Cu 1: C ch sinh bnh v triu chng

ca Hi Chng Ure mu cao

C ch sinh bnh:
- Ri lon gy ra do s tch t cc cht
thi, v c cht trong c th, m quan
trng nht l cc sn phm bin dng
ca protein.
- Hu qu ca s mt dn cc chc
nng khc ca thn nh iu ha thng
bng ni mi, nc in gii, ni tit t.
- Hu qu ca phn ng vim tin trin
gy nh hng ln mch mu v dinh
dng
Triu chng
1.Ri lan nc in gii Thng
bng kim toan

RL CH Na: g u gim ti hp thu

Na, tng bi tit di tc dng
ANP, v sau tng gi mui, nc, gy
THA, ph.
RL bi tit nc: mt kh nng c
c v pha lang nc tiu.
RL CH K+: tng khi STM g cui hoc
km nguyn nhn khc.
Toan chuyn ha: do lng acid bi
tit b khng ch.
RLCH Ca-P:Tng P, gim Ca, cng
tuyn cn gip th pht.
Tn thng xng do mt khang
cht
Tn thng do lng ng phc hp
CaP ngai xng nh ti m mm,
ti khp, m quanh khp, c tim,
mt, phi v mch mu

2. Ri lan v tim mch:

THA v dy tht tri

Suy tim sung huyt
Ph phi cp
Bnh mch mu: mch vnh, MM
no, MM ngai bin
Vim mng ngai tim

3. Ri lan v huyt hc:

Thiu mu:
- Thiu mu ng sc ng bo do
thiu Eythropoietin
- Khc: thiu Fe do km hp thu,
vim cp v mn gy RL s dng
Fe, cng tuyn cn gip nng

gy x ty, tn huyt, thiu Folic

v Vit B12
Ri lan ng cm mu: ko di
thi gian mu ng, gim hat tnh
yu t III TC, gim tp trung TC v
gim prothrombin. D XH, bm mu
trn da, chy mu vt thng ko
di.
Ri lan chc nng BC: D nhim
trng

4. Ri lan tiu ha v dinh dng:

Hi th c mi khai v c v kim lai
trong ming.
Vim let ng tiu ha gy ra au
bng, bun nn, nn, v xut huyt
tiu ha.
Chn n, nc cc

Suy dinh dng

5. Ri lan thn kinh c

TKT: gim tr nh, km tp trung, RL

gic ng. Sau , nc cc, vp b, au
xon vn c. Nng hn: rung vy,
clonus c, co git v hn m.
TKNB: TK cm gic d tn thng hn
TK vn ng, chi di nhiu hn chi
trn, phn ngn chi nhiu hn phn gc
(Hi chng chn khng yn).
V sau, yu c, mt phn x gn c, lit
ngai bin hoc lit mm t chi.

6. Ri lan ni tit v chuyn ha

Bn T: H n nh khi suy thn nng

do tng Insulin trong mu
Gim Estrogen gy RL kinh nguyt,
Gim kh nng th thai v d sy thai
Gim testosterone gy RL tnh dc v
gim thiu tinh trng

7. Tn thng da

Da vng xanh do thiu mu

XH da nim, mng bm trn da do RL
ng cm mu
Da tng sc t
Nga
Da x tin trin do thn

Cu 2: Chn on v cc yu t nguy
c suy thn mn:
Chn on
Da vo Creatinine HT nn tng trc
y

Tm cc bng chng khc ca suy thn

mn
Tr rng
Bnh thn do ri lon chuyn ha
khong cht v xng mn tnh
Hai thn teo nh trn siu m
Sinh thit thn
Nguy c suy thn mn
1. Gim th tch mu lu thng, suy
tim sung huyt
2. Thay i HA nh tng hoc h HA
(thng do thuc h p)
3. Nhim trng
4. Tc nghn ng tiu

5.
6.
7.
8.
9.

