BENH VIEN NHI DONG 1 Conon ec EOREIM CTC UM UUM EDL) NHI KHOA 2020 2! aa Vy] NHA XUAT BAN Y HOC aaa aiLan xudt ban thie 1 - 1995 Lan xudt ban thir 2 - 1997 Lan xudt ban thir 3 - 2000 Lan xudt ban thir 4 - 2005 Ln xu&t ban thi § - 2006 Lan xuat ban the 6 - 2009 Lan xuat ban thie 7 - 2010 Lan xudt ban thir 8 - 2013 Ln xuat ban thy 9 - 2020re CHU BIEN Chi bién: PGS.T3.B3. Nguyén Thanh I lung - Giém dc Bénh vign Nhi Ding 1 THAM GIA BIEN SOAN ThS.BS. Nguyén Binh An ThS.BS. Bui Gio An ThS.BS. Hoang Vinh An ThS.BS. Phan Nguyén Lién Anh BSCK2. Nguy&n Thi Ngoc Anh ThS.BS. Bach Nguyén Van Bang ThS.BS. Hd Thi Ngoc Bich TTND.BS, Bach Vén Cam BSCK2. Phan Ngoc Duy Can BSCK1. Huynh Cong Chan Nguyén Minh Chau BSCK1. Tran Phi Chau ThS.BSCK2. Nguyén Thi Tran Chau BSCK1. Lam Minh Chinh ThS.BS. Cao Tran Thu Cic inS.6S, Le minn Cuong BSCK2. Nguyén Ngoc Cuong PGS.TS.BS. Phan Hou Nguyét Diém BS. Pham Thuy Diém BS. Pham Trung Ding ThS.BS. Nguyén Thuy Duong TS.BS. Va Thuy Duong ThS.BS. Vi Dirc Duy ThS.BS. Bui Quang Duy ThS.BS. Van Thé Duy ThS.BS. Tran Ngoc Hanh Dan BSCK1. Nguyén Thi Anh Dao BS. Tian An Hai Dany BSCK1. Luong Hitu Dang BS, Ngé Van Dau TS.BSCK2, Nguyén Van Dau KTV. Pham Thi Hing Biép ThS.BSCK2. Dé Thi Cam Giang ThS. Lé Tudng Ciao BS. Te Thi Ngoc Ha BSCK1. Ngé Thuy Ha Khoa Ngoai Than tiét niéu Khoa Tim mach Khoa Than N6i tiét Khoa Sét xuat huyét Trung Bon vj Mat Khoa Héi sire tng cusng chéng déc Khoa Than Noi tiét C6 van Khdi hdi strc cép cou Truéng khoa Biéu tri trong ngay Khoa Ngoat Thén tét nigu Khoa Dinh duong Khoa Rang ham mat Phé Trung Khoa Héi site ngoai Khoa Chén thuong chinh hinh Khoa Sét xudt huyét Khoa Thar Not et Tring Khoa Phau thudt gay mé héi suc Nguyén Trudéng khoa N6i ting quét 2 Khoa Phéng Tao hinh Khoa Tiéu héa Khoa Sét xudt huyét Kiwet Dinh rong Khoa Biéu tri trong ngay Khoa Tai mili hong Khoa Tim mach Khoa Nhiém Than kinh Khoa Ngoai Thén tiét niéu Khoa Diéu tr trong ngay Khoa Tai miii hong Khoa Phau thuat gay mé héi size Truéng Khoa Rang ham mat Khoa Phau thuét gay mé héi site Khoa Tim mach Trdg Khoa Vat Ij tri liéu-phuc hoi chive nang Khoa Rang ham mat Khoa Nhiém Than kinhBSCK1. Nauyén Minh Hang ThS.BSCK2. Nguyén Tri Hao BSCK1. Quéch Thanh Hau BS. Than Thi Thy Hién ThS.BS, Dao Trung Hiéu BSCK2. Nguyén Thi Nguyén Hoa BS.CK1. Tran Thi Thanh Héng BSCK2. Hé Thi My Hué TS.BS, Lé Thanh Hing PGS,TS.BS. Nguy&n Thanh Hing ThS.BS. Binh Viét Hung Th$.BSCK2. Nguy&n Thj Thanh Huong ThS.BS. Tran Thi Bich Huyén CN.VLTL, Duong Thi Digu Huyén ThS.BS. Trinh Kién BS. Truong Hau Khanh BS. Lé Hiru Khanh BS. Nguyn Van Khanh BSCK1. Mai Chi Lan BSCK2. Nguy&n Thanh Liém TS.BS. Lé Bich Lién ThS.BSCK2, Nguyén Phuée My Linh ThS.BS. Nguy€n Thi Triie Linh BSCK1. Ha Van Luong ThS.BS. Trang Thi Hoang Mai BS. Phan Thiy Mai ThS.BSCK2. Nguy€n Kién Mau ThS.BS. Nguyén Kién Minh ThS.BS. Dang Khai Minh PGS.TS.BS. Lam Thi My BS. Phan Huynh Bao Nghi TS.BS. Nguyén An Nghia CN.VLTL, Nguyén Thi Bich Ngoc BSCK1. Tran Thi Héng Ngoc BSCK1. Nguyén Thi Ngoc BSCK2. Nguyén Tuan Naw TS.BS. Pham Binh Nguyén Ths.BS. Nguyén Phan Nguyen PGS.TS.BS. Phung Nguyén Thé Nguyén BSCK1. Tran Bai Phu wl Khoa Rang ham mat Trvéng Khoa Tim mach Khoa Phau thuét gay mé hdi strc Khoa Than Né Pho Giém déc Bénh vién Khoa Dinh duéng Khoa Tai mai hong Don vj Mat Truéng khoa Ngoai Thén tiét niu Giam doc Bénh vién Khoa Ngoai t6ng hop Pho Trung khoa So’ sinh Khoa Than noi tiét Khoa Vat Iy tr iu-phue héi chic nang Khoa Chan thuong chinh hinh Khoa Nniém Than kinh Khoa Chan thuong chinh hinh Khoa Rang ham met Khoa Rang ham mat Trung Khoa N6i ting quat 1 Nguyén Pho Giam déc Bénh vién Khoa Tim mach Khoa Ngoai Than tiét niéu Phé Truéng Khoa Phau thuat gay mé hdi sue Khoa Nniém Than kinh Khoa Ho nap Truéng Khoa So’ sinh Phd Trudng khoa Nhiém Than kinh Khoa Chan thuong chinh hinh Khoa Sét xuat huyét Khoa Phau thuat gay mé hdi stec Anoa Wniém Than Kin Khoa Vat ly tri ligu-phuc hoi chive nang Khoa Tiéu hoa Khoa H6 hdp Truong Khoa Tai mai hong Khoa Tai mai hong Kiva Tai mdi ong Pho Trudng khoa Héi stkc tang cudng chéng dc Khoa Ngoai Than tiét niéuBSCK1. Lé Hau Phuc TS.BS. Hoang Lé Phuc PGS.TS.BS. Vi Minh Phuc BSCK1. H6 Van Phung BS. Lé Hau Phuéc BSCK2. Nguyén Bure Quang PGS.TS.BS. Pham Van Quang InS.BS. Tran Hou Minh Quan BSCK2. Du Tuan Quy ThS.BS. L@ Nguy&n Phi Quy CN. Bui Thi My Quyén ThS. Hoang Van Quyén ThS.BS, Nguyén Thai Son Binh Thi Ngoc Suong BSCK2, Pham Doan Tan Tai ThS.BSCK2. Pham Thi Thanh Tam CN. VETL. Tra Thanh Tam ThS.BS. Dinh Thac BS. Tran Chau Thai BSCK2. Plias Nyuyén Thai ThS.BS. Ma Tu Thanh BS. Dinh Thi Nhu Théo BSCK1. Tran Anh Thé BS. Nguyén Thi Hong Thién ThS.BSCK2, Nguyén Thi Minh Thu THS.B3, Nguy&n Huynh Phuong Thay BSCK1.Trdn Bich Thuy BSCK2, Hoang Thj Thanh Thiy ThS.BS, Nguyén Thi Anh Tin TS.BS. Dé Nguyén Tin BSCK2. Hoang Thi Tin ThS.BS. Lé Binh Béo Tinh TS.BS. Nguyén Thu Tinh ThS.BS. Nguyén Binh Toai BS. Nguyén Thi Huyén Trang KTV. Nguyén Thi Thu Trang ThS.BSCK2. V6 Bure Tri BSCK1. Phan Minh Tri ThS.BS. Digp Qué Trinh ThS.BS. Tran Thanh Tréc Ph6 Truéng khoa Chan thuong chinh hinh Thong Kiva Tiéu Ina Nguyén Truéng khoa Tim mach Pho Truéng khoa Rang ham mat Khoa Phong Tao hinh Trwéng khoa Than N6i tiét Trréng khoa Héi sue tich owe chéng déc Khoa Than N6i tiét Pho Trung khoa Nhiém Thédn kinh Khoa Tim mach Khoa Phau thuat gay mé héi strc Khoa Vat ly tr ligu-phuc héi choc néing Khoa H6 hap Khoa Dinh duéng Khoa Tai mai hong Truong Khoa Héi sic so sinh Khoa Vat ly tr ligu-phuc héi chic néing Tring khoa Tam I Don vj Mat Khoa Tai mii hong Khoa Héi sie tich cye chéng doc Khoa Rang ham mat Khoa Didu tri trong ngay Khoa Héi stic ngoai Khoa So sinh Khoa Tim mach Khoa Phéng Tao hinh Phé Trudng khoa Dinh duéng Khoa So’sinh Khoa Tim mach Truéng Khoa Dinh duéng Phé Trung khna HA hap Khoa H6i sire so sinh Khoa Tim mach Khoa Rang ham mat Khoa Phau thuat gay mé hdi sire Phd Truéng khoa So’ sinh Khna Ngoai tong hop Ph6 Trung khoa Phéng Tao hinh Khoa Nhiém Than kinh vilBS. Nguyén Hiéu Trung DSCK2, Pham Xuan Trung ThS.BS. Tran Van Tuan TS.BS. Tran Anh Tudn TS.BS. Nguyén Minh Tuan ThS.BS. Nguyén Minh Tuan ThS.BS. Dang Thanh Tuan BSCK1. Vuu Thanh Tung BS. La Ngoc Tuyén BSCK1. Tu Linh Uyén BS. Nguy8n Thi Thuy Van ThS.BS. V6 Lé ViVi Ths.BS. Phu Quéc Viét BS. Nguy8n Quang Vinh BSCK1. Vé Thanh Vi BAN HIEU BINH PGS.TS.BS. Nouyén Thanh Hing ThS.BS. Dao Trung Hiéu TS RS 14 Bich Lian TS.BS. Ngé Ngoc Quang Minh TTND.BS. Bach Van Cam TS.BS. Hoang Lé Phuc ThS.BS. Dang Thanh Tuan ThS.BSCK2. Nguyén Thi Minh Thu: BSCK1. Nod Thi Ngo Thiiy NHOM Y HQC CHUNG CO” PGS.TS.BS. Nguyén Thanh Hung TS.BS. Ngé Ngoc Quang Minh ThS.BS. Bang Thanh Tuan TS.BS. Lé Nuyén Thanh Nhan TS.BS. Hoang Lé Phuc ThS.BSCK2, Nguyén Thj Minh Thu BSCK1. Ng6 Thi Ngoc Thuy vill Khoa Thén N6i tiét Khoa Tai mai hong Khoa Tim mach Truéng Khoa H6 hép Trudng Khoa Sét xuat huyét Khoa Nhiém Than kinh Khoa Héi strc ngogi Khoa Héi site téng cutng chéng déc Khoa Rang ham mat Khoa Phau thuat gay mé héi ste Khoa Nhiém Than kinh Khoa NGi tong quat 2 Khoa Tai mili hong Khoa Nhi8m Than kinh Phé Trvéng khoa Héi sive tich cure ching doc Giém déc Bénh vin Phé Gidm déc Bénh vién Nguyén Phé Giam déc Bénh vién Phé Giém déc Bénh vién C6 van kh6i HSCC Truong Khoa Tiéu hoa Truéng Phang Ké hoach téng hop Ph6 Tréng Phong Ké hoach téng hop Phang Ké hnach tang hop Giam d6c Bénh vin Pho Giam déc Bénh vién Truong Phong Ké hoach téng hop Trwéna phona Chi dao tuvén Truong Khoa Tiéu héa Ph Truong Phong Ké hoach téng hop Phéng Ké hoach tng hopXay dung pha dB diéu uj la mt féu chi quant yng trong danh gla chét veng khém chira bénh cilia BG Y té va cdc T6 chirc kiém dinh chat lvong bénh vién danh tiéng trén thé gidi, Hién nay, Phac dé diéu tri la tai li8u khong chi co gia tri khoa hoc ma ca phdp ly quyét dinh chét lveng didu tri cing nhu' viéc thanh quyét todn chi phi khdm chiva bénh bao hiém y té. Trén tinh than 46, Phéc dé didu tri Nhi khoa cia bénh vién Nhi Dang 1 qua 8 lan xuat ban d& mang lai higu qua trong viée dam bao chat long diéu tri, gip gidm ty 16 tw vong mét cach r6 nét. Tir nhiéu nam qua, Phdc dé diéu tri Nhi khoa ctia bénh vién Nhi dng 1, dug bién soan céng phu béi ddi ngii chuyén gia nhiéu kinh nghiém trong lanh vuc nhi khoa, da tr’ thanh tai ligu tham khdo khéng thé thiéu trong thyrc hanh lam sang ctia bac si nhi khoa, hoc vién sau dai hoc, va sinh vién y khoa tai