BNH N

I. HNH CHNH:
H v tn bnh nhn: ....................................................................................... Tui: ..................Gii: Nam/N
a ch: .................................................................................................................................................................
Vo vin (ghi r ngy gi): ..................................................................................................................................
Ngi lin lc: ...................................................................... St:d: ................................. c: ............................
Ra vin:......................................................................................... M bnh n: ...................................................
II. CHUYN MN:
Bnh s:
01. Nguyn nhn:
u di ng
u c nh

Tai nn giao thng

Tai nn lao ng

Tai nn sinh hot

02.M bo him:
03. Ung ru, bia:
04. Tri gic sau tai nn:
05. Thi gian t khi tai
nn n khi nhp vin:

Khng

Khng

Tnh

0-6 h

C-Nng cn:

M ngay

6-24 h

L m
............................

>24 h

06.

X tr tuyn trc:
Khng
C:
Hi sc

Th oxy

MKQ

NKQ

Th my

t c nh c

Khm khi nhp vin:

07. Din bin tri gic:

C khong tnh

Tri gic xu dn

Hn m t u
08.

GCS:..........im

11.

Du hiu TKTV:
Mch: ..........ln/pht
HA:........../..........mmHg
Nhit :..........
Nhp th: ..........ln/pht

iu tr

Chng ph no

An thn

Truyn dch

09.

ng t:
Bnh thng, u 2 bn
Gin 1 bn, PXAS (+)
Gin 1 bn, PXAS ()
Gin 2 bn, PXAS (+)
Gin 2 bn, PXAS ()

10.

Lit na ngi:
Khng
C

12.

Tn thng da u:
Khng c
Vt thng da u
Sy st da u
T mu

13.

Thng tn phi hp:

Khng c
Chn thng bng
Chn thng ngc
Chn thng hm mt
Gy chi
Chn thng ct sng

Cn lm sng:
14. X-quang s quy c:

Khng chp

C chp:
C ng v xng
Khng c ng v

15.

X-quang ct sng c:
Khng chp
C chp:
C tn thng:.........................
Khng c tn thng

16.

Chp CLVT:
Mu t ngoi mng cng n thun
Mu t di mng cng n thun
Mu t trong nhu m no
Khc (dp no, chy mu no tht...)
Mu t phi hp trong s

17.

Di lch ng gia:
Khng lch
Lch < 5 mm
Lch 5-10 mm
Lch > 10 mm

18.

Xa b y: Khng
C

19.

ng v xng:

iu tr
21.

24.

25.

Hi sc:
Khng NKQ, MKQ
t NKQ
MKQ
Th my

Bin chng:
Bin chng sm

Khng c

Chy mu no

Ph no

Gin no tht

Kt qu:
Gn: GCS:............im

Ln 1 Ln 2
20.

Khng

o ICP:
Khng
C - Kt qu o:
Trc m:..........mmHg
Sau m:..........mmHg

22.

iu tr ni khoa:
Mannitol 20%
Huyt thanh mn
Li tiu
An thn

23.
Phu thut:
Thi gian can thip:
sau vo vin ...........gi
Cch m:
Ly mu t
Gii ta no

Bin chng mun

Khng c

Vim mng no

R dch no ty

Vim phi

Vim ng tit niu

Lot do t
Xa:

Sng GOS 3 thng:..........im

T vong

Ngy lm bnh n:........../........../.......... Ngi lm bnh n: ...............................................................................