O VI\u1ec6N<\/strong><\/p>\n \u0110au + v\u1ebft th\u01b0\u01a1ng c\u0103\u0309ng tay pha\u0309i<\/p>\n III. B\u1ec6NH S\u1eec<\/strong><\/p>\n Ng\u01b0\u01a1\u0300i nha\u0300 b\u00ea\u0323nh nh\u00e2n khai, c\u00e1ch nh\u1eadp vi\u1ec7n 30 ph\u00fat, b\u1ec7nh nh\u00e2n tr\u01b0\u1ee3t ch\u00e2n ng\u00e3 ch\u1ed1ng c\u1ed5 tay v\u1edbi t\u01b0 th\u1ebf khu\u1ef7u du\u1ed7i, c\u1ed5 tay du\u1ed7i xu\u1ed1ng n\u1ec1n nh\u00e0, kh\u00f4ng va \u0111\u1eadp c\u00e1c v\u00f9ng n\u00e0o kh\u00e1c tr\u00ean c\u01a1 th\u1ec3. Sau t\u00e9, b\u1ec7nh nh\u00e2n t\u1ec9nh, kh\u00f4ng \u0111au \u0111\u1ea7u kh\u00f4ng ch\u00f3ng m\u1eb7t, th\u1ea5y c\u1eb3ng tay (P) b\u1ec7nh nh\u00e2n bi\u1ebfn d\u1ea1ng v\u00e0 c\u00f3 v\u1ebft th\u01b0\u01a1ng ch\u1ea3y m\u00e1u t\u1ea1i v\u00f9ng n\u00e0y, b\u1ec7nh nh\u00e2n than \u0111au nhi\u1ec1u v\u00f9ng c\u1eb3ng tay (P), b\u1ec7nh nh\u00e2n kh\u00f4ng x\u1eed tr\u00ed g\u00ec, \u0111\u01b0\u1ee3c ng\u01b0\u1eddi nh\u00e0 \u0111\u01b0a v\u00e0o b\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n * T\u00ecnh tr\u1ea1ng l\u00fac nh\u1eadp vi\u1ec7n:<\/p>\n – T\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n c\u1ea5p c\u1ee9u:<\/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 + Sinh hi\u1ec7u:<\/p>\n Ma\u0323ch: 83 l\u00e2\u0300n\/phu\u0301t\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\u00a0\u00a0\u00a0\u00a0\u00a0 Huy\u00ea\u0301t a\u0301p: 170\/90 mmHg<\/p>\n Nhi\u00ea\u0323t \u0111\u00f4\u0323: 36,5 \u0111\u00f4\u0323 C\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\u00a0\u00a0 Nhi\u0323p th\u1edf: 18 l\u00e2\u0300n\/phu\u0301t<\/p>\n SpO2: 97%<\/p>\n + \u0110au c\u0103\u0309ng tay (P)<\/p>\n + 1\/3 d\u01b0\u01a1\u0301i c\u0103\u0309ng tay (P) bi\u00ea\u0301n da\u0323ng, v\u00ea\u0301t th\u01b0\u01a1ng d #1cm, cha\u0309y ma\u0301u, l\u00f4\u0323 \u0111\u00e2\u0300u x\u01b0\u01a1ng<\/p>\n + M\u1ea1ch quay, m\u1ea1ch c\u00e1nh tay \u0111\u1ec1u r\u00f5 2 b\u00ean<\/p>\n – X\u01b0\u0309 tri\u0301 t\u1ea1i c\u1ea5p c\u1ee9u:<\/p>\n + B\u0103ng \u00e9p c\u1ea7m m\u00e1u<\/p>\n + \u0110eo n\u1eb9p c\u1eb3ng b\u00e0n tay (P)<\/p>\n + Fentanyl citrate 0,1mg\/2ml \u00bd \u00f4\u0301ng (TB)<\/p>\n + SAT 1500IU 01 \u00f4\u0301ng (TB)<\/p>\n + XN:<\/p>\n Ch\u1ee5p Xquang x\u01b0\u01a1ng c\u1eb3ng tay (P) nghi\u00eang<\/p>\n ECG<\/p>\n => Chuy\u1ec3n khoa CTCH<\/p>\n – T\u00ecnh tr\u1ea1ng t\u1ea1i th\u1eddi \u0111i\u1ec3m nh\u1eadp khoa CTCH:<\/p>\n + B\u1ec7nh nh\u00e2n t\u1ec9nh, sinh hi\u1ec7u \u1ed5n<\/p>\n + \u0110eo n\u1eb9p c\u1eb3ng b\u00e0n tay (P)<\/p>\n + Gi\u1ea3m \u0111au c\u1eb3ng tay (P) so v\u1edbi th\u1eddi \u0111i\u1ec3m \u1edf c\u1ea5p c\u1ee9u<\/p>\n + S\u01b0ng n\u1ec1 \u2153 d\u01b0\u1edbi c\u1eb3ng tay (P)<\/p>\n * Di\u1ec5n ti\u1ebfn b\u1ec7nh ph\u00f2ng<\/p>\n Ng\u00e0y 1-4: b\u1ec7nh nh\u00e2n t\u1ec9nh, gi\u1ea3m \u0111au c\u1eb3ng tay (P), v\u1ebft th\u01b0\u01a1ng \u1edf c\u1eb3ng tay (P) ch\u1ea3y \u00edt d\u1ecbch th\u1ea5m b\u0103ng<\/p>\n X\u1eed tr\u00ed t\u1eeb ng\u00e0y 1-4: b\u00f3 b\u1ed9t c\u00e1nh-c\u1eb3ng-b\u00e0n tay (P), thu\u1ed1c gi\u1ea3m \u0111au, kh\u00e1ng sinh, huy\u1ebft \u00e1p, thay b\u0103ng r\u1eeda v\u1ebft th\u01b0\u01a1ng<\/p>\n IV. TI\u1ec0N C\u0102N<\/strong><\/p>\n – N\u00f4\u0323i khoa: T\u0103ng huy\u00ea\u0301t a\u0301p #2 n\u0103m, \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n