cac Truéng dai hoc Y cing nh cac bénh vién, co’ s@ y té c6 diéu tri bénh nhi trén cd nuréc. Voi cau tric Phac dé duge bién soan xiic tich, day dui theo trinh ty cc buéc trong thuc hanh lam sang. khéi du voi viée khai thée bénh si’, kham lm sang, chi dinh ©€n lam sang, chan doan, én nguyén tac va cac bu diéu tri, phong ngtra, Phac 6 diéu tri bénh vién Nhi Ddng 1 cung cdp cach tiép c&n thyc tién déi vai tling benh y.cy thé giip nha lam sang nhanh chéng thy hién viée éénh gid, chan dodn va digu tri hiéu qua ngvoi bénh. Trong [an tai ban thir 9 nay, Phac 6 diéu tri Nhi khoa 2020 vn dya trén nén tang chinh la *Y hoc dya vao chieng 06”, da cap nat lai toan bo cac phac dd trong 4n bén gan nhét, dng thd bién oan thém 4 chuong méi va hon 100 pha dd uluyén s4u méi nhu théim do va can thiép dign sinh ly tim, ohurong phap oxy hoa qua mang Nngoai cor thé (ECMO), cac bénh ly huyét hoc chuyén sau, céc bénh ly ngoai than kinh, mién dich, réi loan chuyén héa di truyn... Phae dd diéu tri Nhi khoa 2020 gom 2 tap voi gan 500 huréng dan diéu tri cho hau hét cdc bénh ly ti phd bién dén hiém 9p 6 tré em 6 tat c cdc chuyén khoa: Hai strc cp ctu nhi, Ndi nhi, Ngoai nhi, Mat, Tai mii hong, Rang ham mat va cc chuyén khoa khac la mét bé tai liéu tham khdo rl CO gla tl trong linn vuc Nni khoa. Chting t6i tran trong gidi thigu dén quy déng nghiép Phéc dé diéu tri Nhi khoa 2020 - tap 1 va 2, va hy vong nhan duge sy don nhan va dong gép cia cdc ban dé quyén Phac d3 ngay cng phong phui va hoan thién hon. Tran trong PGS.TS.BS. Nguyén Thanh Hing Giam déc Bénh vign Nhi Dang 1LOI MO DAU . CHUONG 1: CAP CU’U - TAI NAN. Loc bénh va xt? tri cp ctru TTND.BS. Bach Van Cam Cap cwu ngung tho ngung tim nang cao trong co’ sd y té va béenh vién............14 TTND.BS. Bach van Cam Chan doan va xtr tri cAp evr phan vé TTND.BS. Bach Van Cam S60 sissies TTND.BS. Bach Van Cam Séc nhiém khudn Le NLL 45 1 ND.BS. Bach Van Cam Sdc mAt mau do chéin thurong....ecccccccssscesssssssssseeecesssccccssseeeeeseeeetsusssssonsscesseeeed 56 TTND.BS. Bach Van Cam Séc tim. 63 PGS.TS.BS. Pham Van Quang Phu phdi cdp do tim oa TTND.BS. Bach Van Cam" Suy hé hap cdp. es TTND.BS. Bach Van Cam Héi chieng suy hé hép cép tién tridn.... ThS.BS, Dang Thanh Tudn Di vat duong thé... TTND.BS. Ba Co giat.. TTND.BS. Bach Van Cam Hén mé.. TIND. BS. Bach van Cam Chét nao... TTND.BS. Bach Van Cam Tang Ap lve néi so. PGS.TS.BS. Phung Nou Thé Nguyén xlH@i cheng Stevens — Johnson .... AB TTND.BS. Bach Van Cam HOi ching ure huyét tan huyét.... TTND.BS. Bach Van Cam Réi loan dién giai. TTND.BS. Bach Van Cam Réi loan toan kiém... TTND.BS. Bach Van Cam Ha duong huyét... TTND.BS. Bach van cam Viém hoai tir ruét non. TTND.BS. Bach Van Cam Xuat huyét tieu héa. i TTND.BS. Bach Van Car Suy gan cp... TTND.BS. Bach van Cam H6i chtrng tang ap lye 6 byng..... TTND.BS. Bach Van Cam Thuyén tac tinh mach do huyét khéi IhS.BS. Bacn Nguyén van Bang PGS.TS.BS. Pham Van Quang Ngat nude TTND.BS. Dién giat TT 139 148 + 152 183 Ong dit... TTND.BS. Bach Van Cam Ran can. TTND.BS. Bach Van Cam Loc mau cp ctru bang ky thuat than nhan tao ThS.BS. Hoding Vinh An BS.CK2. Nguyén Bure Quang Loc mau hap phy bang cét than hoat tinh.... BSCK1. V6 Thanh Va BSCK1. Vuu Thanh Tang Loe mau lién tue . BSCK1. V6 Than PGS. TS. Pham Van Quang 216 xlThay huyét tuong........es. BSCK1. V6 Thanh Vi PGS.TS.BS. Pham Van Quang Trao déi oxy qua mang voi tuan hoan ngoai co’ thé (ECMO)... BSCK1. V6 Thanh Va BSCK1, Vuu Thanh Ting PGS.TS.BS. Pham Van Quang Thudc van mach va tang strc co bép co’ tim.... TTND.BS. Bach Van Cam An than va giam dau trong thi thuat TTND.BS. Bach Van Cam Tho ap lye dvong lién tye qua Milli... ThS.BS. Pang Thanh Tuan Tho may... ThS.BS, Dang Thanh Tuan Thé may khong xam [dn 6 tré em ThS.BS. Bach Nguyén Van Bang PGS.TS.BS. Pham Van Quang CHU'ONG 2: CHAN THUONG CHINH HINH Dai cuong gay xuong tré em... BS. Lé Hau Khanh Gay than xuong canh tay.. BSCK1. Lé Hau Phic BS, Lé Hau Khanh Gay trén [di cau hai xwong canh tay... BSCK1. Lé Hau Phic BS. Lé Hau Khanh Gay dau tr8n xuong cénh tay...... BSCK1. Lé Hau Phuc BS. Lé Hau Khanh Gay [81 cau ngoai xuong canh tay BSCK1. Lé Hau Phuc BS. Le Hau Kiran Gay Idi cau trong xuorng canh tay BSCK1. Lé Hau Phuc BS. Lé Héu Khanh Gay mém trén rong roc xuong canh tay ... BS. Lé Héu Khanh Gay hai xuong cang tay... BSCK1, Lam Minh Chinh BS. Lé Hu Khanh oD xiGay Monteggia . BSCK1. Lam Minh Chinh HS. Le Huu Khanh Gay chém quay .. non BSCK1. Lé Hau Phac BS. Lé Hiu Khanh Gay mdm khuyu..... BSCK1. Lé H@u Phuc BS. Lé Héu Khanh Gay than xuong dui BSCK1. Lam Minh Chinh BS. Lé Hitu Khanh Gay than xuong cang chai ThS.BS. Trinh Kién Bleu tri gay xwony bay dink ndi thy 66 ché' ThS.BS. Trinh Kién BSCK1. Lé Hau Phiic Gay xwong ving NANG... eee BSCK1. Lam Minh Chinh BS. Lé Hifu Khanh Trat khép hang ohén thong... BSCK1. Lam Minh Chinh BS. Lé Hau Khanh Trat khop hang bam sinh ..... BS. Lé Hau Khanh Trt khop khuyu BSCK1 146 Him Phiic BS. Lé Hau Khanh Tat ban chan bet bam sinh.............. BSCK1. Lam Minh Chinh BS. Lé Hau Khanh Chan khoéo bam sinh... BSCK1. Lé Hau Phuc BS. Lé Hau Khénh Tha ngon bam sinh . BSCK1. Lam Min! BS. Lé Hau Khanh Ngon tay co suing bam sinh.. BSCK1. Lé Hau Phuc BS. Lé Hitu Khanh 313 320 335 344 xivDinh ngon tay BAM SiN... issecssessesssessesstense 357 BSCK1. Lam Minh Chinh BS. Lé Hétu Kiidiih Nouc lom... 11.359 ThS.BS. Bang Khai Minh ThS.BS. Dao Trung Hiéu Liét dam réi than kinh canh tay... ThS.BS. Dang Khai Minh Diéu trl co clrng co tw chi & tré bai nao bang toxin botulinum type A... BSCK1. Lam Minh Chinh CHU'ONG 3: DINH DU'ONG.... Nhu cau dinh duéng va ché dé an theo lira tu BSCK2. Nguyén Thj Nguyén Hoa BSCK2. Hoang Thj Thanh Thuy Suy dinh duéng BS.CK2. Hoang Thi Tin TS.BS. Hoang Lé Phuc Diéu tri béo phi tré em TS.BS. Vii Thuy Duong BS.CK2. Hoang Thj Tin TS.BS. Hoang Lé Phuc Dinh dudng qua sonde da day.... TS.BS. VG Thuy Duong BS.CK2. Hoang Thj Tin TTND.BS. Bach Van Cam Dinh duéng dudng tinh mach hoan toan...... TS.BS. Vi Thay Duong BS.CK2. Hoang Thj Tin TTND.BS. Bach Van Cam Dinh dung trong tim bam sinh/suy tim TS.BS. VG Thay Duong BS.CK2. Hoang Thj Tin Dinh duwong trong benh no nép man/suy no hap. TS.BS. Vii Thay Duong BS.CK2. Hoang Thi Tin Dinh dung trong bénh than — néi ti TS.BS. Vi Thuy Duong BS.CK2, Hoang Thi Tin Dinh duéng trong bénh ly duéng tiéu héa.... TS.BS. Vi Thuy Duong BS.CK2. Hoang Thj Tin 371 +378 +385 +391 +404 xvChé do an sinh ketone... TS.BS. Vi Thuy Duong BS.CK2. Hoang Thj Tin Dinh du6ng hé tre bénh nhan phong.... 422 TS.BS. Vai Thuy Duong BS.CK2, Hoang Thi Tin Cac ché d6 an thyc hién tai Khoa dinh dng... 424 Nguyén Minh Chéu Dinh Thi Ngoe Suong CHUONG 4: GAY ME HOI SU’c - CHAM SOC TRUOC VA SAU MO. Chuan bj bénh nhan truéc phau thuat BSCK2. Nguyén Ngoc Cuong Khang sinh dy phéng trong phau thuat BSCK2. Nguyén Ngoc Cuong PGS.TS.BS. Phung Nguyén Thé Nguyén Gay té ving i BSCK2. Nguyén Ngoc Cuong Gay té khoang xwong cling... BSCK1. Ha Van Luong BECK2. Nguyén Ngpe Cudng Gay mé..... BSCK2. Nguyén Ngoc Cuéng Gay mé nhi khoa 462 BSCK2. Nguyén Ngoc Cudng Bu dich va truyén mau trong luc gay mé .. 467 DSOK2, Nguydn Ngoe Cusng Nhin an udng trudc khi gay mé. KTV. Pham Thi Héng Biép BSCK2. Nguyén Ngoc Cuong Gay mé bénh nhan suyén .. BSCK2. Nguyén Ngoc Cuong Gay 16 113i stro cho phdu thudt con &ng déng mach.......--- ATR KTV. Nguyén Thi Thu Trang BSCK1. Ha Van Luong Gay mé hai sto trong phau thuat Thang lién nhi ........- BSCK2. Nguyén Ngoc Cuong Gay mé hdi sire trong phdu thuat Théng lién that 2481 BSCK2. Nguyén Ngoe Cirong Gay mé hai strc trong phau that Tu ching Fallot ..........-. 