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- MSSV : 1253010245
- Lp : i hc Y a khoa kha 5
c. 12 i dy thn kinh s :
- Dy I: khng khm c
- Dy II: mt nhn m
- Dy III, IV, VI: ng t kch thc 3mm, trn u 2 bn, phn x nh sng trc tip v
ng cm
- Dy V:+ phn x gic mc 2 bn cn
+ cm gic vng trn, g m, cm dng tnh
+ h ming c
- Dy VII:
+ Mt nhm kn
+ Np nhn trn cn
+ Np m mi cn
+ Nhn trung khng lch
- Dy VIII :cha ghi nhn bt thng
- Dy IX, X : li g khng lch, phn x nn v du vn mn khng khm c
- Dy XI : c c n chm 2 bn cn i
- Dy XII: li khng teo, khng rung git c li
d. H vn ng
- Trng lc c: tng
. chc: 2 bn bng nhau
. ve vy: 2 bn bng nhau
. gp doi: 2 bn bng nhau
g. Du mng no
- c mm
-kernig m tnh , brudzinski m tnh
h. Cc thnh phn khc: nh hp s, ct sng, mch mu, h thn kinh tht vt cha
ghi nhn bt thng
3. Khm tim
- Lng ngc cn i, di ng theo nhp th
- Khng rung miu, Harzer (-), TM c khng ni
- T1, T2 u r, tn s 80 ln/pht, cha nghe m thi bnh l
- Mch mm mi, p r vi tn s 80 ln/pht
4. Khm phi
- Rung thanh u 2 bn
- G trong khp phi
- R ro ph nang m du, cha ghi nhn ran bt thng
5. Khm bng
- Bng mm, di ng u theo nhp th, khng co u cu c, khng c tun hon bng h,
khng c du sao mch, khng c so m c, khng du xut huyt
- Cha nghe m thi bnh l, nhu ng rut 5 ln/pht
- G trong
- Gan lch s khng chm
VI. TM TT BNH N
Bnh nhn nam, 58 tui vo vin v au u. Qua hi bnh s, tin s, v thm
khm lm sng ghi nhn:
. TC: 213.109/l
- Ha sinh mu: .ure: 3,6 mmol/l .creatinin: 103 mol/l .glucose: 4,5 mmol/l
.Na : 135 mmol/l .K+: 3,9 mmol/l
+
.Cl-: 103 mmol/l
.GOT: 25 U/L .GPT: 15 U/L
cc ch s nm trong gii hn bnh thng
- Chp CT scan s no khng tim thuc cn quang (t 1-32 dy)
M t
* Ca s nhu m
+ Tng trn lu:
- Tn thng tng m thy nh chm (P)
- H thng no tht bn khng dn, khng tng m
- Cu trc ng gia khng di lch
+ Tng di lu:
- Cha pht hin bt thng m trn tiu no
- No tht IV khng dn, khng tng m
Kt lun: xut huyt no vng chm (P)
- ECG: Nhp xoang u, tn s # 80 ln/pht
IX. CHN ON SAU CNG: xut huyt no vng nh chm (P) /Tng huyt p
III theo JNC VII
X. IU TR :
1. Hng iu tr
-nm u cao
- Chng ph no
- Kim sot huyt p
- iu tr triu chng
2. iu tr c th
a. Thuc
- Manitol 20% 250ml
chai x 3(TTM) C g/ph
-pantocid 40mg
01 l (TMC)
- Losartan 50mg
01 vin (u)
b. Chm sc
- thc n d tiu ha, sp, cho, sa x 4,5 c/ ngy
- Theo di sinh hiu
XI. TIN LNG :
Gn: Nng, nu khng iu tr tt c th dn n t vong, hoc di chng v sau
Xa: Nng, tin s tng huyt p, cn phi kim sot huyt p v thuc trnh nguy c
t qu
XII. PHNG BNH
- Kim sot huyt p
- Ch n gim mm, du m, ngt
- Vn ng thng xuyn