Dng thuc c cho thn

Bin chng mch mu thn
Tui
Gii tnh: nam
Chng tc: da en i tho ng
10. Yu t di truyn v chc nng
thn nn tng lc pht hin bnh
11. Mc tiu m
12. Bnh thn cn nguyn: i tho
ng, bnh cu thn
13. Mc lan ta ca tn thng
ng thn m k trn STT
14. Tng Lipid mu
15. Ht thuc l

Cu 3: Bnh suy thn mn theo KDOQI v KDIGO?

nhng bt thng v cu trc v chc nng thn xy ra trong t nht 3 thng, biu
hin:
1. Tn thng thn km hoc khng km gim lc cu thn (LCT)
- Bt thng bnh hc m thn (sinh thit thn)
- Du chng tn thng thn
+ Bt thng nc tiu (tiu m)
+ Bt thng sinh ha mu ( HC ng thn
+ Bt thng v hnh nh hc
- Bnh nhn ghp thn (T)
2. Gim LCT < 60ml/ph/1,73 m2 da ko di trn 3 thng km hoc khng km tn
thng thn
TN THNG THN CP khi c t nht mt trong cc tiu chun sau:
- Tng SCr 0.3mg/dl trong vng 48h
- Tng SCr 1.5 ln so vi baseline cch 7 ngy
- Th tch nc tiu < 0.5ml/kg/h trong 6h
1.
Cu 4 Xt nghim tm sot bnh thn mn
- Creatinine Huyt thanh ( c on lc cu thn hoc thanh lc
Creatinine )
- Tm Albumine niu ( mu nc tiu bt k ) t l albumine niu/ Creatinine
niu
- Cn lng nc tiu hoc XN giy nhng : hng cu , bch cu
- Siu m kha st thn v h niu
2.
Cng thc Cockcroft Gault
(140-age)xbodymass(kg)
ClearanceCreatinine=
(x0,85)(ml/ ph)
72xSCr (mg%)

Chn on sm bnh thn mn :

- khng ch bnh nhn n khm v bn ch n khm khi bnh tin trin

- cn tm sot bnh nhn trn nhng i tng c nguy c cao b bnh thn
chn on sm bnh thn
- tm sao cac i tng nguy c cao : T, THA , Tin s gia nh

Cu 5: Suy thn cp, tn thng thn cp l g?

1.Suy thn cp (acute renal failure, ARF)
Suy gim cp tnh lc cu thn trong vi gi n vi ngy v c kh nng hi
phc.
Suy thn cp c th din ra trn thn trc bnh thng hoc trn thn c bnh
thn mn
2.Tn thng thn cp (acute kidney Injury, AKI )
L hi chng vi nhiu mc trm trng thay i, din tin qua nhiu giai an,
c trng bng gim cp tnh lc cu thn (tng BUN, cratinine HT
trong vi gi n vi ngy) km hoc khng km gim th tch nc tiu
Hi chng c trng:

Gim nhanh lc cu thn trong vi gi n vi ngy.

Dn n ng nhng sn phm bi tit c ngun gc nit nh Ur v
Creatinin
Lm sng din tin qua nhiu giai on khc nhau v thi gian v mc
nng, t khi u, suy thn tin trin v hi phc.
Hi phc chc nng ty thuc vo cn nguyn, bnh thn c trc v iu tr.
1.
Cu 6 Cc tn thng thn cp
2.
Tn thng thn cp :
a. Tn thng thn cp trc thn
Gim th tch ni mch
Gim cung lng tim
Dn mch ton thn , co mch thn
Thuc nh hng ln c ch t iu ha ti cu thn ( ACEi , ARB II, Nsaid)
b. Tn thng thn cp sau thn :
Tc nghn do tinh th ti ng thn : acyclovir , indinavir, sulfonamide , methotrexat
,triamteren vitaminc C liu cao , quanifenesin , ephedrine
X ha sau phc mc : methysergide
c. Tn thng thn cp ti thn ( suy thn cp ti thn )
Tc ng tnh mch thn
Bnh cu thn ( vim ,huyt khi )
Vim ng thn m k cp
Hoi t ng thn cp : 4 giai on khi u tn thng lan rng duy tr hi ph
Do thiu mu cc b ko di ( chong )
Do c cht ( ni sinh , ngoi sinh )

