PHÁC ĐỒ NĐ1

1. BENH VICN NHI DONG 1
PHAG DO
DIEU TR!
ilHr Kl{oA
2o12
NHA xuAr BAN Y Hgc

2. fil- JGq.rn.:'
-
ay"r-c4o
-
o+. lllr.
ryt r'$,- bt;is !
Ld MdDAU
Hien nay, tai nhi6u benh vi6n tren thd gidiv) trong nudc, didu tri
nsoaitrU da chOng minh hieu qua trong viec ai5m nhip vien kh6nq
cdn thidtv; s6p ph6n h?n chi gla ting chiphi di6u tri.
Tuy nhien, dd that s( ph;t huy hieu qua tr6n,.hdt ludng .ti€u tri
ngoai tri la m6t nong v5n dd uu tien cdn duoc quan t5m v) aliu tu
dUng ml]c. Ngoaiviecd6u tuphdttridn hardng cds4 fng dvng.6ng
ngh6thongtin,c;itidn c6cquitrlnhthn tuc henh chiinh; thivie. chin
do6n d'jng, ke ddn hdp li, loc benh t6t chic chSn se g6p phdn nang
cao chdt [1dn9 di6u tri ngoaitri. Vdinhung muctieu trcn, b€nh vien
Nhi D6ng I ldn dlu tien ra met tei lieu hudnq drn didu tri ngoai tr,
nhi khoa.I)i ligu dlrqc bi€n soin bdi tap thd c5c bec si c6 nhidu kinh
nghiem cia bCnh vien, d(aviodcch(ng cdkhoa hoc hien c6vAtlnh
hinh thrrc td cira benh vien.Vdihdn 70 cht d6 khitc nhau v6 cdc bgnh
li va hoi(hnng phiS bidn tai€5c phdns kh6m nhi, ph6c.16.ludc trlnh
bey theo trlnh tg ciic bud. rrong them kh6m rrE t?i phdng khlm sE
gitp cho c6c bic sith{c hinh dE dans 5p dung.
Do ldn ddu xudt ben kh6 tranh kh6l nh(ng thidu s6t, ch0ng
t6i mong su s6p , cLld c5c ddng nghiep dd tai li€u nsay cang ho)n
Thenh ph6 Hr3 ChiMinh, ng;y 26 th6n9 6 n;m 2012
6l5m ddc b6nhvien Nhltldng r
TS.BS,Ting chlThudns

3. MUC LUC
Loimddiu .. .. .1
rs.BS. Tdng Chl Ihnqng
-Quaibr ii.r,*,is ir" xt:it',
rhiydau . .55
Bs.Trtdng Hnu Khanh
A,PHAN NQr
Sdtxujt huydt Dengue .. s8
' ES NqrYEnMinhTidn
62
62Chudng l: Kh6m ifinh gi6 - Lec benh .. 10
- Khiim,d5nh sli, va phan loaitrenh6dridi2thing tudi t0
ThS.BS. Nguyen KiAn Mdu
- loc benh va xf tri c5p cllu trE em . .... 14
BS. Each Vnn Com
Chl,dng ll: Sdslnh j9
Chudns lV:Tim me<h
- Oau khdp
- Tr;o nguqcda day-thucqu;n sd
ThS.Bs.NguYAnT Hdo
- Dau nouc dtre€m .. .64
' ' ThS.AS inonqThlThnY Moi
IhS.B'. NguyAn Hdo
68
Ths'Bs NsuYen Hdo
- Ngit 70
ThS. 8s. Phan ncn Ldj
- Theo d6ibCnh nhan sau ph:uthuattim bdm sinh 13
Th'.BS Trdn rh!Thonh Van - PGSIS vn Minh Phnc
Theo d6ibgnh nhan sau th6ng tim can thieptim bdm sinh :76
BS- BniGio An
Chudngv:Then nieu. ----. .... 79
' R,iilo?n dltidu dtr6 em 79
Ths.BS. NguYen O(tc Quans
8s. Ddng Hoang Sdn
ES.EingHodnssdn
- Viem mi amidan cdp 94
Bs.D,iag Hodng ,dn
- Viam thanh khlphdquen .. 96
ThS.BS. NguYinThdisdn
- Viem ph6l - - ., . . , ,, .-, .190
lh5.B5,ltanAnn tuon
r03
Kh6
rhs.Bs. Nguyen Kidn MAu BscK2.LAVdnTri
VA Dk Tri
29
Nhi6m trnng dudng udu €s
Ths BS. Hurnh Thoai Laan
chddng vl: H6 hdp ..88
- Vie; m0idifns 88
Bs. NguyAn Th{ Huy
36 - Vlem mli hqnq 90
Ih5.8S. Vd Dtlc Tri
Nhi6m khLren h6 h6p(dptresdsinh
Ths.BS. Nguyqn Kidn MAu - BscK2. NouyanThanh Liern
Chudng lllr BCnh nhiEmtdng
92
Tl€p can benh nhin s6t
41
41
TS.8s. Ng uyCn Th o nh H n nq
85. Ttttong HOU Khanh
47
Bs. Nguydn Duy ri,n - BS. Pham Van Hodns
50
- H? Can-ximiu sdsinh 21
ThS.BS. NWyEn Kidn MAu - 8s. NquyenThiThanhTuyen
- (norro4 24
ThS-BS- V6 OtL -hi
- Tao b6n sdsinh 26
ThS.BS. Nguyen Kidn MAu - T'S.BS. Hohng Ngac Dung
i Sva sosinh 2aNhi6m trnns da
fh5.R5. NguyAn Kidn Mdu'ThS.B'. NguyanThiThanh Hudng
%nq da k6o d;i 32
ThS.BS. NguyAn Kidn MAu - IhS.9S. NsuyAn Thi MtnhThn
Nhiamtrnngrdn 35
ThS.BS. Va Dtk T
Viam kdt macsosinh
Benh tay chan mi6nq
BS.Ttndng Hilu Khonh
Ths.Bs.hdn AnhTudn

4. ch(dng vl:Ti€u h6a I I O
TrAo ngudr. da dly thu. quAn I to
- Tieu (hey
BSCK2. Hodng La phttt
I3
B6o
IhS.BS. Hodnolhlln
B9CK2_ Hadns Le pha.
Dau bung man ]]6
BS. NgrEn Vtu ttudng - BSCte- Haang Le phtjc
rao bon
118
BS.T6nrhiThonh Hd - BSCK2. Hadng Le phic
Nft heu m6n 122
- BS. Nguyen phLlc Thinh - BSCK2- HoAng Le phnc
NhiEm kisinh t.nng dudng ru6t 124
B.PHAN NGOAI
- Dau bunq cdp 168
IhS.BS. Ddo Trung Hidu - BS. Tq Huy Cdn
17r)Chdn thuonq al6u
rh'.Bs. odo kung Hidu - 8S.Iq Huy Cdn
- Ndm ludi 128
BSCK2_ Nguyan Thi Kin Thoa
ChudhsVlllr Oa liEu
i a;,;;;;;; 113
BS. Vt) Thiy Along - BSaK2. Hodng Le phic
ThS-85. Nquyin Dinh Hudn
rh S. B S. Nq uyi n D) n h Hu dn
BSCK2. NquyenThiHoa
ThS.8S-HodngThtTin
r59
gsc 12. Hod ng Th i Tha n h Thny
162
ThS.BS. Nguyen Bao Tndng
. 180
8sCK2. Le CbnsThAns - Bs. Nguyen Hdng Nhdn
Benh lY6nq ben 18s
BscK2- Le Cong Thdng - BS. Nguyan Ti6n Thdnh
Dinh m6inh6
172
ThS.BS. EAo Trunq Hi6u - 85. Tq Huy Cdn
174
BS. LA HOU Kh.lnh
Bs. Le Hnu Khdnh
199
BS.TtdnChAt lhai BS. NguyenhnongTu'ng Duy
210
BS. Trdn (hdu Thdi - 8SCK2. Hd Thi Mi HUC
212
85. Tran Chau rhdi - 85. NsuyAn Thi Ngec Anh
214
ch5n th(dns phen
Biintiat.h6m quay
B6ng do nhritd
' ChAm thdtang 138
- ViCm da ti6t be
ch6c lay u'u'n**i:! 192
BSCK2. LeconqThdng
Tinh hoan dn 194
IhS.BS. LA Thanh Hnnq - Bs. Phan Le Huy Lam
Nq6n tay.dsunq 197
Budu mAu
Th'.BS. NguyAn Bdo fidng
c.PHAN cHUYEN KHoa MAT, TAI Mot H9NG, RANG HAM MiT203
Vi6m kdt m9c 2o4
ThS.BS. Nguyen Ohh Hudn
- Nhi6m tring da 143
BSCK2. Nguyen Thi Kin Thoa
Chrldng lx: Thln kinh-;;;i;;i;;'' "" 112
BS. Nguyen MinhTudn.BS. Nsuyen euansvinh
151
_. 85 . Nguyen Du, Tien - BSC! t . phoa Van Hoanq
Chddng X: Dtnh dudng I54- Bidns En iio
ch:P
5uy dinh d(r6ng
Dinh th6ng ludi
Thidu m6uthidu srt BS.Nguydnvnn Ddu
. 217
85-LCTttThdnh NhdnCdixudng do thidu vitamin D
BSC(2. Hodng Thi Thonh Thiy
Bs.Odng Hoang Sdn

5. - Vi6m taigina c6p
Es.Nguy€nTudn Nht
Vi6m taiqifra man 226
Es.NguyenTudn Nhn
- Ph!lv(l:Lichti€mch,tng..... ... t7s
- PhU luc2:Lidu luong thudc 230

6. O T. KIdMTEA VA XUTRI CAC DTU
KHAM, DANH GIA VA PHAN LoAI TRE NH6
Duot 2 rHANG TUdi
CHUONG T:(HAMOANH GIA LQCBENH T T1
o 2. NEUTRE KHONG CO DAU HIEU CAPCUU
'l,en hann l_oi b.nh sJv; kharn cii. Ld quar
2.1. H6ibenh si
Lrlu i:trvdng hqP nghingd nhiEm tdrng chu iinh
':n
h6itldn cen
me: s,5t irlc gSnianh. thdiqian vo 6i k€o dai, me binhi6m tdng, tidu
aludng, trE bisanh ngat.
2.2.o6nh sie ph5n loaitheo r$qF(d9yn L c
a,Hdhdq: l, Lh-r'I"'
D6rr thrp rhd trong I phnl: h: tre ohAi n;r ven, khdng
btl, khonq kh6c. Nhlp thd nhanh > 60 1an/Ph t ho;< cham
< 30 len/phnt.
' Tlm ddu hiCu: rnt l6m ngqc n;ng, tlm t6i, Phap ph6ng ciinh
moi,tidng thdren l(cthl tha ra
Danh qid md.h ngoaibren
. xiLdinh lim bdn (P) hoac (T).
- Ddm ;hip tim, tidng tim, em thditrudc tim
Il- ddu ih.,isian ihuc h6lmiu da. CRf
- TrA.6 bn kem ho;c b6 b'i.
- Ouan s6t: (em v6 co ngi li b' hay kho danh lhJc khong?
- rl;;6 (" q,a kh..s/ i6rr6an rh;ri krn dlo nav < o g6ns co'
- can ph6; blCtcogiatv6irun chi(run chithddng linh t(nh):
DiAm aidna nhaa:
+ G nhths ctdons nhanh,lep di l;P lai.
+ T5ng len bdiva ch?m hdctidnq 6n.
Di€m khdcnhou:
{- Lanhuns cndonscnngbiend0vacnns hudng'
+ ch6mdotcdn run chlbeng.schgap chidans run hoA(6m
trA G'o ldng hoic trd;n.
- O6nh gi6trvdng lLi( (d, tlm ddu hiqu th6P Phdng.
- KhSm ph:n xa nguycn PhAt.
- Kiim tra ddu hicu vinq da du6i5nh siing mattrdi'
- Phen lo?ivang da:
NGAYcAc DAU HIEU cAP cUU
LYdo mang 116 ddn kham
Ire bao nhiau ng:y tudi?
Tre c6 v5n dd qi, khineo?
NgLhg th4ngUng
tim hoSc
Thd hLJ6c hoec
Thd chem <20lrnl
phdt, tim t6i
Nhiipvien cdp.Llu
H6lstc nglrng tim,
ngunq thd
Cung cep oxy
TrA dang co giat
Nh6p vi6n dp cfu
Th6ng dudng th4
oxv, 1Dextrostix (t), g

7. odu hieu
Vlng da aldn m6rdtr6 < 1 ng)ytudi.
Ving da ddn tay v; chan d trA 2 ngiytuiji.
Vans da d6n l6nq bin tay,ldnq b)n chen dtrE
> 3 ngiy tudi
V;ng da ninq
cdnnh6pvi6n
Vang da sau 48 gidv; kh6ng vang da $n tay
r2 ! PHAN A:NO FHOA
- Quan s6ttrudc khisd, rim ddu hi6u:
+ BunS chudns v) dich (dich, m6u), hdi (rhnns ruot, dd khi
thur qulr), tan9 {gdn.lach to. u),lac ruqr.
+ Blrns xep, buns l6m ldns thuydn va tdng ngu. nh6 cao
trong thoiiivihoanh.
' Tlm da'u thanh bqng dd, kh6i u bung, gan ro ndu hdn 2 cm
dudi bd 5udn phai.
- Nghe nhu d6ng ruot, blnh thLrdns to - 30 nhu.t6ng/ph!t.
- Da dd: da h6ng cau, rang 6-xy, ting than nhiet. Da tiiiithidu
miu, ngat s6.. Da tim:
+ trung Lrdng (tlm da, m6i):tim bdm sinh, b6nh phdi.
+ ngo?lblen (tlm da, m6ihdng): tvl€themogtobin.
+ d6u chi: (tlm b:n ra, b:rn chan): ha than nhi6t, s6c giam
thdtl.h
Quan rit r6n:ridjch vang rru hoi, t5y66 da quanh, chty Tdu,
ch6, 16n,
- Tlm cac mun mi dda.
- Ilmtlrban dldm, bdm mlu ch6 chrch.
- Dandrbong:h?thannhtEt,gi,mthdnch,nhtAmtrunghLyet.
9. KlEm trc non ahltng kht ue cin ndng tn. sanh dndl25OO grum:
- Hdl, kidm tra tu6ithai, cen n6ng, sdtr€ trong ljn sanh n;y.
U6(
CHJdNC TIKHAMOANH G A LOC8ENH ! T3
- N6u la l6n kh6m lai' dinh 9!: sut;ng
'an'
h. Xidln t,o d!r4t bdn sinh v'n song
'hdn 'dn
khoa:
" "
i,;. ,,;;, rar: .ft ro'' chi vom' (han knoeo' rhua ho;'
,'"'"ll l;. i,i, .r, ,"oar v: lirv narq ruv' thodi vr ro1
hn rha; bunq, l.hong hau mon.
;:;;;i ;;: ;; ;0"'1 .
".;i ^uns
hnoner r i-ct mat v'u r;e'
.6nh tav, trAt kh6p h5n9'
- ii- .17iil
'-.n'
,e' oem trm do sans chsn san khoa; btrd'l
huy6tthanh
D3. TIEU CHUAN NHAPVIEN
. Tim hav da niii bong.
il;;1 fu,
"-
.e ro sr;! rn6p ph6aq nav srarr r'"ons
i -
"Y;,;t;nu
, uo urohut, rha rLit l6m, cdn nsuns thd dai' thd
t-d''
e
{
sothavha than nhiEt
ui"" i" L' 'u^. ""
at th;ns hoa( co 'm benh lv l'hic'
sanh non.
"i
r.a. t,.a..o" ,f.,otg iuven au bu {> I' 'uoag mot bia'
u,"n ,
"*",ii.
ai." -"n, or rd'r' ti'J -;J' ri'u phbn su
(
"iilil,l.,
,". ,..,"ne dd ror 2 cm' run mi oa nnr'u
lan rOnq.
Kh6nq diirdu 24 gLd sau sanh
Tra vira sanh r6ttainha trong ngdy dau'1
X)
can ninq theo tudirhat:
Tu6lthal(tuenl:". l
24 600
2A 1200 (600 x 2)
33 1800 (600 x 3)

8. T4TPHANANOt(HOA
LOC BENH VA XOTRICAP CI'U TRE EM
o 1. OAt CLTONG
- Tnvongr,org binh v,in thuong x)yrd trons v6n9 24qio.tijL,.phan rdn r;c rrLrdns hop r.trvons n:y (o rha ng6; nq;a duoc
r_eu rre banhndng duo( to< Uenl. pntt hier d;u triau capcnu
som va r rtr vl kip rhdi.
::.,-liin,: Tr,il,'.,,lh sdne ioc nhanh r,6 benh kh,t,. duo(
oua den (osdyt-6taiohong dang (i ngo;;racorhdapdung
la, phong tham banh ho6c (noa (,ip ( Lju.
D2. PHAN LoAl Nhanh.h6ng phan toaitrAthanh 3 nh6m saul. TrA (o dtu hie.r c:p cdu c5n cap cnu ngay hoa, chuydn vao
Ihoa Cap cdu.
- Tre c6 ddu hi6u uu ri6n sE atrldc kh6m trrrdc dd atiinh giij v;didu rri kip thdi.
CHt/dNG 1: (FAM OANH GIA LQC sENH T I5
+ Thd rit thl hitvao khi n5m Yen
Td tha rlt h6i $ me tr6 c6 hit sac khong. Ndu c6, td bidivat
dudng thd. i
b. Ddu hiCusdc: a
Tay chan ldnh kam.
I Th;i oian d6 d;v mao ma( h chem : 3 srsv bang ca( h 5n
l)m ;enq mong tdv.'lho: gian dd d;v mao maL5 la thoi
oian lam h6nq trd lOi mong tay'
' i,a,.h,6iavvdu. nhanh ho:tc lh6ng b':tduoc
nmrdttf,uonq aa'nq(hly miu de c;m mau va hoiba meneJ vuat
hien d6t nq6t sau;hichlhudc hav c6ntrnng c'n nqhisdc phenv6'
.. Ddu hieu hbn nA hodtc co siqt:-'
iruraiao,tlot.ari.dS;h gianhanhbdithansdi6mAVPU'
A (alert): tratinh.
v (voice): dlp rng v6ildin6i'
P ipain): d6p ,lnt v'Ji kich thich dau (veo da hodc kdo t6c
vnng tntn).
U (0nconscious): hon m0'
+ rr; cen cJpcl]u khikh6nq d6pungvdiki'h thich dau hoic
alanq co qiil.
* r'rali,.'. i,a, o oi,Un thuons dau (d N€uc6 ho6cnshi
nqd, Ph:ic6 dinh.d ngaY'
.t. Ddu hieu mat n'ra. nins t tft bi rieu
'hdv:
+ [4:t nudc ning khic6 > 2 ddu hiEu saul
6 TlA libihosc kh6dinhth(c'
o Dduhjeum&trnnq'
o Ndp v6o da bvng m6t rdt cham (>2 siav)'
3.2. tim(licddu hieu du tien di tre dridc khemfi'dc''liiu tr!
klEthdi
- ilt.od;u hieu uu tian khicomqr rrong()cdiu hiiu sdtr:
+ 56tcao.
+ Libi, bft r{r, kh6nsyen.
* iru'nO f,oo,'qr*g,1'd nh"nh, r'A t 2lhung' ' 60 l:"'
onrr: tr" ) tn-g' dtldi l') thang: z 50 ldn/phJt:Tre l2
thiinq 5 tu6ir> 40 I6n/Ph[t
- G6Y mon nang hoa' Phuhaiben(5an'
+ LdnS b:!n tay r5t nhgt
+ 86n9.
+ Tainan, nq6 doc.
+ TrA bCnh dU6i2thiingtudi.
' Co grjy chuye.l vrFn trl luY6n l!udc'
Tre kh6ng.6.ddu hieu c6p cfu hoic uu ti6n sa atrrdc khrm
O3. THt,Tu cAc BIJdc Loc BENH
H6ibe metidodua rrd d6; kh6m cnng lnc quan s6t v; sdtaych5ntra.
3.1. Tlm nhong ddu hitu.iip <rtu d,6ns thdixttri cip cltu nsay
holc (huyan vio khoa (dp Gfu
- Ndu trd cobdr ry.d6u hrau r6p cuu nao phjictp cdru ngd, kaJ
sorsrup.rd.ldudo rrep ruc v; hodn rhanhvjE. danh gj;v;lam
rer nghrem rjp rdru: rht d,rd"g hrydt b:"g qr" ,;;";.-ri;";;
dr'ng tich h6nq.5u (Hct)
, Tim ci. ddu hiCu c6p ctu rheo thttu rru tiEnl
a. Ddu htcu cdp ctu h6 hdp:
+ Ngrhg thdhoac con noLrno thd
+ Ritt6mngucneng.
C5p c6'u 0
10
Kh6nq cep cdu,
120