2485 BSCK2. Nguyén Ngoc Cuéng aGay mé hdi svc cho phdu thuat déng thong lién nht bang dyng ou...... BSCK1. Ha Van Luong V6 cém cho bénh nhan dong con éng dong mach bang dung cu... BSCK1. Ha Van Luong V6 cam b&nh nhan trong théng tim chan doan va can thiép......... BSCK2. Nguyén Ngoc Curdng V6 cam cho bénh nhi diéu tri rdi loan nhip bang séng cao tan BSCK2. Nguyén Ngoc Cuong Gay mé trong bénh ly véng mac 6 tré non thang...... BSCK2. Nguyén Ngoc Cudng Gay mé cho bénh nhan suy gan....... BS. Ngé Van Bau Gay mé cho bénh nhan cé suy giém chirc nang than. BS. Ng6 Van Bau Gay mé héi strc trong phau thuat l6m ngve... BSCK1.Ttr Linh Uyén BSCK2. Nguyén Ngoc Cuong Gay mé hdi strc cho bénh nhan dj dang nang tuyén bam sinh... BSCK1. Ha Van Luong Gay mé hdi sc trong phdu thuat u gan...... BSCK1. Ha Van Luong Gay mé hai strc trong phau thuat u trung that... BSCK1. Ha Van Luong Gay mé bénh nhén budu tan dich vung cd... BSCK2. Nguyén Ngoc Cuong Gay mé bénh nhan si? dung corticoids (B6 sung corticoids) .... BSCK2. Nguyén Ngoc Cuéng Gay mé hdi strc trén bénh nhan béo phi... BSCK2. Nguyén Ngoc Cuéng Gidm dau ngoai mang céng... BSCK2. Nguyén Ngoc Cuéng Gay mé hai st’c trén bénh nhan chay mau muén sau cat amidan BSCK1. Quach Thanh Hau BSCK2. Nguyén Ngoc Cuong Gay mé hdi sto trén bénh nhan gap dj vat dueng thé BSCK1. Quaéch Thanh Hau BSCK2. Nguyén Ngoc Cuong Gay mé bénh nhan Hemophilia BSCK2. Nguyén Ngoc Ct XVIIGay mé bénh nhi Thalassemia... neem BSCK2, Nguyén Ngoc Cuong Gay mé bénh nhn hep mén vi phi dai BSCK2. Nguyén Ngoc Cuong Gay mé cho bénh nhan mé tac rudt 541 BSCK2. Nguyén Ngoc Cuong Gay mé cho bénh nhan Hirschprung.... 544 BSCK1, Ha Van Luong Gay mé trong md néi soi 6 bung .. BAT CN. Nguyén Thj Thu Trang BSCK1. Ha Van Luong Gay mé ndi soi tiéu hda trén. CN. Bui Thi My Quyén BSCK2. Nguyén Ngoc Cuong Gay mé néi soi tiéu hoa dui .......-- ee CN. Bui Thi My Quyén BSCK2. Nguyén Ngoc Cuong Gay mé hdi strc cho phéu thuat viém rudt thiva... BSCK1. Ha Van Luong Gay mé hdi strc cho phau thuat u tUy thurgng than. BSUKZ. Nguyén Ngoc Curly Gay mé héi strc cho bénh nhan phau thuat duong mat 6 tré em. BSCK1. Ha Van Luong Gay mé hi strc cho bénh nhan thoat vi hoanh... BSCK7. Ha Van Luong Gay mé héi strc cho bénh nhan phau thuat dong tiét nigu BSCK1. Ha van Luong Gay mé hdi strc cho bénh nhan bai nao.. BSCK2. Nguyén Ngoc Cuong Gay mé hdi strc trong phau thuat than kinh & tré em... BSCK2. Nguyén Ngoc Cuong Gay mé hai sive 6 tré bj chdn thuong than kinh.. BSCK1. Ter Linh Uyén BSCK2. Nguyén Ngoc Cuong Gay mé cho bénh nhan chup cat l6p vi tinh (CT) va cong hung tir (MRI)......577 BSCK1. Ha Van Luong V6 cm cho bénh nhan bénh bach cau......... BSCK2. Nguyén Ngoc Cuong Mask thanh quan....... BSCK2. Nguyén Ngoc Cuong 554 xviCo that thanh quan .--589 BSCK2. Nguyén Ngoc Cueng bat ndi khi quan & bénh nhan cé da day day.. +593 BSCK2. Nguyén Ngoc Cuong Dat ndi khi quan kho tré EM 2... ecseee BS. Phan Huynh Bao Nghi BSCK2. Nguyén Ngoc Cuéng Ha huyét ap chi huy.... : BSCK2, Nguyén Ngoc Cuong Tng than nhiét dc tinh. BSCK2. Nguyén Ngoc Cuéng Cham séc bénh nhan hau phau ling nguc .. TTND.BS. Bach Van Cam Rut ndi khi quan sau gay mé tai phong hdi tinh .... BSCKT. Ha Van Luong ‘S4n séc hé théng dan luu.... ThS.BS. Bao Trung Hiéu San séc dan luu mang ph ThS.BS. Bao Trung Hi Cac bién ching sau ph&u thuat DUNG 00... InS.BS. Bao Trung Hiéu Héi strc bénh nhan sau mé tim h& BS. Nguyén Thj Héng Thién Dac diém héi strc sau mé mét sd bénh tim bam sinh... ThS.BSCK2. Nguyén Thj Tran Chau MOt sé van dé sau mé tim... ThS.BSCK2. Nguyén Thj Tran Chau 595 598 610 CHUONG 5: HO HAP. Diéu tri con suyén ..... TTND.BS. Bach Van Cam TS.BS. Tran Anh Tuén Phong ngwa suyén .. 659 TTND.BS. Bach Van Cam ‘Viém thanh khi phé quan cap...... 665 TTND.BS. Bach Van Cam TS.BS. Tran Anh Tuén Viem tiéu phé quan cap. TS.DS. Tran Anh Tudén xixVier tigu phé quan tac nghéi TS.BS. Tran Anh Tuén Viém phéi cong déng 6 tré em... TS.BS. Tran Anh Tuan Viém phdi hit do Hydrocarbon... TS.BS. Tran Anh Tuén Viém phéi kéo dai — viém phéi tai phat. TS.BS. Tran Anh Tuén Vier phéi hoai tir va ap-xe phdi. PGS.TS.BS. Phan Hau Nguyét Diém TS.BS. Tran Anh Tuan Bénh phdi mé ké 6 tré em... TS.BS. Tin Anh Tuén Tran dich mang phéi. PGS.TS.BS. Phan Hau Nguyét Diém Tran dich dudng trap. PGS.TS.BS. Phan Hau Nguyét Diém Tran mu mang phi TS.BS. Tran Anh Tuén PGS.TS.BS. Phan Hau Nguyét Diém Tran khi mang phii.......-..- ThS.BS. Nguyén Thai Son TS.BS. Tran Anh Tuén Mém sun thanh quan... ThS.BSCK2.Nguyén Kién TS.BS. Tran Anh Tuén Tiép can the rit ThS.BS. L6 Binh Bao Tinh Kho Khe tré em... PGS.TS.BS. Phan Hu Nguyét Diém Tiép cn ho kéo dai 6 tré em. TS.BS. Tran Anh Tuén Tip can ho ra mau 6 tré em...... ThS.BS. Nguyén Thai Son Tiép cn di ting 6 tré em TS.BS. Tran Anh Tuan Cae xét nghiém di ting ... TS.BS. Tran Anh Tuén 693 702 708 3 742 XKDj tng thudc 768 ThS.BS BS. Phan Thuy Mai Dj teng thie an... BSCK1. Nouyén Thi Ngoc CHUONG 6: HUYET HOC Truyén mau va san phdm cia mau... TTND.BS. Bach Van Cam Tai bién truyén mau... TTND.BS. Bach Van Cam H6i chteng xudt huyét . PGS.TS.BS. Lam Thj My Xuat huyét gidm tiéu cau mién dich... PGS.TS.BS. Lam Thi My Bénh Hemophilia A va B.. TS.BS. Nguyén Minh Tuan .783 Déng mau noi mach lan téa.. 1819 TS.BS. Nguyén Minh Tudn Suy thy, PGS.TS.BS. Lam Thi My Thiéu mau. 827 TS.B: “TRASSEM ccs soccer conssnssecenvnsransgersanesseeeesvorennnsenunn state ssttecenendncteene eee 831 TS.BS. Nguy6n Minh Tuan Thiéu mau thidu s&t...... B3R PGS.TS.BS. Lam Thi My Thiéu mau tén huyét c4p 842 TS.BS. Nguyén Minh Tuén Thiéu mau tan huyét mién dich .. 847 TS.BS. Nguyén Minh Tudn Tidép cn cuy giam mién dich tién phat & trd om... 852 TS.BS. Nguyén Minh Tuan PGS.TS.BS. Lam Thi My H@i chtong thye bao mau .-..860 TS.BS. Nguyén Minh Tuan PGS.TS.BS. Lam Thj My Tiép can chan doan bénh ly ac tinh tré em .. TS.BS. Nguyén Minh Tuan PGS.TS.BS. Lam Thj My .-- 867873 Tang bach cau nguy kich TS RS Nguyén Mini Bénh khéng gamma globulin mau lién két nhiém sac thé X seceeeBT8 ThS.BS. Nguyén Thuy Duong TS.BS. Nguyén Minh Tuan Bénh suy giam mién dich thay ddi phé bién. TS.BS. Nguyén Minh Tuan Hi chung Wiskott- Aldrich ccnccoisresenascanss.ceal GRE ThS.BS. Cao Tran Thu Cuc TS.BS. Nguyén Minh Tuan Giam bach cau hat trung tinh bam sinh..... ThS.BS. Cao Tran Thu Cuc TS.BS. Nguy6n Minh Tuan Bénh tu viém... ThS.BS. Phan Nguyén Lién Anh TS.BS. Nguyén Minh Tuén Bénh suy giam mién dich két hop nang. TS.BS. Nguyén Minh Tuan PGS.TS.BS. Lam Thj My uan Bénh u hat man tinh... 908 ThS.BS. Phan Nguyén Lién Anh TS.BS. Nguyén Minh Tudn Buou than 6 tré em. 912 TS.BS. Nguyén Minh Tun CHUONG 7: MAT... CHAP, 190... BSCK2. H6 Thi My Hué Tac lé dao bam sinh BSCK2. H6 Thi My Hué BSCK2. Nguyén Thi Ngoc Anh Viem két mac. BS. Tid Chau Thai viém két mac so’ sin! BS. Trén Chau Thai ‘viem giac mac.. BS. Tran Chau Thai Phong mat ss BSCK2. Nguyén Thi Nyye Ault BS. Tran Chau Thai xxlChan thuong mat BSCK2. Nauyén Thi Naoc Anh BS. Tran Chau Thai Tiém thuéc chéng tang sinh tan mach (Anti — VEGF) vao ndi nhan diéu tri benh yong mac tré sinh non (ROP) 2 947 BS. Tran Chau Thai 943 CHUONG 8: NGQ DOC Ng déc cp tré em... TTND.BS. Bach Van Cam Ng6 doc thudéc paracetamol... TTND.BS. Bach Van Cam Ngo ddc thuéc chéng tram cam ba vong ccccsesssieiesensneeecsneeeneerersee GO5 TTND.BS. Bach Van Cam Ngé d6c thuéc khang Histamin... TTND.BS. Bach Van Cam Ng6 dOc thuéc Metoclopramid. TTND.BS. Bach Van Cam Ng@ déc thuéc nhé mai Naphazolin.. TTND.BS. Bach Van Cam Ng6 déc thuéc Phenobarbital TTND.BS. Bach Van Cam Ngé déc thudc Salicylat TTND.BS. Bach Van Cam Ng@ déc thudc diét od Paraquat. TTND.BS. Bach Van Cam Ng@ déc thudc triv sau Phospho hiru co’. TTND.BS. Bach Van Cam Ng@ déc thudc diét chudt Phospho kém.......... TTND.BS. Bach Van Cam Ng6 dOc thudc diét chudt Fluoroacetate........... TTND.BS. Bach Van Cam Ng@ dOc hda chat 4n mon... TTND.BS. Bach Van Cam Ng6 d6c rwou Ethanol... TTND.BS. Bach Van Cam Ng d6c rou methanol... TTND.BS. Bach Van Cam Ngo dc dau lira... TTND.BS. Bach Van CamNg6 dé6c chi .... TTND.BS. Bach Van Cam Ng6 d6c khi carbon monoxide... TTND.BS. Bach Van Cam Methemoglobin mau TTND.BS. Bach Van Cam Ng6 d6c thie an... TTND.BS. Bach van Cam Nad doc mat ca. TTND.BS. Bach Van Cam Ng6 d6c trieng céc............ TTND.BS. Bach Van Cam Ng6 déc khoai mi... TTND.BS, Bach Van Cam Ng6 déc ndm déc... TTND.BS. Bach Van Cam Ng6 déc thye vat TTND.BS, Ng6 déc thudc 16... TTND.BS. Bach Van Cam Ng@ déc thudc digt chuét nhém khéng déng Warfarin ThS.BS. Ma Tui Thanh PGS.TS.BS. Pham Van Quang CHU'ONG 9: NGOAI TONG HOP Tiép can va cép ctu chan thuong TTND.BS. Bach Van Cam Da chan thuong ... TTND.BS, Bach Van Cam ChAn thiveng hung TTND.BS. Bach Van Cam Xt? tri mét s6 chan thuong bung kin thuong gap... ThS.BS. Dao Trung Hiéu TTND.BS. Bach Van Cam Chén thong ngve.... TTND.BS. Bach Van Cam ChAn thuong dau TTND.BS. Bach Van Cam xxivTeo thyc quan... TTND.BS. Bach Van Cam Hep mon vj phi dai... ThS.BS. Bao Trung Hiéu Teo rudt non... TTND.BS. Bach Van Cam Ruédt xoay bat toan.... . ThS.BS. Dao Trung Hidu Bénh ly tdi thtra Meck ThS.BS. Bao Trung Hiéu Léng rudt cdp & nhd nti... 4129 ThS.BS. ao Trung Hiéu Vidm ruét thiva 6 tra em... 1133 ThS.BS. Bao Trung Hiéu Phinh to dai trang v6 hach bam sinh (bénh Hirschsprung)....... ThS.BS. Dao Trung Hiéu Dj dang hau mé6n tre trang ThS RS ian Tring Ong tang sinh mén (rd hau mén-tién dinh & tré em cd hau mén binh thong) ... 