 Do thuc : bleomycin, cisplatin ( thuc tr ung th ) ; Clopidogrel , ticlopidine ( thuc

chng huyt khi ) ; thuc nga thai c estrogen; quininel; cocain ; cyclosporine A ,
Tacrolimus
Tn thng thn cp do thuc :
Hoi t ng thn cp : aminoglycoside , amphotericine B, cephalosporine , cisplatin
Vim ng thn m k cp :
Khng sinh : penicilln, Rifampin , vancomycin , Ciprofloxacine NSAid
Li tiu : Thiazide , Furosemide , Triamterene

I THO NG
1. nh ngha

i tho ng l mt nhm cc bnh l chuyn ha c trng bi tng

glucose mu do khim khuyt tit insuline, khim khuyt hot ng insuline,
hoc c hai.
Tng glucose mu mn tnh trong T s gy tn thng, ri lon chc nng
hay suy nhiu c quan, c bit l mt, thn, thn kinh, tim v mch mu
2. C ch bnh sinh
Type 1:
Qu trnh t min dch ph hy t bo beta ty gim tit insulin tng
ng huyt
90% T tp 1 mi chn on c anti-GAD (+), khng th khng tiu o ty
anti-ICA (+)
Thng gp tr em v thanh nin
Type 2:
Gim tit insulin t tuyn ty do ri lon t bo beta ca tuyn ty
khng insulin: insulin gim kh nng c ch qu trnh to ng t gan v
kh nng bt gi glucose c
Nguy c ca bnh TD Type
Mp ph, mp ph dng nam
Tng huyt p
Ri lon chuyn ha lipid
Gia nh c ngi h hng i th 1 b T tp 2
Ph n sanh con > 4kg, a i, hay b sy thai
Tin cn T thai k
Ri lon dung np glucose, ri lon ng huyt i
t vn ng, n nhiu thc n nhiu nng lng
3. Chn on
ng huyt lc i 126 mg/dL x 2 ln
ng huyt bt k 200 mg/dL + triu chng i tho ng ( n nhiu
,ung nhiu ,tiu nhiu, st cn nhiu )
ng huyt 2 gi sau khi ung 75g glucose 200 mg/dL ( tiu chun vng )
HbA1c 6.5%

Bin chng
Bin chng cp :
Hn m tng ng huyt :
Hn m do nhim acid ceton
Hn m do tng p lc thm thu
Hn m do h ng huyt ( do iu tr thuc h ng huyt )
Bin chng mn
Bin chng mch mu ln
Bnh mch vnh : bnh c tim thiu mu cc b ,nhi mu c tim
Tai bin mch mu no : nhi mu no
X va ng mch ngoi bin
Bin chng mch mu nh
Bnh l mch mu vng mc: hu qu lm gim th lc, c th
dn n m
Bnh l cu thn : tiu albumin vi lng or i lng
Bin chng thn kinh :
vim a dy thn kinh ngoi bin
vim n dy thn kinh : c tay rt, bn chn rt hoc lit dy
thn kinh III, IV, VI
Bin chng thn kinh t ch ( hay tk thc vt )
Tim mch : h huyt p t th, lonh nhp, t t
Tiu ha : lit d dy, tiu chy or tao bn
H niu sinh dng : gy ra lit dng
Bn chn i tho ng d b l lot :
Nhim trng : ng huyt kim sot km => gim sc khng
ca co th nn d b nhim trng
5. Nguyn tc iu tr
Gim triu chng do tng H
Kim sot H gn mc bnh thng ngn BC cp v mn tnh
Ci thin cht lng sng cho bnh nhn
4.