9. .. r ;_r,, : .i0rxHoA
.'.-nng trd co da'u hiau (u ti6n ddu c6 nquy cd diEn tjdn n;ns
,e nhanh, vl thd cdn khdm, d6nh gjd trud. dd xt tri kip thdi
ih6.9 phri xdp chd thf tu kh6m. Ndu 116 c6 .h6n thudng
ho;. c6 vdn dd ngoatkhoa thi.jn c6 sq h6 trdcna nqoaikhoa.
33. Ira kh6ng c6 ddu htCu (dp.dfu, kh6Dq(6ddu hieu tuti6n
. eu I e khong co d;u hieu (dp c(fu.dng nhu urr tiEn rh, chd
(hiim theo thrt(
ll€u chuiin chuydn vio khoa.ipclu khitre c6 m6ftrong ciic
diu hieu:
t'lgJ"q th6 ho;((dn nqunqthd. . Ho1Ti.
*Tim t;i. +cogiir
+ 8ir l6m ngqc ninq. +Tl6u cheycdp mdinudc nang.
+Thdrit thlhit v;o khinAm yen. +Tai nan, ng6 .t6c.
+56..
c4- xuTRl
CBLIdNG l: (HAM OANH G A _ LOC BENH r l7
T5t ca ve sau khl tltldc l9c benh vi xB trf c5p cuu ph:i dtJdc h6i
rCnn srr,irrrm namtoan diln, chldlnh x6t nghiem d6 c6 chen doen
xic dlnh ve didu tringuYCn nhen
4.2. c'D du s6c
Thd oxy
Lip dudnq truydn: tinh mich ngoalblAn
Truydn dich nhanh 20 ml/kg
56c m5t m5u c5m m6u
Truv€n dlch nhanh,truy€n m5u 20 ml/kg
s6. ohen vC Adrenalln l%00,3 mITDO
4.1. cdp (fu h6
xi trf cdp .dil
Ngrng thd Ngra ddu
Cd dinh.d khinshichdn thuonq cot sdnq cd
B6p b6ng qua mask
DivAt dLrong rha Thi rhuet Heimtich n6u tra > 2 tudi
Tht thuatv6 tung in nguc ndu 116 s 2 tudi
Tim tiii
Frt 16m ngu(
Thd rit khin;m yen
ThAoxy
ai. cCD cfu rrE h6n mt (o
HOn mC
Th6ng duung thd
c6 dinh cot 56ns d ndu nshl ngd chdn
thudng cot !6n9 <6
Nam nghl0ng
GlucoseT[4
co sl{t
Th6ng dudng thd
Nlm nghi€ng
DlazepamTM/bdm hau m6n
4.4. Cdp dtu m5t nud.
Mrt n(6c ninq kh6ng luy
dinh dudng ning
Truy€n dlch theo ph6c d6 tlCs chay
mdt nudc ning
M5t nudc ning kem suy
dlnh du6ng nlng
Bn oresolqua sonde dq dly

10. : r :r,r! A: Nor xHoa
LI-IU od Loc BENH VAxUTBIc6P cUU
TRAO NGUqC DA DAY-THUC QUAN SO Slt'lH
O 1. OINH NGHiA
- ino nouoc da davr huc qu;n INDDIQ) l; trrdung dtlmd ll su
v6n do'rq nqUoc ria nhung thanh phan rong da dbv rLhdnq
Lhi.lhuc an. dich,dcid, "i6m,
mudim;t)v;o thu( quAn'
- BCnhTNDDTQ khiTNDDTQ gav ra trieu chfig dau, cham tang
.6n. viem thuL qu61, oi 'nau, rieu chung vrem dudng ho hip'
nqung thd, viem phOi hir, vrem ohditiii phal b'nn pho' man
D2. 9ANHGIABENH NHAN
2.1. H6ibenh
' Ngaytu6i, dn th6ns hav non th5ns. can nang l csanh'
- Ti6n snsuy h6 h6p sau sanh, sanh ng4t
- Non 6i:sd ldn/ng:'Y,sd ngir
- chit n6n 6i: s!a, dich nhdy, mdu.
- Kichthlch, qudy kh6..
- ch6m tinq can.
- Ho, khd khat6iPhat nhiiu len.
2.2. Khiim l8m dng
- Can nanq, nhiPthd, con ngLhg thd.
- Dau hieu hdhap:ho,khd Lhe ran phdi'
2.3. X6t nghi6m
- SiAu am blrng: cd > 3ldn tt;o ngudc/5 phlttr6n siau am, xem
N h U C6 TN DDTQ.
TIM D
NEU c6
'
(u HrEuc{pcuu
XOTRIcAP CUU NGAY
lh6ng auarng rhd
Cd.linh (6 (nghlGh{n rhudrg.d)cIP.UUHOH{P
lruyan dlch nh.hh, m{u
Adr.n.lln (16( phan vC)
s6c
Th6ng alddrg thd
cd dlnh Gd (nghl.hJn rhud.g (d)
NlmnqhBnq
Ol.:.prm TM/bdm HM
Glu(o5cTM
HON MG, co GIAT >
MIT NUdC NANG >
Bn dich u6ng^ond.da diy
rlM cAc D(u Hfu uu nlN
N6uc6 )XHAMrRUd(
|GONG DAU HGU ({p(Ou, KHONG rru fllN
)KHAMTHEOlHI'TU
Hd BENH sU KHAMtoAN DteN, xETNcHtlM
)CHAN ooAN vA otauftlNGUytN NHAI{

11. 20 ! PH{N^ NOTKHOA
O3. CHAN ooAN
3.1. Chin ilodn
- Lem s:ng goir+ sj6u am (+).
- Um s:ng gdiy + d6p fng didu trt.
3.2. Chrn.roSn phan biar pheichdn do6n toattrtt.
- Bet thudng giei ph;u va ru6r bdm sinhr teo th(. quiin, db khi
thu.. quln, thoat vi rdn, hd rhlnh bung, thoat vt hoanh, ru6t
xoay biit roin, hep m6n vi, teo ru6t non.
- C6cbenh rychuydn h6a, nhi6mtrnng.
- CiicbStthudng c5u trdc nio.
O4. Dt€UTRr
4.r. Nguyan t6< iflgu rri
- Oidu hda cdthet thrrc quen dudi.
- Trenh ciic y€u t6llm khdiph6ttrao ngudc.
4,2. Tl6ududn nhap vEn
- C5 cdn ngungth4 ttm.
- N6n 6l ra miu.
- N6n 6l nhi6u len,€dn ph6inu6ian qua sondedader
c6 bi6n <hl1n9 vtcm phdi.
4.3, OiCu t.irriau.hfng
, Brldc r ; kh6ng dnng rhu6c.
- Tuthdnlm:deu cao 301
- sna me., chia nh6 cac cosna, to-t2 c0.
Ndunqhlngdd!(,ng sBa bd ding stathrty phan protein trong
I tudn.
- B(dc 2: Dnng thu6c:
+ Metoclopramide: o,t-0,2 mq/kglndy m6i6 qt4 tn dcin 20
phrt.
+ Omeprazole 0,5-t,s mS tks/nsty. chta 2 tit.
+ Ranitidine:6 mS/kSlnSiy, chia 3len.
Dnng 1-2tudn,c6th64tujn,tdida8turn.
O 5. THEO DOI -TAI KHAM
s.l. Theo d6tr m6i tudn trong thang itau itd it6nh gH itdp rlhg.
s.2. D5u hiau ning (3n khtm ngay
Cdn t,m, thd mat.
- Di.h n6n oi: mitu, mAt.
aHlrdNG 2: SO slNH r 21
5.3. Hudnq dAn (him t6(tqlnhir
- Tu thd nrm: diLr cao 30''
- TidP tqc bn me.
- chia nh6 cAc crl sfia,l0-l2 t(
HA CAN-XI MAU Sd slNH
O 1. DINH N6H[A
' iriiun-ri A
"e
to ti.t khi luqng can-ri ron hoa th;p hdn I mmol/L'
O2. OANHGIAEiNHNHAN
2.1. Hdi bCnh
d. Benh s,l.-'
l-ria. oarn,'*,a. aa aa" hav con kh6c cothet'
D6 m6 hoi trom'
- oE ndc c,.rc, qc sra,tieutidu s6n nhidu len-
b. Tidn can:
"' :'Z;;;, c6 anh chi bi h? can xi, cdi xudns' me tidu
iiitiJ, .r""g ; siap, tt'iE'
'itu'rn
D' me ki6ns ;nh
srenq, kiEnq 5n'
' ir?^ii r,r."rn,,o ,l"i
'a
sinh: rrudc sanh thai ct1 dons v€u'
'r"i
r""
'i"t
atr,
'i"r'
t", chAm phattrl6n trons ti cuns'
sinh ngat
_ Bu srja me hay sua cdng thtlc'
2.2, Khim l5m si'ng
- Co giStcd, ngungthd, tim'
Co oi;t.
- ili .uno ,ronq,.h'r veu Id 6 hop so:th6p r0ns 4xs cm dddng
k'nh, d'ud;S n6' thop lruoc thop sdu dan I6t rOng:2'l cm' oau
nhuvEn qo:didn khuvet ruong tren hoP so'
- Benh Iv ket hqp: sinh non'dir6t bdm inh"
2.r. Cin Emsing:ion dd <htiirhem Mg'

12. 22 T PHAN A: NOI XHOA
O3. CHANDOAN
3.1 . Chdn iro5n x5G .finh: trrgng can-xi ion h6a < 1 mmol/l.
3.2. Phan b?t
o. Hq.dn-xi ttm (<72 gid); nguy6n nhen thLrdng do
- Sinh non.
- MS bitidu atudng.
- cham phat tridn trong tfrcunq.
- Nguyen nhan khjc: dtrng gentamycin, me bi thidu
vitamin D
b- Hq-con-xi mu6n (sou 3 rgay) nguyen nhen thudng do:
- Suycan gi6p, gi: ruycin giap:me bicudng L6n;:ap.
- 8.im tinh:hdichung Dig€orge. hoi(hihg hennyCaffey.
- H9 Ms.
Ti6u vitamin O (thudng gAprong tu6n drdu).
- Xlim mau, dunq bicarbon.r.
, Truydn nhanh m5u chra nhi€u cttrate (vd,thay miiu).
- si5c hay nh,Emtrtrng.
- T:ng hdp thu phospho.
- S uy th6 n c{p (thr.rdng kam t; ng phospho).
- Eanh lychuyin h6avitamin D.
3.3. chin ilo5n phen bGt
- Trao nguoc da diy-thLrc quan.
- Cdn rim, ngungthdsinh non...
- cdn kh6c co that (cotic).
O4. OIEUTRI
4.1. Nguyanti(: b6 sung can,xivA dtiutrjnsuyan nhan ndu.6.
4.2.Tlau Ghuln nhep vlen
- Khikem tri6u chfng co giat,tim hoec ngung rh&
4.3. Bd sung (.n-x:
- Ca n xi nguyen t6 2O-8Om g/kg/^gay. .hia 2 t5n.
- Calcium carbonat, phosphate, tactare 3OO-60Omg /nghy, ,hia 2
- Calcium g lu bionate 3omg/kglng:y, chia 4-6 tdn.
CHUdNG 2: SO slNH
' 23
6-4- oiEu tri h6 trd kh6(-.''--ia-r"g,ri";"i" oq00Ul/ngav, udng trr ngrv th!(7 sau sinh cho
den tuor Dlet or.
- Phdinrnq #ng cho mev:! con
. D6ivditrd blrme c6n bd 5ung (an xicho me
o 5. lAI KHAM VA HIJdNG DAN CHAM 56C TAI NHA
" -' ljai'tijrn,ii',JI oi"" deu theo doi m6i s ns;v sau do t6i rham
m6ituiin hoic lau hon tirv diip dng lim *ng'
- Din do oia <Iinhtheod6i d5u hiC'r nSng'
- ;il;;&; il il;; rieu can'ri ch;me v:' be khi den tu6i
;n dAm.
O6. PHONG NGUA
"- l,ii,,l"la,loio,en:sdn5ns 6n ki6ns cir trudcva sau sinh'
- xr,,il" r,r'r.r, *'i,
"a"scho'6
harme con v'o budrsitnq
- Ddivoibe c6 nguy cdca
i
"i.,no,iorni,ioqooul/nsav,(hod6nrL6i
biEtdl'
- iia q"i
^.", 'i"n
aoi, t6
'une
vitamin D 1000 dv/neev va
can_xi lronq th'ng diu tian'

13. 24 r PHaNA.NOI(HoA
cHot R6N
O I. OINH NGHIA
.Chdj rdn,i tlnh trans hinh thinh md hat va chem bidu m6 h6a tai
cudne ,6n do cham runs ron, rr,uo.q qu" 5 _ s
"!Jf
.;;;".
* '.'
O2. DANH GIA BENH NHAN
2.1. H6i banh si
- Thdi didm runq rdn.
- Ti6r dich ndichan r6n.
2.2. Kh6m l6m sing
, Xu;thi6n m6 hat ndi.han rdn,c6thdcdn rrdich.
- Trm d;u hidu nhiEm rrnnq tdirdn:chjy mt, m;u, sL/r,q dd.
O3. CHANDoAN
CHUONG 2: 90 slNH r 25
b. Tdn rai 6ng 6n ru6r, 6n9 ,iEu rdn: tlnh trdng ri dich k6o dai
raich;n r6n. Khbnq nhln I he'v mo hal tdi chan rdn. sieu am buag grip
.hen do6n.
..Thodtvi.udng flin nhd: nhln ro thdv ohr ddi chSn 6n ro hor
!lch tl_udr mo hal 161.5'eu;m giup lhav 16 c;u Iric chua b6n trorg
cudns r6n l) ru6t.
o4- ot€urRr
4.1. Chdi rd; AtrE drrdi mot thdns tudi: thoa bleumethvlene 2lin
m6ing)y, gira.han rdn kh6thoins, dd r6n hA kh6ng bans kln
qiUp mau kh6.
4.2. Chdi rdn tre hdn mot thang tudi: d6t dien chSn r6n. sa'r d6
(Mm s6c taich6 vi thoa bleumethylene.
4.3.T6ikh5m
- T5i5 ng:ysau ndu r6n cdn ridich.
- TAi kh6m nsay ndu chey mI, meu, quang d6 quanh r6n.
D 5. PHONG N&IA
. Dem beovtiung vuoc va sau khr srnh.
- CAtvS c6t 6n benq d!,ng cu v6trnng
' Rl]a taytrlrdc khich6m s6.tr€.
3.1, Chdn doan phen biat
a, Polyp chan rdn: m6 h?t tai .han 6n ch(a
ru6t.

