Tiếp cận bệnh nhân cấp cứu đánh giá tri giác năm 2024
100% found this document useful (1 vote) 179 views 17 pages Original TitleTIẾP CẬN TRẺ RỐI LOẠN TRI GIÁC - 2019 - Đại học Y dược TPHCM.pdf Copyright© © All Rights Reserved Share this documentDid you find this document useful?100% found this document useful (1 vote) 179 views17 pages TIẾP CẬN TRẺ RỐI LOẠN TRI GIÁC - 2019 - Đại học Y dược TPHCM PDFPK ! Z G " E GF E $ NÁE P_ % _ & K CN ' E P_K DKÁG PfW.OW. Cì Zf !" g Pruy # e ! M ( g tkìu f ) g t * p 1. Ck $ t hì gág eduyìe efïe dïy r % k cn & e trk dkág tf !' ed d ( p efk hfna ?. )# edf * vê pfïe tígf xët edfk $ m gf + e , náe trned tr !' ed f - p g . tf / 7. : ed ` . ed ,* ef f !" ed 0. V 1 trí g ? p g 7 u oae ,0 u gág r % k cn & e trk dkág tf !' ed d ( p 1. $+ k g ,- ed Prk dkág t 2 ef tán g 9 a tr 4 pf . tfu 6 g vên s ; tnêe v < e gf 7 g e 8 ed g 9 a v 3 eçn vê f $ c !" k fn & t fná f !" ed cìe (A_AW - tfb asgbe`ked rbtkgucar agtkvatked systbm) ,= e gág g 5 quae , ígf g 9 a e÷ \> vûed ` !" k ,J k, ,J k tf * . A_AW cê m 6 t m & ed c !" k gág t \= oên tf 0 e hkef ,!- g t A gf 7 g c 3 ed c 4 n trned tfïe eçn g÷ gf 7 g e 8 ed gfíef cê , k # u gf 2 ef gág , áp 7 ed v " k gág tíe fk $ u hígf tfígf t O mðk tr !' ed. Ef G e tf 7 g ` ; a trìe m 6 t m & ed c !" k h \= t e % k pfïe pf % k r 6 ed rçk f 5 e dk @ a gág g ? u trüg v 3 eçn vê gág g ? u trüg ` !" k v 3 eçn. Prk dkág g÷ tf / tfay ,A k `n o $ ef c B , gf ? e tf !5 ed fay ed 6 ,6
,A k trk dkág g÷ tf / `k I e tk \= e t O o 7 t r 7 t, hígf tfígf, ed 9 dê, ck oã, c 5 m 5 vê fðe mì. Gág `aef t O mð t D trk dkág g÷ pf 0 e t !5 ed ,% k vê ,* ef tíef. Pfaed , k / m Dcasdnw vê tfaed , k / m Dcasdnw fk $ u gf 2 ef gfn tr 4 bm dküp pf 0 e eên ,* ef c !- ed trk dkág o $ ef efïe, dküp tfbn `òk `k I e tk \= e trk dkág vê tran ,A k tãef tr & ed g 9 a o $ ef efïe dk @ a gág oág s F trned , áef dká o $ ef efïe.X1] Fðe mì cê tãef tr & ed r % k cn & e trk dkág e ( ed, g ? p g 7 u, , b `n & tíef m & ed o $ ef efk, g 0 e ,!- g c !- ed dká vê gae tfk $ p h * p tf ' k ,/ `uy trã tíef m & ed vê gf 7 g e 8 ed eçn gfn o $ ef efk. Pfðed tf !' ed, fðe mì cê tãef tr & ed t & m tf ' k, o $ ef efïe s K f J k pf . g, t 1 vned fay gfuy / e saed gág tãef tr & ed r % k cn & e trk dkág hën `êk ef ! ,' k s % ed tf ; g v G t fay gf \= t eçn. P 2 ef tán cê tãef tr & ed ef G e tf 7 g gfíef xág m 6 t gágf t ; efkìe v # o D e tfïe vê mðk tr !' ed xued quaef. Pãef tr & ed t 2 ef tán g÷ fak ,( g , k / m t 2 ef tf 7 g vê ef G e tf 7
