MC TIU THC HNH LM SNG BC S A KHOA

MC TIU THC TP LM SNG NI

CHUYN KHOA TIM MCH
I TNG Y2
Cch khm Tim mch Phi Bng
I TNG Y3: 4 tun/tri
1. Bit cch hi, hiu r, c im, c ch gy ra cc triu chng c nng tim mch
2. Khm thc th tim mch, ng phng php, theo trnh t: Nhn - S - G -Nghe.
3. Ting tim + ting thi ti tim:
- Bit cch nhn bit
- Hiu c ch hnh thnh
- Gp trong bnh l no
4. Lm bnh n ng phng php: THA, bnh van tim, suy tim
5. Bit ngh cn lm sng phc v cho chn on.
I TNG Y4: 2,5 tun/tri
1. n li chng trnh Y3
2. Trnh by bnh n vi yu cu bit cch t vn v t cc xt nghm cn lm sng i vi
cc bnh l sau:
- Bnh THA
- Bnh mch vnh
- Bnh van tim hu thp
- Bnh vim ni tm mc bn cp do vi khun
3. Bit phn tch in tm theo tng bc vi cc bt thng sau:
- Ln nh & dy tht
- Nhi mu c tim, thiu mu c tim
- Ngoi tm thu nh, ngoi tm thu tht, rung nh
- Block nhnh phi, block nhnh tri, block AV
4. Bit cch phn tch 1 phim Xquang tim phi trong bnh l tim mch.
5. Xem c t nht mt ln hnh nh siu m tim thc t ca bnh hp van 2 l.
I TNG Y6: 2 tun /tri
A. n li chng trnh Y3, Y4
B. c c xt nghim cn lm sng
1. Xquang tim:
- K thut
- nh v ph tng
- Tun hon phi
- Cc cung tim
2. ECG:
- c cc ri lon nhp thng gp (ngoi tm thu nh, nhanh nh, cung nh, rung nh, ngoi tm thu
tht)
- Mt s ri lon nhp cp cu (nhanh tht, cung tht, rung tht)

C. Chn on v iu tr
Bit chn on, t xt nghim v iu tr cc bnh:
1. Suy tim: nguyn nhn, yu t thc y
2. Suy mch vnh: cn au tht ngc, nhi mu c tim cp.
3. Tng huyt p.
4. Bnh van tim
5. Vim ni tm mc nhim trng
6. Cp cu:
- Ph phi cp
- Chong
CHUYN KHOA TIU HA - GAN MT
I TNG Y2
Cch khm Tim mch Phi Bng
I TNG Y3: 4 tun/tri
1. Bit cch khai thc cc triu chng c nng thng gp v Tiu ho-Gan mt
2. Bit cch tip cn bnh nhn theo cc triu chng v hi chng
3. Bit cch khm bng theo cc k nng: Nhn, S, G, Nghe
4. Bit cch lm bnh n, t vn theo hi chng, ngh cn lm sng phc v cho chn on:
Vim lot d dy t trng, Vim ty cp, bng bng, gan to, hi chng tng p lc tnh mch ca,
vim gan, x gan, p xe gan, xut huyt tiu ha.
I TNG Y4: 2,5 tun/tri
A. n li chng trnh Y3
B. Lm v trnh by bnh n lin quan n ch sau
1. Tiu ha:
- Xut huyt tiu ha
- Cn au bng cp
- Vim i trng mn
- Vim ty cp
2. Gan mt:
- X gan (nguyn nhn v bin chng).
- Vim gan
- p xe gan/sn l gan
C. Phn tch c cc kt qu
1. Xt nghim chc nng gan
2. Xt nghim dch bng
3. Huyt thanh chn on vim gan siu vi
4. Xquang bng khng chun b trong cn au bng cp
I TNG Y6: 2 tun /tri
A. n li chng trnh Y3, Y4
B. c v gii thch cc kt qu cn lm sng
1. Xquang: d dy t trng khung i trng