14. 25 T PHAN A: NO] KHOA
- Od hdrdn, kh6,triinh drp vat ta vao rdn.
- Then nhencen quan s5t rdnvach6n rdn m6i ngAy dd phiit hjen
sdm nhi6mtrnns.
TAo B6N sd SINH
O 1. olNH NGHiA:dn ba tieu chudn
- 5d tan ditieu < 3 t6n/rudn,
- Phan cfns,
- Kh6 khin lic ditiCu (dau kh6c, nh;n m;t, rin, bft n t...)
O2. DANHcIA BENH NHAN
2.1, Hiibanh
+ 5au sa;h bao lau mditiCu phan su?
+ Bd danq dnng sra m9 haysl]a c6ns thrc?
- Ddu hieu lam sing
+ T5o b6n bao leu nay?
+ Tdn suSt diti6u?
+ Tinh chdt phan?
+ Kh6 khSn khiatitieu?
+ Di hm c6ch n;oddb6d6atitieu hdn:bdm hau mon, massage
bung, kich thlch hau m6n b:ns quegdn, cong hrnh...
2.2. Khdm lam sing
, C6 16 h5u m6n hay kh6nq? c6 bdt thlrdng xung quanh t6 hau
m6n nhi., n!( do, viam nhiEm, ( hiiy mJu...
' Bung chudng.
Tinh chSt phen (ndu c6 sgn).
clc bdtthudng haytar bdm sinh soi, benh suygijp bdm sinh
nhu ludito dey, viing da k6o dei, tho6t vi rdn, phn ni€m, qiem
trudng lq. cd, ldn cln, ...
23. CAn Emslng:thudns kh6ng cdnx6t nghi6m thudng qui.
- 5i6u am bung, X quang buns kh6ng stla soan: khi blng c;ng
chudng nghi ngdviem ruot hay b6t thudnq bdm rinh h6 tieu
h6a (tic ruot ...) hay benh cjn can thi6p ngoai khoa khdn nhu
thing ru6t, kh6ng hau m6n, trc ru6t...
CHUONG 2: sO S|NH
' 27
- X quang dai trenq c6n quang: khit6o b6n k6o dil, d6 ch'n
.loiin bCn h H iIs€hspru n9, dolichocolon, m icro(olon..Jh Uc hien
khi khOns c6 tlnh tQng viem ruoL soi phan am tlnh, khong
danq dit sond hau m6n trons vdng 6 gidtrudc
- Xdt nghiem tlm ca( bgnh li noiti6t ndu nqhingd (T3, T4TSH,
PTH,..).
'':t iH:*:il;*": "?'Jff
irt'*ilr'";;f lt::r*"* "*" i{- neu chudn can 6m sins:Dd giupum nsuvcn nhan'
3.2. cha'n ilo5n nsuyan nhan gayt6o b6n d{a vao lam sins ve x
quang (An quang ilai tring
. Hirrahsprung: bqnq ( nudng xouangrJnquanqgdiv(odoan
dan van hep d(6i, x6c dinh beng sinh thidt ltc pMu thuat c6
doan ruot vO hech.
- Ooiictrocolon: buns c6 thd chudng hav khong, X quang c6
dodn dai trdnq d5r' thudng l| dloan igma, khdng c6 doan hep'
Microcolon: tnuonq qap d trA sanh non, X quang ruor nhd
- Rdi loqn thdn kinh cd ruot thudns gap A tre sanh non, do he
th6n kinhthqcvathoBtdQng chuat6t,Xquang blnh thudng '
o4. otEurBt
4.1. Nguya. rlc di6u tri
- Di€u tlitrieu chfng
- Tlm nguyan nhan ndu c6.
4,2. nau Ghudn nheP vien
- c6 nsuyan nhen cen can thiep nhu ph6u thuat benh
Hirschsprung, nong hau m6n hav dit sond hau m6n <6 kem
haykhonq thutthlotrons bCnh rdilo?nthdn kinh cd ruoJ d?i
treng d)i,daitdng nh6, hep h6u m6n...
- C6 bidn chrng viEm ru6r, th0ng ruot.
- T60 b6n kamlheo <6c tAt bdm sinh hav benh ry (huvdn h6a,
noi tidt can didu tri.
4.3 Oi6utridi.hleu Tny lheo nguvFn nhSn:
- Hilschsprunq: Phau thuat.
- Hep hau m6n:nong hau m6n.

15. 23 I PHAN A: NOI(HOA
4.4. OlCu l'itrieu chUhg
8dm rectiofan I, I dng/lln,ldu itriinh treyxudc.
- D6tsond heu m6n.
4.5, oi6u iri hd rrq khdc
- Massaqe bunq.
- odisna niu dang bn sua c6ng thfc.
O5. TAI(HAM
- TiiikMm:tUvlingiyddn khoangvAltuann6ucdntiiob6n.
- Da-u hicu n?n9 cen kh6m ngay: bgns.hu6ns c;n9, kh6ngtieu
drrdc di d6 bdm hAu m6n hayd;tsond hau m6n, phenxeu hoi
xanh (o nhdy m;u, n6n 6i
NHIEM TRUNG DA dTRE sd sINH
D 1. OINH NGHIA
Nhi6m trirng da lA tlnh tr?nq mung mtr da va mO dudida dtrd so
sinh thudng do tu cdu trung.
O2. DANH GIA BENH NHAN
- Khsm va tim ddu hicu cia nhi6m trnng da:Im mun mn da, hay
mun mn nhiSm khudn neng (dudng klnh mun mn tr6n 1 .m,
trAn l0 mqn mrl hay mun mn da r:ir6c to:rn than).
- Khiim toan than ddtim ddu hi6u bi6n ch'lnq.
O3. CHANooAN
3.1. Nhi6m trnngda: Da c6 mun mn.
3.2. Phan d0
Nhi6m trinq da khu tru.
Nhi6m trnng da nangr dudng kinh mun mrl rr6n 1 cm, tren tO
mun mrl hay mun mt da reir;ctoin than hay kam sdt,li bi, al6
da toirn than.
cHl'oNG 2 Sos NH i 29
o4. ElcurR!
4.1. Nsuyen tAc diiu tri
- Khiinq sinh v; ch6m so'tai(ho'
4.2.oieu tr!
o- Nhiid tin| .ld khu tri:- -'rii"q i.; ,6"s' o'a( illir 50 ms/ks/nsav ( hia 7 16n uonq
trong)-7ngay.
Tho" bleun_tthYlen"'
b, NhiiI, tnnsda;dng:tho nh?p vigr didu rri ndi rtu
a.3. Ti€u chudn nhaP vfn: .ludng kinh mqn mi trCn 1
'm'
tren 10
- -'
.v" ." ,.!,. ;t ai rei r6c 6en than hav k'm s6t' li bl' d6 da
toen than.
4.4, T6i khSm
- TAikham sau 2 ngiy'
- iii r.r'a. .s;v tri
';t'ta,n
trnns lan rons ra m6 xuns quanh hav
trE sdr libl, bu k6m.
O5. PHONG NGUA
Rta tav irudc khich;m s6c vE'
ahrm s6c. vE sinh th;n thd be hanq ngijy
il;;;;;;;;;,;;;"i da t,+ mdi nelv dd phir hi6n som nhiEm
trUnq.
VANG DA Sd SINH
D 1. OArClrdNG" " Ii7i." a" i,,e *
'lnh
l) tlnh tr?ns tane bilrrubin slen tl6p do
ii.i ii,,r,"i.r'itipna lnvdd thtvthe bAns h6ns cdu trudns
iii"iida..r,* "i^s.n;
c6c men chuvdn h6a do san
"nxu6tva do tanq chu trlnh ruqt gan'
- 6l'd cii t',ri"s hsp
"}ns
da thudns nhe lV kh6l saLr 7'10
"iari.,-i
i'r,[l],'.<;t
'a
t;dns hsp vens da c6 thd dlEn tidn
nlng dEnvAng da nhen

16. 3O T PHAN A: NOIKHoA
O2. DANHcIA B€NH NHAN
2.r. H6l banh
- Thdigtan xuet hien v:ng da:
L Sdm 124-48 gid,au sanh):v;ng dd ran huydt do bdr do']q
nh6Jn mdu me con (b6t ddng ABO, Rh), nhi6m rruns.
I Mudn (nSay t4 r,ddi):vangda sua me,vangda r:ing-bilirubin
trL/c tidp.
- lr:eu chung d; kem: 16r, b6 br, g5ng uon ngudi, (o giir. linh
chet ohan. nud. tiiu
- Sanh non hay d0 th6ng.
- 80 me hay sila c6nq thfc.
- Tidn cen sia dtnh:c6 anh chibivanq da khilanh...
2.2. Xh6m Emsing
cdch khdm ddu hlcu vins da:
+ Quan s6t dudijnh siinq tunhi6n.
+ Trong trudng hdp kh6 nh6n bidt (da tre d6 hdng hdc den
rar),dung ngon tay de nhe tan da vaiqiayddqu;n s6i vnng
da ben dudi-
, O6nh gia mfcd6vanq da:dL.rav;o
- Oultdc Klam€rl
1 2 3 '5
{mgldl)
s-7 810 13-15
85 11 136-170 141221 221-25s > 25s
r Vdng da nhevangda xuat htan ti/ ng)y thu3, vang da nhe 6
mit, nq!rc.Trav;n kh6e_ bn rrir
+ TheoWHq phSn todivansdandng ndu:
o Ng)y l:trA da c6 venq da.
o Ng:y2: vlng da d6n ceng chan (ndu ddn $n chan, tay =r6t nang).
o > 3 ng:ry:vang da den ban ch5n (b:n ravl.
- Budu huy6trhanh.
- Tim bidn chfns v;n9 da nhen: ti bl, m6t phen xa bn,96n9 udn
ngudi, co qi6t.,,
CHUONG 2: 90 slNH r 11
2J. can Em si'ns
ahi x6t nohiem bilrtrbin m5u (TB TT' GT) khi:
TrA ve;q da som ' 14 ngav diu sau sdnh vi vang dd d6n dui
(vnns 3).
- Tle vang da k6o d;i
O3. CHAN OOAN
Chln do6n chn ydu du-av)o lam sangv)/hoictSns bilirubln meu'
o4. DrcurRt
4.1, NsuyAn trc di6u tri: di€u trih6 trg v) theo d6i'
4.2. oi6u trih6 trq
- Bn metheo nhu ceu
- pf'J ia"g tSrg .ai
"gev:
thdi sian khoang ]o-1s phtt m6i
ngay, thdidid;7 - 8 sid s6ns (trenh si4 boc l0 toen than b6'
che m6tve bO Phen sinh dvc)'
4.3. TlAu chudn nhiP viqn
- VAns da xu5t hien sdm hon 4sgidsau sanh'
- vanq da ning (vhng 4-s).
- Veno da tanq nhanh (> s mg/dunsay)
- Coc;ctricu chung thSn kinh cr)a vang da n'1an'
Vano da kam theo nnung bCnh lv khlc: sot' sanh nor' tanh
noei aa tr6ns c,iu, sans chln sen khoa "
O 5. THEO D6I.TAI KHAM
5.1. Tllkh5m: t6i kham m6i n*tv cho d€n khitr' hdtv)ng da'
s.2. Ddu hlCu cdn tei khSm ngay
- Vanq da d{n ta, chan.
Libl.
- &i Ydu holc b6 b'i
- Kh6cth6t, gdng ngudi, co qiat'
_ S,jt.
s.3. Hudns dln ch;m 56( ngudl benh t?i nh)
- BU me theo nhucdu.
/"__!'
l')

17. r2 r PHaN A. NorKHoA
- Phdi ndng s6n9 m6j nqey: thdigian khoang t0-15 ph[t m6j
ngey,thdidiCm 7 - 8 sid s;ns (tranh 9i6, b6c t6 toAn than be,
che mrtvi b6 phan sinh duc).
VANG DA KEO DAI
O 1. oINHNGHiA
V:ng da kdo dAI(VDKD)la hten tuqng vang da v5n cdn ri6ptucsau
14 ng:y tudi. Nguyan nhan c6 thC do tang Bitirubin gijn tidp (thudng
gip le vlng da sna me...) hoSc do ti69 bitirubin trvc tigp (kht mfi
Bilirubin trvc tl6p > 2mg% # >34lmot/L hoic > 1 5% bilirubin toen ph6n).
O2. OANH GIA BENH NHAN
2.1. H6lbCnh
- Thdidl6m xurt hiCn vang da dgn nay.
- Ti€n cAn:nhl6m tring beo thal, nguy cdvtcm gan siau vt, c5n
ning l0c sanh,sanh non, nu6iAntinh mech k6odai.
- ndn c5n gia dhh: co anh chi bivAng da, chtng ngira cJa m9.
- TInh.hSt ph5n (bac meu) v) n'Jdc $du {srm mAu).
2.2. Kh6m llm sang
- Tdngtrangrtlm dru hBu nhi6m rin9.
- sinh hieu: m?ch, nhtCt d0 (560, nhlpthS.
- DarvAng tudt cam, vang sAm jnh xanh, ndi hdng ban Jan t6a,
chim xudt huy6t hay bam m6u.
- Metr duc thiytinh th6.
- Odu: al, u nh6, budu mdu, brrdu huyAt thanh to
- Tlm:em thdi, nhipth,
- Phdl: nghe ran.
- Bvngrganto,lSch tq bung chudng, r6n tdi.
2.3. Cen l3m slhg
- Khoeng 30% trA di th6ng kh6e manh c6 vanq da k6o dJ sau
2tudntudt.
+ NAU khim I6m 5Ang + nudc du + phanrbtnh thudng + theo
d6tratkham.
CHUONG 2:sOS]NH r 33
+ Ndu vang da van cdn sau 3 tuen tudl_ thoBilirubin.
' N6u nghi ngd vins da tang Bilirubin TT (nudc tidu
'sam
mau, phan b?c mau hoic khrm lam sang c6 gan l6ch to)
- tht bilirubin (TP TT, GT), sGoI SGPT, PAI- GGI TPINI
stercobilinosen/phan, si6u am b!ng.
O 3. CHAN OOAN
3.1. chCn do6n x5c dlnh
a. Vdns dd sto me:
Tieu chudn hm sang.
- Td dn th5ng, kh6e m4nh.
' BU me.
Kh6m hm sing: blnhthudng.
' Tidu venstrong,ieu PhAn v,ng.
Tieu chudn .,An ldm sanq t; ns bilirubin si6n tidp
b. Vdng da tdng bilitubln trt tiip:
Tieu chudn lan sdns:
- Tieu phan bac m)u,tidu sam mau.
- Ddu hieu nhi6mtrirng,gan llch to.
rieu chudn can bm sangl
- Bilirubin trlrctiip tang (theo tieu chudn).
- Mengant;ng.
- Sieu am bqng:c6thit;c mAttrong hoic ngoiisan'
3.2. chdn doSn nguYAn nh6n
o. Vdno da tdtng bilitubln gid, t gp; da 16 ving da do sBa mp'
b. vAng da tnng bilitubln t !. ttdP:
Eenh ngoqikhoa:
- U nang 6ng matchi:chdn do6n sdm nhdsleu 5m,lam sang
c6 thd sd duoc nanq.
- Teo dudns mat bdm sinh:
+ Chdn doiin x6.dlnh:
, chup dudng mattrons l(c md.
. L6m *ng + 5inhthiitgan
+ Chdn doiin c6 thd: lam s;ng + sicu am kh6ng th6v ttli
m6vttimAt ritnh6 sau nhin bLl.
Eenh n1ikhoo:
' Vi6m qan dovirnng (xem $inhiam $tng sdslnh).
- Vi6m gan siau vi.
- SuYgiSP
- Nu6i5n tinh m?<h kdodai.

18. 34 T PHAN A: NOI KHOA
, Vi6m gan sdsinh v6.5n: chidm 30% c6c rrddnq hoo ti.h6n
doen loai trn + sinh thidr gan c6 hiCn tLrong vi6m gan dai
bloc6 xito tron ca-u trnc ttdu thny qan.
O 4. Dt€uTRr
4.1. NguyCn t5. di€u tri: OiCu tri h6 trg + tim V; di€u tri nquyen
4.2. OlCu trl h6trd
Vlng da ssa me: kh6n9 xOt 9l, bt me tidp tuc + phdi ndng seng
+ theo d6it6ikMm.
43. n€u (huin hhip vian
HAU het ving da ting bi,irubin tnlc ti6p n6n nhap viCn d6 chan
do6n nsuyen nhen ve di6u tringuyan nh6n.
4.4. Oiiu rri ali( htau
Ngoai trtr cec nguyan nhAn c6 th€ di6u tri dud€ (ph;u thuat) va
m6t s6 trudng hdp vi6m gan so sinh v6.in, hau nhuciic nguyen nhan
cdn laidiu dua ddn viem gan man tinh (xem Miv)ng da tdc m6r).Didu
trichn ydu dinh d(6ng, bd suns viramin + udng ursodeoxychoti..
O 5. THEO D6IvATAIKHAM
Vang da ssa mer hen t-2 tuen titi kh6m {n6u .6n vang da). V}nq
da c6thd k6o d)iddn t2 tuin tudi.
O6. PHdNG NGUA
Phu nutronq d6 ludi sanh at6 n6n chi.g ngua (6( benh t o rh6 iay
truyen tu 11e sang con (Bubella. vta- qan sieu vi...).
aHLldNc 2:SdslNH r 35
, NHIEMTRt'NG RON Sd 5INH
o l. otNH NcHiA
Nhi6m tdng rdn lA nhi6m t{rng cu6ng r6n td sdsinh sau khirinh lim
met ra nh gidi blnh thudns gina da va day rdn, 95y rl dich h6ive c6 mn.
Nhiam trirng r6n c6 thE khu tal quanh .u6ng rdn hay Phn nd lan
rong ra thinh bung xuns quanh gay nhi€m trnng r6n ning.Vi khudn
gey nhiam trung rdn thudng do tv c6u, kd ddn c6 thddovikhurn qram
am nhuE.coli.
O2. OANH CIA ECNH NHAN
- Kh6m v; tlm deu hieu cna nhi6mtrnnq r5n:
+ R6n Uot, h6i, dich mn,tdy d6quanh rdn.
+ ViCm tey mo mdm, viem m?ch b?.h huydt da thenh bqns
chuns quanh r6n.
+ Viemt5y can cdsau rOnS.
- C6cd6u hieu nhi€m trnnq to:n thSn: seit,libi, bn k€m.
o3. cHANooANxAcolNH
3.1. chdn do6n
Rdn c6 mi, qudng dd nd quanh r6n.
3.2, PhAn d6
d. NhiArn tltng 6n khu tt i mdt ranh gidi blnh thudng giia da
v: dey rdn. Dayrdn viem d6.6 mn,d6ikhic6 m6u.
b. Nhii.I:. tnhg dn ning:
- Nhi6m trtng r6n lan rqng ra m6 li6n k6t xung quanh, gay
viemddcl1ns quanh r6n,tao qudns d6 quanh r6n.6dudng
kinhtrcn2(m.
- Nhi6m trnng dn khutrn nhunq kEm bidu hlCn nhi6mtdns
tointh:n nhusdt cao,libl, bU k6m.
o4. DrEurRl
4.1. Nguy6n tac diiu tri
Kh6nq sinhvi chim s6c t?ich6.