1149 ThS.BS. Dao Trung Hiéu Thodt vj hoanh.. TTND.BS. Bach Van Cam Hé thanh bung -Thoat vj rén..... TTND.BS. Bach Vin Cam Nang dng mat chit... ThS.BS. Bao Trung Hiéu Nang gidp lu ThS.BS. Dinh Viét Hung BS. Tran An Hai Bang BSCK2. Phan Nooc Duy Can Bénh ly hach lympho ngoai vi do lao.... ThS.BS. Va Duc Duy BS. Tran An Hai Dang BSCK2. Phan Ngoc Duy Can Nang dang bi dudi may . BS. Tran An Hai Dang BSCK1. Tran Anh 1hé BSCK2. Phan Ngoc Duy Can TI71 75PHY LUC.. Tiém ching... Liéu Iveng thudc thuong ding... Gia tri binn thvéng cac xét nghiém thuong gap Bang d6i chiéu dién tich da véi cn nang - chiéu cao. Mic 46 ching oir cho van a8 didu tri TAI LIEU THAM KHAO... XXVIChuong Cap cwu tai nanTir vong trong bénh vién thudng xay ra trong vong 24 gid dau. Phan lon cac trong hgp tir vong nay cé thé ngan ngiva dugc néu tré bénh nang dug loc bénh, phat hién ddu higu cap clu som va xi tri kip thoi. Loc bénh la mot quy trinh sang loc nhanh tré bénh khitré duoc dua dén co sé y té tai phong dang ky, ngoai ra cé thé 4p dung tai phong kham bénh hodc khoa cp ctru. Nhanh chong phan loai tré thanh ba nhom sau: Tré cé ddu higu cAp ctru can cAp ctru ngay hodc chuyén vao khoa Cap ctu. Tré ed d4u higu wu tién sé dwoc kham trudc dé danh aia va diéu tri kip thoi. Tré khéng cé dau higu cap ciru hoae wu tién sé dugc khaém bénh theo tht ty. Héi ba me ly do dva tré én kham cing lic quan sat va so tay chan tré ip. do, sau ir dvong Néu tré co bat ky ddu hiéu cdp ctru nao phai cdp ctru ngay, kéu goi 6 tiép tue va hoan thanh viée danh gia va lam xét nghiém cap ctru: huyét bang que (Dextrostix), dung tich hong cau (Hct). Néu Dextrostix < 50 mg/dL hoac nghi ng& ha dong huyét va bénh nhan con tinh, uéng dug‘: cho udng glucose 15g/lan, lap lai sau 5 - 10 phut néu can. Tim cdc dau higu cap ctru theo thi ty wu tién: Déu hiéu cp céru hd hap: - Ngtng the hodc con ngivng tho.LOG BENH VA xU' TRI CAP CUU - Tim tél. - Ratl6mngyonang. _ + Tho rit thi hit vao khi nm yén. - Tré thé rit, hdi ba me tré c6 hit sAc khong. Néu co tré bj di vat dung tho. e DAu hiéu séc: - Tay chan lanh kem. - Thoi gian dé cay mao mach cham > 3 giay bang cach An lam trang méng tay. Thdi gian 45 day mao mach Ia thdi gian am héng tré lai méng tay. - Mach cé tay yéu, nhanh hoac khéng bat duoc. = Tim vét thuong dang chay mau dé cam méu va hoi bé me néu xuat hign dot ngot sau chich thudc hay cén truing can nghi séc phan vé. Du hiéu hon mé hodc co giat: = Mac dé tri giac duc danh gia nhanh béi thang diém AVPU: A (alert): tré tinh. V (voice): dap tng voi lai ni. P (pain): dap wng véi kich thich dau (véo da hoac kéo téc ving tran). U (unconscious): hén mé. Tré can cép ciru khi khéng dap tng voi kich thich dau hoac dang co giat. - Hi ba me tré 66 bi chdn thurong dau cd. Néu c6 hoae nghi ngd, phai cd dinh cé ngay. © DAu higu mat nude nang 6 tré bj tiéu chay. MAt nuee nang khi co > 2 dau higu sai Tré li bi ho&e khé Aanh thse - Déu higu mat tring. - Nép véo da bung mat rt cham (> 2 giay). 2. Tim cdc du higu wu tién dé tré dug kham trude, diéu tr) kip thoi Tré c6 dAu higu wu tién khi cé mét trong céc dau hiéu sau: © Sét cao. e LI DI, but rut, Knong yen. © Suy hé hap: (nguOng the nhanh: tré < 2 théng: > 60 lan/phut; tré 2 thang - dui 12 thang: > 50 lan/phit; tré 12 thang - 5 tudi: > 40 l&n/phut). © Gay mon nang hode phil 2 ban chan. e Long ban tay rat nhot. © Bong. © Tainan, na déc. © Tré bénh dudi 2 thang tudi. © Cé gidy chuy&n vign ti tuyén true. Nhing tré c6 dau higu wu tien déu co nguy co dién tién nang va nhanh, vi thé cAn kham, dénh gid true d8 xv tri kip thei, khéng phai xép cho ther ty kham. Néu tré o6 ch4n thong hoac cé van dé ngoai khoa thi can o6 sy hd tro cia ngoai khoa. 3. Tré khéng cé d4u higu cép civu, khng c6 dau higu wu tian Néu tré khéng c6 dau hiéu cép cu cling nhu wu tién thi cho kham theo the ty. Tiéu chuan chuyén vao khoa cép cttu khi tré c6 mét trong cac dau higu:CHUONG 1: CAP CU'U TAI NAN Ngteng thé hoac con ngting thé. e Tim tai. e Rut lém ngyc nang. : Th@ rit thi hit vao khi nam yén. Séc.LOC BENH VA xU TRI CAP CUU 4. Cap cru mat nec nang (Luu dé 9) pt BOR am Mine Sm Derma) Bu ORS qua sonde da day. Dec h trea e)] ua) Mat nudc nang kem SDD Tat cd tré sau khi durgc loc bénh va xt? tri cAp ciru phai duoc héi bénh sir, tham kham toan dién, chi dinh xét nghiém dé c6 chan doan xc dinh va diéu tringuyén nhan. LU'U BO 4. LUU BO LOC BENH VA XU’ TRI CAP CU’'U TIM DAU HIEU CAP CUU NEU CO xU' TRI CAP CUU NGAY Arad urn mo inh cé (nghi chan thong cé) cAP ctru HO HAP Bép béng qua mask Tho oxy cam mau soc Thé oxy ‘Triiyén dich nhanh. mau Adrenaline (séc phan vé) Thong dvdng the | Cé dinh cd (nghi chan thuong cd) Nam nghiéng HON ME, GO GIAT Thee Diazepam TM/bom HM. Sluvuse TM MAT NU'O'C NANG. u di (TRE TIEU CHAY) Tee pom ee TIM CAC DAU HIEU UU TIEN Neu CO — KAM TRUOG Y KHONG DAU HIEU CAP CUU, KHONG UU TIEN — KHAM THEO THU TY vo HOI BENH SU, KHAM TOAN DIEN, XET NGHIEM » CHAN DOAN VA DIEU TRI NGUYEN NHAN-CHUONG 1: CAP CU'U TAINAN LUU DO 2. XU’ TRI TRE B] KHO THO’ DO SAC (D| VAT DUONG THO) TRE NHO: THU THUAT VO LUNG AN NGU'G Nam sp, dau th4p trén canh tay. V6 lung 5 cai bang gét ban tay gita 2 xwong ba vai. Kiém tra: - Cdn khé thé: lat ngiva, dn ngye 5 cai b&ny 2 ngon tay tren xvong We duo mie lién vii 1 khoat ngén tay. - _H6t khé thd, hong hao: bing tré dau cao, git yén. Kiém tra miéng lay dj vat néu cé. Con tac nghén, lap lai vé Iung, An ngyc 6 lan. Vé lung TRE LON: THU THUAT HEIMLICH Ding sau, véng 2 tay qua ngudi trd, Dat 1 ban tay (nam dAm) diva mili ten Dat ban tay kia én nam dam. An bung manh huéng dui Ién 5 lan. Kiém tra miang ly dj vat néu cd. Con tac nghén, lap lai n byng 6 lan. Heimlich 6 tré l6n.LOC BENH VA XU'TRI CAP CU'U LUU DO 3. KHO THO DO TAG NGHEN 9UONG THO’ HOAC MOI NGUNG THO KHONG NGHI NGO CHAN THU'O'NG COT SONG CO ‘Tré tinh 4. Kiém tra miéng ldy di vat néu thay. 2. Hut sach chat tiét. . 3. Dat tré 6 tu thé dé chiu nhat. ‘Tré hon mé 4. Nala dau. Tré <1 tudi tu thé trung gian. Tur thé trung gian tré < ‘tudi 2. Kiém tra ming ldy di vat néu thay. 3. Hut sach chat tiét. 4. Kiém tra thd: nhin di dng Ing ngyre, nghe cam nhan hoi thé 5. Dat tré & tu thé an toan. Ngira dau 6 tré lon Nhin, nghe, cam nhan hoi tho NGHI NGO CHAN THU'ONG COT SONG CO 4. C6 dinh cd. _ . 2. Kiém tra miéng, ly dj vat néu thay. 3. Hut sach chat tiét. 4. An ham. 5, . Nhin di dong Iéng nguc, nghe hoi thé. Néu khéng thé sau thie hién cde déng téc trén tién hanh bop béng qua mat na.CHUNG 1: CAP CU’U TAI NAN LUU BO 4. CAP CUU NGUNG THO, NGUNG TIM O TRE TREN 1 THANG TUOI Lay goi Mé — kéu gidip 46 Bat mach trung tam Khong mach trung tam An tim ngoai ling ngye Th6ng duong the Quan sat ldng ngye Khéng di dong 2 phat Bép bong/mask 2 cai higu qua An tim/hap bang: 15/2 Adrenalin An tim <4 tudi An tim 1-8 tudi An tim > 8 tudi (2ngon cai dat auoravong (7 ban tay ren mom x.ue (2 ban tay tren mom x.ue néi 2 vi 1 khodt ngén tay). 1 khoat ngén tay). 