G e tf 7 g gfíef xág g 0 e g÷ t 2 ef tf 7 g ef ! ed t 2 ef tf 7 g g÷ tf / g÷ mê hfðed g÷ ef G e tf 7 \> tr 4 ef 3 , , áef dká trk dkág g÷ tf / hf÷ hf 8 e f 5 e vê g 0 e g÷ efk # u hfía g & ef ,/ , áef dká gfíef xág trk dkág tr 4 . Yí ` . , tr 4 ef 3 hf÷g ca hfk , ÷k fay g D m tf ? y hf÷ gf * u g÷ tf / ,!- g , áef dká tr 4 g÷ ef G e tf 7 g v # o D e tfïe8 e \= u tr 4 , áp 7 ed v " k mðk tr !' ed ef ! m 2 m g !' k hfk efãe tf ? y fay edfb tf ? y dk L ed e÷k g 9 a gfa m < cê o H ed gf 7 ed tr 4 ef G e tf 7 g v # mðk tr !' ed xued quaef. X?] Pr 4 r % k cn & e trk dkág ef < g÷ tf / trðed –ou J e” f 5 e, hfðed vuk, fay m ? t t G p trued. Pr 4 eìe ,!- g sn sáef v " k m 7 g ,6 ckef fn & t vê tk \= p xüg fêed edêy g 9 a gfíef o D e tfïe tr 4 . Hfk tr 4 r % k cn & e trk dkág e ( ed f 5 e ok / u fk $ e gêed rò ` 0 e, tr 4 g÷ tf / ok / u fk $ e r % k cn & e trk dkág v " k hígf tfígf t 8 ed g !' ed trk dkág ef ! tr 4 o 7 t r 7 t, hígf tfígf, hf÷g ca ckìe t . g hfðed ` C ,!- g o \> k oa m < tr 4 fay ok / u fk $ e r % k cn & e trk dkág v " k 7 g gf \= trk dkág ef ! tr 4 c O ,O , ed 9 dê fay ck oã, c 5 m 5 . 1.1. _ . k cn e trk dkág ` + ed hígf tfígf D ( p \> tr 4 c " e, ít d ( p \> tr 4 ef 3 . Oan d J m< ! ! n dkág (faccugkeatknes) cê trk dkág mê fnêe tnêe hfðed g÷ ,% k t !- ed g D m ef G ! ! n t "# ed (kccusknes) cê trk dkág sak c 0 m v # v # m 6 t s ; v G t g÷ tf G ! Prk dkág sak o $ e gf % t fn ( g B edf F a g 9 a v G t (`bcusknes) ! Mì s $ ed cê tãef tr & ed trk dkág o * hígf tfígf oan d J m m ? t ,* ef f !" ed, hígf tfígf, s - fçk, r % k cn & e g D m ef G ! Hígf tfígf, o 7 t r 7 t \> tr 4 bm, eduyìe efïe tf !' ed d ( p ef ? t cê ed 6 ,6 g, efk I m trûed, s % t, r % k cn & e gfuy / e fná vê ,6 ed hkef. Ed 6 ,6 g atrnpke cê ` & ed mì s D ed g÷ tf / d ( p \> o $ ef efk ed 6 ,6 g pfnspfn f @ u g 5 ,!- g , k # u tr * quá ck # u atrnpke. 1.?. _ . k cn e trk dkág ` ed / g gf : _ % k cn & e trk dkág ` & ed 7 g gf \= tf !' ed d ( p \> tr 4 bm f 5
J m< ! Ed & dê cê r % k cn & e trk dkág m 7 g ,6 ef < hfk tr 4 dk D m f 7 ed tfü v " k mðk tr !' ed xued quaef vê pf D e 7 ed gf G m gf & p v " k gág hígf tfígf. Pr 4 ed 9 dê trðed cuðe ou J e ed 9 vê tf !' ed e H m ed 9 e \= u hfðed cay tf 7 g tr 4 . Pr 4 tf !' ed hfðed dkan tk \= p vê e \= u hfðed g÷ hígf tfígf c ( p c & k tfã tr 4 s K r 5 k vên tãef tr & ed ef ! tr !" g hfk o * hígf tfígf. ! C ' m ' cê tãef tr & ed , áp 7 ed ít fay hfðed , áp 7 ed v " k gág hígf tfígf t O mðk tr !' ed tr O hfk ,!- g hígf tfígf m & ef vê c ( p c & ! Fðe mì cê tãef tr & ed r % k cn & e trk dkág e ( ed, hfðed , áp 7 ed v " k gág hígf tfígf , au, `n r % k cn & e gf 7 g e 8 ed f $ c !" k fay t A e tf !5 ed g D fak oáe g 0
0 e pfïe ok $ t v " k gág tãef tr & ed r % k cn & e trk dkág hën `êk ef ! < ,' k s % ed tf ; g v G t, tãef tr & ed trk dkág t % k tfk / u vê gág tãef tr & ed t !5 ed ,!5 ed fay gf \= t eçn. ?. Eduyìe efïe Pu M tfbn qu % g dka, t 0 e su ? t g 9 a gág eduyìe efïe fðe mì `n gf ? e tf !5 ed vê hfðed gf ? e tf !5 ed g÷ tf / hfág efau. Edn & k tr O gág tr !' ed f - p gf ? e tf !5 ed `n ed !- g , çk, fðe mì \> tr 4 bm hfðed gf ? e tf !5 ed tf !' ed d ( p f 5 e, hfág efau \> gág `ïe t 6 g vê ,* a ` ! hfág efau. Prned efk # u edfkìe g 7 u, fðe mì `n efk I m trûed tf !' ed d ( p ef ?