t\u1ea1i b\u1ec7nh vi\u1ec7n Th\u1ed1ng Nh\u1ea5t, huy\u1ebft \u00e1p t\u00e2m thu cao nh\u1ea5t ghi nh\u1eadn l\u00e0 170mmHg, huy\u1ebft \u00e1p t\u00e2m thu d\u1ec5 ch\u1ecbu l\u00e0 120-130mmHg, \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi Losartan 50mg 1 vi\u00ean u\u1ed1ng s\u00e1ng<\/p>\n – Ngoa\u0323i khoa: Ga\u0303y k\u00edn \u0111\u1ea7u d\u01b0\u1edbi x\u01b0\u01a1ng quay (T) #1 n\u0103m, \u0111i\u00ea\u0300u tri\u0323 b\u0103\u0300ng ph\u01b0\u01a1ng pha\u0301p bo\u0301 b\u00f4\u0323t<\/p>\n – Tho\u0301i quen: kh\u00f4ng hu\u0301t thu\u00f4\u0301c la\u0301, kh\u00f4ng u\u00f4\u0301ng r\u01b0\u01a1\u0323u bia<\/p>\n – Di\u0323 \u01b0\u0301ng: ch\u01b0a ghi nh\u1eadn ti\u00ea\u0300n c\u0103n di\u0323 \u01b0\u0301ng thu\u00f4\u0301c, th\u01b0\u0301c \u0103n<\/p>\n 2. Gia \u0111i\u0300nh:<\/strong> ch\u01b0a ghi nh\u00e2\u0323n ca\u0301c b\u00ea\u0323nh l\u00fd li\u00ean quan<\/p>\n \nV. L\u01af\u01a0\u0323C QUA CA\u0301C C\u01a0 QUAN <\/strong>(l\u00fac 21 gi\u1edd 30, ng\u00e0y 30\/11\/2024)<\/p>\n – Tim m\u1ea1ch: kh\u00f4ng h\u1ed3i h\u1ed9p, kh\u00f4ng \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, kh\u00f4ng \u0111au ng\u1ef1c<\/p>\n – H\u00f4 h\u1ea5p: kh\u00f4ng kh\u00f3 th\u1edf, kh\u00f4ng ho<\/p>\n – Ti\u00eau ho\u00e1: kh\u00f4ng \u0111au b\u1ee5ng, kh\u00f4ng bu\u1ed3n n\u00f4n, kh\u00f4ng n\u00f4n<\/p>\n – Ti\u1ebft ni\u1ec7u: kh\u00f4ng ti\u1ec3u g\u1eaft bu\u1ed1t, n\u01b0\u1edbc ti\u1ec3u v\u00e0ng trong<\/p>\n – C\u01a1 x\u01b0\u01a1ng kh\u1edbp: \u0111au 1\/3 d\u01b0\u1edbi c\u0103\u0309ng tay (P)<\/p>\n – Th\u1ea7n kinh: kh\u00f4ng \u0111au \u0111\u1ea7u, kh\u00f4ng cho\u0301ng m\u0103\u0323t<\/p>\n VI. KH\u00c1M L\u00c2M S\u00c0NG<\/strong> (l\u00fac 21 gi\u1edd 30, ng\u00e0y 30\/11\/2024)<\/p>\n B\u00ea\u0323nh nh\u00e2n ti\u0309nh, ti\u00ea\u0301p xu\u0301c t\u00f4\u0301t<\/p>\n Sinh hi\u00ea\u0323u:<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ma\u0323ch:\u00a0 80 l\u00e2\u0300n\/phu\u0301t\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\u00a0\u00a0\u00a0\u00a0 Huy\u00ea\u0301t a\u0301p: 150\/90 mmHg<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nhi\u00ea\u0323t \u0111\u1ed9: 37 \u0111\u00f4\u0323 C\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\u00a0\u00a0\u00a0\u00a0\u00a0 Nhi\u0323p th\u1edf: 18 l\u00e2\u0300n\/phu\u0301t<\/p>\n Th\u00ea\u0309 tra\u0323ng: g\u00e2\u0300y (IDI & WPRO), BMI=17,3 kg\/m2 (c\u00e2n n\u0103\u0323ng 40kg, chi\u00ea\u0300u cao 152cm)<\/p>\n Da ni\u00eam m\u1ea1c h\u00f4\u0300ng<\/p>\n L\u00f4ng kh\u00f4ng r\u00e2\u0323m b\u00e2\u0301t th\u01b0\u01a1\u0300ng, to\u0301c kh\u00f4ng d\u00ea\u0303 ga\u0303y, mo\u0301ng bo\u0301ng<\/p>\n Kh\u00f4ng ph\u00f9, kh\u00f4ng xu\u00e2\u0301t huy\u00ea\u0301t d\u01b0\u01a1\u0301i da<\/p>\n Tuy\u00ea\u0301n gia\u0301p kh\u00f4ng to, ha\u0323ch ngoa\u0323i vi s\u1edd kh\u00f4ng cha\u0323m<\/p>\n L\u00f4\u0300ng ng\u01b0\u0323c c\u00e2n \u0111\u00f4\u0301i, di \u0111\u00f4\u0323ng \u0111\u00ea\u0300u theo nhi\u0323p th\u1edf, kh\u00f4ng se\u0323o m\u00f4\u0309 cu\u0303, kh\u00f4ng \u00f4\u0309 \u0111\u00e2\u0323p b\u00e2\u0301t th\u01b0\u01a1\u0300ng<\/p>\n Mo\u0309m tim \u01a1\u0309 khoang li\u00ean s\u01b0\u01a1\u0300n V \u0111\u01b0\u01a1\u0300ng trung \u0111o\u0300n (T), di\u00ea\u0323n \u0111\u00e2\u0323p 1×1 cm<\/p>\n Rung miu (-), Harzer (-)<\/p>\n T1, T2 \u0111\u00ea\u0300u r\u00f5, t\u00e2\u0300n s\u00f4\u0301 80 l\u00e2\u0300n\/phu\u0301t, kh\u00f4ng \u00e2m th\u00f4\u0309i<\/p>\n L\u00f4\u0300ng ng\u01b0\u0323c c\u00e2n \u0111\u00f4\u0301i, di \u0111\u00f4\u0323ng \u0111\u00ea\u0300u theo nhi\u0323p th\u1edf, kh\u00f4ng co ke\u0301o c\u01a1 h\u00f4 h\u00e2\u0301p phu\u0323<\/p>\n Rung thanh \u0111\u00ea\u0300u 2 b\u00ean<\/p>\n Go\u0303 trong \u0111\u00ea\u0300u 2 ph\u00ea\u0301 tr\u01b0\u01a1\u0300ng<\/p>\n Ri\u0300 ra\u0300o ph\u00ea\u0301 nang \u00eam di\u0323u 2 ph\u00ea\u0301 tr\u01b0\u01a1\u0300ng<\/p>\n Bu\u0323ng c\u00e2n \u0111\u00f4\u0301i, kh\u00f4ng se\u0323o m\u00f4\u0309 cu\u0303, kh\u00f4ng tu\u00e2\u0300n hoa\u0300n ba\u0300ng h\u00ea\u0323<\/p>\n Kh\u00f4ng nghe \u00e2m th\u00f4\u0309i \u0111\u00f4\u0323ng ma\u0323ch ch\u1ee7 bu\u0323ng, nhu \u0111\u00f4\u0323ng ru\u00f4\u0323t 6 l\u00e2\u0300n\/phu\u0301t<\/p>\n Kh\u00f4ng go\u0303 \u0111u\u0323c vu\u0300ng th\u00e2\u0301p<\/p>\n Bu\u0323ng m\u00ea\u0300m, kh\u00f4ng \u0111i\u00ea\u0309m \u0111au khu tr\u00fa<\/p>\n Gan, la\u0301ch s\u1edd kh\u00f4ng cha\u0323m<\/p>\n H\u00f4\u0301 th\u0103\u0301t l\u01b0ng c\u00e2n \u0111\u00f4\u0301i, kh\u00f4ng u cu\u0323c, kh\u00f4ng s\u01b0ng n\u00ea\u0300<\/p>\n \u0110i\u00ea\u0309m \u0111au ni\u00ea\u0323u qua\u0309n tr\u00ean, gi\u01b0\u0303a \u00e2\u0301n kh\u00f4ng \u0111au<\/p>\n Cha\u0323m th\u00e2\u0323n (-), b\u00e2\u0323p b\u1ec1nh th\u00e2\u0323n (-)<\/p>\n C\u00e2\u0300u ba\u0300ng quang (-)<\/p>\n B\u00ea\u0323nh nh\u00e2n ti\u0309nh, ti\u00ea\u0301p xu\u0301c t\u00f4\u0301t, GCS 15\u0111<\/p>\n C\u00f4\u0309 m\u00ea\u0300m<\/p>\n Kh\u00f4ng d\u00e2\u0301u th\u00e2\u0300n kinh khu tru\u0301<\/p>\n * Tay (P)<\/p>\n – Nh\u00ecn:<\/p>\n – S\u1edd:<\/p>\n – G\u00f5: kh\u00f4ng g\u00f5 do b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y x\u01b0\u01a1ng (bi\u00ea\u0301n da\u0323ng), khi th\u01b0\u0323c hi\u00ea\u0323n se\u0303 la\u0300m b\u00ea\u0323nh nh\u00e2n \u0111au th\u00eam<\/p>\n – C\u00e1c nghi\u1ec7m ph\u00e1p: nghi\u1ec7m ph\u00e1p Cozens kh\u00f4ng l\u00e0m do b\u1ec7nh nh\u00e2n \u0111au<\/p>\n – \u0110o:<\/p>\n <\/p>\n<\/td>\n C\u0103\u0309ng tay tra\u0301i<\/p>\n<\/td>\n C\u0103\u0309ng tay pha\u0309i<\/p>\n<\/td>\n<\/tr>\n Chi\u00ea\u0300u da\u0300i t\u01b0\u01a1ng \u0111\u00f4\u0301i (mo\u0309m tr\u00ean l\u00f4\u0300i c\u00e2\u0300u ngo\u00e0i x\u01b0\u01a1ng ca\u0301nh tay – mo\u0309m tr\u00e2m quay)<\/p>\n<\/td>\n 24cm<\/p>\n<\/td>\n 23cm<\/p>\n<\/td>\n<\/tr>\n Chi\u00ea\u0300u da\u0300i t\u01b0\u01a1ng \u0111\u00f4\u0301i (mo\u0309m tr\u00ean l\u00f4\u0300i c\u00e2\u0300u trong x\u01b0\u01a1ng ca\u0301nh tay – mo\u0309m tr\u00e2m tr\u1ee5)<\/p>\n<\/td>\n 23cm<\/p>\n<\/td>\n 22cm<\/p>\n<\/td>\n<\/tr>\n Chi\u00ea\u0300u da\u0300i tuy\u00ea\u0323t \u0111\u00f4\u0301i (ch\u1ecfm quay – mo\u0309m tr\u00e2m quay)<\/p>\n<\/td>\n 23cm<\/p>\n<\/td>\n 22cm<\/p>\n<\/td>\n<\/tr>\n Chi\u00ea\u0300u da\u0300i tuy\u00ea\u0323t \u0111\u00f4\u0301i (mo\u0309m khuy\u0309u – mo\u0309m tr\u00e2m tru\u0323)<\/p>\n<\/td>\n 22cm<\/p>\n<\/td>\n 21cm<\/p>\n<\/td>\n<\/tr>\n Chu vi c\u0103\u0309ng tay (vi\u0323 tri\u0301 \u2153 d\u01b0\u01a1\u0301i c\u0103\u0309ng tay, t\u01b0\u0300 mo\u0309m tr\u00e2m quay l\u00ean 5cm)<\/p>\n<\/td>\n 13cm<\/p>\n<\/td>\n 17cm<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n <\/p>\n – Kh\u00e1m v\u1eadn \u0111\u1ed9ng:<\/p>\n – Kh\u00e1m c\u1ea3m gi\u00e1c: c\u00f2n ca\u0309m gia\u0301c v\u00f9ng m\u1eb7t tr\u01b0\u1edbc, m\u1eb7t sau c\u1eb3ng tay<\/p>\n * C\u00e1c chi kh\u00e1c kh\u00f4ng \u0111au, kh\u00f4ng bi\u1ebfn d\u1ea1ng, kh\u00f4ng h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng<\/p>\n VII. T\u00d3M T\u1eaeT B\u1ec6NH \u00c1N<\/strong><\/p>\n BN n\u01b0\u0303 88 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u00ec s\u01b0ng \u0111au v\u00e0 bi\u1ebfn d\u1ea1ng c\u0103\u0309ng tay (P). Qua ho\u0309i b\u00ea\u0323nh va\u0300 th\u0103m kh\u00e1m l\u00e2m sa\u0300ng ghi nh\u1eadn:<\/p>\n * C\u01a1 ch\u1ebf ch\u1ea5n th\u01b0\u01a1ng gia\u0301n ti\u00ea\u0301p: tr\u01b0\u1ee3t ch\u00e2n ng\u00e3 ch\u1ed1ng c\u1ed5 tay v\u1edbi t\u01b0 th\u1ebf khu\u1ef7u du\u1ed7i, c\u1ed5 tay du\u1ed7i xu\u1ed1ng n\u1ec1n nh\u00e0<\/p>\n * D\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn c\u1ee7a g\u00e3y x\u01b0\u01a1ng:<\/p>\n * D\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn c\u1ee7a g\u00e3y x\u01b0\u01a1ng:<\/p>\n VIII. CH\u1ea8N \u0110O\u00c1N L\u00c2M S\u00c0NG<\/strong><\/p>\n G\u00e3y h\u1edf \u0111\u1ed9 I theo Gustilo \u2153 d\u01b0\u01a1\u0301i th\u00e2n 2 x\u01b0\u01a1ng c\u1eb3ng tay ph\u1ea3i gi\u1edd 1 do tai n\u1ea1n sinh hoa\u0323t hi\u00ea\u0323n ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng\/T\u0103ng huy\u00ea\u0301t a\u0301p \u0111\u00f4\u0323 2 theo ESC\/ESH 2018<\/p>\n G\u00e3y \u0111\u01a1n \u0111\u1ed9c x\u01b0\u01a1ng quay ho\u1eb7c x\u01b0\u01a1ng tr\u1ee5<\/p>\n Fracture of Monteggia<\/p>\n G\u00e3y tr\u1eadt Galeazzi<\/p>\n IX. BI\u1ec6N LU\u1eacN L\u00c2M S\u00c0NG<\/strong><\/p>\n – B\u1ec7nh nh\u00e2n n\u1eef 88 tu\u1ed5i, v\u00e0o vi\u1ec7n v\u00ec s\u01b0ng \u0111au v\u00e0 bi\u1ebfn d\u1ea1ng c\u1eb3ng tay (P), ngh\u0129 \u0111\u1ebfn c\u00e1c nguy\u00ean nh\u00e2n:<\/p>\n + G\u00e3y \u2153 d\u01b0\u1edbi th\u00e2n hai x\u01b0\u01a1ng c\u1eb3ng tay (P): ngh\u0129 nhi\u1ec1u nh\u1ea5t v\u00ec b\u1ec7nh nh\u00e2n c\u00f3 d\u1ea5u hi\u1ec7u ch\u1eafc ch\u1eafn g\u00e3y \u2153 d\u01b0\u01a1\u0301i th\u00e2n 2 x\u01b0\u01a1ng c\u1eb3ng tay ph\u1ea3i bao g\u1ed3m bi\u1ebfn d\u1ea1ng c\u1eb3ng tay ph\u1ea3i: g\u1eadp g\u00f3c \u2153 d\u01b0\u1edbi c\u1eb3ng tay (P) la\u0300m c\u0103\u0309ng tay cong, chi\u1ec1u d\u00e0i t\u01b0\u01a1ng \u0111\u1ed1i, tuy\u1ec7t \u0111\u1ed1i c\u1eb3ng tay pha\u0309i ng\u1eafn h\u01a1n b\u00ean tra\u0301i; k\u00e8m d\u1ea5u hi\u1ec7u kh\u00f4ng ch\u1eafc ch\u1eafn bao g\u1ed3m \u1ea5n \u0111au ch\u00f3i, s\u01b0ng \u0111au d\u01b0\u01a1\u0301i \u2153 d\u01b0\u01a1\u0301i c\u1eb3ng tay ph\u1ea3i, m\u00e2\u0301t c\u01a1 n\u0103ng (s\u00e2\u0301p ng\u01b0\u0309a c\u0103\u0309ng tay)\u00a0<\/p>\n + G\u00e3y \u0111\u01a1n \u0111\u1ed9c x\u01b0\u01a1ng quay ho\u1eb7c x\u01b0\u01a1ng tr\u1ee5: \u00edt ngh\u0129 v\u00ec kh\u00e1m c\u00f3 bi\u1ebfn d\u1ea1ng g\u1eadp g\u00f3c c\u1eb3ng tay r\u00f5, m\u1ea5t c\u01a1 n\u0103ng ho\u00e0n to\u00e0n (s\u1ea5p ng\u1eeda c\u1eb3ng tay)<\/p>\n + G\u00e3y tr\u1eadt Galeazzi: \u00edt ngh\u0129 v\u00ec kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u tr\u1eadt kh\u1edbp, c\u1ed5 tay kh\u00f4ng l\u1eadt s\u1ea5p v\u1ec1 ph\u00eda x\u01b0\u01a1ng quay, s\u1edd m\u1ecfm tr\u00e2m quay th\u1ea5p h\u01a1n m\u1ecfm tr\u00e2m tr\u1ee5<\/p>\n + G\u00e3y tr\u1eadt Monteggia: \u00edt ngh\u0129 