2 khoat ngén tay). Ty Ig An tim/bép béng trong NTNT Tré 1 thang - 15 tudi = 15/2LOC BENH VA XU TRI CAP CUU LU'U BO 5. TU THEAN TOAN CUA TRE HON ME THANG DIEM AVPU © A: Tré tinh. V: Dap ting Idi néi. © P:Bap Wng kich thich dau. © U: Hén mé. Khi tré khéng dap tng Idi néi (P,U) tu thé an toan. KHONG NGHI NGO CHAN THUONG COT SONG CO - At tré nAm nghiéng bén dé giém nguy co’ hit sac. Cé hoi ngira, dat 1 ban tay tré dui go ma. = Pat 1 chan & tr thé co va lu6n git tu thé nay. NGHI NGO CHAN THUONG COT SONG CO co DINH COT SONG CO Tré nam ngira, luén gir dau theo truc co thé. - Dung nep cd cé dinh. - Dat 1 tdi dich 4 lit hoac tdi cat moi bén dau dé c5 king di dong (khéng 6 sn nep cd). - Bang cé dinh tran tré ra 2 ben clia mat phang ctrng.CHUONG 1: CAP CUU TAINAN LUU DO 6. XU’ TRI TRE DANG CO GIAT THEO THU TY ABC ® Théng dwéng thé (A), hé tro hé hap (B), tuan hoan (C). * Khéng cho vao migng tré vat dung, thudo, ké ed edy dé Iudi chura quén gac. DIAZEPAM BUONG TINH MACH Diazepam: lidu 0,2 mg/kg (TMC). j © Cdn.co giat sau 10 phut: lp lai 0,2 mg/kg (TMC). © Co git van tiép tyc sau 10 phut: lip lai 0,2 mg/kg (TMC) (hoa Phenobarbital TTM/30 phit). - Néu st cao: lau mat dé ha sét. (Nhigt do 2 40°C, dang hoac doa co giat do sét). Tim va diéu tri nguyén nhan co giat: Dextrostix. Néu ha dung huyét (< 3,0 mmol/l < 45 mg/dl) Glucose 10%: 5 ml/kg. (*) Siv dung phenobarbital ligu 20 mg/kg kiém soat co giat & tré nhé < 2 tuan tudi. DIAZEPAM HAU MON acum ne amon Pree h Cmemn aes Bryden ROR OL Mins aD or melee eed eed dul PRM ue eR en en eekeul Lele ie Maat Mea enen ee mentsLOC BENH VA XU’ TRI CAP CUU LUU BO 7. XU TRI CO GIAT DO SOT C4p ctvu thudng gap 6 TE 6 thang - 5 tudi va hay tai phat. Tré sét 38°C kém co giat toan than ngan < 5 phut, sau giat tré tinh. Ngat thé: khi co giat tré tiét nhiéu dom gay tac dudng the. Thiéu oxy nao, tén thuong nao: khi co giat kéo dai. TRE CO GIAT SAU SO CU'U PHAI DUA DEN CO SO Y TE DE CHAN BOAN, DIEU TR! THICH HOP \Vat chanh, 48 thudc vao migng khi dang co giat gay hit sac, ngat thé. Quan kin, & dm lam nhiét dé tang cao va co gidt kéo dai. Lau mat bang nue da vi it higu qua hoae bang rugu gay ngé doc.CHUNG 1: CAP CUU TAI NAN LUU BO 8. TRUYEN DICH CHONG SOC xu TRI © Chich TM, thét bai sau 5 phit: tiém ty xuong. @ Lay mau XN cp ctu, dudng huyét ode Dextrostix. © Truyan | RINS 20 ml/kg nhanh hode 20 mi/kg/gia. / Sau d6 danh gia lai: MeCN ins (UR Mm ae eC ae STINTS ern ear ae eaten ta emer see SPP aaa hum aeeaetas ‘Sau cai thién (M, HA, t{gian 46 day mao mach binh thuong): gidm téc 46, truy&n dich duy tri, TW er en gay séc. Chu y: Néuha DH (<3 mmolll hodc < 45 mg/dl) truyén glucose 10%. S6éc mat mau: truyén mau 20 mi/kg sau LRINS lan dau. © Xac dinn va aiéu ti nguyen nhan s6c pan ve, séc Urn. KY THUAT TIEM TUY XUONG Dung cu: kim 18 G (kim rat thuéc), éng tiem 3 mi Kg thuat: = Nam ngta, dat drap cudnitdi cat dudi géi, géi co. - Vj tri: xwong chay dudi Idi cl chay 1-2 khodt ngon tay. - Dung dng tiém 3 mi gan kim 186 dam goc 90° dén kim xuyén qua vO xirong - KT vi tri dung dau kim: kim tw dang thang, rut ra dich tuy. - Gan dich truyén. Luu y: dong truyén tly xwong: dich, mau, thudc cap ctru. Rut kim ngay khi c6 dudng truyén < 24 gid tranh viém ty xuong.LOC BENH VA xv TRI CAP CUU LUU BO 9. PHAC BO DIEU TRI TIEU CHAY MAT NUOC NANG (NHANH CHONG DIEU IR] MAT NUOT NANG) THEO CHIEU MUI TEN, NEU TRA LOI “CO” THUC HIEN THEO MUI TEN NGANG; NEU TRA LOI “KHONG” THI THEO MUI TEN XUONG BAT BAU TU’ DAY Truyén TM ngay duge|_C° [e Bat adu truyn TM ngay. Uéng ORS khi chudn khong? *| bj. Truyén LR 100 ml/kg (ho&e NaCI 0,9%). Khong Pte eee nn ent ren Sun iWaoge toons? | 62, | Ca co fh dase toa | Oo (*) ae 14n n@a: tuong tw néu M yéu, M= 0. Khong v © Cir 1 -2gid danh gid lal: mt woe khong cai Hun luyén cach ding éng théng da day d& bu nwo'c cha’? Khong co thign truy€n nhanh hon. ® Uéng ORS Khi udng duoc (5 milkgigio): thong sau 3-4 gid (tré < 12 th); 1-2 gid (tré > 12th). © Banh gia sau 6 gid (tré < 12 th); 3 gid (tré > 12, th). Phan loai mat nu. Chon phéc 46 A,B,C. Tré uéng duge khéng? Khéng ¥. Chuyén GAP dén BV dé truyén dich hay dat éng thong da day e Chuyén ngay tré dé truyén TM. __Tré uéng duge: uéng ORS trong khi chuyén. ORS 6ng da day hoac uéng 20 mV/kg/gie trong 6 gid (tng céng 120 mlikg/6gid). © Ctr 1 -2gid dénh gid lai: NOn nhiéu hoac chuéng bung: dich cham hon. © Sau 3 gid mat nude Khdng cai thién: chuyén tuyén tren dé truyén 1M, e Danh gia lai sau 6 gid. Phan loai d6 mat nude. Chon phac d6 A,B,C. Chi y: theo déi it nhat 6 gid sau khi bu dich dé biét chac chan ba me o6 thé duy tri bu nuwc bang ORS.CAP CUU NGUNG THO NGUNGTIM NANG CAO TRONG CO SGY TE VA BENH VIEN |. DALCUONG e Phan Ion ngizng thé ngieng tim (NTNT) tré em do suy hé hap thiéu oxy. Dau higu bao déng NTNT: suy hé hap, tai tim, séc, hon mé, co giat kéo dai, r6i loan nhip tim can cAp ottu kip thei tranh NTNT. Thdi gian vang cap ctru NTNT [a 4 phut ké tl thoi diém NTNT, sau 4 phit no sé bj tn thuong nhiéu di ching than kinh hoac tt? vong. Bénh vién can trang bi xe cp ecru ngtng thé ngling tim vi day dui y dung cu va thudc cp ciru. Nhiéu nghién ctru cho thdy ap dung hé thong canh bao sém tré em va déi cAp ctu néi vién nh&m myc dich phat hign sém dau hiéu bao déng ngira NTNT, cp cru nhanh da lam gidm ty 18 tl vong. Chan doan NTNT: - Hon me. - Khéng cd mach trung tam. - Léng ngye khéng di déng. Il. NGUYEN TAC CAP CUU NGUNG THO NGUNG TIM 4. Nh4n biét com va cdp etru nhanh NTNT. 2. CAp ctru NTNT theo ther tyr wu tién: an tim, thong dung thé, bop béng gitip thé (CAB). 3. An tim truéc, 4n manh va nhanh, it gian doan. 4. Bop bong qua mat na véi FiO, 100% va hiéu qua léng ngye phai nhé lén khi b6p. 5. Ty Ié an tim va bop béng NTNT tré em voi 2 cap otru vién la 15/2. 6. Thudc chil yéu cap ctru NTNT la Adrenaline inh mach huge bum qua NKQ. 7. Séc di8n sém khi c6 chi dinh. 8. Luén ggi gitip dé, hoat déng nhém khi cp cfu NTNT. In. CAP CUU NGUNG THO NGUNG TIM NANG CAOTAICO SOY TEVA BENH VIEN Cp etru NTNT edn it nhat 2 cp ctu vin: 1 4n tim va 1 bép béng gitip theCAP CU'U NGUNG THO NGUNG TIM NANG CAO TRONG CO SO’Y TE VA BENH VIEN cAc BUO'C CAP CUU NTNT TRE EM TAI CSYT - BENH VIEN BuO 1: X4c dinh hon me Buéc 2: An tim néu ngung tim Buc 3: Théng dudng thd Buse 4: Bép bong qua mat na khi ngivng tho Busc 5: Adrenaline tiém tinh mach Bude 6: Mac monitor nhip tim Budéc 7: Séc dién diéu tri rung that hoac nhip nhanh that mt mach 1. Buéc 1: Xac dinh bénh nhan hén mé. Lay goi nguéi bénh Néu bénh nhan con tinh: = Dat tur thé an toan nghiéng trai dé tranh hit sé. - Danh gid nhanh va cép ctu theo thi ty ABCD. - Tho oxy va git SpO, 94-98%. - Lay va theo déi DHST, Sp, - Tim va diéu tri nguyén nhan. ¢ Néu bénh nhan hon mé: = Goi gitip 46 ngay khi bénh nhan hon mé. = Dat bénh nhan nam nguva. = Ngtea efi nang em hnde nang ham khinghi chan thwona cot séna 66 é thong duong tho. - Hon mé kem tai tim va ling ngwe khéng di déng nhiéu kha nang NTNT. = Hén mé —» XAc dinh cé hoae khéng ngling tim 2. Bude 2: An tim néu ngirng tim e Kiém tra ngivng tim. = Kidn Wa nhaul nyiray tin (ti da 10 giéy). - Xée dinh ngung tim bang cdch + Konig 66 mach trung t€m: mach cé 6 tré lon hoac mach khuyu 6 tré <1 tudi. + Hoae khong nghe duroc tiéng tim. + Hoac dang dién, khéng séng dién tim trén monitor ECG. - H6n mé kém tai tim va lng ngye khéng di d6ng nhiéu kha nang NTNT. An tim néu ging tim. Néu c6 2 cap ctu vién: 1 ngwdi An tim va 1 ngwéoi bop béng. Thay ddi luan phién méi 2 phut & thoi diém danh gid lai bénh nhan. - Antim ngay khi ngting tim - An tim 15 lan sau a6 bép béng qua mat na 2 lan. - Truéng hop chi cé 1 cap citu vién: An tim 30 lan, bop béng 2 lan. - Anmanh va nhanh. + An-sau 4/3 chiéu day cla lbng ngye: 4-5 om. + Annhanh 100 - 120 lan/phut.CHUONG 1: CAP CUU TAINAN. - Bogi ling ngye no lai trvec khi an tim tiép. - Han ché ngieng an tim, chi ngirng khi bop bong qua mat na hoae khi - Bat bénh nhan trén mat phang ctrng. - Anniva dudi xvong tc. - Vi tri dat ban tay: Hut dam néu can. Nowra dau nang cam. Nang ham khi nghi chdn thong cot sing ©é. Dat dng thong miéng hau 6 bénh nhan hon mé t that bai hut dam va ngtva dau nang cam. Dj vat duwong thé: vd lung An ngue hoac Heimlich.CAP CU'U NGUNG THO’ NGUNG TIM NANG CAO TRONG CO’ SO Y TE VA BENH VIEN 4, Buée 4: Bép béng gitip tho qua mat na khi ngieng the Kiém tra ngteng thé: - Kiém tra nhanh ngwng tho (t6i da 5 glay). = Quan sat léng nguc khéng di déng: ngiyng the. Bop béng qua mat na néu ngung tho: - Bép béng qua mat na véi FiO, 100%. = Dung bong gitip th ty phdng, khong dung bong gay mé. - Chon kich thuéc bong giuip tho va mat na phi hop: + Tré so sinh nhGi nhi dén 2 tudi: bong 500 mi. + Trélén: béng 1.500 mi. - Chon c& mat na phi hop. ~ N6i béng c6 tui dy tra vei nguén oxy 10-15 lit/phut 48 cung cdp FiO, 100%. ~ Bop béng cé higu qua khi thay Ing ngye nhé lén khi bop. = Ngung 4n tim khi bép béng qua mat na. Ty [@ 4n tim va bop bong qua mat na ty 16 15: Néu bénh nhan con thé va khong ngwng tim: - Théng duong thd. - Tho oxy gitr SpO, 94-98%. = Thiét lp duéng tinh mach ngoai bién. = Bu duh chéng séc néu od. Dat ndi khi quan va bop béng qua néi khi quan: - Xem xét dat ndi khi quan khi khi cdn ngtyng thé sau khi An tim va bop bong 2 2 phut. - Co éng NKQ: Cannang | Co dng NKQ(ID) | nin nee Chiéu dai NKQ dong miéng = An tim lién tuc khéng ngung khi bop béng qua néi khi quan, chi ngung khi séc dién.CHUNG 1: CAP CUU TAI NAN An tim lién tue khéng