2. Xt nghim chc nng gan

3. Cc xt nghim ch dn nhim siu vi vim gan
C. Nm c cc bc tin hnh mt s th thut trong cp cu tiu ha gan mt
1. t tube levine
2. t sonde Blakemore
D. Chn on, ngh xt nghim v iu tr mt s bnh thng gp v THGM
1. Lot d dy t trng
2. Xut huyt tiu ha do lot d dy t trng, v dn tnh mch ca
3. K d dy
4. Lao mng bng
5. X gan
6. p xe gan
7. Vim ty cp si mt nhim trng ng mt
8. Vim i trng mn
9. Hn m gan
CHUYN KHOA H HP
I TNG Y2
Cch khm Tim mch Phi Bng
I TNG Y3: 4 tun/tri
1. Bit cch hi triu chng c nng h hp, hiu c im c ch cc triu chng
- Kh th
- Ho ra mu
- Tm ti
- Ho
- au ngc
- Khc m
- Kh kh.
2. Bit cch khm thc th h hp ng phng php: Nhn S G Nghe.
3. Phn bit cc ran bnh thng- bnh l, hiu c c ch gy ra ting ran v bnh l thng gp
v cc hi chng h hp
4. Lm bnh n h hp:
- Hen
- Vim phi
- COPD
- Trn dch mng phi
I TNG Y4: 2,5 tun/tri
A. n li chng trnh Y3
B. Chn on, t xt nghim cc bnh
1. Vim phi
2. p xe phi

3. Vim ph qun mn cp, hen ph qun.

4. Trn dch mng phi, trn kh mng phi
5. Ho ra mu
6. Suy h hp cp, mn
C. c v gii thch cc kt qu cn lm sng
1. Chc nng h hp, kh mu ng mch
2. Xquang phi
3. ECG tm ph mn
4. Dch mng phi
I TNG Y6: 2 tun/tri
A. n li chng trnh Y3, Y4
B. Lm c 1 bnh n ni khoa v h hp
t vn chn on s b - t xt nghim - chn on phn bit v iu tr cc bnh:
1. Vim phi
2. Abcs phi.
3. Vim ph qun mn cp, hen ph qun.
4. Trn dch mng phi, trn kh mng phi..
5. Suy h hp mn.
6. Cp cu:
- Ho ra mu
- Suy h hp cp
CHUYN KHOA THN
I TNG Y2
Cch khm Tim Phi Bng
I TNG Y3: 4 tun/tri
1. Tip cn v cch khm mt bnh nhn bnh thn
2. Phn tch xt nghim nc tiu
3. Cc hi chng lm sng trong thn hc
4. Hi chng thn h
5. Vim vi cu thn cp
I TNG Y4: 2,5 tun/tri
A. n li v nm vng nhng phn hc qua ca nm Y3
B. Chn on c cc bnh l sau
1. Hi chng thn h
2. Suy thn cp
3. Suy thn mn
4. Nhim trng ng tiu
Mi bnh l trnh c t nht 1 bnh n
C. Th thut
Xem c t nht 1 ln sinh thit thn