v\u00ec b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 d\u1ea5u tr\u1eadt kh\u1edbp, kh\u00f4ng h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng kh\u1edbp khu\u1ef7u<\/p>\n – G\u00e3y h\u1edf v\u00ec co\u0301 v\u00ea\u0301t th\u01b0\u01a1ng \u1edf 1\/3 d\u01b0\u1edbi m\u1eb7t tr\u01b0\u1edbc trong c\u1eb3ng tay, k\u00edch th\u01b0\u1edbc #1x1cm, b\u01a1\u0300 nham nh\u1ee1, ch\u00f4\u0303 v\u00ea\u0301t th\u01b0\u01a1ng tra\u0300o ma\u0301u khi th\u0103m kha\u0301m \u21d2 \u0110\u1ed9 I theo Gustilo.<\/p>\n – C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a g\u00e3y x\u01b0\u01a1ng:<\/p>\n + Choa\u0301ng ch\u00e2\u0301n th\u01b0\u01a1ng: i\u0301t nghi\u0303 vi\u0300 l\u00e2m sa\u0300ng b\u00ea\u0323nh nh\u00e2n ti\u0309nh, kh\u00f4ng cho\u0301ng m\u0103\u0323t, sinh hi\u00ea\u0323u \u00f4\u0309n, ni\u00eam h\u00f4\u0300ng nha\u0323t, chi \u00e2\u0301m, CRT < 2s va\u0300 chi\u0309 s\u00f4\u0301 s\u00f4\u0301c 0,48 (<1)<\/p>\n + T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh: i\u0301t ngh\u0129 v\u00ec b\u1ec7nh nh\u00e2n c\u00f2n c\u1ea3m gi\u00e1c v\u00f9ng \u1edf c\u1eb3ng tay v\u00e0 b\u00e0n tay, v\u1eadn \u0111\u1ed9ng du\u1ed7i, d\u1ea1ng ng\u00f3n tay ph\u1ea3i b\u00ecnh th\u01b0\u1eddng. V\u1eadn \u0111\u1ed9ng c\u1eb3ng tay ph\u1ea3i h\u1ea1n ch\u1ebf do b\u1ec7nh nh\u00e2n \u0111au nhi\u1ec1u.<\/p>\n + T\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u: i\u0301t ngh\u0129 v\u00ec b\u1ec7nh nh\u00e2n c\u00f3 sinh hi\u1ec7u \u1ed5n, chi \u1ea5m, CRT <2s, b\u00e0n tay v\u00e0 c\u1eb3ng tay v\u1eabn h\u1ed3ng v\u00e0 s\u1edd \u1ea5m \u2013 \u0111\u01b0\u1ee3c t\u01b0\u1edbi m\u00e1u t\u1ed1t, b\u1eaft \u0111\u01b0\u1ee3c m\u1ea1ch quay, tr\u1ee5 \u0111\u1ec1u r\u00f5 2 b\u00ean.<\/p>\n + T\u1eafc m\u1ea1ch m\u00e1u do m\u1ee1: i\u0301t ngh\u0129 do b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng suy h\u00f4 h\u1ea5p, l\u01a1 m\u01a1, tuy nhi\u00ean c\u1ea7n ph\u1ea3i theo d\u00f5i t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n th\u00eam v\u00ec bi\u1ebfn ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u t\u1eeb 12h \u0111\u1ebfn 3 ng\u00e0y sau ch\u1ea5n th\u01b0\u01a1ng.<\/p>\n + Ch\u00e8n \u00e9p khoang: i\u0301t ngh\u0129 do b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u00e1p \u1ee9ng v\u1edbi thu\u1ed1c gi\u1ea3m \u0111au, m\u1ea1ch quay, tr\u1ee5 \u0111\u1ec1u, r\u00f5 2 b\u00ean, \u0111\u1ea7u ng\u00f3n tay h\u1ed3ng, kh\u00f4ng d\u1ecb c\u1ea3m, kh\u00f4ng t\u00ea li\u1ec7t chi.<\/p>\n + R\u00f4\u0301i loa\u0323n dinh d\u01b0\u01a1\u0303ng sau ch\u00e2\u0301n th\u01b0\u01a1ng: i\u0301t nghi\u0303 vi\u0300 b\u00ea\u0323nh nh\u00e2n kh\u00f4ng m\u00e2\u0301t ca\u0309m gia\u0301c, kh\u00f4ng teo c\u01a1, kh\u00f4ng n\u1ed5i b\u00f3ng n\u01b0\u1edbc, ma\u0300u da va\u0300 nhi\u00ea\u0323t \u0111\u00f4\u0323 cu\u0309a chi kh\u00f4ng thay \u0111\u00f4\u0309i so v\u01a1\u0301i b\u00ean co\u0300n la\u0323i, tuy nhi\u00ean b\u00ea\u0323nh nh\u00e2n co\u0301 s\u01b0ng c\u00e2\u0300n theo do\u0303i th\u00eam<\/p>\n \u2013 B\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i (> 60 tu\u1ed5i), c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 lo\u00e3ng x\u01b0\u01a1ng: n\u1eef, l\u1edbn tu\u1ed5i, \u0111\u00e3 m\u00e3n kinh, co\u0301 ti\u00ea\u0300n s\u01b0\u0309 ga\u0303y x\u01b0\u01a1ng va\u0300 hi\u00ea\u0323n ta\u0323i b\u1ecb