ngung khi bop béng qua NKQ - An tim 100 - 120 lAn/phut - Bop bong 10 - 12 lan/phut 5. Buéc 5: Adrenaline tiém tinh mach © Thiét lp dvéng TM ngoai bién e Tiém ty xvong voi kim tiém tly xuong hoac kim rtit thudc c& 16 - 18G néu sau 1 phtt that bai TM ngoai bién. e Tiém TM Adrenaline 1/10.000 liéu 0,01 mg/kg (hoac 0,1 ml/kg). Tdi da 1mg/ lan. Lap lai méi 3-5 phut néu can. e Tiém tiy xwong Adrenaline 1/10.000 liéu 0,01 mg/kg (hodc 0,1 mi/kg) néus sau 2 - 5 phiit that bai tiém TM ngoai bién. © Bom Adrenaline1/1.000 qua néi khi quan liéu 0,1 mg/kg (hoc 0,1 mi/kg) pha voi NS cho du 3-5 ml. e Sau bom NKQ phai bop bong dé day thuéc phan tan hét phé quan. 6. Buc 6: Mac monitor nhip tim © Khony 960 digén khi ngirng tim (vo tam thu) hode phan ly dién ww @ Luu dé cdp cru dn tim va tiém TM Adrenaline 1/10.000. An tim va bp bong 2phit] 2phat} 2phat| 2phit} 2phut| 2 phat Tim dap lai Adrenaline Adrenaline Adrenaline 1.1 mofo 0.01 moheg 0,04 mola, Lan Lan 2 Lan NKQ Thiét lap TM, tiém tdy xwong » Biéu tr nhip tim nhanh va nhip tim cham (xem phée dé diéu Uj rdi luau uhip tim).CAP CUU NGUNG THO NGUNG TIM NANG CAO TRONG CO SOY TE VA BENH VIEN 7. Bu6c 7: Séc dién diéu tri rung that hoac nhip nhanh that mat mach © S60 dién sém khi 6 chi dinh. Chi dinh séc dign: rung thé, nhanh that mat mach. May séc dién 2 pha t6t hon 1 pha Cé thé dung may sdéc dién ty dong 6 tré em voi lisu 50-60 J. S6c dién voi ban dién crc tré em. Néu khéng cé ban dién cure tré em ding ban ngudi én dat rude sau ngyc. Cac bude tién hanh: - Bat dau 4 Joules/kg. - An tim va bop bong (AT/BB) trong 2 phut, ngay sau s6c aien. - kiém tra nhanh mach va monitor nhip tim truéc méi lan lap lai séc dign. - L&p lai séc dién 4 Joules/kg néu can va tiép tuc AT/BB trong 2 phut. ~ Adrenaline 1/10.000 tiém TM liéu 0,1 mi/kg/lén va Amiodaron 5 mg/kg/lan hoac Lidocaine 1mg/kg lan & lan séc dién 3, 5 néu can. © Luu dé séc dién diéu tri rung that hoac nhip nhanh that mat mach Séc dién Aukg 43mg Akg Akg eg Akg kg An tim va 2phat WR phat YP 2 phat We 2phot ’ 2phat WF 2 pnt W 2ohat bép béng Adrenaline | t t t t t t Adrenaline t t t Adrenaline i A 0,01 mgikg aatraohe | 0,01 mokg I i Y Amiodarone Amiodarone 5 molkg ‘5 mgikg ‘Thiét fap TM, tiém tiy xwong, © Cham dirt an tim va bép bong = Khéng c6 quy dinh cy thé thei diém ngung 4n tim bop bang - Thueng sau 15-30 phut ma ngyo'l benh tim cha dap lal, con ngung tho kem: + H6n mé séu, dau higu chét nao. + Béng ttr dan to, khéng phan xa + Khéng cé nhip ty the khi test ngung bop bong. + Kh6ng co dién tim tren ECG hoac khong co séng dién néo trén EEG. - Sau khi bac si aiai thich va déng ¥ cla than nhan ngudi bénh.CHUONG 1: CAP CU'U TAINAN Bang tém tat thuéc c4p cteu ngirny 19 ngi¢ng tim tr aU ny us Meter)CAP CUU NGUNG THO NGUNG TIM NANG CAO TRONG CC SO Y TE VA BENH VIEN D6i cp ctu ngieng thé ngieng tim tai bénh vien 2 May séc dién : 4 4. An tim ) 2. Sécdign 3. Bac sTtruding nhém CCNTNT 1 4. Bép béng gitip the 5. Diéu dung tiém TM, Tiém thudc Iv. DIEU TRI SAU CAP CUU TIM DAP LAI Phéi hop vei bac st hdi strc cap ctru va chuyén khoa, muc tiéu ctru séng ngudi bénh va khéng di ching than kinh. Xem xét cho cha me hién dién khi cap ctu NTNT nhung BS phai giai thich tre vé tinh trang bénh. phon ohap diéu tri va tién long. © Bién ching sau nging tim: - Tén thong nao do thiéu oxy: + Hén mé, co giat. + Tang hoac ha than nhiét do t6n thuo'ng trung tam diéu nhiét, | + Tang than nhiét thudng xay ra trong vong 48 gid dau va la yéu t6 tién lvong xdu. ~ Suy chiro néng oo 00" tim. Tut huyét 4p, cung Iueng tim gidm, réi loan nhip tim. - Tén thvong da co quan hau qua thiéu tudi mau va oxy. + Tang hoac ha dung huyét. T&ng kali mau. Toan hé hap hoae toan chuyén héa. Suy gan, suy than. Ol loan dong mau. © Theo doi - DHST, SpO,, tri gido, nuéc tiéu. = Monitor nhip tim = Xét nghiém: + Céng thirc mau. + Buong huyét, lon dd. + Lactate mau. + DoECG. + +++ 24CHUONG 1: CAP CUU TAINAN + Khi mau dong mach hoac khi mau tinh mach + Chirc ning gan, thén, dong mau. + Siéu 4m tim, X quang ngu'e néu oan. © HOi strc cp cru sau cp ctpu khi tim 4p lai Tranh thiéu Oxy va séc kéo dai gay tién long xdu. Hi ste hé hp: + Tiép tue bop bong qua néi khi quan néu con NTNT. + Thé Oxy gid SpO, 94-98%. + Tho may. + Theo dOl khf mau néu can. Hoi sto sdc néu co voi NS hoac LR nhanh 20 mi/kg cho dén khi ra séc. Néu sdc that bai bu dich can str dung thuédc van mach va t&ng co co’ tim. Diéu tri ha duéng huyét néu cé: + Ha duéng huyét va tang duong huyét du tién long xAu. + Khéng TM Glucose 10% thudng quy. + Ha susing huyét: didu tri Glucose 10% TM ligu 2 mL/kg. Diéu © Dibutrsét (> 37,5°C) hoac ha than nhiét (< 35°C) néu 06. + Muc tigu gid nhiét 46 < 37,5°C. + Phwong phap ha than nhiat tré em khéng cai thién dug tién lugng va di chtrng nao. Tim va didu tri nguyén nhan néu co. Cece Cee ced Emer uch ue © Cac yéu t6 anh hwong tién Ivong cép ctru NTNT = Thoi diém phat hién va cp ctru NTNT. ~ Thai gian cp ctru dén khi tim dap lai, ty tho. Nguyén nhén NTNT. - Bénh ly nén, man tinh, ac tinh, suy giém mién dich. Tuan hoan ngoai co’ thé (ECMO: Extracorporeal membrane oxygenation). Xem xét ECMO khi NTNT trong bénh vién duge phat hién som kém bénh ly co thé diéu tr duoc. 22CAP CUU NGUNG THO NGUNG TIM NANG CAO TRONG CO SOY TE VA BENH VIEN BANG TOM TAT CAC BU'OC CAP CU'U NTNT O' TRE EM SAU CPR TRONG CO’ SO Y TE HOAC BENH VIEN NGUNG THO NGUNG TIM + AN TIM va BOP BONG GIUP THO (CPR) Tile 1512 Ngimg tim Phan ly dign co Tier 6c BIEN Monitor nip tim Tyc 4g CPR z Sau séc dign lan 3 va 5 Héi sire sau khi tim dap lai ~ TM Adrenaline 1/10.000 ~ Thé may/bép bing NKQ. liu 0,04 miVkg ~ Tho Oxy = Aniodarone ibuS malkg | |~ Bu in s6c ~ Digu tri sét ~ Didu tr) ha dudng huyét, toan = Bibu tri nguyén nhan = Xem xét ECMO = Yat aghiéen = Theo doi DHST, SpOz, tri giée, ECG 23CHAN DOAN VA XU TRI CAP CUU PHAN VE 1. DAICUONG Phan vé (anaphylaxis) la mét phan Leng dj (eng, c6 thd xuat hién ngay lap ttre tir vai gidy, vai phut dén vai gié sau khi co’ thé tiép xite v6i chat la cdn goi lé di nguyén gay ra cac bénh canh lam sang khac nhau tty nhe, nang, nguy kich cé thé dan dén tiv ong nhanh chong. Séc phan vé la mtre dé nang nat cla phan vé do dét ngét gidn toan bé hé théng mach gay tl vong trong vong mét vai phut. Adrenaline la thudc thiét yéu, quan trong hang dau cAp civu phan vé va phan lon sédap tng tét sau 1 [an tiém bap Adrenaline. Bac si, y sf, diéu dung, ho sinh, ky thuat vién phai xt? tri cAp céru ngay khi ngudi bénh bj phan vé. Cac chat gay phan tng phan vé thuong Ia: khang sinh, SAT, thude can quang co lod, djcn truyén mau, ong dt, thuc an. I. CHAN DOAN 4. Céng viéc chan doan a. Héi bnh © Bénh st: mdi tiép xtic (vai phuit dén vai gid) voi chat la, tiém thude. ¢ Tién sv dj wng: — Djtng khi tiép xtic voi thuéc, thtre an. - Co dia suyén, cham, viém mii di tng. b, Kham lam sang > Cac trigu ching xudt hién nhanh thong vai phut sau tiém (5 - 10 hit, : Sea Ga: ndi mé day, do da, ph mach, ngtra. © Tinh trang séc voi: = Tay chan lanh mach nhanh. — Tut huyét dp: + Trétlel—12 thang : HAtam thu < 70 mmHg. + Tré tty 1-10 tudi :HA tam thu < 70 mmHg + (2 x tudi). + Tr >10 tudi 2 HA tam thu < 90 mmHg. 24CHAN BOAN VA XU TRI CAP CUU PHAN VE © DAu higu ho hap: khé th thanh quan, thé rit, kho khé, tim tai. © Dau higu tiéu hoa: di mvva, tiéu chy, dau byng. © Réiloan tri gidc: vat va, birt rurt, gong ngudi, hon mé. > Cac trigu chieng goi y, nghi dén phan vé Khi xuat hién nhanh it nhat cé mét trong cac triéu chieng sau: @ May day, pht mach. © Kh6 thd, ttre ngye, thé rit. © Dau bung hoac nén. © Tut huyét dp hodc ngat. © R6i loan tri gide. c. Xét nghiém © Binh lugng tryptase mau: Tryptase due san xudt va dy trit dung bao va bach cau 4i kiém, ndng d@ trytase tang t6i da sau 15-120 phut sau phan vé. — Tryptase/mau binh thong la 2-14 pg/lit. = Thdi diém ly méu la sau 1-2 gid cp ctru. - Kétqua Tryptase tang > 20 pg/lit giuip xac dinh chan doan, tuy nhién két qua am khéng loai chan doan phan vé. Céng thirc mau, bach cau di toan c6 thé tang. e ®vdng huyét, ion dd, lactate mau, khi mau, chirc nang gan, cht’c nang than trudng hop phan vé nang hoac nguy kich. 2. Chan doan xac dinh Chan doan phan vé chi yéu dua vao déu higu lam sang: Bénh str moi tiép xtc (vai phut dén vai gid) voi chat la hoac tiém thud. e Khdi phat d6t ngét vdi bidu hién ngoai damé day, ngtra hodc tut huyét ap