TC DNG PH CA THUC
TRN THN
Gim ti mu thn gy suy thn chc nng : NSAID, IEC, ARA2,ciclosporine,
tacrolimus
Tc dng c trc tip ln ng thn : Aminoside, thuc cn quan ,
cisplatine,tacrolimus
Tc dng c gin tip ln ng thn :
do ly gii c vn : Fibrates , statines
do tn huyt : quinine , Rifampicine
do lng ng tinh th : Indinavir , Sulfamide, Methotrexate
Tc dng c trn ng thn m k : lithium , tenofovir
C ch min dch d ng ( hi chng ng thn cp ) : NSAID , betalactam ,
Rifampicine, Cimetidine, Ciprofloxacine, li tiu, allopurinol
C ch min dch ( tn thng cu thn ) : AINS, D-penicillamine , interferon, mui
vng
Huyt khi vi mch : Ciclosporine , mitomycine
X ha sau phc mc : ergotamine, c ch beta
TRN H TO MU
1.Thiu mu i nguyn bo
6.Tng bch cu i toan
2.Tn huyt
7. Gim s lng tiu cu
3. Suy ty
8. Gim chc nng tiu cu
4.Gim bch cu
9. Ri lon ng mu
5.Gim bch cu ht
10. Hch to
TRN PHI
1.Bnh phi m k : vim ph nang or
4.Co tht ph qun : Adenosine ,aspirin
x phi mn tnh : Amiodaron, vng,
v NSAid , c ch beta, sotalol
5.SLE ( lupus) do thuc :
Nitrofurantoin, methotrexate , Nsaid
2.Ph phi khng do tim : amiodaron,
Hydralazine , isoniazide ,
aspirin v NSAIDs, an thy gy nghin,
procainamide , quinidine
6.Vim tiu ph qun tc nghn :
thuc iu tr sn khoa ( terbutaline ,
vng , penicillamine
isoxuprine, ritodrine)
7.Xut huyt ph nang : Cocain ,
3.Gim thng kh ph nang :
penicillamine
Aminosides , polymixin , an thn gy
nghin

8.Thm nhim phi tng Eosinophil : KS

9.Vim ph nang: Bleomycin: thuc ha
betalactam, sulfamide , quinolone,
tr
Amiodarone: tim mch
tetra
Tc dng ph ca thuc trn tim mch
a. chc nng co bp ca tim : -blocker c ch s co bp ca tim gim chc
nng tng mu , c bit bnh nhn suy tim
b. chc nng to nhp : adrenalin lm tng trng lc giao cm tng nhp tim .
Verapamil c ch nt xoang chm nhp tim
c. chc nng dn truyn : Amiodarone block nt nh tht gy gim tn s xoang
d. Chc nng vn mch ca mch mu : Nitrate gy dn mch, Thuc gy co
mch ngoi bin: c ch
e. Sinh lon nhp: QT ko di xon nh: thuc nhm Ia (quinidin, procainamid,
disopyramide), thuc nhm III (dofetilide, ibutilide, sotalol) Nhanh tht:
dofetilid, Ngoi tm thu tht: digoxin
f.
VIM GAN DO RU
Biu hin lm sng :
Cn lm sng :
Gan nhim m : khng c c triu
Gan nhim m
chng , ( ) gan to
chc nng gan bnh thng hoc
Vim gan do ru :
transaminase tng nh, AST > ALT
khng triu chng
Vim gan do ru
nh : st , au bng ,bing n ,
transaminase tng r , AST > ALT
bun nn, nn, st cn, vng da
ALP tng , Bilirubin kt hp tng
nng : suy gan nhanh, bnh no
Thi gian PT/INR ko di
gan, bng bng, xut huyt, t
X gan do ru : bt thng chc nng
vong
gan
X gan do ru

VIM PH QUN

nh ngha
Vim kh ph qun, thng di 3 tun di 8 tun, t gii hn v lnh, hi phc
chc nng hon ton
Nguyn nhn 16-29% trng hp
metapneumovirus
- Cc siu vi h hp thng gp: 80%
Vi trng (trong khong 20%):
+ Influenza v parainfluenza virus
+ Mycoplasma: gy ho ko di
+ Adenovirus
+ Chlamydia: gy khn ting
+ Rhinovirus
+ Pertussis: gy ho g => dch
+ Coronavirus
Him gp Haemophilus v
+ Khc:
si,
RSV,
human
Pneumococci

Triu chng vim ph qun

C nng:
+ Triu chng ging vim ng h hp
trn
+ Ho, thng nng, nhiu, ko di hn,

trung bnh 1-3 tun

+ Ho khan ri m trong, nhy sau vi
gi n vi ngy; sau m nhiu

hn trng, nhy hoc nhy m

+ Kh kh, c bit khi ho hoc lm
FVC; him khi km kh th
+ Triu chng ton thn: au c, mt
mi
+ Thng ch nng nh hoc