19. 36 T PHAN A: NOIKHOA
{.2,OiEutr!
a, Nhiem tring rdn ktu rrn:
- Khi:n9 sinh u6ng: oxacillin s0 mglkglngey (hia 2 ldn, udng
tronq 5-7 nqey.
- Ria rdn hang ngeyv6ic6n 70".
- lhoa bleumethylene.
- Di rdn hd
b. NhE',itrnns dn nins; nhap vien didu ninoit,(.
43. Tieu (hurn nhap vleh
- Nhi6mtrnns r6n lan long ra mo liAn kEtxung quanh,geyvi€m
al6.tnq quanh rdn, tao quinq d6 quanh riSn c6 dLrdng kinh
tran 2 cm.
- Nhi6m trnng rdn khu tru nh(ng kAm bidu hien nhi6m trung
toen th5n nhusdt cao,libi, bti k6m
4.4. T6i kh5m
- I6ikham sau 2 ngay ndu rdn cdn rldi.h,mt.
IaikhSm ngay khilan rong ra m6xunq quanh haytrAs6L libl,
bn k6m.
O 5. PHONG NGIJA
- Rna tay tftrdc khichim s6c tle.
- Od hdr6n, kh6,trdnh d6p v6t la veo r6n.
- Ih5n nhencdnquan sit rdnvi.han rdn m6ingiy dd phAthiCn
s6m nhiemtrnnq.
CHL'/ON6 2: sO SINH r 17
O2. DANH GIA BiNH NHAN
2.r. H6i bqnh
- rhdi.lidm xudthlEn:' ,i,!- t!, .". i. u" .lu thudns xuat hEn 56m 2 - 4 nslv
.", t"^n. vie. Ui .x ao hoa chiit (thuoc nh6 ) thudng
k€o deitrong 24 - 36 gid'
* iii#rJii,-nJo"q s : r2 ns:v sau sanh ce€ vitrins kh6c
rhu.rn; sau I tuEn tu6i
- s.i[""'i'".r,'
'""r,
;O;m dqo m] me bi nhi6m trunq do r5u !
iaviriramvaa rracnimatis nsuvcocao lav nhi6m cho tre' :
. il'.
""i
r,riu.
"r,J.a,
aa (n;une (ho tra co ih6 sav viem kdt
macd; h6a chSt nht Nitrate bec'
-
'ni,e.,iJ"" i,a,
",t' 'inh
dvc me c6 hav khons tdeu ch(ng
v6n c6 nguYco l6Ynhi6m cho<on'
2-2. Kh5m l6mslng:Kdt m?( m6tvidm cl6lthaynhi6u' mau sec mn'
-- ;'il;;;ii;;;r8,, roans hav daL, mot hav har m6t' phu mr
m6t, kem lo6t gie( mqc kh0n9'
2.3. cln Hm sang: phEt mU m't nhu6m sram tlm sonq ceu glam
am.
D 3. CHAN DOAN' -'
--vri* r.ar mac do l5u c5u:Thudng xu,t hi'n sau sanh 2 4 nqlv'
-
.iii''i.jii,i "r,, ""s
ndns;5n' chav nhi6u rnn v:'ns d6c'
phu mi mal co th6lh:rv loet giiic mac Soi mn th'v tong cau
- ii"- uJ, -* a, c,r"'vdia: 116 sanh nsd am d?o' sau sanh s --
ii.i,l,. rii.*,4 "n6,
vua d mot hoac d haimat' nhrdu mi
"r'lv]
rir-rv€tthann chdn doan'
vie'i t"ii"ii a. no" .la,: thudne do thudc n h6 nhu nitrat bac
nii io,-'J"g .l .a,
"t'ns
kh6ns ti6t dith' mi"Iinh tr?ns
thudno k6odei24 - 36 gid'
- ;,l r"eia.,, ,,r,"s khic (tv c5u' ph€ cau' lien cau): xudi hten
-
;*.;; ; ;i;",,di, dd moi hdv hai mat' phu mi' ir mi'
ojp uig tdt vaikhang sinh nh6 matt?ich6'
VIEM KET MAc sd SINH
D 1. DINH NGHIA
, viem kdt m?c so sinh IA tlnh tr?nq k€i mqc mdt do, phn, chey
dichtrong thdi ki,sdsinh.
, vi6m kdt mac sd sinh c6 thd do nhidu nguyan nhen nhu h6a
.hdt, sieLr vi triing, vi trlrng. Nguy hidrn nhdt l:r do lau c6u v;
chlamydla trachomatis vl n6u kh6ng duqc chdn dodn v; didu
lrirhl(h hqp c6 the gay seo giiic lnac va mLr.

20. 33 T PHAN A: NOI XHOA
O4. DI€UTRI
4.1. Nguyan t5c: khiing 5inh va (h;m s6c taich6.
4.2. Di€u tri di. hieu
- Ria ray truocv; sau lhich;m so, mli re.
- Laur nhap vi6n dd dnng khins sinh nhd mit vA khiing sinh
to)nthan.
- Chlammydiar Nhap vicn dd cho khenq sinh nhd v: udng
Erythromycin.
43. Tieu (huSn nh6p vien
- ViCm kit mac ndng: m5td6 nhieu, nhidu mJ, sung tdy mimit,
lo€t gi6c mac.
Vicm kdt mac xudt hien sdm nghi do l6u ceu hay kh6nq girm
sau didutridn da khSm chuyen khoa mit.
O 5. PHONG NGUA
- RJd ray trJoc va sau kh, thdr 6( -6t tre
- Ch i dung thu6c nho -fi lleo y.ann bd. sj.
NHIEM KHUAN HO HAP cAP dTRE so sINFI
O 1, DINH NGHIA
- La bcnh nhiCm khu;n (na dudnq hd h;p.
Co hai loail
+ Nhi6m khudn h6 h;p trcn: viem nhi6m virng tai mni hong
thudng do si6u vitrlng.
+ Nhi6m khua'n h6 hap dudi:vicrn phdi.
D 2. oANH GIA BENH NHAN
2J. H6ibenh: s6t, khd khi, ho, s6 moi, oc sna, bn k6m....
CHI/ONG 21sd SINH I l9
2.2. Kh6m lem sing
- Ddu hieu nhiem trnng (sdt,lu dq bn kem...)
- D:u hleu suy h6 haPr
+ Thd nhanh > 60lAn/Phut.
+ Cdn ngung thd > 20 giay.
+ Co 16; nsrlt nins, phap phdnq c5nh mni, tim t6i'thdr6n
+ Kham phdi:ran Ph6i
2.3. CAn lam senq:,et ngnien ouanq ol_6ikhingn' ngdtla b viFm
ph6i(thd nhanh, thdco keo ran phdi).
o 3. CHAN DOAN
3.1. Chdn alo6n xS. alinh
a- Nhftm khudn hO hdP trCn:
- Ho, khd kha, nshet mni, sd mni.
- Khong c6 ran Ph6i.
- Khong suy ho h;P
b. Nhiam khudn hA hdp dndt lviamph6i):
' Suy h0 hAP.
Ran ohdi.
X quang c6 tdn thudng nhu m6 Phdi'
O4. DICUTRI
4.r. Nsuyen t8c didu tr!
- Um th6nq thoAng dudng h6 hdP'
- DlEutr!h6trg.
- Vi khudn khic: Khrng sinh nhd tai ch6. Khong
khiim chuy6n khoa m:t.
- Do h6a chdt Rda mit blnq nudc mu6i linh li
khiinq sinh nh6tai.h6.
si:m chuydn
Nh6 mdt vdi

21. 40 T PHAN A: NOI KHoA
4,2.IlCu<hudn nhepvl6nr Khitr6.6 d5u higLl
- s6t.
- Suy ha hdp: thd nhanh > 60 l5n/phut, rnt l6m ngvc nlng, thd
r6n,tlmtdl, phip ph6ng c6nh mnt.
- 8( k6m hoac b6 b[,lirdn
4.3.OlCutd
- Lam th6ngthodng dudng h6 h5p:
+ Nh6 moibeng nu6c mu6lsinh li.
+ I)m th6ng thorng mot,
+ Vat ytrilieu h6 hdp.
- Glgdm cho tre.
- Oidutfltreo nquEcda d:y-th(cquan ndu c6.
- B[ m9.
o s. HUdNG DAN CHAM s6cTAt NHA
- cho tre b[ d6y dr].
- LAm thong thoSng mil.
- Tdikh6msau2hglydEddnhgiiid6prhgcriatrav)quydtdrnh
- Ddu hieu ninqcan khdm ngayl
+ s6t.
+ Thd nhanh, co l5m ngvc ninq, c6 cdn ngUng thd,ttm.
+ tlr dU b( kdm hoAc b6 bd.
+ Eenh nins hon.
O6. PHONG NGUA
- Bn me.
- Chtng ngr)a ddy d'l theo ltch.
' Glfvaslnh sEch s6 cho tr6.
- TrShh ndi6 nhi6m, kh6ibu.
- Gindm.h6trA.
T|EP CAN BENH NHAN 56T
D T. DINH NGHiA
srt'duqc xec dinh khithan nhiet dod hau m6n hoic mang nhi tir
:a'iirA nn. lliq.a6 ao d nSch ho..ic trcng mleng cd thd thdp hdn
oi.i. nrin ntretiren +o'c.luoc aoila sdt r6t cao (hvperpvrexia)' tr6n
41,7'c: s6t nquy klch (l€thal).
'
s6t la ltio manq tra em d6n kh6m thudng glp {>20%) Nguvcn
nfran s6l iuOc + nnim ch in h: nhlEm trir ng trnh trang vi€m' uns thu
'-
ii r.ao aaiiir" ,o ne,v6n nhan (FUo) li ns uvcn nhen sav sdt chua
x5c elnh duqc sau 3 tuendi€u trlngoqitnl holc I tu'n dj€u trinoitrn
O2. TIEPCAN BENH NHAN
2.1. Hdl banh
- oSc didm s6e thdi qian s6t, nhiCt d0 cao nhdt' s6t cao lien tuc
trav tung con: mot holc nhi€u cdn thav d6i hav c6 dinh theo
nhip nq)y dem, ..
- DAu hleu kdm theo sdt:
+ Ho, thd met, nudtalau.
+ CogEt nhtlcddu, n6n 6i
+ Phet ban, ban m5u.
+ Dau tai, chav mt tai, r6i loqn alltidu.
+ Ti6nsnrs6tcao co glltsuvdinh du6ng,suv giem miCn dich'
.ai J1 t6t, Uat *',ran! ra. slnh tim, ph6i, benh ph6i m?n
tinh, bCnhthrn klnh co,dich0ng n6o'
+ Tlnh treng ching nglla.
- or.i ta' aaio sintr s6nq hav vua du lich t?i vung dlch tE lw
frintr f,oa. alrns c6 di;h benh nht1 tdt r't, t6t xuSt huv6r

22. 4' t PHIN A: NOIKHOA
2.2 Kh6m lam sang: kh6mtlmitoanthen:
Deu hieu to;n than: tr6 tlnh t;o, hay.6 ve mir nhi6m rrnng,
nhiEm dO..
- Da-u hi6u sinht6n: mach, huyit 6p, nhip th4 nhietd6 (tdt nhdt
do hau rn6n).
- Thdn kinhrmfcd6 r6iloan rrisii., dru mans nao.
- KhAm tim, phdi, gan,ldch, hach, tai m rli hqng, cd xudng khdp.
- Kh;m tidt.iau sinh duc, th;mtrrlctdng khicdn.
- Khiim da, nlam macrtim ciic sang thLrdng da, ni6m mac.
- DAU hiCu mdt nddc.
2.f Can l.m sing: Khons c6 xit nghiem tht dng qui. Chi dinh x6t
nghi6m tnythuoc hudng chdn dodn sau khi h6i bCnh vA kh6m
lam s:ng:
' C6ng th[. m5u, t]m ki sinh tring s6t r6t, tdng phan tich nudc
tldu, X quanq ph6i, siau 5m.
- crc x6t nqhiem td b:o, vi sinh: phdt honq, phan, ciic dich tidt
D 3. cHAN DoAN NGUYEN NHAN s6T
CHI,ONC 3] SENH NHIEM TRITNA T 4T
chdm xu6t huydt dudi da, 6i m5u, tieu
ra mau, chaymiu m0i, cheymiiu.han
ring, alau bUng, gan to
sdc
56r xu;t huy6t Dengue
- Lo6t hong, hdns ban d tay, chen,
mi€nq
Benh tay ch6n miCng
Lao, Ebstein-barr vnu s,
Dau h6.hiiu Ph,i
' TrE tir6thinq -6 tu6i, sdt, co giet toi'n
thd, tlnh t6; va kh6ng c6 d6u then
kinh khu tni sau co giit
Sdt cao co giat
o4. xurRi
4.1. Nguy6n 15. iliEu tri
- Ha nhiet.
- Di6u $insuyan nhan-
4.2. H? nhiet
o- rhud. gftn sdt:
- chi dlnh:
+ Than nhiet trcn 39'c.
+ s6t kem :ec dl tat, bat thudng bdm sinh tim, phdi, bcnh
phdiman tinh, bCnh than kinh cd, dich(ng nao'
+ c6 tidn sJs6t cao co qiat.
+ TrA c6 ve rnet m6i, kh6 chiu do sdt'
- Thu6c ve li6u dnng:
+ Acelaminophen lA thu6c hq nhiet hieu qua vA an to:n
cho tr6 em Li6u dirng ]o-ls mg/kg u6ng hay tqa dtloc
m6i4_6 qio. Anh hJdng rhuc nang 9an'
lbuprofen 510 mg/kq/l,n uong m6i 68 gid Do lrh
huJngchfcnAngthanvidudngtieuh6a.'h6nschldinh
ibup;fen trongllLrdng hgp lo6t d? da, xudt huvdt ticu
h6a, sdt xudt huydt.
t, u6ngiii6u ni*, tidptt .bt me, dh udns btnh thndns' nAm
.hA thodng
c. Lou mdt hq sdt ttd.. <hl qnh rrcng
''n'
itdng hdp:
- 56tcao kem dang co giat.
- Than nhlet trcn 4b"c, tra c6 bidu hien kich dong, dqa co giat
, Chr. Ao{n ndhi.ldn'
- T6ng trang t6t, s,5t < 7 ngiy, kh6ng
ddu nhi6m khudntai.h6
S6ng hoa.lultdivnng dich t6 sdt r6t,
thidu m6u,l6.h to
Co d5u hieu nhi6m trnnq, nhiEm d6c
siSc
Nhi6m trnng huyit -
- xu6i huydt du6ida, ban mdu hoaitn
- 56c
Nh,Em n5o m6 clu
- Dau khi .li tidu, tldu nhi6u hdn binh Nhi6m trnnq tidu
Ho, th8 nhanh, kh6 tha Vi6m ph6i
Co d nhiEm khudn taich6 Ap-xe,viCmtai giia, vi6m
Ddu manq n:o

23. 11 T PHAN A NOI KHOA
Lau met ha sdt vdi nudc a'nr ho?c nddc th(dnq, kidm tra latthan
nhiet m6i30 60 phUt. Cha'm ddt lau mat khtrhan nhiCt drrdi38,5"C.
4.3. Oidu tri nguyan nhan: Oidu tri d;c hi-;u tty theo tnng nguy6n
nhan qey s6t.
4,4. Chl dinh nhapvien
56t tren 40"c.
S6ttren 39"Cve kem alijp Ung vdithudc ha nhiet.
56tkdm BC > 20.OOO/mm: hoec Band Neutrophile > 2O%.
- TrA dudi 60 ng;ytudi.
- S6t k€o d)ichua 16 nguy6n nhAn.
- Chlalinh nhapvien theo nquyen nhan qaysdt.
4.s. TSikhin
- Tiythuoc chdn doan.
- Khirnr lai ngay neu bcnh nSng hdn hoac khi c6 ba't ki, trieu
chfng mdixudt hl6n.
- Tji khim khitlnh trang khong.rithi-an sau 48 gid hodc tly
nguyen nhengaysdt.
O5. HU6NG DAN CHAM s6cTAI NHA
- Ucins nhi6u nu6c,tidptucin u6n9 binhthudng, nrm.h6thdns.
- Chotra udng thu6c ha s6tve lau m6t theo chialinh.
s6T PHAT BAN
O 1. OINH NGHIA
Sdt phdt ban le b6nh truydn nhi6m do liau v,gey ra, bidu hian tam
s)ng s(it kAm sang thudng da dang h6ng ban. NguyCn nhen thudng
gap l:l rubella hay sdi.
O2. DANH GIA BENH NHAN
2.1 H6lbanh
- 56rthdigian phrt ban sau khisd! tlnh.hdtve trlnh tu phat ban,
crc trieu chrng dikam (ho, chay mrli,6i, ticu.ha, nqfa...)
cN].'oNc l: BCNH NHr'M TnuNc r 45
- Tiep )ic nqudi o sOt pndr bdn trong !oag 3 rJir'
- Tnuo( da ounq vd ta IsJorurglhu6('
- Ti6n sarPhetban.
2.2. Khem l;m teng-'-
tll" r,"i,:,;". ro). (h;n. dale p5:ns noac ddr sin'
- 'llm hach sau tai
*'i <."i,'-ir'i"., 'tv - r't'o( nav rodv dau r' bdn v3 oien
*li'uJ,," ae qtd'""i,-t brr:roL tr;ns r'r(h thr d. rho bans
deu kim, d niern m?c md vnng r;ng him'
- D5u hieu vicm long
Deu hiclr c6 bidn chl]ng'
(> 3. CHAN OOAN
3.1. chdn iloen x6( dinh d(a vio lam s;ns 90m:
sot. ihuonq qL,m 1'h b;t d;u Phit ban'
.ronq ou" i;i',.,."' tl'i' chi v'u 6
'
o va rran m'1h'
3.2. ChCn alo6n
a. chdn Aottn nquvennhA'i sdi, rubella '
i. cnan uoa, pha, biCtj Nhi6m tdns huvAt n;o mo cdu'
Kawasakr, banh ch;n tay mieng'
- 61 ^udt nuvE( DerqJe <ot'ro idn tLL'_7
'o;v
kawasakir Phat ban kdm s6t cao, honq d6, phn lbng b'n tav
deu xu6ns than v:r chi,
ban lencdnddlaivdt
rham da, s6t giam khi
(+++) Kh0ng
.6 hach
(+)
theo tinh t( ban lan
kh6n9 dd laivdttham
da, thudng hdt sdt khi
(+) Hach G)

24. :. I ,llAN A: NOI KHOA
chan, bong da tdns ban tayb)n chan trong, kim ha.h c6
, Di ting da: phiit ban kam ngda, th(dng khdipMt sau rhrc
;n haydnng thudc, kh6ng kam sdt.
-
.Dd
da do nhiam tu c5u: kem rt or do, horq oan ddng m;ng
ld. n6n9 vung da ph;r bar, kem edrcdo.
- Nhi6m trnng huydt n6o m6 c6ur ph;t ban satr nsiy ddu s6t
phitt ban it, chu ydu ta sang thudng xu6r huydt d;;g ti ban
dang chdm haymenq.
- Tay chan miengr ban it g4p, chn ydu la b6ng nudc t6ns b)n
tay, b)n chan, m6ng, s6i.
O4. DICU TRI
a.r. NsuyAh t6c itiiu rri
Di6u tritri6u chtlng.
Vitamine A ndu cha'n do;n sai.
Phiirhian vA didu tribjdn.hd,ng_
4.2. Tieu chudn nhAp vien
Sdt cao kh6ng ha sau 48 gid ho;c ven.dn sdr cao sau khiphbt
- C6 vicm phdi.
- Co giat.
- Ihay dditrigi6..
4.3.OiiutritrtCu.hfng
- Ha.sdr st dung acetaminophene ti6u to - I s mslkg x 4 tjn/
nsav.
Giam horthudc gjam ho an to)n nhuAstex. pectol.
4.4. oi6u rri h6 trd kh6c
- Ndu E sdi bij sung Viramin A, trt, nhsng rra da udnq dn ti6u
tronq v6ns 1 rhiing. Cho 2 ti6u: Li6u dtu ngay khi ch;n do;n,
lidurhr2ngiyh6rr1 sau.
+ T16 < 6thSngrso 0oo dvlJi€u.
+ T16 6 - I i th6ng: tOO.oOO dtv/ti6u.
+ TrB t2 thi:ng - 5tudir2oo.oo0 dv/lidu.
- Kh6ng sinh khic6 b6inhi6m.
.HUONG ]]BENH NHICMIRITNC ' 47
O5. THEO DOI
s.1. Tii kh6m mdl nsay n6u sdi cao; .6( trudng hqP kh6c t5l
kh6m 2-3 ngly, khi.5n.
5.2. Ddu hiCu ning cdn khdm lclngay
- Co giAt.
Thd met.
- 56t.ao khonq ha.
Thay dditi giiic.
5.3. Hudnq d5n (h6m s6(ngudt blnhtal nhir
- Dlnh dudng daydU, u6ng nhi6u nudc.
- iranr, t'olir.n tt ong t;t nhukicng an, kicnq Ii6' ki6n9tdm'
- cho tre nghi hqc, han chd tidp nic ngudi xung quanh 5 ngiv
sau khiPhat ban.
o5. vAc-xlN PHONG BENH
- chich v6c_xin sdilncgth6ngtheo chLrdnq trinh qu6' gia'
- Chkh vdc_xin 3 trong I (sdi, quai bi, rubella) l0c 12 - 1 5 th6ng
ve nh:c lailidu 2 U( 5-6tudi
NHIEM SIEU V!
O 1. DINH NGHIA
- Nhi6m sieu vi li tinh trang <d thd nhi6m si6u vichua xiic dinh
duqc t5c nhan dac hieu.
Nguyen nhan: hEu hCt nhi;m siau vi trunq o giai dodn d6u dEu
co-h;i cha'nq nhi6m sieu vi nhu <61, hc td mur' dau nh&''or
loan ti€u h6a
o 2. oANH GIA BENH NHAN
2.1. H6i benh: rriai. hung 5ol:nnh chat s6t v) La( triEu (hung ldm
- Ho. sd mni.
Met m6i, bi6ng;n.