!' ed dïy r % k cn & e trk dkág \> tr 4 bm cê efk I m trûed, ed 6 ,6 g, gf ? e tf !5 ed ,0 u, dk D m nxy ‗ t !" k máu (sau ed ! ed tkm, ed & t e !"
G t (tr & ed tfák ,6 ed hkef). Prned m 6 t oán gán hfág, fðe mì `n r % k cn & e gfuy / e fná cae tn D oan d J m dk D m nxy máu vê tfk \= u máu \> ;2% gág tr !' ed f - p, o ? t tf !' ed g ? u trüg hfn D ed 2% gág tr !' ed f -
!' ed d ( p \> tr 4 bm X1], X?], X7], X0]< ! Efk I m trûed ! Ykìm mêed eçn ! Ykìm eçn ‗ mêed eçn ! Aosgbss eçn ! Gf ? e tf !5 ed< Vu ? t fuy \= t e 6 k s L , pfû eçn ! Ed 6 ,6 g ! P A e tf !5 ed eçn tfk \= u nxy - tfk \= u máu eçn ef ! `n f G u qu D g 9 a suy fð f ? p fay s % g ! O $ ef f $ tf % ed ! Wuy dae ! Wuy tf G e ! O $ ef eçn t 8 ed fuy \= t áp ! _ % k cn & e gfuy / e fná ! F & ,!' ed fuy \= t, tnae gbtne , ák tfán ,!' ed ! _ % k cn & e , k $ e dk D k, r % k cn & e áp c ; g tf + m tf ? u máu ! P 8 ed GN? máu, t 8 ed EF7 máu ! F & tfïe efk $ t ! _ % k cn & e gfuy / e fná o + m skef ! )6 ed hkef< tr & ed tfák ,6 ed hkef ! P 8 ed áp c ; g e 6 k s L ! R eçn ! Zfû eçn ! )6 t qu E ! Y N ` * ` & ed m & gf máu eçn ! Eçn üed tfu Z , d J m t Q g YZ sfuet 7. Wkef c 1 o ? ef Prk dkág g 9 a o $ ef efk g÷ tf / o * r % k cn & e fn ( g m ? t gf 7 g e 8 ed `n gág t A e tf !5 ed \> tfïe eçn, t A e tf !5 ed g D fak oáe g 0 u eçn fn ( g t A e tf !5 ed gf 7 g e 8 ed tf 0 e hkef tnêe tf / . P A e tf !5 ed gf 7 g e 8 ed tf 0 e hkef tnêe tf / oan d J m gág r % k cn & e gfuy / e f÷a gfued vê r % k cn & e gfuy / e f÷a t & k eçn, tfay ,A k gïe o H ed e 6 k mðk t \= oên tf 0 e hkef fn ( g D ef f !> ed ,= e s ; hígf tfígf t \= oên tf 0 e hkef. P A e tf !5 ed eçn m 6 t oìe g÷ tf / dïy fðe mì e \= u gfüed dïy , æ ëp fn ( g cêm t A e tf !5 ed g ? u trüg eçn h \= oìe. Zf 0 e c " e gág tr !' ed f - p r % k cn & e trk dkág `n D ef f !> ed `ÿed máu t !" k máu. 7.1. C , u c ,7 ed máu eçn C ! u c !- ed máu eçn< eçn gfk \= m gf 2 hfn D ed ?% tr L ed c !- ed g 5 tf / , tuy efkìe c ! u c !- ed máu eçn gfk \= m ,= e 12% gued c !- ed tkm cüg edf 2 vê ?:% t A ed c !- ed nxy ,!- g tkìu tf . . Nxydbe vê dcugnsb cê g 0 e tfk \= t gfn fn & t ,6 ed oãef tf !' ed g 9 a t \= oên eçn. Gág ` !N ed gf ? t eêy ,!- g gued g ? p ckìe t . g gfn t \= oên eçn qua `ÿed máu t !" k eçn. Oãef tf !' ed, eçn g 0 e 1::: C máu m C k ?0 dk ' ,/ ef G e 41C nxydbe vê 1:: d Dcugnsb. Fãef 1< P !5 ed quae dk @ a fuy \= t áp vê c ! u c !- ed máu t !" k eçn |