hodc khé tho. © Tryptase/ mau tang > 20 yg/lit néu cé. © nan doan pnan ier: = Séc tim, séc gidm thé tich, séc nhiém khudn. - Tai bién mach mau no, xuAt huyét no. — Di vat dudng thd. — Ha dudng huyét: xa biva An, tay chan lanh, va md héi, mach, huyét ap binh thuong. - Conhen phé auan. — Ngé doc cAp. = Dau khitiém bp hoc phan ting déi giao cam: khéc, mach cham, huyét p binh thong, 25CHUONG 1: CAP CUU TAI NAN 3. Phan d@ phan vé Phan vé nhe c6 thé nhanh chéng chuyén d6 néng hodc nguy kich Phan ve Pee) ea Pc ae ee a) Ema MM ue aon Teme a | PEM mm IN ee cuuace Me eea eee} aul} enc al) | Sa Ue od Re Un ans Se ame SM ed Reece eek seca a etek ee eek cue IN. DIEU TRI 4. Nguyén tac diéu tr © Phat hién som phan vé. Ngivng ngay thudéc hoac dj nguyén gay phan vé. Thudc cht yéu didu tri phan vé la Adrenaline tiém bap Bu dich khi that bai Adrenaline tiém bap. Thuéc Corticoid va khang Histamine chi cho sau tiém Adrenaline. Bac si, diéu dung, hé sinh, ky thuat vin phai xi? tri ngay tai ch khi od phan vé. Hoi ky tién st? dj (eng thudc va khong ké don thudc da gay di tng d& phong ngiva phan vé. 2. Didu tri cdp ciru 2.1. Xie tri phan vé nhe (a6 |) Phan vé nhe cé thé chuyén thanh nang hoac nguy kich. 2.1.1. Ngiing ngay thuéc dang tiém. 2.1.2. Sirdung thudc: © Diphenhydramin uéng hoac tiém 1 mg/kg. © Methylprednisolone uéng hoae tiém 1 — 2 mg/kg tiy tinh trang ngudi bénh. 2.1.3, Tiép tue theo doi it nhat 24 gid a8 xir tri kip thoi, do phan tng phan vé nhe c6 thé dién tién chuy€n d6 nang nhanh sang phan vé nang hoac nguy kich. 2.2. Xtb tri phan vé nang (dé Il) hode nguy kich (a6 Il) 2.2.1. Ngiig ngay thudc dang tiém.CHAN DOAN VA XU’ TRI CAP CU'U PHAN VE An tim ngoai lng ngue, thong dong thé, bop béng gitip thé qua mat na. Adrenaline1%o (1/1000) tiém bap liéu 0,01 mi/kg/lan. — Hau hét bénh nhan dap tng tét, ra séc sém sau 1 [an tiém bap Adrenaline néu dugc phat hign phan vé nang kip thoi va cho Adrenaline som. = Néu ben nhan con séc: lap lai TB méi 3 - 5 phuit khi chwa 66 dwéng truy€n tinh mach va cho dén khi huyét dp va mach 6n dinh. — Néu that bai sau 2 lan tiém bap Adrenaline dau tién nén sém chuyén sang truyén tinh mach Adrenaline. Liéu Adrealine 1% tiém bap theo tudi va can nang: Ligu Adrenaline 1% tiém bap trong hgp cdp ciru khéng biét tudi va can nang khi bj phan vé: Adrenaline la thude chi: yéu, ciru mang trong diéu trj phan vé tir d6 II. - Tac dung cia Adrenaline trong diéu tri phan vé: co mach (séc phan vé d&n mach tang ste co co’ tim dua huyét ap tré’ vé binh thvong). - Bac si, diéu duGng, hé sinh, ky thuat vien pnai tem bap Adrenaline ngay tai ché khi cO phan vé. - Tiém bap Adrenaline 1%o mat trude dui (Adrenaline mét phan ngan, kh6ng pha lodng) do tiém bap hiéu qua hon tiém duréi da. = Déivdi ngwdi cé tién st” phan vé c6 sn Adrenaline mang theo ngudi thi ngudi bénh hoac ngwrdi khac khéng phai la nhan vién y té duoc phép sir dung thudc trong trvéng hop khan cAp dé tiém bap cdp ctu khi khong co nhan vién y té. ar OUT “ig *eto | CHUONG 1: CAP CUU TAINAN © Thiét lap 2 duéng tinh mach ngoai bién & chi vdi kim ludn: ~ Buéng truyén (1) truyén Adrenaline. - Bung truyén (2) truyén dich nhanh Normal Saline 9%uo. © Trong luc ché thiét lap duong truyén tinh mach ngoai bién néu bénh nhan cén séc phai lap lai TB mdi 3-5 phat cho dén khi huyét ap va mach 6n dinh. 2.2.6. Truyén tinh mach Adrenaline Néu that bai sau 2 lan tiém bap Adrenaline dau tién: cén séc hodc dau hiéu hé hp va tigu hda nang hon hodc cé nguy co ngung tim nén chuyén sang truyén tinh mach Adrenaline. Adrenaline pha voi NS 9%e truyén qua bom tiém dién hoe may truyén dich dé dam bao téc dé va liéu long chinh xdc. Adrenaline truyén TM qua bom tiém bat dau 0,1 pg/kg/phut tang dan dén khi dat higu qua, tdi da 0,5 pg/kg/phut (dé gidm tac dung phy cla Adrenaline). B&nh nhan phai duge theo di sat va monitor dién tim khi truyn Adrenaline dé phat hién va xiv tri kip théi ri loan nhip tim. é tranh tac dung phy clia Adrenaline dac biét a nguy co’ rdi loan nhip tim nang c6 thé tir vong: chi si7 dung Adrenaline truyén tinh mach sau khi that bai voi TB Adrenaline va phai do bac si chi dinh. e ©’ tré em Adrenaline khdng duge tiém tinh mach cham (tiém tinh mach Adranalina ngat qi ing) ma phai truyén finh mach lién te Cach pha Adrenaline truyén qua bom tiém dién - $6 mg Adrenaline pha véi NS cho di 50m! cla dng tiém = 0,3 x can nang (kg) ~ Técd6 bom tiém tmi/giv = 0,1 yg/kg/phitt. 2.2.7. Th6 oxy sau khi tiém Adrenaline Thd oxy va Garrot phia trén navi tiém thud (néu doe) sani khi tiém Adrenaline Dat noi khi quan giup thd néu séc kéo dai khong dap Weng voi cdc thudc van mach, tang strc co co tim va bu dich. 2.2.8, BU dich nhanh va tiép tuc truyén Adrenaline Truyén Normal Saline hoac Lactate Ringer 10- 20 mi/kg/trong 15-20 phut hoac 1 gig ty mirc d6 séc cia bénh Saudo: ; ' = Néu huyét d6ng hoc cai thign tét: gidm liu Normal Saline cdn 10mV/kg/gid. - Néucén séc: + Bo va theo dai 4p Ive tinh mach trung wong (CVP): Theo déi sat CVP vi bién ching phu phdi rat thong gap khi bénh nhan truyén dich nhanh nhét la khi hét giai doan dan mach. + Do huyét dp xam ln. | Truyén dung dich cao phan tir (Haesteril hodc Dextran) téc a6 10 — 20 mi/kgi/gid va diéu chinh tdc dé truyén theo CVP-Trong trong hop s6c nang téng thé tich dich cé thé dén 60 — 80 ml/kg. | 2.2.5. Thiét lp duréng truyén tinh mach ngoal bién 28CHAN ®OAN VA XU’ TRI CAP CUU PHAN VE © Phdihgp truyén Adrenaline . . Adrenaline truyén TM qua bom tiem bat dau 0,1 ug/kg/phut tang dan dén khi dat hiéu qua, t6i da 0,5 g/kg/phut (48 gidm tac dung phy ciia Adrenaline). © Phéi hyp thém cac thuéc van mach khac - Dopamin, Dobutamin, Noradrenaline truyén tinh mach khi ngudi bénh c6 s6c nang da dugc truyén du dich va truyén Adrenaline liéu 0,5 pg/kg/ phut ma huyét ap khéng cai thién. + Dopamin: truyén tinh mach Dopaminliéu bat dau 0,3 gikg/phut tang liu dan méi 10 - 15 phut dén khi dat hiéu qué, ti da 10 ug/kg/phut. + Dobutamin khi suy tim, phi phdi: Truy€n tinh mach Dobutamin liéu bat dau 0,3 yg/kg/phut tang li8u d&n mdi 10 - 15 phutt dén khi dat higu qué, tdi da 10g/kg/phut 4 + Noradrenaline khi that bai voi tat ca thuéc van mach va tang strc co co’ tim. Truyén tinh mach Noradrenaline lidu bat dau 0,1 pig/kg/phut tang lidu dn mdi 10 - 15 phut dén khi dat hiau qua, t6i da 2 y/ko/phuit + Néu that bai véi Dopamin, Dobutamin va Noradrenaline: tang liéu dan Adrenaline truyén tinh mach tir 0,5 yg/kg/phut dén khi dat hiéu qua, tdi da 1 ig/kg/phut. — Bénh nh&n phai dugc theo doi sat va monitor dién tim khi truyén thuéc van mach dé phat hién va xi tri kip théi réi loan nhip tim. — Sau khi huyét dong hoc én dinh ttr 6 - 8 gid xem xét giam liéu va ngtng thudc van macn theo thu ty Noradrenaiine, Adrenaline, sau do Dupatiit va Dobutamin. 2.2.9. Thués Methylprednisolone hoac Hydrocortisone sau khi tiém Adrenaline e Tac dyng Methylprednisolone: = Tang tac dung Adrenaline. - Giam phéng thich héa chat trung gian, giam phan tng khang nguyén — knang tné. - Giam dé nang séc phan vé. - Phong ngira tai séc (tai sdc it gap, sau 2-6 gid). © Lidu Iwgng: - Methylprednisolone 1-2 mg/kgTMC, liéu t6i da & tré em 50 mg. - Hoac Hydrocortisone 5 mg/kg/lan mi 4-6 gid. = _Liéu Hydrocortisone/lan: Tré <6 thang: 25 mg; Tré 6 thang — 6 tudi: 50 mg; Tré > 6 tudi: 100 mg. 2.2.10. Thuéc khang Histaminsau khi tiém Adrenaline va Methylprednisolone Khang Histamin H1 nhw Diphenhydramin tiém bap tré em: 10-25 mg (nguéi lon 25-50 mg) hoac Promethazin (Pipolphen) 0,5-1 mg/kgTB méi 6-8 gid. © Phéi hop Khang Histamin H2 trong trréng hep séc phan vé nang va kéo dai. — Ranitidin tiém tinh mach: 6 tré em 1 mg/kg pha trong 20 ml Dextrose 5% tiém finh mach trong 5 phut (ngudi lon 50 mg) c6 thé [ap lai mai 6 - 8 gid — Phéi hop khang H1 kém khang H2 tac dung tét hon st? dung don thuan khang H1. 29CHUONG 1: CAP CUU TAI NAN 2.2.11. Biéu tri khac IV. THEO DOI © Khi co kho thé thanh quan: Adrenaline 1%0 2 - 3 mi/lan phun khi dung. © Néu co kho ke: Salbulamol 2,5 - 5 ing/lan phun khf dung hoae xit hong Salbutamol 2-4 nhat/lén méi 20 phut. 1, Phan vé nang, nguy kich ® Trong giai doan séc: theo déi mach,huyét 4p, nhip thé, monitor dién tim, tim tai, tri giac, mdi 15 phut cho dn khi dn din. © Trang giai doan huyét dong hoc dn dinh: theo doi |mach, huyét ap, nhip tho, tim tai, tri giac, SaO,, méi 1 - 2 gid’ trong 24 gid tiép theo vi nguy co’ tai séc. ® Theo di tac dung phu ctia Adrenaline: — V@t va - Xanh tai. - Nhe dau. - Cao huyét dp. — Non 6i, dau bung. - Nhip tim nhanh. - Tw ngye. ~ Réiloan nhip tim. 2. B4i véi bénh nhan phan vé nhe. Theo dl it nhat 24 gio vi nguy co chuyén dO va phan ve phia 2. V. PHONG NGUA PHAN VE 1. 