25. 43. PHANA NOIXHOA
- R6ilo?n rieu h6a.
- Oau nhfc, qudy kh6c.
- Ciicthudc de dins.
2.2. KhSm hmsang
- Ornh giii sinh hi€u.
- Kh6m cdn rhan vi dey dt coquan dd khons s6t d nhiEm rn)nq.
l-r.n cac dlu hieu:phdr ban, na(t- sau tai, viam kdt ma( ...
2.3. c6n lam stng
CTMrn6u rre sdt cao ngayth112,I trddi, thudng thay ddi kh6n9
al:c hi€u, c6 thdting td bao lympho.
- CRe TPTNT niu chua loai tril bEnh n h i6m trnnq.
O 3. CHAN DoAN
3.r. Ch6'n do5n: Nhi6m si6u vit).hdn do;n loaitrlr
- IrE s5r. dau thtr co, mel mdi. tdng lldngthdong hii tdr.
- Khong c6 nh(nq d5u hieu ning to:n than.
- Kh6n9 dm thdyd nhiam trnnq.
3.2. Chdrl itotn ph6n bier: chn ydu phan biet vdi .dc nquyan nh6n
gay sdt.dp tinh khe., nh(
- 56t xu;t huydtr tre sdt €ao tien tuc c6 thd tir dd, dau bung, n6n
6i,xudthuy6tda, ni6m, Hctr;ng, tidu c6u gi;m.
- Senh taychan mieng:c6ihd c6 h6ns ban mun nudc kin diio d
ldng ban tay, ch,n, d6u g6i rdt d6 b6 56t, h6i ki d6u hieu giat
mlnh. Ndu b6 s6t tr6 c6 thd ttvons rdr nhanh do viem n6ol
- Cdc benh li nhiEm trnng khi:c vicm hong, viCm amidan mt,
vi6m rai gi(a, vicm phdquan....
- Cdm mia.
o 4. x0rRl
4.1. Nguyen t6( didu rri
- Di6u tritrieu.hrng.
Didu rri h5 tro.
4.2. Dliu tri
Di€u trirrieu chfng:
+ Ha s6t:paGcetarnol to-15 mg/kg x 3,4ldn khis6t > 38.C. Luu
)ranh hudng chr. nSng gan.
cHuoN63i BeNH NHIIMTRtTNG r 49
+ Hoac ibubrofen 1om9/kg/15n, ngAy 3 len. Luu y 6nh hudng
dudng ti€u h6a v; chLlc nangthAn.
- gldu trih6 rg:
+ U6ng nhidu nL16c.
+ VitaminC.
4.3. riau €hudn nhAp phAng luu
- s6t co siat.
- Nghindsdtxudt huydt:tr6 s6t cao licnt!rc, m€t m6i, ti€u cdu
d gidihan thdp tn l5o.ooo-160.000/mm3.
4.4, Hd6ng d5n chim 36( vt theo dSit?i nh)
- Udng nhi€u nudc.
- LaLr m6t khite sdt cao.
- An nhi6u b(a nh6 dddn chdtdinh dudng.
- Danlheodoi(lcd6uhigubanhnSng n6u cd phli kham ngav:
U d4 dau bqnq ndn oi, ruSt huvdt bat thuong, giit mlnh' co
si1t.
4.5. Hen tal kh6m
- Ndu l5m tlnq 6n vij Lhong co (hldinh nhapviin: iaikh'm sau
l-3 noav.ho aldn khihdt56t.
- Truoriq hgpn9hingd l5m sing(hua 6n,rhan nhen(dn lo
'5ns
nan t6i khim mdingay.
O 5. PHONG NGUA
- Gi[9]n vg sinh s?ch s6.
- Tranh ddtr6 b!nhi6m lenh.
- Ti€m chUng day dU theo llch

26. 50 I PHAN A: NOI(HOA
BENH TAY cHAN MIENG
O 1. DINH NGHIA
Benhtaychan mi6nq lA benhiruydn nhiamdo si6uvjtrtnq dudnq
ruot thu6c nhom Coxsackievirusee vA Entercvirus 7t (EV7i) g6y ra,
bidu hi6n chinh la lo6t mieng hoac/vd b6ng nu6c dtang tan tay, iang
ban chan, m6ng. g6i.
Bcnh c6 thd gay nhidu bidn ch.hs nguy hiim tirvong nEu kh6ng
drldc ph6t hiCn sdm va xOtri kip thdi. BAnh thudnq g;p A ra dd6i 5
tudl, nhdr li drldi3 tudi.
O2. DANH GIA BENH NHAN
2.1. H6i bahh sn
- Dich tE:tidp xlc vditr6 benh.
- Ddu hieu lam sang V; di6n ri6n:
+ Thdigian xuat hiCn sang thudns.
+ sdt, rhdigian sdt.
+ N6n 6i.
+ Giat minh chdivdi(thddns xu6t hicn t0. b6t ddu grdc nsrl
hayllc n5m):tdn sua_tvathdigian giar m)nh.
+ Bun chi, aliding toanS cho?n9.
2.2. Khim lemsing
a. Ddu hiau sang thndng da niem:
Vdt lo6t trong ni€m m?. mi€ng gay Gng ti6t nud. mi6ng,
dau, bd;n.
- 86ns n(dc haysin c6thdmdihayd6 khd kh6ngdau,kh6ng
ngua.-hudng xu;r h dn d tong ban ta, ban chan. monq,goi.
b. Ddu htcu bidn chnnq:
- Thdn kinh:
+ B']t rllt, ln d4 run chi, trdn mdt, giat mtnh .h6i vdi, d1
loanq choang.
- vdu , hr. run qiar nhdn cau. ti6r thdn kinh so.
- H6 ha'p, tim mnch:
+ Mach nhanh, nhip tim tren l3o tan/ph[t, da ndi b6ns,
rhdigian phuc h6i mau dd rren 2 gi;y.
+ Dcimd hoilanh: ri.hihay khu tru.
+ Huyitiipr;nS.
+ Thd kh6ng dAu,thdnhanh, rlit t6rn nqV..
.Ht/ONCA: BENH NHL.MlRLJN6 T 51
2.3. chdn iloen xie(iiinh: dua vao lam sang gdm sang thudng da vi
trididn hlnh hoi</ve loet mieng.
2.a. Chdn ilo5n phan bigt
O3. DIEUTRI
3,1. Nguyen tic ili6u tri
- Diar tritri=6u chLlng.
- Ph,t hien kiprhdibi6n chr.trg.
3.2.Ti€u<hudn nhapvlen
Sdt cao > 39'C hoi./G hdn 2 ngay.
- N6n 6i nhi6u.
' c6 bidu hien bi6n .h0ng then kinh hay h6 hdp tim m?ch.
3.3. ol€u tritriCu chi'n9
- Gi;m dau, he sdt: ibuprofen s - ]omg/kg x 3 ldn/ng;,
Paraceta.nol l0- l5 mg/kgx3-416n trong ngey.
- c6 thi sir dung Antacide dang gel cham v;o sang thuong d
mi-4n9. Lltu i nguy cd hitsa..
- Khanq sinh khic6boinhl6m.
O4. THEO D6I
4.1. T6i kh6m: m6i l-2 ng;ytrong 8 ngay.
ThUdng tiidiriiilai
taim6tvitrinhar
Thudng tap trung d
mot vnng da
Sanq thudnqthLldnq lan ra da xung quanh

27. 52 T PHAN A: NOI(HOA
a.2. O{u hi6u n6ng.6n kham lai ngay
- GiAtminh chdivdi.
- Run chi.
- Oilo?ng cho?ng.
- Thd met.
- Sdt.ao kh6ng h?.
- N6n 6i nhidu.
4.3 Hudns dSn.h5m 15< ng(di bgnh qi nha
Dnng th(c an l6ng.
- Gi!'ve sinh rang miqng.
- Nqhlhgc,triinhti6p xlcvditre kh5. it ohdt lO ngiy.
O5. PHONG NGUA
- Vlc-xin phdnq bCnh:chua c6vec-xin.
- Bi6n ph6p phdng ngUa khiic:
+ Thudngxuy€n rila tay brng xa phdng dudivdinudc.
+ Silttrirnq m6itnldns sinh hoat blnq dunq dich siit khudn.
.HUON6 3: BENH NHI[MTRi,NG T 53
QUAI BI
D,I. OINH NGHIA
- "oiiiiil"t"^'r' *,a. rruns i6p rrnh do sidu vitruns rhu6c nhom
p"nmvovnus oe ta.
'- ii..rr" rl -* a""1u)/dn nu6( boL rchi veu l; tuvin mdng tal)
"u,
o'nl uu. ,"'i- i,iu" ,nh; +c vidm m'ns nso v'Em ruv vd mot so
O 2. OANH GIA BENH NHAN
2.1. Hdlbanh
' :iff#''+;*'*!i:';:"""'- fl- sot, sunq dau ham m6t hoac harben'
2-2. Khiim Hm sinq
''' -"i,,i.."""i-",lr,l"q, bo rhudng khons 16'dd tr'n tuvdn sunq
iil-10"" "aio.;"i;"a"n
h5i,cotheroxem sLhs tuven dud'
ham va dv6i lL.idi
-
'ti'ii""* i,"s dt, ao'thic6 9ia m?c nhuns kh6ns c6 mi'
- nm bien chunq:
- Viem m;nq;,o: nhuc dSu non oi' diu ming neo
- ,ia- irrul, 'inh du. (tinh holn' mao rlnh hoan bu6nq
i,l'r.qt,ti,nq rinl' Loun' An dau hd chau m6t hoic hai ben'
+ Vi€m tuyralau bung, n6n 6inhi6'r'
2.3. CAn lem slnq-
i,"; i. i;,* i,v." 'anq
tar: hi (5n phan biet vdi vrem hach
v.rnq ham hay viem tuydn mang tai do vi lrirng'
D 3- CHAN ooAN
-r-.i.
iilii.e, *.or,h e6m lam slnsvA dlchta
-" ];i.iia-t J" atrl;sira quaibi, chua m:c benh quaibi' c6tidp
r;cvdi benh nhanquai b!2-3tu6ntrud''
' iii ii.d, .* .ra^ rnans tai m6t hoa< hai ben' 16 stenon
sdng d6.

28. s4. fHiNA NO rHo^
biet
Qua bi Oau, sUng Sung al6 kh6ng
ThLrdnq kh6nq alau Kh6ng sung dd
Viem tuydn mang raido sdnq n6ng d6 alau Sdng d6 thudng
D4. oIEUTRI
4.1. N9uy6n tr( .tidu tri
- Oidu tritriCu chling.
- Phdt hi6n vij didu tribt6n chfns.
4.2. Tieu <hudn nhap vi6n
- Sdr.ao khdnq ha.
- Dau buns nhidu_
- NOn 6inhidu.
- Dau deu nhidu.
- Vnng biu sung d6.
4.3. Oidutritri€u (hfng
Ha ,ciL, gi;r dau Lyen m.ng (d: tbJoro,en 5 . romg tq i llan'r qdyhdy%rocerano tO .5
Tq "g { , a rdn rro;q;gay.
- Che do an rhuc;n t6na denuot
55n s6c rAng mieng.
4.4. Diiu tribidn (hUhgvi6mtinh hoen
- Nanqddtai.h6, nghjnq6i, han chdvan dons.
Pred ntsone: I mg/kglng;y x 7 ro nq;y.
O 5. THEO DOI
5.!. Tiiikh6m sau t,5 ngay khi.idn.
s.2. Diu hi6u ning (dn kh5m ngay
- Oau buns.
- Non 6i.
CHL/ONG 3: BCNN NHI.MlRI]N6 . 55
Dau ddu.
Vnng blu sung al6.
s.3 Hudng dAn (him 56c ngdi,ib6nht?inhir
- Trin; th6i quen khonq t6t nhu boi, dAp n6ng vnng tuvdn
- Nghihoc 7 ngay.
Cech ly, lrinh ti6p xuc vdi nglrdi xung quanh-
O 5. PHONG NGUA
VSclxin phons benh:ti6m v:. xln Luc l2 'ls thiing, nh6' hill6Lr2
Ii.5 6 tudi.
, THOYOAU
O I. DAI CIJdNG- rii"arr r" t"nn
".,:m
lr'.nq (;p t, 1 oo er'u v e'p"' vai''lla'
l"/. ru;eu bdrg JLd19 to 1;o oLa
'hLag
qror nuo(borb"r 'atrr
Benh ddL r,.aq bd pha' Ddn odrq oo'q rJoc o da vd ni'm md' '
oient,en oihL. rr-nnrrr qco'n' gavru!o'qooorpa'Jlqv'err;o'
O 2. DANH GIA BENH NHAN
2.1. H6i b+nh st
- Ti6p xuc vdi ngudi bithiy da-u hoqc dang co dich benh tqi dia
CnJng agJu lhuy d.lu t en. i '
b' llLv dau
56t.
H6n9 ban khoens vai mm nhanh ch6n9
'huvdn
thanh b6ng
nLJdc sau 24 gio.
2.2. KhAm lam 5;n9
- B6ng nudc da tir 3 l0 mm' lrc deu chUra dich trong, sau 2a gld
hoa;uc, nhi6u Lfa tu6i(c6 bons ndo' mdimoc xen k6 bong
'i;hoa duc v: bOnq da d6nq mav hav bong vAv).
ch6in

29. 56 r PHANA:NO I(HOA
_ Bong ilroc i o tt e .oc d n,em mac r ing.
Tm cac bidn.hL/n9 rhdonq qap:
Vier' -o td bdo do bo, nh,E1: bo.g nLoc hod r L do da hay
ru,]q tay !ung qud,rh bong 1udc. vA iar thi6T trJ,rg nhieT
doc.
- Viem nao:trigiec tLldu, hdn me. co oiar.
V,em ruy:yau chi.
H6ichfng Reye:n6n oinhidu, h6n m6.
O 3. CHAN DOAN
3.1. chdn doan x6c itinh
. Dkh_l;:Chddchunq ,rqLath:/dau.(hua ml, belh rnLyddJ.
co lreo ruc v.jr binn nhdr thuv ddu ono vong 3 tuJn.
- Lem sing:b6ng nu6. nhi6u tda tudidda, niem mac.
3.2. Chdn doih phan bier
O4. DIEU TRI
4.1. N9uy6n r5c itiiu tri
, Oidu tridAc hieu.
- Eidu rritriCu chrj.ng.
- Ph6t hien va diCu tribidn chLtng.
4.2. Tiau <hua'n nhep vien: m6ttrons ce.ttnh hu6ng sau:
- 56r cao liCntuc kh6ha.
-Tra<lthiinq.
CHUON6 TIBENH NH.MTRUNG ! 57
Codiasuyglem mi6n dich: HIV/AIDs, dang dnns corticoid.
Sang thudng que nhl6u.
- Nqhi nqd nhi6m finn9 huy6trs6t cao, ve m;t nhlEm trirng, Ltl
dn.
4.3. Di6u tr!tli( hiqu: A.yclovir:
Hieu que cao n6u duqc slrdung sdm trong 24 gid sau khikhdi
- Li6u luqng:80 mg/kg/ngiy chia l;m 4len (t6i ala 800m9/lan)
udng.
' Thdigian.lidu trli5 nq)y ho?c d6n khl kh6ng xua't hien thCm
- Luu)r:niubenhtLrdndinhtrong4sqidthlkh6nqcinchidinh
4.4. Oiiu tritrieu <hnng
Ch6ng ngfa: antihistamin
Giam dau, h? s6t:dnnq Parac6tanrol, kh6n9 dnng Aspirin'
4.5. Diiu tri h6 trd.kh6(: Chdm xanh meihylen vio sang thuong da
O 5. THEO D6I
5.1. T6i khiim sau 3-5 n9aY.
5.2. Ddu hieu n6ns.,n khiim ngaY
86ng nudc nditoen than.
- B6ng nud. h6a mi va tdyd6 xung quanh.
- S6tcaokh6ng ha.
, Ln drl, bd;n.
' co giet,ydLr chi.
si. Huirng d6n <ham s6( ng udi benh tqi nhi'
' Vg sinh cdthd:kh0n9 klcng t6m.
- KhOnq kienq an.
' Nghiho.T-10 ng;Y.
' Trinh tidp xnc vdinqvdixung quanh alic bi6t la phq nimang
thai.
Nen mang khiu trang
B6ng nudc rren
nin hdns ban
Nhidu tudi