n lnh; st 38,3 n 38,8

C (101-102 F) trong 3 ti 5
ngy. St nu c xy ra
phi coi chng cm hoc
vim phi

Thc th: Khm c th pht hin

+ Ran m, to ht: m

Khng c
+ hiu
Khng
+ nhy

+ Ran ngy: ri rc
Cm: t l mc rt cao/c tr liu c hiu
+ Mycoplasma pneumoniae: Ho ko di 4 6 tun, c th km au hng
+ Chlamydia pneumoniae: Khn ting, st nh, ho ko di
Ho g Pertussis: d gp v t vong khi cha c vaccin
Cn lm sng ca bnh vim ph qun cp
- Thng BC khng tng, c th gim BC trung tnh v/hoc tng lympho.
- CRP thng thp. X quang bnh thng
- Chc nng h hp:
+ 40% VPQ cp c FEV1 80% d on.
+ Phn ng tnh ph qun vn tng trong vng 5 tun sau t vim ph qun
- Thng khng cn X quang, ch chp khi:
+ Nguy c cao vim phi: trn 75 tui, nghin ru, tng b vim phi trong nm
qua
+ Khng in hnh: ho trn 3 tun, khng c triu chng ng h hp trn, bnh
nhn nng
+ Nghi ng vim phi khi khm: mch >100/pht, nhp th >24, hoc nhit
>39oC, nghe ran n phi
+ Dch t nghi cm, SARS
Chn on vim ph qun cp
Chn on xc nh:
1. Ho m cp (< 3 tun). 2.Khng bnh phi trc 3. Khng bt thng khi
khm gi vim phi
=> in hnh th khng cn o oxy, chc nng h hp, th m hoc chp X quang
phi
Chn on phn bit:
- Ho cp:
Vim phi st cao >
+ Nhim siu vi h hp trn
+ 39oC
+ Cc trng hp vim hng in hnh
+ Hen

+ Vim xoang
- Cc loi vim ph qun khc
+ Vim ph qun cp kch thch do tip xc vi ha cht, khi bi c hi...
+ t bng pht vim ph qun mn hoc t bng pht bnh phi tc nghn
mn tnh
+ Vim ph qun mn: ho hu ht cc ngy trong thng trn 3 thng/nm trong
2 nm lin tip

VIM PHI

L bnh vim cp tnh hay mn tnh ca nhu m phi do tc nhn vi sinh vt.
Vim phi cng ng l bnh nhn b mc bnh ngoi cng ng.
Vim phi bnh vin l bnh nhn b mc bnh vim phi khi nm vin, c s
chm sc y t, vin dng lo.
Nguyn nhn
- Vi khun: Streptococcus pneumoniae (2/3 trng hp), Haemophilus influenzae,
Moxarella catarrhalis
Staphylococcus aureus, Vi khun gram m
- Virus: Influenza virus (virus cm), Respiratory syncial virus (virus h hp hp
bo), Adenovirus
Parainfluenza virus (virus cm), SARS va cm g
VIM PHI IN HNH
VIM PHI KHNG IN HNH
St cao lnh run, au ngc, Ho khc m St nh, Triu chng c quan khc: ri
m, Hi chng ng c, Ran n,
lon tiu ha, au c, au khp Xq: tn
Xquang: thm nhim, tn thng thy.
thng m k
Tc nhn:
Tc nhn: Leigionella pneumophila
Streptococus pneumoniae Heamophilus
Mycoplasma pneumoniae
influenzae
Chlamydia pneumoniae
Moraxella catarrhalis
TRN DCH MNG PHI
Bnh thng khoang mng phi c t dch, khong 15-20ml gip 2 l mng phi
trt ln nhau
Trn dch mng phi khi c s hin din dch bt thng trong khoang mng phi
- Dch thm:
Do gim p lc keo (x gan, HCTH)
Do tng p lc thy tnh ( suy tim)
Nguyn nhn: X gan, Hi chng thn h, Suy tim, Suy dinh dng
- Dch tit: l do tn thng mng phi lm tng tnh thm v gim dn lu bch
huyt (vim nhim, khi u xm ln)
Nguyn nhn: Vim nhim: VT, virus, KST
Bnh l c tnh: ung th phi hay ung th di cn n mng phi
Bnh t min: lupus, vim a khp dng thp
Bnh tiu ha: thng thc qun, vim ty cp
Thuyn tc phi