g\u00e3y x\u01b0\u01a1ng. \u0110\u1ec1 ngh\u1ecb \u0111o lo\u00e3ng x\u01b0\u01a1ng, x\u00e9t nghi\u1ec7m \u0111\u1ecbnh l\u01b0\u1ee3ng 25-OH vitamin D \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n X. \u0110\u00ca\u0300 NGHI\u0323 C\u00c2\u0323N L\u00c2M SA\u0300NG<\/strong><\/p>\n – X quang th\u0103\u0309ng, nghi\u00eang x\u01b0\u01a1ng c\u0103\u0309ng ba\u0300n tay (P) (\u0111\u00e3 c\u00f3)<\/p>\n – \u0110o m\u00e2\u0323t \u0111\u00f4\u0323 x\u01b0\u01a1ng<\/p>\n – \u0110i\u0323nh l\u01b0\u01a1\u0323ng 25-OH vitamin D<\/p>\n – T\u00f4\u0309ng ph\u00e2n ti\u0301ch t\u00ea\u0301 ba\u0300o ma\u0301u ngoa\u0323i vi<\/p>\n – \u0110i\u0323nh nho\u0301m ma\u0301u<\/p>\n – Bilan \u0111\u00f4ng c\u00e2\u0300m ma\u0301u (aPTT, TQ, TL, INR)<\/p>\n – Sinh ho\u0301a ma\u0301u (AST, ALT, glucose, ure, creatinine, bilan m\u01a1\u0303, \u0111i\u00ea\u0323n gia\u0309i \u0111\u00f4\u0300)<\/p>\n – T\u00f4\u0309ng ph\u00e2n ti\u0301ch n\u01b0\u01a1\u0301c ti\u00ea\u0309u<\/p>\n – ECG (\u0111\u00e3 c\u00f3)<\/p>\n – X quang ng\u01b0\u0323c th\u0103\u0309ng<\/p>\n – Si\u00eau \u00e2m Doppler tim<\/p>\n XI. K\u00ca\u0301T QUA\u0309 C\u00c2\u0323N L\u00c2M SA\u0300NG \u0110\u00c3 C\u00d3<\/strong><\/p>\n – C\u00f4ng th\u1ee9c m\u00e1u:<\/p>\n + WBC: 5.34 K\/uL<\/p>\n + NEU%: 60.1%<\/p>\n + RBC: 3.58 M\/uL<\/p>\n + HGB: 11.7 g\/dL<\/p>\n + HCT: 32.8%<\/p>\n + MCV: 91.6 fL<\/p>\n + MCH: 32.7 Pg<\/p>\n + MCHC: 35.6 g\/dL<\/p>\n + RDW: 13%<\/p>\n + PLT: 175 k\/uL<\/p>\n => Chi\u0309 s\u00f4\u0301 ba\u0323ch c\u00e2\u0300u trong gi\u01a1\u0301i ha\u0323n bi\u0300nh th\u01b0\u01a1\u0300ng, kh\u00f4ng thi\u00ea\u0301u ma\u0301u, ti\u00ea\u0309u c\u00e2\u0300u trong gi\u01a1\u0301i ha\u0323n bi\u0300nh th\u01b0\u01a1\u0300ng<\/p>\n – Nho\u0301m ma\u0301u: O+<\/p>\n – \u0110\u00f4ng ma\u0301u:<\/p>\n + aPTT: 31.3 gi\u00e2y<\/p>\n + TQ: 13.1 gi\u00e2y<\/p>\n + TL Prothrombine: 100%<\/p>\n + INR: 1 null<\/p>\n => Ch\u01b0a ghi nh\u00e2\u0323n r\u00f4\u0301i loa\u0323n \u0111\u00f4ng c\u00e2\u0300m ma\u0301u<\/p>\n – Sinh ho\u0301a ma\u0301u:<\/p>\n + Glucose:\u00a0 9.2 mmol\/L<\/p>\n + Ur\u00ea: 9 mmol\/L<\/p>\n + Creatinine: 84 mol\/L<\/p>\n + eGFR: 58.99 ml\/phu\u0301t<\/p>\n + \u0110i\u00ea\u0323n gia\u0309i \u0111\u00f4\u0300: ca\u0301c chi\u0309 s\u00f4\u0301 trong gi\u01a1\u0301i ha\u0323n bi\u0300nh th\u01b0\u01a1\u0300ng<\/p>\n – T\u00f4\u0309ng ph\u00e2n ti\u0301ch n\u01b0\u01a1\u0301c ti\u00ea\u0309u: ca\u0301c chi\u0309 s\u00f4\u0301 trong gi\u01a1\u0301i ha\u0323n bi\u0300nh th\u01b0\u01a1\u0300ng<\/p>\n – X quang x\u01b0\u01a1ng c\u0103\u0309ng tay pha\u0309i<\/p>\n M\u00f4 ta\u0309:<\/p>\n BN n\u01b0\u0303, 88 tu\u1ed5i, h\u1ecd t\u00ean: Phan Thi\u0323 U.<\/p>\n Ng\u00e0y ch\u1ee5p: 30\/11\/2024<\/p>\n Ti\u00eau chu\u1ea9n phim: c\u01b0\u1eddng \u0111\u1ed9 tia v\u1eeba, b\u00ecnh di\u1ec7n nghi\u00eang<\/p>\n T\u1ed5n th\u01b0\u01a1ng:<\/p>\n – X quang x\u01b0\u01a1ng c\u0103\u0309ng tay pha\u0309i sau khi n\u1eafn<\/p>\n M\u00f4 ta\u0309:<\/p>\n BN n\u01b0\u0303, 88 tu\u1ed5i, h\u1ecd t\u00ean: Phan Thi\u0323 U.<\/p>\n Ng\u00e0y ch\u1ee5p: 01\/12\/2024<\/p>\n Ti\u00eau chu\u1ea9n phim: c\u01b0\u1eddng \u0111\u1ed9 tia v\u1eeba, b\u00ecnh di\u1ec7n th\u1eb3ng<\/p>\n T\u1ed5n th\u01b0\u01a1ng:<\/p>\n – X quang ng\u01b0\u0323c th\u0103\u0309ng:<\/p>\n M\u00f4 ta\u0309:<\/p>\n BN n\u01b0\u0303, 88 tu\u1ed5i, h\u1ecd t\u00ean: Phan Thi\u0323 U.