30. 53 T PtsAN A: NdI KHOA
O 6. PHdNG NGUA
- Vdc xin phdng b6nh:
.r liem v6c &n:bjr cr5u tuc t2 thiing (n6u r,ong nha (6 nguo,
benh.o thd tuc 9lhdr9). rh6(,aiti6u 2 tic 5 _ 6rudih"y;iirh
li6ulli3rhiinq.
+ Ngudildn ti6m 2 Ji6u cach nhaLr I rhiing.
- Eien phiSp ohong nqua kha, : r,an1 tieo xu, v6: nguo benh, rLla
tay rhudng xuyen.
s6T xUAT HUYET DENGUE
O 1. DINH NGHIA
Sol luat huydt Denque ta benh l,uydn nnrer gay drch do vi .ul
Dengue gay 1en. 8F1h g?p d cii irA em va nquoi ,dn OaL aridm .rl,
ot:Ldr l-uydtDengue t sol. uar huyer va th;jt huvet rudrg, co rha
ddr d;nscicsrd11rhCticnrLSn t o;n. r6i todn dorg mau. suy r;19 niu
kh6ng.tLrd<.han doan som ve xn tlikip th;id€ d-;n de.n tt]von;
O2. PHAN LOAt rl.eoTo.hr/L v ra 'ha qioindm 2009. benh sdl xuar
huyet Dengue atuoc (hia'am I mu. i,6:
a. sdt xudr huydr Dengue.
b, ,dr xudt huydt Dengue .tt dau hiau oitnh b<io.
.. sdt xuAt huyit Dengue nang.
O3. DANH GIA BENH NHAN
3.1. H6ibenh
- 56t: Ngay s6t, tinh chdr s6t: Sdt cao d6t n96t? Ng;y thll mdy?
sdt ddnthu6n hay co kdm ti-au chrrns h6 hlp: ho !d mri, tiirl
h6a:budn n6n, n6n oi,ti6u.hey.
D.i'u hiCu kEm:Dau bunq, nhllc deu, chiin;n, dau c4 dau khop,
nhf. haih6 m;t,.hAy m6u r;ng,.hAy miru cam.6ira m;!,ticu
3.2, Xhim lem sang:D6nh giii
' Tri gidc vat vi, ln dLr, ti bi.
.NL'ONC T: BgNH NHITM TF{JNG T 59
- Tlrdim6u chi: lenh d6u chi,da l?nh im.
- Mach, huy6t ep.
- Kh6m qan:9anto,dn dau vnng gan.
' Khdm da sung huydt, Ph6t ban.
- DAu hieu xudt huydt nhlr.h6m xu:t huvdt a da c6. vnng
thudng gip nhuc6, m?ttrong c6nh tav, ceng chan, m6ng.nm
ddu xudt huydt niem nhuchay m6u chan rEns, chav m6u cam,
6i ra mau, tiCu Phan den.
3.3. can lam sang
' cTM, ddm tidu cdu, thtrdns lam nsav thf 3 cna benh, va nen
thir-dinqaydu alo,cho thayba, h JL thLong 9.amdin. dunq
tl(h hdnqi6u b rhrh,Jong noa( tang d;n, tiduc;u binh tl_ubrg
hoi.giamdin.
- Huydt thanh chan do;n, khico di€u kien.
O4. CHAN DOAN
4.1. chdn do6n v:' Phan 68,
a. s6t xudt huYdr Dengue
- Lam dn9rS,5t.a;d6t ngot,lien iuc tir2_7 ng;vvi
'6
it nhdt
haitlong c6c da'u hieu sau:
+ Bidu hien xudt huydt c6 thd nhv nghlcm ph6p dav th;t
dudng tinh, .hdm xuit huvdt d dtldi da, chav mau chan
r;ng ho;. chay mau cam.
+ Nhnc dau. ch5n 5n, bu6n n0n.
+ Da sung huydt, Ph6t ban.
- Dau co. dau khoP,.]hft hainomdt'
- Cen lam sinq
+ Dung tich h6nq cdu binh th(dng hoictang
+ 56luqng tidu cdu blnh thudng hdc hdigiem
+ 5d lugng b?ch ciu th(dng 9iam.
b, sdt xudt huydt Dengue .i' ddu hieu .dnh bdo: bao g6m
'ac
triCu chLlng lam seng cna sdt xudt huvdt Dengue, kem theo
c6c deu hieu canh bao nhusau:
- Vatv6,lUd4libl.
- Dau bung virns 9an ho;c dn dau vnng gan'
Gan to > 2cm.
N6n nhidu.
Xuit huydt nicm m9c.

31. 50 ! PNIN A: NOI(HOA
- Xdt nghiem miiu:
+ Duns ti.h hdng ceu ting cao.
+ Tidu cdu Siam nhanh ch6nq.
.. Sdt xudt huyit Dengue ,,1ir9: ihi n gudi banh c6 m6t trong
cec bidu hian saur
- Thodt huyd1tudng nang dAn ddn sdc giam thdtich (sdcsdt
su;t hrJyat Oengue: mach nhe, huyer ap kep < 2ormHg,
dc sdr xu;t huydr Dengue n;ng ma(h, huyer iip oing
kh6nq), rdich dkhoanq m;ns phdivA d bung nhieu.
- xudt huydtnSng.
' Suytang.
a.2. chdn do6n phsn biet
- T Jdng hdp ban tuar huyir
+ Nhi6m nao m6 c6u: ban ho?itrbdkh6ng 16 n6t.
+ Xu6t huydt gi6m tidu cdu:kh6ng sdt ho;csdt nherchdm xuit
huydt hay b6m m6u da.
+ BEnh tay chan mreng: h6ng ban mqn nu6c dldn htnh kam
trieu chlhg rMn kinh.
- Trudng hdp dau bung: c;n chdn doan phen bi6tv6,ivi6m ru6r
lhi,a: rhuong bidu hian dau bung hd.hru phii. I,rc. Burney
o s. xoTRi
5.1. Nguyan trc ifiiu trt
- Phdt hien sdm.
' Bi6u tritri6u chdns.
5.2. DiCo rrirriCu (h'rng
- H? 5dt khi sdt> 38.c, chl ding para(etamot tiCu tr:r io_ts m9/
kg cen nSns/16n, ct.h nhau m6i4.6 gjd (kh6ng quii 6om9/ig
can neng/24gio).
- 8n dich sdm bang .fudng udngrkhuydn khich tr6 udng nhi6u
nlidc (nudc!6idd ngu6i, nudcrriiicey, n(dc dira, cam, chanh,...
5.3. Ti6u chudn nhap vign
- Khic6 ddu hi4u cenh biio.
- Khic6 ddu hieu s6c: vat ve, b*r rut, tndu, tibl, chi, da tanh dm.
mach nhanh nhe, r6iloanvan mach,thiriqian phuc h6imau da
> 3 giay, huydt iip kep, tut ho6. kh6ng do dud..
.HI,dN6 3: S.NH NHIEMTfiIJNG
'
6]
- Nh: qu6 xa benh vien, kh6ng thd nhap vien kip thdi khi benh
tId nAng
5.4, Hdrnq d5n (him 56( tli nhi
-- '-
ir1. i'e ro"s
"hie,
nudc, khuvdn khich thfc ; n l6ns' de ticu'
- Chothudc ha sdt theo toa b;c si
- Theod6id6u hi6u.5nh bio ddcho trE lham'dingav'
5.5. Hen tdi kh5mr m6i ng)v, l-2 len/ngiv cho tdi hdt 7 nsiiv (ia
b6nh hoic it nhdt4s gidsatr khihdt sdt'
(>6. PHONG NGUA
- Hien chua (6vac-xln Phdns benh'
- Trinh mu6id6t
- Kidm so6tc6ntrinq trung gian truy6n bCnh nhu:
+ Di6t loang qu;ng, mu6itnldng thanh'
* i.iiuo air',]"
"'ra.
aqns:trong le hoa, chan ch?n' lv nudc
crlng, ch6n b6,g5odna, hOP nhva' bao nvlon' lon bia '

32. DAU KH6P
O 1. DINH NGHIA
- Diu khdp c6 bidu hicn dau tai vi rri khdp, A tlC em do kh6 xijc
dlll.ll',nn,^d( vl I'r dlr vrvay daJ khdp (o the hieu ra dau nqa;
vrFirhop hdyvung chung qudn'1 no.Dau khop c6lhe kam the;
sunq khdp ho;. kh6ns.
Nquyen nh;n rhudng gip: aiau kh6p tong trudng, vi"m khdp hi.vrer r rdo sieu vi, v em I hcro darg rhap. pe.lor h.s.ho-lrein, rhap
rhop cap, ( hd'n rhudnq khop.
H;u hCrddL knopcnt(jndrr6u r,ira phong kh6r.
O2. DANH GIii BENH NHAN
2,r. H6ibanh
-'lidnc;ii:ch;ntt,Lrong. rungaidL khop. nhrem ieu vi.viem honq.
-
^no
pndt:cJp(, I rualthaymant_6ru;.)
- Thdididm dau khdp tronq;qa;
- Sunq mdt hay nhieu khdp, c6tinh ch6t djchuvdn.
- Gi;mct.ukhinshtnsoihoacdungrhLd, havidngkhilard6n9.
rrieu ch!ng ali lem:sot, ph;t ban,
2.2. Xhim lam iins
Diu hieu sint lor: na.l-. nhiD thd. t,uyat ap. nhrer do.
- D.iu hieu nhidm truno. nhiam d6.
, Ng6 v;o ndu nqhiviem khdD mj.
Dau h 6u v em kt-6p sunq, nonq, do, dau
- Diu chung to;nth;n:lrm. gan,ia(h. ha,h, h519 ban...
2i. can16m ring: kh6nq c6 x6t nghi-6m thudng qui, ngoaitr,
- cTM. CRP vS. neu nqh ngLyp,] nh;r nh;m r(r;9 nay benl ti
A50.i;uamtjm:neunshidothdpkt opcap.
(HUONG4:T]M MACH'KHOP
' 6T
- RF. ANA. d'en didam odu neu nqhi viem dd lh6p danq lh'ip
X qua,rg khdp:kh, nghi nnrem trLng chin luonq kh6i u hay
kh;m thdy bidn dqng khdp.
SiCu em khdp: khitha-Yslhg khdp.
D 3. CHAN DOAN NGUYEN NHAN
3.1. chdn thrrdng: ti6n c;n, sung bam taich6, xquang'
3.2. viem khdp mn:ciptinh, s6t,slhq khdp,thudng la mot khdp' X
qLrang, Si6u am, cT[4, cBP.
3.3. Oau khdP tans trudng:3-8 tudi, ddu khdp ldn (chn vdu li' s6i)
dauv6 ban dem, nqev ho:rn to)n blnh thudng'
3.4, Benh osgood-s(hlatter: th idu nien, suns ngav vitril6i<n chiv'
5n.lau,X quan9.
3.5.ThdP kh6F.
3.6. Vicm khdp dang thdp.
3.7. oau khdp lien quan 5ieu vi: dau cnng lnc hay xuSt hien sau
nhi6m sieu vil-2 tudn,dau nhidu khdp.thoins qua'
3.8. Heno(h-Schonlein: h6ng ban dqc tdng, dau sung kh6P' dau
bqns.
3.9. Ea(h c6u <dp: sdr dau h6p mo hd rhidu maJ'
'uit
huvdr dd
niem, CTM lympho chiEm du th6.
3.10. Hemophilia: tidn (in, tran dich bao kh6p'
3.11. Mqr sti nguyen nhen it glP kh6c: ho?itil ch6m xddng dniv6
trirng, u x'Idng ...
o4. olEurR!
4.1. NguycntS(
Oi6u trigi6m alau.
Khang viem
- oidu tringuyen nhan.

33. 64 . PHiNAINOI KHOA
a.2. Chl6inh nh6p vten
- Vi6m khdp mi.
- Viam khdp dang thdp (;n pn6n biel v,6m khcrp mn, tupus d6.
- Th;p lhdp cap co bien chunq r,m.
. Dau.khopvo_nq benh cenh cna balh ti huvet hoc (hemoph;tie.
benh bach.Su).
4.3. OiCn tri
- Chdn thudng: chuyin ngoaikhoa.
. Khdrg.vidm. giJm dau:pardcerarothoac khang viem khdng
steroid,.6c bien phap viir ti rritieu.
- Oidu tridac hjeu tuy nguydn nh6n.
- Nghlnqdi,h?n chd.n d6ng kh6p.
OAU NGUC dTRE EM
O1. DINH NGHIA
Dau nguc rra em thudng d lt]a tudi tu 8 tudi ddn ts tudt, dLihg
heng rhf haivd ,i do ddn lham tai phong kham rtm mach. Oau n9L1:
tre em rhudng l)nh nnh.
O2. DANH GIA EENH NHAN
2.1, H6l banh
- n€n.sn:BenI Kawas.ki, tidu dudng, ph:uthuat rim,giadinh co
ngddidort4 lang ch6n tam ti
- Ttnh chdt dau: Co tian quan den gdng slrc,;n u6ng, chdn
thuong, hrtrhd.Ddu en tuc, tlhq IUc, cing tuc ceng r6;q.Thor
gian dau: Cdp ttnh hay k6o daj nhidu th5;9, nhidu;am:U tri
hrrdng lan, hlnh thi,c dau, crrdnq dO.
- 'lriCu chung kAm theo:56! ho. thdnhanh
- Nhnng diu h,eu kCm rheo sau deyggryco benh rim:
I Ngiir, hdi hop danh rrdng nqsc, chonq mat.
+ Eau ng(c khiSdnS 5fc.
2.2. Khdm lam sing
- odu hieu rinhidn: m?ch, huy6tiipva ditnh gij r(dtm6u ngoai
CHLJON64:TlM MACH - KHOP
'
6s
, Khiim nsqc: tim vdt bem ho;. vdt suns, sq can ddi l6ng nquc
can ddi, dau ngqc khisddn.
- TSng along bdtthudng trud.nguc, nghetimTl,T2 b6tthudng,
Am thdi6tim, diu hiCu qan to.
- Lam mOt s6 nghiom ph;prHit sau, nang c6nh tav, n6ng aldu"'
2.3.Can lam seng: Khong c6x6t nghi6m thudng quindu benh sn v;
lam s:ing binh thudng
X quang ngdc thAnql Khi nghl ngd benh litim nrqch v; dudng
ho h5p.
- Dicntamd6,si6u6mtim:khinghinqdbcnhtim.
- Di6n tam d6 Holter, g:ng sl]c: khi nghi ngd r6i lo?n nhip tim'
thidumiu cotim.
DIEUo3. cHAN OOAN NGUYEN NHANVA
Dau nguc k6o daitvvii tu;n d6n
oau nh6i,cdn ngrn, kh6rg triau
Giaithi.h.d6nq
9
B
^4ang
c,p qu6 n;ng tGn m6r val,
tap ta, chdi thd rhao. cHn thudng
Oau dtrE binh thudng, khdiPh;t
d6t ngo! con ,et nq:n, bi6n m;t
Giaiihich,dOng
xudng ,udn bi vudr, chdn €p lEn
dayT(.TrC nqheti6ng click-oau
sung khdp fc sudn 2,3 qay daL. Verrtrllieu
Oau nho, ah i, m6tben, hn sau
ung.Oau ting khivan d6ng, hit

34. Td dn:oau mdh6, kdodA kdm
alau d5u, dau bqng,thdnhanh,
Ting thbng khiqay.on dau kam
.hong mat do.o th,t.dhoinh,
kh6m Bm ;nd binh th(dnq.
nhSt
cim qidc b6p .hlt ngVc. Khrmr
kh6thd, khb kha, ran.q;y,
oidu ti suyan.
NhAp viCnali6u
LiCn quan vdi bEnh tim, mdt n(oc
catheier rinh machtrung 6m, r6i
loan d6na meu, b6o phl.
ph6i
Mit, kh6rhd, nqat khiqdnq nlc
Cam qiac dau n6n9 rrt sa! xudng
(hem kh6ng timth5ydju hicu bir
$Lrdng kh6..
ng(oc DD-TQ.
oMc.
1ta.
3.TLji ohlnhVahalva vd.
Ngii h6lh6pdirnh tr6ng ngq..
ch6nq mdt,.lau ngq. khigSng
T€n cen qia annh vi b,n thsn:
+ M6timtrudc 60.
+ Mrcb€nhKawnaki.
Ma.h, huy6t iip tr.hl khr. nhau.
5]5 T PHAN A: NOIKHOA CHI'ONG4:IM MACH (HdP r 67
o4, TIEU CHUAN NHAPVIEN: khidau nsvcc6k'mttieu chdns;
_ Nqdt.
H6i hopdinhtrdng nguc,r6i lo4n nhiptim'
Huy6t6p.ao.
- 56t. ho, thd nhanh.
O 5. AUAN LY NGUdI BCNH
- Trudng hdp c6 nguven nhen:theo d6i ui khiim tny nguyen
- Trudng hopvo cin:tu 1 _4tuin-
O 2. OANH GIA BENH NHAN
2.r. H6ibenh
a, Hdi tinh .hdr net:
- xev ra dP hayman?
- r,aJr,;v ia r,i nao: (aJ khi ho4r dQng nhrEu? thbidiim xa
b;a 5n'(llicd6i)? Nghi nsdic6 si'm met?
- lvlet.6 x6y ra thudng xuyen trong ngiv?
C6li6n quan ddn giSc ngi kh6ng?
' Licn quan ddn hqc hinh; m6i quan he vdi ba me' anh em
tronq 9ia dlnh?
- Co li6n quan ddn;n u6nq?
- C6lien quan kinh nguyet dtr6gii?
b. Cdc dtiu hiau Ai kam A hC h6 hdp,
'i,Il.
nqch, ticu h6o" '
2.2. Kh6mlem sing
- Dau hiCu,inh t6n.
MET
.,,-.*ili'!,:fg'xf.:i:.:riffi i,tli?iixi:i,I#"fl',ili(
lqn,';c;i loan t;m th;n hoi( do oung mot so thuoc g;v mCt m6" ho;c
do tam li.