TRIU CHNG LM SNG

Ho khan
Kh th 2 th khi TDMP lng nhiu
au ngc kiu mng phi

Triu chng ca bnh l gc

Khm thy NT nhanh, co ko c h hp ph
Lng ngc cng phng, khong gian sn dn rng, km di ng hn
Hi chng 3 gim:
RRPN gim
Rung
thanh gim
G c
VIM GAN SIU VI

a s bnh
tin thun li
thng, ch mt
c bin chng:
1. Vim
gan
suy gan cp:
cao
2. Vim
gan
tnh:
- Xy ra trong
B, C v D.
- Triu chng
l
suy
men
gan
di sau 6
- C th din
gan, ung th

nhn c din
trong vng 6
s trng hp
siu vi ti cp,
t l t vong rt
siu

vi

mn

vim gan siu vi

lm sng (nht
nhc),
tng
vn tn ti ko
thng.
tin thnh x
gan.

St xut huyt Dengeu/ C ch sinh bnh

Nhim trng cp so siu vi Dengue, c th xy bin chng nng nh sc do thot
huyt tng, xut huyt nng v suy tng t vong nu khng c iu tr thch
hp v kp thi.
Tng tnh thm thnh mch:
Thot huyt tng lm mu c c li v lm gim lu lng tun hon sc nu
lng huyt tng b mt > 20%.
Ri lon ng mu: do 3 nguyn nhn khc nhau

- Thnh mch d v
- Gim s lng v cht lng tiu cu
- Gim yu t ng mu huyt tng.
Biu hin lm sng
A. Giai on st (2 3 ngy u)
- St khi pht t ngt, st cao lin tc
- Mt mi, n km
- au nhc: nhc u, au c, au khp
- Biu hin h hp (s mi, ho): t gp
- Biu hin tiu ha: i, bun i, au bng, tiu chy
- Xut huyt da nim: t gp
- Pht ban
- Bch cu v tiu cu c xu hng gim dn
B. Giai on nguy him (ngy 3 - 7)
- Biu hin lm sng nh giai on st nhng c nhng biu hin c trng hn
+ Biu hin LS ca thot huyt tng: gan to au, DTHC tng, trn dch a mng
(siu m, X quang)
+ Xut huyt da nim mc: t ban im, chy mu chn rng, chy mu mi, i
ra mu, tiu phn en, ra huyt m o
- Bnh tr nng khi bnh nhn ht st (nhit h t ngt), thng ngy 4 - 6
Bnh nhn c t nht mt trong cc du hiu cnh bo sau:
Li b, bt rt
- au bng
- Nn i lin tc
Gan to >2 cm
XN: tng HCT cng vi gim tiu
- C dch trn lm sng
cu nhanh
- Xut huyt nim mc
iu tr
SXH Dengue c v khng c du hiu cnh bo:
- Ch iu tr triu chng
- B dch bng ng ung (ORS, nc tri cy, nc chn)
- Truyn dch (Lactat Ringer, NaCl) khi i ma nhiu, mt nc, c c mu nhiu.
- H st: lau mt, dng acetaminophen (paracetamol), khng dng salicylate v
nguy c xut huyt
- Cn theo di st pht hin sc sm (ch ngy 4 6 ca bnh).

ST RT
A. 10 th nng ca St rt :
1. St rt th no
2.
suy thn cp
3.
vng da v thay i chc nng
gan
4.
thiu mu

5.
6.
7.
8.
9.

biu hin ng tiu ha

biu hin xut huyt
ph phi
sc
tiu huyt sc t

10. h ng huyt
B. PP test nhanh st rt
Pht mu ngoi bin, nhum Giemsa
git dy : tm s hin din ca k sinh trng st rt
git mng : nh danh loi k sinh trng
C. Phng nga st rt
Mefloquine 250 mg mi tun ( 1 vin ) . Nn bt u 1 2 tun trc khi vo
vng st rt ,v tip tc 6 tun sau khi ra khi vng
Ring ph n c thai, ha liu php phng nga khng c li. Tt nht l theo
di st thai k v iu tr y , tich cc khi c cc triu chng lm sng
Phun thuc dit mui , khuyn khch ngi dn nui c dit lng quang, trnh
b mui t, khai khn t hoang, lm sch mi trng