<\/p>\n Ng\u00e0y ch\u1ee5p: 01\/12\/2024<\/p>\n Ti\u00eau chu\u1ea9n phim: c\u01b0\u1eddng \u0111\u1ed9 tia v\u1eeba, b\u00ecnh di\u1ec7n th\u0103\u0309ng, t\u01b0 th\u00ea\u0301 sau tr\u01b0\u01a1\u0301c<\/p>\n Bo\u0301ng tim kh\u00f4ng to<\/p>\n V\u00f2m ho\u00e0nh kh\u00f4ng d\u1eb9t, g\u00f3c s\u01b0\u1eddn ho\u00e0nh kh\u00f4ng m\u1edd, kh\u00f4ng th\u1ea5y h\u00ecnh \u1ea3nh tr\u00e0n kh\u00ed, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i hai b\u00ean<\/p>\n Ch\u01b0a ghi nh\u00e2\u0323n t\u00f4\u0309n th\u01b0\u01a1ng nhu m\u00f4 ph\u00f4\u0309i<\/p>\n Kh\u00f4ng th\u00e2\u0301y t\u00f4\u0309n th\u01b0\u01a1ng x\u01b0\u01a1ng va\u0300 m\u00f4 m\u00ea\u0300m<\/p>\n – \u0110o m\u00e2\u0323t \u0111\u00f4\u0323 x\u01b0\u01a1ng b\u0103\u0300ng ph\u01b0\u01a1ng pha\u0301p DEXA:<\/p>\n M\u00f4 ta\u0309: M\u00e2\u0323t \u0111\u00f4\u0323 x\u01b0\u01a1ng vu\u0300ng c\u00f4\u0309 x\u01b0\u01a1ng \u0111u\u0300i: T-score: -4.7. M\u00e2\u0323t \u0111\u00f4\u0323 x\u01b0\u01a1ng vu\u0300ng c\u00f4\u0323t s\u00f4\u0301ng th\u0103\u0301t l\u01b0ng: T-score: -4.3<\/p>\n -> Theo ti\u00eau chu\u00e2\u0309n ch\u00e2\u0309n \u0111oa\u0301n loa\u0303ng x\u01b0\u01a1ng cu\u0309a T\u00f4\u0309 ch\u01b0\u0301c Y t\u00ea\u0301 Th\u00ea\u0301 gi\u01a1\u0301i (WHO) 1994: b\u00ea\u0323nh nh\u00e2n loa\u0303ng x\u01b0\u01a1ng n\u0103\u0323ng (T-score d\u01b0\u01a1\u0301i -2,5 ke\u0300m ti\u00ea\u0300n s\u01b0\u0309 ho\u0103\u0323c hi\u00ea\u0323n ta\u0323i co\u0301 ga\u0303y x\u01b0\u01a1ng)<\/p>\n – ECG<\/p>\n + H\u00e0nh ch\u00ednh: BN n\u01b0\u0303, 88 tu\u1ed5i, h\u1ecd t\u00ean: Phan Thi\u0323 U. ECG \u0111o ng\u00e0y 30\/11\/2024<\/p>\n + Test millivolt: 10 mm\/mV<\/p>\n + T\u1ed1c \u0111\u1ed9 ch\u1ea1y gi\u1ea5y 25mm\/s<\/p>\n + Nh\u1ecbp xoang \u0111\u1ec1u, t\u1ea7n s\u1ed1 83 l\u1ea7n\/ph\u00fat<\/p>\n + Tr\u1ee5c QRS l\u00ea\u0323ch tra\u0301i<\/p>\n – Si\u00eau \u00e2m Doppler tim:<\/p>\n + Ch\u01b0\u0301c n\u0103ng t\u00e2m thu th\u00e2\u0301t tra\u0301i ba\u0309o t\u00f4\u0300n, EF 64%<\/p>\n + H\u01a1\u0309 van \u0111\u00f4\u0323ng ma\u0323ch chu\u0309 1,5\/4, h\u01a1\u0309 van 3 la\u0301 1,5\/4<\/p>\n + Ca\u0301c bu\u00f4\u0300ng tim kh\u00f4ng da\u0303n, tha\u0300nh tim kh\u00f4ng da\u0300y, va\u0301ch li\u00ean nhi\u0303, li\u00ean th\u00e2\u0301t nguy\u00ean ve\u0323n<\/p>\n + Kh\u00f4ng r\u00f4\u0301i loa\u0323n v\u00e2\u0323n \u0111\u00f4\u0323ng vu\u0300ng<\/p>\n + PAPs = 25 mmHg, kh\u00f4ng t\u0103ng a\u0301p l\u01b0\u0323c \u0111\u00f4\u0323ng ma\u0323ch ph\u00f4\u0309i<\/p>\n + Di\u0323ch ma\u0300ng tim (-)<\/p>\n + Kh\u00f4ng huy\u00ea\u0301t kh\u00f4\u0301i trong bu\u00f4\u0300ng tim<\/p>\n XIV. CH\u1ea8N \u0110O\u00c1N X\u00c1C \u0110\u1ecaNH<\/strong><\/p>\n G\u00e3y h\u1edf \u0111\u1ed9 I theo Gustilo \u2153 d\u01b0\u01a1\u0301i th\u00e2n 2 x\u01b0\u01a1ng c\u1eb3ng tay ph\u1ea3i gi\u1edd 1 do tai n\u1ea1n sinh hoa\u0323t hi\u00ea\u0323n ch\u01b0a ghi nh\u1eadn bi\u1ebfn ch\u1ee9ng – Lo\u00e3ng x\u01b0\u01a1ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng\/T\u0103ng huy\u00ea\u0301t a\u0301p \u0111\u00f4\u0323 2 theo ESC\/ESH 2018<\/p>\n XV. \u0110I\u1ec0U TR\u1eca<\/strong><\/p>\n – C\u00f4\u0301 \u0111i\u0323nh x\u01b0\u01a1ng ga\u0303y<\/p>\n – Gia\u0309m \u0111au<\/p>\n – T\u01b0 v\u00e2\u0301n ph\u00e2\u0303u thu\u00e2\u0323t<\/p>\n – D\u01b0\u0323 