35. 63 . PHAN A: NOIXHOA
, Khirm rdng quiit.
- chd i lh6nr ki cd quan gdi i c6 ti6n quan ddn nguyan nhen
gay mCr.
2.3. Celt lam iing: tam cd. x6t nshi6m hudns ddn nhlng nguyCn
nhen c6 thd nhir
- C6ng thUrc m;u:nhiam trinq, thidu m;u.
- ldng oh;n tkh nudc lieu: r:du duonq. b6nt, 9dn, nhram rr:ln9.
caynudc (i6u ndu nqhinhiamkuno.
- Dien giAr, dudng huydr, ch.( nanq;an. Lhan.
- Chuc nang iuyd,r giiip neu nghi b;;h ruyen si;p.
Vs nau co nghi benh h6 rhcinq. vrem nn:6r
- Xquang phdi: b6nh tim, phdi.
5i6u.am tim: b6ng tim to/X quang, nghi ngd b-;nh tim, ycu cdu
sia dlnh.
- FCG: m qua.nhdnh, qua ch;m,lir
^h61q
ddu, co riin can
nga! gia dlnh cd ngL/dibins;t.
- C6. xet nghi€m kh6ctny nguy€n nh6n.
O3. CHAN OOAN NGUYEN NHAN
NhiaT. kung cAp rinh: lai mli io.rg, dudng ho h;p cap. tieu
h6a, n6r niCu.
- Nhi6mtrnngm?ntinh:lao,vi€mqan.._
- Thi6u miu.
- Ha aludnq huy6t
Benh litim mach
Rd:loan gi;( ngn, r6itodn t8m ti.
O4. NGUyEN TAC DtEU TRt:oidu tritheo nsuyen nhan taiphdng
khiim chuyCn khoa thich hop.
KH6 THd
o r. DAt cudNc
Kh6.rhdla rrieu(hLrng thokh61. ranonhoc. kno chiu kt ,t10.Lijm
la19 biau hi6n tJnhe. (hr( o cam q a. <hOrhdden mt]cato ,rang nhr
thd nhanh, th8 r[r l6m, co k6o cd h6 h;p phu.
CHIJONG -1:-IIM MA.H - KNdP T 69
O2. DANH GIA BENH NHAN
2.1. H6ib6nh
- KhdipMt kh6thdrcap hay m?n.
- Ydu td lam sia Gng hayl;m giam kh6thd.
- Trieu chnnq kemtheo:s6! ho,ch3y nl1dc mni, dau ng(c.
- Tidn c6n: khd kha, suy6n, nhap viqn vi kh6 thd, banh tim, sang
chdn t6m li.
2.2. Khem lam sang
- D5u hieu sinh tdn: mqch, nhipthd, huydt 6p, nhi,at dO.
Kh6m cd quan h6 hip: khd khe, ho ong dng, khan gignq, ran
phdi, si:m mdt ph6am.
- Khem tm:tim, ng6n tay dnitrdns, nhip tim nhanh, nhip ngqa
phi, 5m th6i, gan tim, tin h mnch cd n6i, phu ngo?ibien.
2.3. can lam !ins: Kh6nq c6 x6t nqhiem thudns quindu b:anh snva
lam $nq binh thi-ldng.
- Cdnqthrc mdu:n6u nghinguy€n nhan nhi€mtnng,thi6u miiu.
- X quang nq!1c thing: khinshibenh li tim phdi.
, 5i6u am tim: khi c6 am thdi d tim v; b6ng tim to tr6n X quang
nsvc'
' olen t6m d6: khic6 tim nhanh, cham qu; m(c, khong ddu, ti6n
c;n ngdt.
' Tdng ph5n tich nu6c tidu, €hl,c nans gan, than, tuy6n gi6p,
dudng huydttirytheo hudng chdn doiin nguycn nhan.
O3. CHAN DOAN NGUYEN NHAN
3.r. Di vat A'rdng thd: xly ra (ep tinh, c6 hoi chnng xam nhap, X
quang n9{csqii.
3.2. BCnhlih6hdp:Vicmthanhquancdp,suy6n,viemphdi,benhli
mang phdi, ditat bdm sinh coquan ho hap.
3.3. BCnh litim mach:suytim, phir phdi, cao ap ph,5i,tim bdm sinh,
r6i loqn nhlp tim, benh .otim, mang n9o;itim, thap tm.
3.a. Benh li noikhoa khic: thidu mju, benh Vthen kinh cd, noitidt,
bCnh li than.
3.5. Nguyan nhan tam li: t;ng th6ng khi do t6m lii r6i loen lo au,
hoang h6t.Chdn do;n dat ra sau khiloainguycn nhan thlrcthd.
=:[

36. 70 r PHAN A: NOIXHOA
O4. TIEU cHUAN NHAP vIEN
- Suy h6 hdp.
, Suy tim,
sdc.
- Nqhingd divSt dudng ihd.
NGAT
O 1. OINH NGHiA
Nqa't la tlnh rrang mdtnigidcram thdiva mdr tnrdng tu. cdthdng
qua, nquy€n nhan dothidu tudimju nao.
Cec nh6m nguy€n nh6n chinh say ngdt bao gdm:
fidrloan h6 rhan kinh rrJ.hu:rdiloan dung ndp rdrh6 ng;l linh
hudng, nqat ting phin xa phe vi.
- Nguycn nhan tim mach: rdito?n nhip (hO,chfng eTd;i,WpW
Erugada), b6nh cdtim nsuy6n phdt, benh rim bim sinh khdc.
R6i lod. r;m rh51 ( nn: do.ang thong khrqua mu., dong k:na
- Rdi loan chuydn h6ar ha dudnq huydt, rdi toan dicn giai, n96
O2. oANH GIA BENH NHAN
_Mqctieu
cha'n do;n nh:m xitc dinh nhans b6nh nhinh6m c6 nsuy
cod6ttJcao,la ciictturdng hd.p ngdt do n9uy6n nhen tim mach.
2.1. H6l b€nh
a. od. dAm cdn nsdt:
Ti€n triCu va c6c trieu chrns ri6n quanr hdi h6p, dau nqq.,
kh6thd, ch6ns mat, dau dju,6i.
, Thdididm,tinh hu6n9 xudr hien,tuthi benh nhan khixudt
hien nq6t.
- Ihdiqran ng;r. thudng ta mot viiphur. dd (o dudi2.5 p1nr.
- Lar breu hren trong va ngdy sau khi nga't: be.h nh6n Fliir y
th(c hdntdn, m6r phdn (tronq nudng hoptiin ngdt), mdi
tuth6 alfng hay hdi phlrc hoin toan, kh6n9 di.h[hq.
cHl/oNc 4,TlM MAaH _ KHdP r 7l
b. TiAnsnbenh:
- c;c benh li t'udc day, luu i bCnh tim m?ch, thin kinh, noi
tidt, cac 16iloaniam V.
- Si dunq thu6c r6i loan.hiP tim, t6ng dudng huy6t, cao
huydt iip, thu6c c6 anh huang d6n dien si;i v; ltru i lidu
Iuong.
.. TiAn st gia Anh:
- Benh m4(h Gnh,.6 ngudibingSt, dot ti.
- Bdi lo?n nhip tim, benh V tim m?ch, noitidt, ciic r6i lo?n
tam li.
2.2. Kh6m lam seng
D5u hieu sinh t6n.
Nghe tim, tlm c6c b:t thtrdng nhu am thdi, tidngT2 van9, nhip
tim kh6ng aldu...
- soi.l5y m5t, phan x? san cd, tlm deu hiCu Romberql, d6nh gi5
chtc n6ng tidu n6o-
' Cenl'tu,ddn.;.d5u hiCuthinkinhkhutru,chdnthlldngthLl
ph6t do nqdt.
2.3. cqn lam singr Hdibenhv; khem 16m sans si[p dinh hudns chi
dinh c6cx6t nghi6mtim nguyen nhan.
- Xft nghiem thudngrECG, si6u am tim, x quang ngucthing, ion
dd, dudng huy6t.
- c5. xet nghiem can hoi .hd n ch uv€n khoa: dlen ta m d6 Holter,
sang s(c,test5an nghieng, dien n5od6.
- CT(.an so 1"o:,{'ringhingdch;n lhuong 5o n;o.
O3. CHANDOAN NGUYEN NHAN
ECnh
thudng
sipcdn
Dhanbiat
Tieu chi di phln bEt
Ho:ncinh
xuSthi€n trl6u
BliuhlCn x6t
nghilm
OOns kinh Xudt hiCndot
ngot, thudng it
Kh6ns.6ti€n
nieu
Kh6n9 mdt ali
khibenh nhan
dtuthdn:m
thdc6iiAu
ti6u kh6ng tu
chi, co giitchi
hoicsiat.d,
mat i th Llc keo
dSi,rhudng
Oien nao

37. Ha dudng
huy6t
ThudngxLrSr
bfa 6n, khi
benh nhan d6i
Tidntri6u
kh6ng m6t di
khibcnh nhan
d trlthd nlm
Tri6uchl,ng
xuithi6n ve
mdtdittd
Cii thd
kh6ng brt
ha dudng
huydt
TSng
th6nq khi
ThLldng kam
r6m l, chixuit
hi6n khiting
th6nq khi.R6i
9i.ialoanrhd
R6iioanrri
gid( xuSt hi6n
tlrtir
C6thdnqin
chin vonq
rodn bcnh ly
khiddbenh
nhAn nghingo,
dtrrthdnAm
Cemgiirchdi
h6p, tr. nguc,
kh6thd,dau
b!ns
Hi6m khi.6
ngJr
Ngoaicdn
khong co
cir(dn
thtldng
thvcthd
Hysteria Chi x!;t hi6n khi
c6ngudichrng
ki6n,c6i5iloan
Hidm khixudt
hien tn/dc Io
r0di
Khonq lian h6
ddn thayddi
rurh6
Kh6ns cai
thicn khibcnh
nhan nrm nghi
thc'ddn qdn
I gid
Khonqc6bidu
hicnxanh6l
ha huydt 6p
nhunqet
Kh6ngco
tdn thLtdng
th(c thi
16,loan
thin kinh
tVchil
xudt hien tronq m6trinh h!6no
cOdinh nhu:ditreu ridu, ho ri;
thdduc. alLhg lau
Nq;t phen xa c6 rhd gdp khisd.
giet minh, al.u...
Kh6ng.6ti6n nieu
Thudng nsan
tdGigiayddn
l-2 phit
C6thiphdns
(h6ng dj
chrng
Kh6n9 c6
tijn thuong
th(c th-d
C6 thdpMr
hien brt
thudng qua
nghianq
72 T PHAN
^:
NOIKHOA
O4. TIEU cHUAN NHAPVIEN
- Senh nhan trong.6n nga'r.
- Nghj nsddo nguy€n nh6n rim mach.
- Nghingdc6.ha'n thUong ndng do tE rrong con ngdt.
THEO DOI BENH NHAN SAU PHiU THUAT"--- - -'--iirrr
iarrr stnx
o r. DAt ctJdNG
- B:nh nhan dA d,rgc ph)u tnuat Lm theo doi lai kha- dirh kv
iiir'"i,1'iHlli
j":ili*:ruft
;i,r*'t;rl' tq
ClllrONG 4:TlM MACH Kl'ldP r 7l
os. DtEu rRr NGAT Ddl vdl NHoM R6l LoAuruAtt t<trun
irr iru'
- iloi ch(ng kich thich xoang cenh: hddng dAn triinh m?c 50 cd
chitqua, kh6ns dirns dao c?o dien, udng nudcddvdn.
- Ngitdo tLlth6rtr6nh thay alditllthd at6t ngot,tranh mdt nLldc
, Ngdttlnh hudng:tr;nh ciictlnh hu6ng c6thi96v ngdt.
o2. DANH GTABENH NHAN
2.r. H6i benh
a. TiAndn:
lv'ld tim ddau, ihdiqlan niro, ph6u thuat da dr.rqc tidn hanh
h 9ll
- Thdiqian nAm hau phSu bao lalr,dtlgcdi€u trigi?
- Toa thu6. dang sndunq sau khi B vien ra ,ao?
- T6ikhiim 6 d6u,ldn t6ikhiim niyh l;n thtmiv?
b. Ddu hie! bn snns: H6i c6c trieu chfns s6t, ho, dau nsq.,
met. khot1o, lr11. h6i hop. linh trang ;n bu. ldnq can l'au riiiu
bdtthudng.
2.2. Kh6m lam lang
o, Ddu htau hn tnng:
' Tdnq trans, da niem, can n;ng, Phn.
- Sinh hieu: M?ch, huyEt ap, 5pO? chi oen v; dtrdi, nhip tim,
nhipthS.
- llnh tranq vdt md ndidit6ng d6n luu.

38. 74 ! PHAN A: NOI KHOA
- Nghetim:
- Nhtp rim:ddu hav khdng. rditoa. rhio r,m nhanh, ( hiim.
tienq tim md kem ma.h ndhi.h
+ Am thdi d tim: gdi ), tudris ih6n9 t6n trtu ho:c hqp t6n
. luu hod( tdn lhlrong chua dud( cdn rhr-;p.
b. rvrhe phdi tin dau h,eu goi y nhi6m rdng drJong ho hep.
c, Khdn cd qudn khdc d6 ttrll c6c trj6u ch;ng kh;c nh,rthdn
kinh. co song, rhuyan tE( n.io hoac rhieJ o;y nao hoar cac
binh h mdi,u6t hiin gan day lren berh nhan at; duo. m.;
2,3. Can lam sahg
, Si6uemtim:
. Dlnh 9i6 (hfc nang ri.n. trnh rrang hd. hep vdn tim !o vdi
tn6.
^6+ Kidm tra:tren dich mlng rim, tudng thdngtdn tuu.
+ Do 6p tucd6ng ma.h phdit6m thu.
+ Ttm siidbudns tim,van tim.
Drdn t;m d6: khi(;n xa( dinh roi toan nh,p (rar.
- X quang phdr:tim rdn thudnq phdi.
. Cong thu( rdu ld( d6 miiu ting, CRp: lim ddu h6u nhiE_
lrunq
lon dd, chf. ndng rhan, TpTNt khi c6n dirnh gii, chdc n;ng
rhan.
O 3. CHAN DOAN
3.r, Chin ilolnx6<itinh drra vio:
- TriCu chUhg t6m sang: h6ib6nhv, th6m khdm.
- rriau chung can tam sang. cijc xer nghiem h6 tro I ho tim $19
dd co chdn doen
3.2. ChCn ilo6n ph6n bt6t: tiry tihg trudng hdp tam san9.
O4. CHiDINH NHAPVIEN
- SuvtiT niing. ruyhohap,(aoiip phdinang.
-
.ftdndi(hmanqtimvdidaJchenrim(
jphot.cdnnhipnhant-.
- Loannhrpch6mcandiitm;yraonhiphoactjntheoo6i.
- Nhierr rrung n;n9: viem xdong f(. vi6m noi r;m mdc, nhii_
fiunq vet m6, nhiem trurlq h ry€'r.
CHI.,ONG 4:TIM MACH (HOP T 75
o5. DIEUTRI NGOAITRU
- Di6u $iiac bie; chuns €ao dp Ph6;, suv rrm t6n tri dJ phiu
thuat.
Didu viciicbenh lldikdm:thidu m6u' nhi6mtrnng hdhdp,suv
dinh dudng.
O6. OUAN LiNGt,dI BENH
- ( hu ki Lheo da,r:Tiikham dinh ki m6i thang,3 thi5nq' 6 thang
I nam tuy il6nh gil lam sang va sieu am tim' N6u c6 suy tim'
caoaP Phdining can ur khiim 6m l_on'
- Din ddtdikh6m nqay khic6:
+ MCt, kh6 th8, hdihop,
+ Ho nhi6u, dau n9{c,
+ 6inhidu, tidu it,
+ Sait k6o d:i,
+ Vdt md slhg tdy
- Hudng d5n <h5m s6ct?inhi:
I Dinh dudng. giU im,
+ Ginve sinh r;ns mieng,
+ chnng ngna ddydn,
+ U6ng thu6ctheotoavi teikhim theo lich'
- Hd sdtli kh6m:g6m
+ Ol sieu amti;trudc md, ol sieu emtimsau md,dientamdd'
X quanq phdi, mot van ban ghi l4i t6m tdt tlnh trqns benh
ntrin tr-uic m,i tuthg trlnh lnc md va dien ti6n sau m6 kim
di6urri.
+ BCnh nhan gil]motvan ban t6mtdtn6i tlen'
+ lvl6ildnt6ikh6mghilaitrieuchfngvlcapnhatcanlemseng
(ndu c6).

39. 75 T PHAN A: NOI (HOA
THEO D6I BENH NHAN SAU TH6NG TIM
CANTHI€PTIM BAM SINH
O 1. DAI CIJdNG
. Binh nl"an r.m bim s.rh sau rhonq tim can rhiep (;n duoc riil
{narndtnh rv nhJm phat h an va dreu tri sdm c;c bren ( hUng.
rlen (hamg sau rhong r.m ( orhd xuar hien r;r sdm r.on9 24 9]ddau hoa. co the ddn nhidu rn;n9 s"u can thiep. M6r so b;en
(n1jn9 nang co the g;y ti/vong dot ngot na.u khdng dudc phat
hian ldm. rrb.l r6L m;ng tim.lhLy6n t6( mach d; lr;idunq( L, rdJ loan nhip lin. rhuyen tac nao, r;n huyar...
CHI,ONG4:TlM MACH l(HdP r 77
2.3. Cin lam sAng
- Sieu am Doppler mach mdu; Chidinh trons.:c trudns hgp c6
l6n lhuong macn mau taicl'6 (du lhong lim.
- Sieu am tim m;u: c6 haichidinh chinh:
+ Th(c hien thudns quy sau thong tim can thiep nh:m kidm
va vi tridung cg, shunt ho;. hep t6n luu, phiit hlCn huy6t
kh6i.
+ Khinghingdbenh nhan c6 bi6n chl]ng nhLltroidung
'V, '5n
hoichin bac sitim mqch .an thiep.
- Oicn tam d6: Ndu c6lo?n nhlp
- Dien tam dd Holter n6u nghinqd.6 rung nhi'
- x ;uans phi5ir Khi nqhi ngd tr6i dung
'q
hoac c6 t6n thudng
- Ll scdn nao: bilh th;n nqh! ngo tdn lnudng ndo'
- TPTNI tim m;nh vd h6ng .3u tlons nud< iidu, billrubin miu:
nghingdt6n huydi dodqng cu.
- CTM,V5, CRB si6u anr tim um siri:nghi ngdvi6m noitem m?c
nhi6m trlrng.
. IPINT ure,(rpdtin:n:nqhinqosuyth;ncap.
O 3. AUAN Lf NGtJdI BENH
3.1. chu ki theo d6i tSikh6m
Benh nhan duac tdr <hirm dirh kV: I rhdrq, ' lhanq b thanq v)
I n;msautdnthep.5audoluytl_eordtqu;jeuanlim'bd' si
phdng kh6m quydtdinh lich hen t;ikh5m tidptheo'
r,,rdrig l,op tinh ti ph,r. t4P can can thi€p nhi6u len, c6 bidn
ch(nq sdm sau can thiep: hen t6i kh6m sdm hdn
3.2. Diu hiCu ning.an khSm laingay
- Met, kh6 th4 ng3t.
- Dau ngqq hdihop, tim daP kh6ns deu.
- 56t kdo dei, nhl1cd;u, ho ta m6'r'
- Tidu nau ho?ctidu d6.
3.3. Hudng din chim s6c ngtrdi banh tainhi
TrSnh ch6n thLlong trrlJ ti6p vnng ngqc d benh nhan c6 d!']ng
cq trong l6ng ngrrc.
3.4. K6 hot(h theo d6i
Lap h6 sotiiikham bao g6m:
+ Ban sao tudnq trlnh thi thuat.
O2. DANH GIA BENH NHAN
2.r. H6ibanh
- Ti-dn sn benh:
+ Loaithi thuat.
Phuong ohtp t"n thiip: dong .u.ing lhdng beng dung cu.
:'ons
me(h md hod( va- rim ufng aung cu.
-"t g," aJ
6tenr) mach m;ju...
. Ca( rfieu , hung sdl. dau nguc. mer. kho rhd, ho ra mau, nhuc
oau, ngat. rd, todn tri g dc lhoaig qua. hoi hop, trm dap kh6n9
ddu, ttdu niu.
2.2. Xham lam sAng
hh6m vita chi( h macn mdu:xuet huyer. khoimju ru, kh6r u do
::li.nllh Ii!h h9l ;m rhdido do done trnh mach. chn i brr
mach lnchr ph.r hian )om r6c ra.h o^ huvet ap SpO) chir+n
va chrdtloinCu co bit thlrond
- Nghe rjm phat hr6n:
+ Am thdir6n tlIu. Nquyen nhan:
. Ludng th6n9 hoec hep t6n luu.
. Dungcu bidit6ch.
' rdn rhudrg cri ken (hua atud( (dn rhiep.
+ Nl-ip tim no kem mdch nghkh {chen rim caDl, rh.p tim
kl-onq deu
'r,6idung
( u). nr,,o,,-.r,a- rtU. nr,iit,;i,]nlip
rim nhanh trunq nhi).
- Xham rhln kinh neu binh nlin nghi nqd to rriau chrrng
thuven 16. n;6
' Kid; tra thidu mi5u, ving da niem ndu bcnh nhen c6 ffiCu
,l-rlng rdr nJyer.
{(