30 Trwéc khi ding thuéc cho bénh nhan can © Hi tién sir dj wng thuéc, dic biét ngwi cé co’ dia dj ng. Day la bién phap phéng ngiva quan trong nhat. ® ansan sang hp thudc cap ctru phan vé. - Khéng thi thuong quy phan tng (test) cho tdt ca cac loai thudc triv nhtng trudng hgp c6 chi dinh. Phai tién hanh test da true khi sir dung thuédc hoc di nguyén néu ngudi bénh cé tién st? di ting véi thuéc hoae di nguyén cé lién quan hode véi nhiéu di nguyan khaée. nhau Khi thir test phai eA sAn eae phiveng tian ep etou phan vd. Sau khi tinh trang dj ung dn dinh duge 4- 6 tuan, khém chuyén khoa dj ung- min dich lam sang dé lam test xac dinh nguyén nhan phan vé. . Phat mau thé dj Ging va théng bao nguéi bénh tac nhan gay phan vé khi xuat vién va dan do bénh nhan cé phan véphai bao cho nhAn vién y té biét khi kham benh.CHAN BOAN VA XU’ TRI CAP CU'U PHAN VE (Theo Huong dan phong, chan dodn va xt tri phan vé - BO yté 2017) (*) PHAC BO XU’ TRI CAP CUPU PHAN VE 1, Methylprednisolone hoac Liphenhydramin udng hoac wem bap toy unn trang ngudi bénh. 2. Theo déi it nhAt 24 gir 48 xiv tri kip thei. 1. Nging ngay tiép xtc voi thuéc hoc di nguy&n (néu c6). 2. Cho ngudi bénh nam tai ché, dau thap. 3, lembapAdrenaline éng 1mg/mi, Neu ire em 1/3 1/3 Ong, nywoI lon 1/2 dug. Lap lai méi_ 3-5 phuit cho dén khi mach va huyét dp én dinh. 4. Thé oxy qua cannula hoac qua mat na. 5, én gia tinh trang hé hp, tuan hoan, tri gidc va biéu hign & da, niém mac. An tim va bép bong néu ngirng hé hp, tudn hoan. 6. Thiét [Ap sn Gudng truyén Adrenaline tinh mach va truyén dich nhanh Normatsaline. 7. Hi chdn voi bac si chuyén khoa hdi strc cp ctru, bao cao cap trén. Oe ouu 2 oyCHUNG 1: CAP CU'U TAINAN SO’ DO CHAN DOAN VA XU TRI PHAN VE TRE EM CHAN BOAN XAC BINH TINH TRANG PHAN VE NGUNG NGAY TIEP XUC VOI THUOC HOAC D] NGUYEN + GOI HO TRO PHAN BO Nhe (9 I) Chic tribu ching dai m& ay, ngva, pha mach Xi tringay bing tiém bap Duy nbdt ciru séng ben nhan xO TRICAP CUU HAN VE Diphenthydramin uéng hogetiém | mark Mettyiprerisolone uéng hoe idm 1-2 mgkg hy reo mae op ararig grog ‘ae tube tong ty) Nye lu du tr huyét dp tam the :>7OmmHg + (2xtubi) 1. nan vien y té age phép tiém nép Adrenaline theo phac ab Khi xay ra phan ve. 2. Phat thé theo dai dj ng thuéc ~ Kham lai chuyén khoa di ing - mién dich lam sang sau 4-6 tuin, 6 g e i f E E 5 2 B] [reo abivong 24 0 S|} | mach, nuyét 4p, ship &) le : G e 33 z 321. DAICUONG 6c h@i chizng thiéu cung cdp mau va Oxy cho mé, co quan so véi nhu cau. Néu khéng xi tri som séo sé dan dén toan chuyén héa, tén thuong da co quan va tl vong. Séc: Cung cp Oxy (Oxygen delivery) 3 gidy. © Tut HA la dau hidu tré khi séc mat bi. @ Tut HA khi HA tam thu < 70 + (Tudi x 2). BT aria PU eC (lia |) eT nent Z at) eae cl aia Web aay EanCHUONG 1: CAP CUU TAI NAN Dau higu sdc som: - Mach nhanh. - CRT>3 gidy. - Huyét ap binh thuong. Dau hiéu séc muon: = Réiloan tri gidc. - Mach nhe, nhanh hoae cham. — Huyét 4p tut (d4u hiéu tr). - CRT rat cham > 3 giay. - Tho nba. ~ Tiéu tt. Réi loan tri gidc. Tay chan lanh. Thdi gian dé day mao mach kéo dai > 3 gidy. Mach nhanh nhe, hoac bang 0. Huyét ap tut theo tudi. 36soc HA trung binh < 65 mmHg. Thé nhanh theo tudi, Lactate mau > 2 mmol/l. Nuoc tiéu < 1 mi/kg/gic. BO bao hda oxy mau finh mach trung tam (ScvO,) < 70%. 3, Xét nghigém Céng thtre mau, dinh nhém mau. wong huyét. lon dd. Lactate mau: s6c khi > 2 mmol/L Khi mau. ScvO, (Central venous oxygen saturation) khi cé dat CVP: ra s6c khi SCvO, > 70%. CRP hoc Pro-calcitonine. Cay mau trong séc nhiém khudn. Men tim: tang CK, CKMB, Troponine trong séc tim, viém co’ tim. Tryptase mau trong séc phan vé. Chtre nang gan - than. Chwe nang déng mau. Téng phan tich noc tiéu. X quang tim-phdi. SiAu Am ngiee - hung Siu 4m RUSH (Rapid Ultrasound in Shock) danh gia chirc nang co bép co tim va thay ddi tinh mach chi dui theo nhip thé. Khi séc khé chan dodn phan biét gitra séc gidm thé tich va séc tim: sigu m RUSH tai givéng sé gitip chan doan. eee eB aici Ree Wane inact) | Séc tim RC sah: ee ea el (ive) ee eT o nua w) neue tai] | DCm efed lentes Dudnglink IVCthdra_Dudng kink IVC hitwao Duong kinh IVC thé ra (*) Chi sé IVC xep = x 100 37soc Phat hién séc sém va cp cttu kip theiCHUIONG 1: CAP CUU TAI NAN Chan doan nguyén nhan soc. HG tro’ ho hép. Thiét lap dwong tinh mach. Biéu tri séc tty theo nguyén nhan. Theo ddi sat dp Ung diéu tri. Bidu tri bidn cheng. 2. Diéu tri 2.1. Diéu tri séc giam thé tich ° Nam dau phang. Thé oxy cannula cho tat cé banh nhan dang séc do thiéu oxy mé, git SpO, 94-96%. Bat ndi khi quan the may som: — Th may som sé dam bao cung cap oxy va th6ng khi gitip cai thién cung lwong tim, giém nhu cau bién dung, vi thé ty Ié thoat séc sé cao hon. ~ Chidinh: banh nhan dang séc, that bai sau 1-2 gid thé oxy (cdn dau hiéu suy h6 hap, the nhanh, thé gang strc ngay ca khi SpO, > 92%). ~ Khéng dgi dén khi bénh nhan, 6 con ngting thé hoac ngiing the vi sé khéng thé dwa bénh nhan ra séc va chae chan tt vong do thiéu oxy nang kéo dai tén thong da co’ quan khéng héi phuc. = Thuéc an than dat ndi khi quan: chon Iva ketamine. Thiét lap dwong TM ngoai bién 6 chi voi kim ludn. Tiém tay xworng hi sau 6 10 phut that bai thiét lp duéng tinh mach & trd <6 tudi. Bu dich nhanh LR hoac NS 20 mi/kg/15 phut. Co thé lap lai t6i da 40-60 miligia’ ddu hoac chuyn sang cao phan tir cho dén khi cai thién huyét dong hoc. Theo déi sat déu higu qua tai hoac phi phéi d& ngung dich. Xem xét thudc van mach khi séc that bai bu dich LR hoac NS: — Dopamine truyén 1M leu 3-10 po/kg/pnut. ~ Adrenaline truyén TM liu 0,01-1 yglkg/piut. — Noradrenaline truyén TM liéu 0,01-2 ug/kg/phut. 2.2. Bidu tri sée mat mau (xem phe dé diéu trj s6c mat mau) 2.3. Diéu tr] séc tim (xem phac 46 diéu trj s6c tim) 40 Nam dau cao. . Tho oxy cannula cho tat cd bénh nhan dang séc do thiéu oxy mé, git SpO, 94-96%. Tho NCPAP khi phi phdi hoac that bai Oxy. Ngung dich néu bénh nhan cé dau hiéu phi: phdi dang truyén dich. Thiét lap dong TM ngoai bién. Dobutamine la thuéc tang co co’ tim dug chon trong séc tim. - Dobutamine truyén TM liéu bat dau 5 jig/kg/phiit, tang lidu dan dén khi Gap tng tat, tdi da 20 jig/kg/phut.soc - Téc dung Dobutamine: tang co co’ tim (61) va dan mach (62) nén lam gidm suc cn mach méu, giém hau tai va khéng tang nhip tim. Néu séc nang (M = 0, HA = 0): Noradrenaline truyén TM liéu 0,01-2 tg/kg/phut, Xem xét test dich truy€n trong trvdng hop chua loai trv séc gidm thé tich k@m khéng cé triéu chteng dur dich hoac phil phéi: truyén 5-10 mi/kg trong 15-30 phut va ngung dich ngay néu xuat hién dau higu qua tai. Bidu tri rdi loan nhip tim néu co. Furosemide oi tiéu liéu 0,5-1 mg/kg/lan khi c6 d4u hiéu qua tai, pha phdi. 2.4. Diéu tri séc tac nghén Nam dau cao. Thé oxy cannula cho tt cA bénh nhan dang séc do thiéu oxy m6, gitr SpO, 94-96% Tranh truyén nhiéu dich. Xéc dinh nguyén nhan séc téc nghén: dau hiéu lam sang, X quang, siéu am ngyec. Dibu tri nguyén nh&n séc tc nghén. Tran khi mang phdi p lyre: choc hut mang phdi giai ap. Tran dich mang tim chén ép: — Choo hut mang tim gidi dp. ~ (&) LRINS 10-20 ml/kg nhanh, theo doi sat d4u hiéu qua tai. Thuy6n tc phdi: thuéc khang déng, héi chan bac si tim mach va ngoai tim mach. 2.5. Diéu tr] s6c than kinh eevee Nam dau phang. Tho oxy cannula cho tat cd bénh nhan dang séc do thiéu oxy mé, git SpO,, 94-96% Thiét 4p dvdng TM ngoai bién. Bd dich nhanh LR hoac NS 20 mi/kg/gid. Theo déi sat ddu hiéu aua tai hodc phil phdi dé nauna dich. Noradrenaline la thuédc van mach, co mach, éuge chon do dan mach trong séc than kinh Noradrenaline truyén TM lidu bat du 0,01 pig/kg/phut tng liu dan dén khi c6 dap teng t6i da 2 g/kg/phut. Biéu tri phu no, r6i loan nhip tim néu C6. 2.6. Biéu tri séc nhiém khuan (xem phdc dé diéu tr sé nhiém khudn). 2.7. Biéu trj séc s6t xudt huyét Dengue (xem phéc dé diéu tri sc SXHD). 2.8. Biéu tri séc phan vé (xem phac dé6 diéu tr] phan vé). V. THUGC VAN MACH VA TANG CO COTIM DIEU TRI SOC Bang tém tat cdc thuéc van mach va tang co ca tim thuong ding diéu tri séc tré em. a