I TNG Y6: 2 tun/tri

A. n li chng trnh Y3, Y4
B. Chn on, chn on phn bit, t xt nghim v iu tr cc bnh
1. Hi chng suy thn mn
2. Hi chng suy thn cp
3. Hi chng thn h
4. Vim vi cu thn mn
5. Vim vi cu thn cp v tin trin nhanh
6. Vim thn lupus "
[Nhng sch nn c khi hc ng Y]
cc bn tham kho bi vit sau ca thy Trn Quang Thng:
Theo quan st ca ti, th bn nn bt u t nhng sch sau:
L lun: bn chc chn phi c mt quyn Kinh Dch ca Ng Tt T. mt cun Ni Kinh. Hin nay, Vit Nam c nhiu bn dch
nh ca cc c Nguyn T Siu, Nguyn Trung Ha, Nguyn ng Di, M Kim Minh, Hunh Minh c, i Hc y H Ni. Nhng
ti thy tt c nhng sch mi th ton b l so nu sao chp, ch c cc sch ca cc c nh ti ni trn l do tc gi dch
thut (100% cc ti liu mi u l sao chp v v gi tr). Trong tt c cc sch trn, c o nht, gi tr nht l phi ni n tc
phm "c V Hiu Bit Ni Kinh ng Y" ca c Nguyn Trung Ha (hnh nh in nm 1982 th phi), cun ny bn cn phi c.
Cc sch v Thng Hn Lun, n Bnh Hc th bn nn c sch ca c Nguyn T Siu.
Sch gio trnh th bn nn c cun: Cm Nang Chn Tr ng Y ca c L Vn Su, v b "L Php Phng Dc" ca Lng
Y Trn Khit (ngoi ra, L/Y Trn Khit cng cn mt tc phm khng km phn gi tr, l "Bi Ging Tm c - c Lun c
Tr".
Mt b sch khng th thiu trong nh l b 4 quyn ca C Trn Vn Qung dch, gm: Y Hc Tam T Kinh, Tn H Mch Hc,
Dc Tnh Ca Qut T Bch V Din Ca, Thang u Ca Quyt. C Qung l mt thy thuc tnh tnh n hu, tr tu hn ngi,
kin thc vng chc. Bn tnh ca c l khng ni tha, khng ni thiu, khng ni v ngha, tm lng qung i. C l ngi vn
hay ch tt, sng tc vn th mch lc trong sng. V vy sch ca c rt c gi tr cho nhng ngi theo hc ng y.
Sch v chm cu th bn nn tm sch ca Lng y L Qu Ngu (Cc sch c L Qu Ngu dch u c gi tr thc t, vit
ngi c hc, ch khng phi vit ly thnh tch. c sch ca ng mi thy ng l mt Thy gio, mt thy thuc lao ng tr
c chn chnh. Cun sch v Nn Kinh ca ng dch cng c gi tr rt cao cho cc thy thuc chuyn mn).
Sch phng thang th bn ch cn mt cun n gin, l cun "250 Bi Thuc ng Y C Truyn" ca Gio S Trn Vn K.
Hin ti cng ch c nhng sch mang tnh s phm v c gi tr. Cn nhng sch no m c cc tiu i loi nh: Gia
Truyn, Thn Phng, B Truyn... th bn ng quan tm, cng ng c d ch mt ch, n s lm bn mt nh hng v d
mt cn bn.
Nh ti tng tm s. Lc b ti b p hc cc sch Thang u Ca Quyt, y Hc Tam T Kinh. V sau, khi c thc, th ti
bt u t Kinh Dch, Ni Kinh, Nn Kinh, Thng Hn Lun, n Bnh iu Bin, v c bit hc k sch Y Tng Kim Gim. Cc
sch lm sng m gia nh thng dng l Phng Th Cm Nang, Vn Bnh Hi Xun, Cnh Nhc Ton Th, Y Hc Nhp Mn,
Th Th bo Nguyn. (v sau cn rt nhiu sch theo thi gian ti kt tp thm. Phng thang th dng: B Cp Thin Kim Yu
Phng, B Cp Thin Kim Dc Phng. Y Phng Kho, Y Phng Lun, Y Phng Tp Gii, Thi Bnh Hu Dn Ha T Cc
Phng. Chm cu th dng ch yu vn l Chm Cu i Thnh, Chm Cu Gip t Kinh. V cn rt nhiu sch na c
ng dng. Ti ni phn tn sch di dng nh vy, l cho cc bn hiu rng khng c ci gi l gia truyn nu khng c cc
sch kinh in. Gia truyn khng c g l gh gm, khng c g l b mt, chng qua l i ng th t hc thut, c kinh nghim p
dng c phng v gia gim. Ngi bc vo hc ng y nghe n gia truyn l cht d, v s mnh khng c cc b kp gia
truyn th s khng i c con ng ng y. Bn c yn tm i ng th t, vn dng ng kinh nghim ngi xa, ch sng
to khi mnh c s kin thc chuyn ngnh.
Chc bn gt hi c nhiu thnh cng trn con ng bn chn!
Trn Quang Thng.