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BNH TAY CHN MING

TR EM

PGS.TS. AN TH NGC DIP

B MN NHI
Mc tiu

1. Nhn bit c bnh tay chn ming v chn


an phn bit vi cc bnh l khc

2. Phn c bnh tay chn ming

3. Trnh by c cc ch nh iu tr bnh tay


chn ming theo phn bnh da trn phc
B Y t
Enterovirus gay benh ngi

Poliovirus

Coxackie virus A, B

Echovirus

Enterovirus 68-71
Enterovirus gy bnh ngi

Viem mang vo trung,


Herpangine, sot,viem ket
A
mac, HFM disease

Coxackie virus
VMN vo trung, sot, benh nang
tre s sinh, viem c mang ngoai
B tim, viem nao,pleurodynia
(Bornholm disease)
Enterovirus gy bnh ngi

Enterovirus 68-71

Benh giong sot bai liet (71)


VMN vo trung (71)
HFM disease (71)
Dch viem ket mac (70)
Sinh bnh hc ca nhim Enterovirus [ Ngun : pathmicro.med.sc.edu]
Ton Ton thng
thng
TKTU than nao

Nhiem Phu phoi cap


virut mau soc
Xuat huyet phoi

Tnh tham
Phan ng
viem toan thanh mach
than
T vong: Ph phi cp - Try tim mch
MRI NO

Tn thng tng tn hiu


A: pha sau hnh no (mi tn) v nhn rng tiu no (u mi tn)
B: pha sau cu no (mi tn)
C: phn trung tm no gia (mi tn)
1. Nhn bit c bnh tay chn ming v chn
an phn bit vi cc bnh l khc
CC L DO N KHM

THNG GP

TRONG BNH TAY CHN MING


Cc trng hp bnh nh, bnh nhn c
a n phng khm v:

Tr c ni hng ban v hoc bng nc lng bn


tay lng bn chn

Tr nh n ung km, chy nc ming lin tc


(nhu nho - dribbling) do let ming lm tr au
nn khng dm nut
Cc trng hp bnh nh, bnh nhn c
a n phng khm v:

Tr ln n khm v au hng

Tr st v khm thy c hng ban tay chn ming


hoc let ming
Cc trng hp bnh nng, thn nhn a tr
n trong tnh trng cp cu:

St cao lin tc kh h, l
Git mnh chi vi, tht thn
Run chi
i lang chang
Cc trng hp bnh nng, thn nhn a tr
n trong tnh trng cp cu:

Co git
Kh th, tm ti
c bit, tr ln c th than nhc u, tc ngc.
y l du hiu nng
i khi tr c a n trong tnh trng ngng
tim ngng th
GHI NH
L do thn nhn a tr n khm
rt a dng

V vy, nhn vin y t cn khm k


tm hng ban, bng nc lng
bn tay, lng bn chn v cc vt
let ming, bt k bnh nhn n
khm v l do g
BIU HIN LM SNG IN HNH CA BNH TAY CHN MING

Sang thng hng ban bng nc v lot ming trn tr mc bnh tay chn ming
Trng hp c bin chng thn kinh:

Triu chng thn kinh trong bnh tay chn


ming c th xut hin t ngy th 2 n ngy
th 8 k t khi c triu chng st

Bnh nhn thng st cao kh h

V mt l
Trng hp c bin chng thn kinh:

Triu chng thn kinh khi u c th l:


Git mnh, chi vi, tht thn. Cn phn bit vi
git mnh kh ng do au let ming
Run chi. Khi a b chi, biu hin run chi r
khi tr a tay ly chi
i lang chang
Yu chi
Run git nhn cu
Trng hp c bin chng thn kinh
nng:

c bit l bin chng vim thn no, biu


hin lm sng in hnh l t chng
vim thn no, gm:
(1) Triu chng st cao lin tc, kh h: do

phn ng vim qu mc

c th c tn thng trung tm iu nhit


(2) Triu chng thn kinh:

t git mnh chi vi, run chi, i lang chang, yu


chi

cho n co git, hn m, co gng mt no, co gng


mt v
Trng hp c bin chng thn kinh:

(3) Triu chng h hp:


t th nhanh, th bng, th co ko c lin sn, th
rt lm hm trn c
cho n th khng u, c cn ngng th
n ngng th han tan
v tro bt hng (ph phi cp)
Trng hp c bin chng thn kinh:

(4) Triu chng tun han:


biu hin u tin l mch nhanh so vi tui,
sau rt cao c th n 250 ln/pht.
Huyt p lc u cn trong gii hn bnh thng,
sau HA c th tng cao.
Vo giai an cui, huyt p tt
v cui cng l sc nng.
Din tin ca bnh tay chn ming
Ngy bnh 1 2 3 4 5 6 7