PHONG
Cu 1: Ba du hiu ca bnh phong dng trong chn on?
1.
Mt hoc gim cm gic r thng tn da hoc vng da b bnh (nhit ,
s m nh, au)
2.
TK ngoi bin ph i v nhy cm, phi hp vi cc du hiu ca thng tn
dy TK nh lit, mt cm gic, teo c, lon lng da.
3.
BH dng tnh.
Cu 2: Trnh by cc thuc v phc iu tr phong hin nay

(1) Phc phong th nhiu khun

Ngi ln:
Ngy 1:Rifampicine 600mg Dapsone 100mg
Ngy 2 28: Dapsone 100 mg
Tr em: Ngy 1:Rifampicine 450mg Dapsone 50mg
Ngy 2 28: Dapsone 50 mg
Thi gian iu tr: 12 v trong vng 12-18 thng
(2) Phc phong th t khun
Ngi ln:
Ngy 1:Rifampicine 600mg Dapsone 100mg
Ngy 2 28: Dapsone 100 mg
Tr em (10-14 tui): Ngy 1:Rifampicine 600mg Dapsone 100mg
Ngy 2 28: Dapsone 100 mg
Thi gian iu tr: 6 v trong vng 6-9 thng

T QU
Khi pht t ngt cc thiu st thn kinh
Tn ti ko di t nht 24 gi hoc t vong trc 24 gi
Phn nh tn thng cc b h thn kinh TW (hn l tn thng ton th)
Hu qu ca cc ri lon h thng tun hon no mt cch t pht (khng phi do
chn thng).
TRIU CHNG
Triu chng t ngt xy ra trn ngi ang sinh hot bnh thng
-

- t ngt t hoc yu lit 1 bn (c hiu)

- L m, lu ln t ngt. Ni kh, khng ni c (c hiu)
- au u t ngt
- t ngt m mt mt hoc c 2 bn
- t ngt xy xm, chong vng
X L
- m bo chc nng sinh tn (ABC)
- iu tr c hiu:
0 Ti thng mch mu cho thiu mu no
1 Phu thut cho nhi mu no/ xut huyt no
2 Can thip ti phnh cho xut huyt di nhn (m, ni mch)
- iu tr chung
- Phc hi chc nng, ti ha nhp cng ng
- Tm nguyn nhn v d phng ti pht
NGUYN NHN
A.Nguyn nhn nhi mu no
- Bnh mch mu
ln
- Bnh mch mu
nh
- Thuyn tc t tim
- Bnh l huyt hc
- Khng xc nh c nguyn nhn
B.
Nguyn nhn ca xut huyt no
- Tng huyt p (nguyn nhn
1st)
- D dng mch mu no
- Thoi ha mch mu no
- U no
- Ri lon ng mu Thuc
C.
Xut huyt khoang di nhn
- v mch mu trong hp s nhng on cha vo no
- 80% cc trng hp l do phnh mch (c t nh sau ln dn v v)
- Mch mu v l on ln nn p lc mu rt cao, mu chy t, rt nguy him

CP CU NHI NGNG TIM

Khng p ng
Khng th/ th ngp
Khng bt c mch trung tm

 nh gi khng qu 10s
Mch cnh tay/ i tr nh nhi
Mch cnh/i tr nh- tr ln

Ngoi bnh vin

Trong bnh vin:

Suy h hp:
Tc nghn h hp trn
OAP
Vim phi
Sc:
Ko di
Ri lon in gii
Ri lon chuyn ha
Ri lon nhp tim

Suy h hp:
Tc nghn h hp
trn
Tc nghn h hp
di
Ngt nc
Sc:
Gim th tch
Sc tim
Sc phn b
CC
BC
TIP
CN
Lon
nhp
tim
t
chnthng
Tip
cn t
an, ton
khng th hay khng p ng kim tra mch trong
10s
Nu c mch:

Thi ngt mi 3 giy.

n tim khi nhp tim < 60 l/p + ti mu km

Kim tra mch mi 2 pht
Nu khng mch: n tim thi 2 ci hiu qu n tim (30:2) v (15:1)
trong 2 pht gi trung tm cp cu