pho\u0300ng huy\u00ea\u0301t kh\u00f4\u0301i tr\u01b0\u01a1\u0301c, trong va\u0300 sau m\u00f4\u0309<\/p>\n – Kha\u0301ng sinh d\u01b0\u0323 pho\u0300ng tr\u01b0\u01a1\u0301c m\u00f4\u0309<\/p>\n – \u00d4\u0309n \u0111i\u0323nh huy\u00ea\u0301t a\u0301p<\/p>\n – Theo do\u0303i ca\u0301c bi\u00ea\u0301n ch\u01b0\u0301ng<\/p>\n – Bo\u0301 b\u00f4\u0323t va\u0300 m\u01a1\u0309 c\u01b0\u0309a s\u00f4\u0309 c\u0103\u0309ng ba\u0300n tay (P)<\/p>\n – \u0110i\u00ea\u0300u tri\u0323 thu\u00f4\u0301c:<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ceftriaxone 1g 1 l\u1ecd x 2 (TMC)<\/p>\n Paracetamol 500mg 1 vi\u00ean x 3 u\u1ed1ng<\/p>\n Losartan 50mg 1 vi\u00ean (u\u1ed1ng s\u00e1ng)<\/p>\n – \u0110i\u00ea\u0300u tri\u0323 ph\u00e2\u0303u thu\u00e2\u0323t: m\u1ed5 k\u1ebft h\u1ee3p x\u01b0\u01a1ng, d\u00f9ng \u0111inh Rush ho\u1eb7c n\u1eb9p v\u00edt<\/p>\n – D\u01b0\u0323 pho\u0300ng huy\u00ea\u0301t kh\u00f4\u0301i:<\/p>\n \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Enoxaparin 40 mg 1A (TDD)<\/p>\n – Theo do\u0303i ca\u0301c bi\u00ea\u0301n ch\u01b0\u0301ng sau ph\u1eabu thu\u1eadt\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n XVI. TI\u00caN L\u01af\u1ee2NG<\/strong><\/p>\n – G\u1ea7n: Kh\u00e1. Hi\u1ec7n t\u1ea1i sau n\u1eafn b\u1ec7nh nh\u00e2n di\u1ec5n ti\u1ebfn t\u1ed1t, kh\u00f4ng ghi nh\u1eadn c\u00e1c bi\u1ebfn ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng c\u00e1c m\u1ea1ch m\u00e1u, th\u1ea7n kinh<\/p>\n – Xa: trung b\u00ecnh. BN g\u00e3y h\u1edf \u0111\u1ed9 I n\u00ean c\u00f3 nguy c\u01a1 vi\u00eam x\u01b0\u01a1ng, t\u1ee7y x\u01b0\u01a1ng sau n\u00e0y v\u00e0 h\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng trong th\u1eddi gian d\u00e0i c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee9ng kh\u1edbp, teo c\u01a1,\u2026 c\u1ea7n t\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u c\u00f3 ki\u1ec3m so\u00e1t, c\u1ea7n t\u00e1i kh\u00e1m \u0111\u00fang h\u1eb9n k\u1ecbp th\u1eddi ph\u00e1t hi\u1ec7n bi\u1ebfn ch\u1ee9ng<\/p>\n XVII. D\u1ef0 PH\u00d2NG<\/strong><\/p>\n – Theo d\u00f5i di\u1ec5n bi\u1ebfn b\u1ec7nh h\u00e0ng ng\u00e0y, ph\u00f2ng tr\u00e1nh nhi\u1ec5m khu\u1ea9n<\/p>\n – Dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7, h\u1ee3p l\u00fd<\/p>\n – T\u1eadp v\u1eadt l\u00fd tr\u1ecb li\u1ec7u v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng s\u1edbm<\/p>\n – Tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u00e1i kh\u00e1m theo h\u1eb9n.<\/p>","protected":false},"featured_media":4256,"comment_status":"open","ping_status":"open","template":"","tags":[],"chuyen-muc":[188],"class_list":["post-4506","chuyen-de","type-chuyen-de","status-publish","has-post-thumbnail","hentry","chuyen-muc-benh-an-mau"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-de\/4506","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=4506"}],"version-history":[{"count":1,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-de\/4506\/revisions"}],"predecessor-version":[{"id":4507,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-de\/4506\/revisions\/4507"}],"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=4506"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=4506"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=4506"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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