St St cao lin tc > 39oC


Mch nhanh
Git mnh Ataxie Co git Hn m
Thn kinh chi vi Run tay Hn m Mt v
Yu chi l m Mt no
o mt
Th nhanh Co ko Ngng
Th bng th
H hp OAP
Ph phi
m k
Mch Mch M=O
Tun han HA / HA HA=0

Giai an St Nguy him Phc hi


T CHNG VIM THN NO

Git mnh chi vi


Ri lan tri gic
Co git St cao lin tc > 40oC
Co gng mt v, mt no
Tng ng huyt

Vim thn no

Th nhanh Mch nhanh > 200


Th bng (ph phi m k) Huyt p tng
Th co ko lin sn Huyt p tut
Phi c ran m (OAP cnh bm) Sc
Ngng th
CHN AN PHN BIT VI BNH TAY CHN MING

Bng nc thy u trn cng chn cng tay v bng nc to lng bn


chn lng bn tay ca hi chng Steven Johnson
CHN AN PHN BIT VI BNH TAY CHN MING

Bng nc phn b theo dy thn kinh lin sn trong bnh zona


CHN AN PHN BIT VI BNH TAY CHN MING

Bng nc do Herpes simplex 1


CHN AN PHN BIT VI BNH TAY CHN MING

Bng nc tr mc bnh gh nga


CHN AN PHN BIT VI BNH TAY CHN MING

Sang thng da do rm sy
CHN AN PHN BIT VI BNH TAY CHN MING

Pht ban do siu vi khc


CHN AN PHN BIT VI BNH TAY CHN MING

Hng ban tr d ng vi acetaminophen


CHN AN PHN BIT VI BNH TAY CHN MING

Hng ban bng nc tr nhim trng huyt


CHN AN PHN BIT VI BNH TAY CHN MING

T ban bnh nhn nhim trng huyt do no m cu


2. Phn c bnh tay chn ming
PHN
BNH TAY CHN MING

Tnh trng BN iu tr

I ch c hng ban/bng Ngoi tr


nc/let ming
IIA C bin chng thn kinh Ni tr
IIB C bin chng thn kinh nng Ni tr - Nm phng
cp cu
III C bin chng suy h hp Nm Cp cu Sn sc
tun hon Tng cng
IV C bin chng suy h hp Nm Cp cu Sn sc
tun hon nng Tng cng
BNH TAY CHN MING I

Ch c pht ban v / hoc let ming


C st hoc khng

N V HUN LUYN BNH TAY CHN MING


BNH TAY CHN MING IIA

c du hiu ca I km theo t nht mt trong cc


du hiu sau:

Bnh s c git mnh t (< 2 ln trong 30 pht v


khng ghi nhn lc khm)

L , kh ng, quy khc v c

St trn 2 ngy hoc c t nht mt ln khm xc


nh nhit 39oC

Nn i nhiu
N V HUN LUYN BNH TAY CHN MING
BNH TAY CHN MING IIB

Du hiu I km theo 1 trong 2 nhm triu chng sau:

Nhm 1: c t nht 1 trong cc triu chng sau:


Git mnh lc khm
Bnh s c git mnh 2 ln trong vng 30 pht
Bnh s c git mnh, km theo t nht mt trong
nhng du hiu sau:
oNg g
oMch > 130 ln / pht khi tr nm yn v khng
st

N V HUN LUYN BNH TAY CHN MING


BNH TAY CHN MING IIB

Du hiu I km theo 1 trong 2 nhm triu chng sau:

Nhm 2 : c t nht 1 trong cc triu chng sau:

Tht iu: run chi, run ngi, ngi khng vng, i lang
chang
Rung git nhn cu, l
Yu chi (sc c <4/5), lit mm cp
Lit thn kinh s (nut sc hay thay i ging ni)
St cao kh h (nhit hu mn 39oC v khng p
ng thuc h st)
Mch > 150 ln / pht khi tr nm yn v khng st

N V HUN LUYN BNH TAY CHN MING


BNH TAY CHN MING III

Du hiu I km theo 1 trong cc du hiu sau y:

Mch > 170 ln / pht khi tr nm yn v khng st


V m hi lnh tan thn hoc khu tr
Huyt p cao so vi gi tr bnh thng theo tui:

HA max:

<1 tui: > 100 mmHg


1 - 2 tui > 110 mmHg
2 tui > 115 mmHg

N V HUN LUYN BNH TAY CHN MING


BNH TAY CHN MING III (tt)
Du hiu I km theo 1 trong cc du hiu sau y:

C nhp th nhanh so vi tui :


<2 thng, th 60 ln / pht
Tr t 2 thng n 12 thng th 50 ln / pht
Tr t 12 thng tr ln th 40 ln / pht

C nhp th bt thng, c ngha l c mt trong nhng du hiu sau y:


Cn ngng th
Th bng
Th nng
Rt lm lng ngc
Th kh kh
Th rt th ht vo

Gng chi / hn m vi ch s GCS < 10 im

N V HUN LUYN BNH TAY CHN MING


BNH TAY CHN MING IV
Du hiu I km theo 1 trong cc du hiu sau y:

Ngng th, th nc
Tm ti / SpO2 < 92%
Ph phi cp, khi c mt trong nhng du hiu sau y:
Si bt hng
C mu ra t ni kh qun
X quang phi c du hiu ph phi cp

Sc khi c mt trong nhng du hiu sau y:


Mch khng bt c, huyt p khng o c
Tt huyt p, c ngha l khi huyt p tm thu
Tr di 12 thng: < 70 mmHg
Tr t 12 thng tr ln: < 80 mmHg
Huyt p kp, c ngha l khi hiu p 25 mmHg
N V HUN LUYN BNH TAY CHN MING
3. Trnh by c cc ch nh iu tr bnh tay
chn ming theo phn bnh da trn phc
B Y t
BNH TAY CHN MING I

iu tr ngai tr nu c iu kin chm sc tt v c th tr


li c s y t ngay nu c du hiu tr nng

Hng dn thn nhn :


oGii thch v bnh tay chn ming v kh nng xy ra bin
chng
oCch phng trnh ly lan cho tr khc
oCh n, c bit l tr c let hng
oTi khm mi ngy n ngy th 8 ca bnh
oTi khm ngay khi thy bt k du hiu no sau y: bnh
nng hn, st cao, l , li b, git mnh chi vi, run chi,
yu chi, i khng vng, th mt, i nhiu
BNH TAY CHN MING I
BNH TAY CHN MING IIA

Nhp vin iu tr ni tr
iu tr:
oPhenobarbital 5 7 mg/kg/ngy (ung)
oHng dn thn nhn theo di du hiu
chuyn bng phiu theo di bnh dnh
cho thn nhn
oTheo di sinh hiu v cc du hiu chuyn
mi 8 12 gi
oXt nghim: cng thc mu v ng huyt
BNH TAY CHN MING IIA

Nu c mt trong nhng du hiu sau y,


phi chuyn vo phng bnh nng, theo di
mi 4 6 gi:

Li b, hoc st > 3 ngy, hoc st cao >


39oC
C git mnh trong 24 72 gi trc
Nn i nhiu
ng huyt > 160 mg% (>8,9 mmol/l)
Bch cu > 16.000/mm3
BNH TAY CHN MING IIA
BNH TAY CHN MING IIB

Nhp vin iu tr, nm phng cp cu


Nhm 2 nu st cao iu tr tch cc khng h th iu tr
nh III
Nm u cao, th oxy
Phenobarbital tnh mch
Immunoglobuline cho nhm 2. Nhm 1 khng cho
thng qui
Khng sinh tnh mch nu khng lai tr vim mng no
m
Theo di sinh hiu v cc du hiu nng
Xt nghim: cng thc mu, CRP, ng huyt nhanh,
chc d tht lng nu st 38,5oC hoc khng lai tr
vim mng no m
BNH TAY CHN MING IIB
BNH TAY CHN MING III

Nhp khoa cp cu hoc hi sc tch cc


Nm u cao
Th oxy. Theo di din tin quyt nh t
ni kh qun
Phenobarbital tnh mch
Immunoglobuline
Thuc vn mch: dobutamine, milrinone nu c
ch nh
Theo di st
Xt nghim
BNH TAY CHN MING III
BNH TAY CHN MING IV

Nm khoa hi sc tch cc
Th my
Thuc vn mch
Test dch truyn nu c sc v khng c du hiu ph
phi v khng suy tim,
Phenobarbital
H st tch cc
Khi huyt p ng mch trung bnh 50 mmHg,
truyn immunoglobuline
Xem xt ch nh lc mu
Theo di tch cc
Xt nghim nh gi tn thng cc c quan
BNH TAY CHN MING IV
TM TT
Nhn bit bnh tay chn ming
Nhn bit bnh tay chn ming

1. Phi tm mi thy,

Phi ngh ti mi tm

Phi bit mi ngh ti


Nhn bit bnh tay chn ming

2. Khi chn an bnh nhn TCM,

Phi tm bin chng vim no

Hy nh t chng vim thn no!


Nhn bit bnh tay chn ming

3. Khi c t chng vim thn no,

d khng c biu hin bnh tay chn ming

Hy ngh ti vim thn no do EV (71)


p n: Bnh tay chn ming
p n: Bnh TCM hoc vim let ming td bnh TCM
p n: thy u
p n: B
p n: khng phi bnh TCM
Nhim trng huyt no m cu - sc nhim trng
p n: gh nga
p n: pht ban siu vi khc