HOI CHNG CO GIAT

BS. NG TH THANH THY

B mn Nhi- HYD TP. HCM

MC TIEU HC TP
1. Ke 5 nhom nguyen nhan co giat.
2. Trnh bay c tieu chuan chan oan co

git do st.
3. Trnh bay c nguyen tac x tr va ieu
tr ban au cua co giat.

II. NGUYEN NHAN

2.1 Chan thng:
Sang chan san khoa.
Chan thng au: xuat huyet nao, tu mau
ngoai mang cng, tu mau di mang cng.
2.2 Nhiem trung:
Viem nao, viem mang nao (vi trung, sieu vi,
lao, nam, mien dch).
L Shigella co bien chng than kinh.
Sot ret ac tinh the nao.
Sot cao co giat n gian

II. NGUYEN NHAN

2.3 Roi loan chuyen hoa:
Ha ng huyet.
Ha canxi/mau hay tang canxi/mau.
Ha natri/mau hay tang natri/mau.
Ha magne/mau.
Xuat huyet nao mang nao muon do thieu vitamin K.
Benh ly le thuoc Pyridoxine.Hoi chng tang ure
huyet cao.

II. NGUYEN NHAN

2.4 Ngo oc:
Ngo oc thuoc: Theophylline, Strychnine,
Parathione, long nao Amphetamine, Nicotine
Hoi chng ngng thuoc ot ngot do lam dung
cac thuoc an than.
2.5 Bat thng he than kinh:
U nao, ken nao, nao ung thuy.
Phnh v d dang mach mau nao.
ong kinh.

III. CHAN OAN

3.1 Benh s:
- Mo ta cac trieu chng xay ra trc cn cogiat
Mo ta cn co giat:
Cac dau hieu tien trieu
Tnh chat cua cn co giat
T the benh nhi,tieu tieu khong t chu.
Tm ?
Trieu chng sau cn co giat, thi gian phuc hoi
lai chc nang bnh thng.

III. CHAN OAN

3.2 Tien s:
Co giat do sot (Sot cao co giat).
Chan thng au. onh kinh.
Benh ly mach mau, tim mach. Ung th.
Roi loan chuyen hoa. Tiep xuc oc chat..
Benh ly nhiem trung. Phat trien tam than
van ong

III. CHAN OAN

3.3 Kham lam sang:
Kham tong quat: chu y
Dau hieu sinh ton: mach nhiet o, nhp th, huyet ap,
tm, SaO2.
Dau hieu ton thng ngoai da lien quan en chan
thng.
Dau hieu thieu mau (tr cn thp)
Benh ly tim mach.
Kham than kinh:
1. Tri giac, dau mang nao.Soi ay mat.
2. Ton thng khu tru sau cn.
3. Ton thng than kinh khu tru sau khi hoi phuc.

Tieu chuan chan oan

co giat do sot
Tre t 6 thang en 5 tuoi
Sot
Cn co giat toan the.
Cn co giat thng ngan trong 10 - 15 phut.
Sau cn co giat khong co dau than kinh nh v.
Khong co dau hieu nhiem trung cua he than
kinh trung ng, roi loan chuyen hoa.
Yeu to gia nh co lien quan en 40% tre b sot
cao co giat

III. CHAN OAN

3.4 Can lam sang:
CTM, KSTSR.
Xet nghiem neu khong ngh sot cao co
giat:
H, dextrostix, ion o, choc do tuy song
Huyet thanh chan oan viem nao HI, Mac
Elisa.
EEG, CT scanner, sieu am nao

IV IEU TR:
4.1 Nguyen tac ieu tr:
Ho tr ho hap: thong ng th, cung cap oxy.
Cat cn co giat.

ieu tr nguyen nhan.

4.2 Ho tr ho hap:
at benh nhan nam nghieng, au nga, mong cao hn
au. at cay e li quan gac neu ang co giat.
Hut am th oxy e SaO2 92-96%.. at noi kh quan
giup th neu that bai vi oxygen hay ngng th.
4.3 Cat cn co giat:
Diazepam 0.2 -0.3 mg/kg/lieu TMC, 0.5 mg/kg/lieu
hau mon. Lieu toi a tre < 5 T: 5 mg, tre > 5T: 10 mg.
lap lai sau 10 phut, toi a 3 lan.
S sinh u tien chon Phenobarbital 15-20 mg/kg
truyen TM/ 30/, neu sau 30 phut con co giat lieu th
hai 10 mg/kg.

4.4 ieu tr nguyen nhan:

Sot: nhanh chong ha sot bang hai phng phap
Phng phap vat ly: lau mat hay tam e ha nhiet..
Phng phap hoa hoc:
Paracetamol: 10-15 mg/kg/lieu uong .
Prodafalgan : 20 mg/kg/lieu TMC.
Suppositore: 10-15mg/kg/lieu nhet hau mon.
ieu tr theo cac nguyen nhan khac.

4.5 Theo doi va tai kham:

Theo doi: tri giac, mach , nhiet o, nhiep

th, SaO2.
Xet ngiem H, ion o neu can.
Tai kham cho cac benh nhan ong kinh,

xuat huyet nao theo doi s phat trien tam

than van ong.

LU O X TR CO GIAT

Thong ng th, hut am

Th oxy, at NKQ giup th.

Thiet lap ng tuyen TM.

Lay mau xet nghiem, dextrostix.

Khong

Ha ng huyet

Co

Diazepam 0.2 mg/kg TMC

Tre ln: Glucose 10% 5 ml/kg

3 lan/301

TMC

SS: Phenobarbital 15-20

SS: Glucose 10% 2 ml/kg TMC

mg/kg TTM 301

Ngng co giat

Co

Khong

Phenytoin 10-15 mg/kgTTM

Phenobarbital 15-20 mg/kg TTM

Diazepam TTM

Ngng co giat

Co

Khong

Thiopental 3-5 mg/kg TMC moi 51.

Vencuronium 0.1-0.2 mg/kg TMC

at NKQ giup th

Chan oan va ieu tr

nguyen nhan

Co giat do sot tai phat

1.
2.
3.

4.
5.

Co giat do sot tai phat: 30% (50% tre< 1T)

Yeu to nguy c tai phat:
Tien s gia nh co ngi b sot co giat.
Co giat lan au trc 18th, ac biet trc 12th
Nhiet o khi co giat < 38 o
Co giat sm, trc 1 gi sau khi sot.
Tre gi ban tru.

CHAN THANH CAM N