40. 5 eL ;r t udc rhong rh, sieu 6m 24 9id sau rhong rjm, ,reu
+ Di6n ram d6.
Ph,m DSA rneu I ot. Bann nhen gir rai mor d-E llru qua rrinh
thr/. hien thi thu6t DsA
- rronq m6itdnteikhim:
+ GhiJaith6ng tin c6n ning, tri6u chfng tem leng be,t rhudng
chinh.
luJ rhong r,n sipu am. dian tam dd. x qJdng. Xat nghiem
kha. nc,' r^
Rdt LoAN ol rlEu 6TRE EM
O 1. DINH NGHIA
Roiioan di tidu .BLO-, dds( dung de mo t6 (6( bat rhudag tronq
.,aidodniuutrtlvd/hoa( bd,,JirrLot rieJLiab;ngqJdng'Khrd61h
i:j srot t r,a
".,:n
r"L de1 luiii phit lridn cnd tre' tr; b nh Lhuong
i" u"- ."j, a-..n,. l;nq dr r:Fu odn ngov ruc <hoanq a tJdr va
chfc n;ng ditidu ban dcm l[c 5 hoacTtudi
Muc riCu ddnh qi;:
li,! +;L
',r - sat rr..,o"q chu( naas 'uL rrn v;'5oac odi YUir
ctd oarg quanq.
. ii, ai.( ,iqrv6.
"i,;"
td lhuc tl d rbdr thuons ve qr;: ohdJ
then kinh)hay.h(c n;ng
D2. PHAN LOAI CACTRIEU CHUNG
u.r. C5t triCu ctrUmq tr"ng giai do?n luu tru
- ' -ioi;"
,i;, O"'
"qav
b:r lhudnq (t-' j s luorr:lang h:
"
8 5n'
oram khi<3lan.
<on tieu: rlnuot lieu khonq i:er 'oit lien lLc ho;( gian doan'
- al m 9i6c s5p tidu (tr6 > 5 tu'5i): cAm gi6c ph6i
'ti
ti-du nsav' dot
noot v; khonq monq ddi
. t,-d, a.m, r,a prr,rnt, odvvaobandpmd6dit'du'
2.2. C6(triCu ch{hg trong giai(toqn biixuit- -
- iid, .sap .sins,t[ pn:i aql InOt tnoi giun ddng kd dd bet
diu titlu.
ii",,on ,,lo.,nq "p
lr., ; bvns dd khd daL va duv rtiditrdu'
- Ddnq nudc tidu Ydu.
Tidu;ien doen (td > 3 tu,si):ddng nu6ctidu kh6ns llcn t'/''

41. 30 t PHAN A: NOI(HOA
2.3. C6( rri6u ch[h9 khCc
- CjcthJ thu;i ki6m ha- (tre > 5 ru6i):dung r,en at;u ngon ( hiir,
ba(chao hai(han hoar ngdixdm v6i9dt ch;r de vao;ung 5an
chdu ara uc I he c;m g,;( 9;priiu hod.rr, hoEn atitjdr.
- qinuo. trdL sJ tieurrtnuor tidu hhonq chi yngaysau khiridLr.
-,r re! dau cirm 9i6( dau d duong lieu dLro: va bo phan sinh dur.
xnonq oaa hreu d116 em
O3. oANH GIT( BENH NHAN
3.1. H6i bahh
- s6l"r d.r,du_ rhd r.cn nuoc lriu. (;c gLrdoqi son tidu, cac trieu
chu,]g ( nd 16,loan diliiu, (6c aldidodn nhrei rrn.9 r,du
- Ihoiquendit,eu:tjooonho;csonoh;n.
- Che do,in uonq: trong va todidi.h udno
- [6n sdr sdnh ngar. sanh ron, nhiem rru;g bdo rhai thi;Tpt jr
tri6ntAm thdn ven d6nq.
- Cicxung d6ttrong sia djnh, tidn snhudn tuyen div€ sinh.
3.2. Nhiim lim sing: ,ap
trung phjr h,-an (dc bjL thudng v6 th;nlrnh va nieu khoa:
. Vurg,thiL tung,cung: ca( diiu hiaL ngo;i da cna ho ddr sonq
noa( oat s;n ruong ( irng ltom iru& xuong cnnq, a tng long,;
mo, khe m6ng bjt ddixuns).
- Khiin" thiin_ kint- (d: <rrc fo chi dudi. phji ra gjn jL, ld tha,pnorhdpvan d6ng tinh. clm gia( sarchaJv;h;umon,truong
lqctrrLtrlnq.
- co quan s,nn du( ngodi: t6 nieu dao, t6;r ddo v; ro;;r hd
vung da quanham h0.
- Quan lettructi6p dong nud. tjdu (ndu c6thi)
3.3. Can Hm iang
- TDTN"|._ldm ang gdi i tidu nhdt, tiCL dL/ong. nhrdr trLng l.eu,
ron rhLJonq th,n.
- Cdy nlrdctidu:khinghinsd c6 nhi€m tdng tidu dikam.
- Ure. ('earinrn md-uj khi(o bang chLng rdn thudng th?n.
5 eu am,buns/heniau: rni nqhi nqo ,o tdn thu;g ih6n kr.h
roa' 9;;i phau, nh,em rrung tieu hoac trieu churig goi y tdc
nghan dudng tidu.
- Chup bing quang niCu dqo nguoc ddnq (VCUG): van ni6u dao
saL,t,ao ngJoc bdiq quang nieu oLrtn. kt losath nndang.id
CNlrONc 5:THAN NlEu r 3l
IvlRlcot sdnq thrt lung cnng: khinghingdc6 trjn thudng than
kinh.
- Do ddng ni6u d,5 (Uroflowmetry): diinh qi5 qiai do?n blixuet
.na bans quang. chl dinh: nhi6m tung tidu tiii phit kh6ns kem
tdn th(ong th6n kinh v; giei ph6u; th€o d6i d6p l,ng didu tri
r6iloan ditidu.
- oo nieu al6ns hac xam in (.ystometry): d;nh gil c; hai giai
do?n luu trnva baixudt nudc tidu. Chldinh:
+ BLOTdo nguy6n nhanthen kinhdnx6cdinhhaynghingd.
+ N40tsddid?nsdudnsti€u nhuvan niCu daosau.
+ R6ilo?n chfc n;n9 diti€u kdm bSng chfngtdn thudng than
(cao huydt 5p, tidu .lam, tans.reatinin miu) ho?c thAn t
+ RLOT chrc ninq khonq dep dng vdi didu tri b6o t6n sau l
th5n9.
+ D5nh qie 6p,qc bans quanq an toen cho than (Pves < 40cm
Hro)trong benh m?ntinh d5 c6chin dorn
D4. CHAN DOAN VA XOTRi
4.1. Mgctl€u.liCu tr!
- friinh tdn th(ong than.
- caithientrieu (hihs.
4,2. Oi6u trids< hieu vArrlqu chUhs
- Didutibeot,jn:
+ oid; trir;o b6n, ndu c6.
+ Tr6nh cac thqc phdm gay t;ng ho?t Mng quangr caffein,
nJ6ccam. ca chua, thL4 ph;m nhi6u s:a vi.
+ VO sinh (oquan sinh duc vi virnq hoiem.
- Ndu di6u tri bao tdn kh6ng cei thicn trieu.hons, cin xdc
dinh nguyan nhan cna RLDT v; chqn lqa can thicp theo
nguyen nh6n.
a. Bdng quang fing hoqt/HAi chitng tidu sdp bvera.tive
bladdeiurg. syndrome)
Le 16l lo?n cna giai do?n ltfu trn (am dly),70vd tr(dng hqp
bidu hien brng tidu g:p, s6n tidu gdp, tidu nhi€u lan ve s6n
tidu ban ngiy.Tang ho?tdOng cdvdng tren nghiCn cl,u nieu
along hoc.
- Didu trlr Th u6c a nticholinerg ic (Oxyb utinin):
I Drptar 5ms:o,l - 0.2 mq/k9/16n.(2 3 lin'nq;y.

42. + Ditropan xL smg (dans ph6ns thich cham). 1 - 2 lien/
l:n/ng)y (tr€ > s tudi).
+ Thdigian alidu tri 6 th6nqtrudc khitho ngung thu6c.
+ Tiic dUng ph!r:b6n, kh6 micns,.t6 m6r, sdt.
b. Tti hoAn d riAu (votding posrponement)
- Trihoan ditidu doth6iquen.
- breu nren banq:
+ G.thrlthuat kidm h;m.
+ s6 ldn tidu ir_
+ Tidu 9;p.
+ Han chd u6ng.
- Oi6u tri- ditidu dinh qid.
., Bdng quans giAn hoq. (undetu<tive btdddert
50 liin rieu ( hdn 3l;nhgay..itng co d6 r'6u, nuo. tidu
nhidu, cam griic aliiy b;nq quanq q'dm.
- Dang ddngtidu gliinrtoan khitam nieu ddng d6. GiAm hoat
d6nq cdvbns khi do nieu dong hoc xam tJn.
- Can thigp-ditidu dinh gio,th6ng tidu sEch giijn doan
d. R6t loan .ht ndng lt< tidu (dysfunctionat voiding)
- Co cd th6t .ludns tidu ngoii khi tidu (urodynamics). scnh
mrc ph:i, hoc kem hoac t6o b6n. Tdn tuu sau tidu tdn ta
nguycd nhi6m tmns tidu.
- Dang dl1dng cong Staccato khit;m ni6u ddng dd.
- H6i chfng Hinmann Ailen TNBONO than Ll nud.. rdh
thuongthan.
- Can thiap:
+ Ditidu dinh qid, ditidu duoc thugian (.titidu 2 tdn, pMn
h6isinh hoc)
+ chdtd6ikhiing thU thd atpha qiao.;m
. Chi dinh:rdiloan chfc nans tnctidu kh6ng do nguyen
nh6n then kinh, rdi loan .hfc n;ng cd b)ns quang
nguy6n phiit.
. Doxa/osine tm9:0.5 - 2 mghgdy, uong r6i (,i6u kldi
d5u 0.5m9. l;n9 d;in o,5mg/2 ru;1 loi khi co dap ung
hoa. c6 tijc dunq phu).
-
. ra( dunq phu: hd huyet ;p, .|gAr. ngt 9a.
e. Ttdu ht nhdr ban nsoy lpo okiutio)
Tidu nhi6u lan,ludng rt suol nqay. Ca( tr,du chirng mat kni
nqi thA rnh nud( tiau dlrdi 50% dung iich bang ouang
norgdo.Cothdkhonq co ion tieu.BFnh tu gio hdn nhlh;
- Kh6nq cd; di6u tri (trdn an).
CNUONG5:TNAN NIEU T 3]
j. Trdo n9@. am h0 (voginal rcnux)
- Thudng sip dtra 96itidn deythi do thuan ldl vd si;i phau
virtuth6. Ri nudctiiu 5-10 phit sau tidu. Kh6ng c6<6ctieu
ch(ng aludng tidu dir6ikhec.
Didu trl:tuthd divC sinh (tva lung tr6n b6n cdu vdi haichan
dang)
s. sin tiiu do strcss (sttas in.ontinence)
- Hidm dtra then kinh binh thudng, bidu hicn:rinhnns luong
nhd nudc tidu lnc adnq sLlc hoic tdnq dp lltc trong d bqn9.
Can phan bi€t vdi trl hoan ditidu vi bAng quang tdng ho?t.
Didu tri:Up tang(uong (aL iovr rh;u.
Os. TlCu cHUAN NHAPVIEN R6iro4n ditidu:
Kam nhi6m trnnq fidu cAn nhAp vi,an (xem b;i nhi6m tmns
- Do idn thudng then kinh hoac giel pMu cen chdn doln x6c
dinh.
, Kdmtdnthddng th€n {cao huydt ep, suythan,than fnLldc).
o5. HITONG DAN CHAM soc Hvdns d5n rra:
Th6iquenditiduvirtuthdditidudUng,
Ch6 d6 5n triinh t5o b6n,
- Ve rinh coquan dinh dvc v: vr)n9 h6i am,
- Theo doi.l6p l]ng didu tribing nhet k), ditidu ve c6ctAc dung
ph!r cUa thudc.
O7. HEN TAI KHAM
- rdikhdm dinh ki m6i2 -4tu6n hoic m6i3 6thengkhiunh
trang c;ithi-an.
- KhAm ngay khi c6 bidu hi€n nhi6m trnns tidu (rdt, ti6u dau,
tidu dqc ...), riic dqnq phq cna thudc dldu tri.

43. 34. PHANA NOLhHOA
CHIJONG5:THAN NIEU T 35
NH!EM TRUNG TI€U
O1. OINH NGHIA
i.lhrdm Iru'rq Lrau la hi-"n luong rLal hicn vi rrung lrong nuo(
tidu.
- Benh thudng gip A tre em dfng h;ng tht ba sau benh li
nhi6m trirng d;dnq ho hdp ve ticu h6a.li lc nhi6m trnns ldu d
tr6 96ll;3ye5% va dtr6 tlaila I %'20lo.
O2. PHAN LOAI
- Nhi6m trir;s tidutrcn {vi6m diibd thAn .5p): sdt tr6n 38,5'c, k'm
l?nh run, dau h6ng lung + x-6t nghiem nudctidu dudng tinh
- Nlhiamtrnngtidududi(vi6mbansquang):tr6khonqs6thoqc,6i
nhe dudi 38,s'C, khong c6 bi€u hien to;n than, kh6ns dau luns +
tidu dau,tidu l6t nhrt, tidu g5t+ x6t nghi€m nudc tidu dudng tinh'
- Nhi6m khudn nieu kh6nq triau chl]nsr clc trudng hqp th0
nudc tidu hoic.Sy nudc tidu dudng tinh nhung benh nhan
khonq.6t eu chnnq larn sang-
D3. OANH GIA BCNH NHAN
3.1. H6ibqnh
- Idu dau. tidu lii nhrt, tidu kh6ns kidm ,oit, tl6u ddm, tidu ns:t
quanq, tidu gdP, d6ng tiic bdtthudng trong l ciidu'dauhqvl'
- iinn ctrdt oitttruonq cira nLrd. idu:tidu mau, tidu
'luc,tiduh6i...
- Trieu chfng kam theo: s6t, bu6n n6n, n6n 6i, slt cen, ti6u
che, tio b6n.
- Nhi6m vingtiAu taiPh6t.
- Sdt khong 16 nsuyen nh5n.
Ditat t6t ni-;u da cluoc chdn alo6n:trao ngudc b;ng quang
niCu quJn, van nieu dao sau ...
Benh li then kinh: thort vi mans nao tiv, u ving cnng cut '
3.2. Khim lam sarng
- Khiim blrng tlm khdibAt th(dng dthan, bbng quang.
- nm d6u hi-au:hep daquidiu,dinh moil6n,tinh trang v!6m am
dao, divetam dao.
- Kham vung cot 56ng thitlung tlm u kh6ibitthuong'
BAng quang t5ng
hott
Tidu sdp, tidu
nhiiu ldn, s6n riiu
ban ngiy
Tang hoat.dvong
tren ni6u along hoc
Bingquanggiam
5d lin tidu It, nLJdc
tiiu nhi6u/l l6n,
dnq cdkhitidu.
- Giem hoat d6ng
covdng trcn nieu
dons ho.
- Dang ddns tidu
giiin aloantren
ni6u dong dd
Tri hoah ditidu
- C6cthi thuat kim
ham
-sd liin tidu it
-ndu q5p
-Hcnchdudnq
RL.hf( n6n9luc
tidu
Co cd thit dudng
tidu nqoai khitidu
-T6n luu sau tidu ldn
Dang dLldng cong
ddng dd
HC Hinmann-AIlen-
Tidu l8t nh6r ber
ngay
lugng it
Cac trieu ch(n9
mdt khinqn
Co thd kh6ng.6
s6n tidu
-Tugi6i han,.6 thd
Trao ngudcam h6
-TrA 96iti€n day
thi
Ri nudc tidu 5-10
phLlt sau tiCu
Khdng c6 cic
triCu chtng
S6n tidu khi cridi
- Rinud.tldu alugc
Kh6ng kam c6.
cht?ng d(dng tidu
drldikh;c
56h tldu do rtres!
- Rlludng nhA nudc
tidu Uc gSns snc
ho;c tEng ap l(c d
HidmdtrAthan
kinh blnh thudng

44. 36 T PHAN A: NOIXHOA
- can l6m sens.
- Tdng phan ti(h nu6.tidu.
, Cdy nud. tidu.
- Si6uam bung.
O4. CHAN DOAN
4.r. Chdn alorn xii( itinh
Khi cdy nLrdc tidu theo phudng phijp se.h, gi8a ddng > too.OOO
khdm/mlvdicnnq m6t loaivi khudn.
4.2. chdn.lo6n (6thi:d(a vio haiydu td
- LAm s) n 9: tidu dau, tidu t:t nh;t, tidu m6u, atau ha v,, tidu duc,
ti6u h6i
- Tdng p han tich n u6c tidu: c6 bach cdu hd. nitrit dudng tin h.
4.3. Chdn doiin ph5n bier
- R6i loan chc. neng aludng tidlr du6ir khi c6 trieu ch(nq b6t
thudng aludngtiiu dudive ca'y nudc tidu am tinh.
- Viemam daohoacdivStem dao:b6nh nh6ntidu dau, dau havi
kam khihrlc6 mnih6i, meu bAtthLrdng.
- Viem nieu daor do Neisseria qonofihoeae, Chtamydia
va(homatis, Ureaplasma urealyti.um gAp dtrE daytht vditriCu
chl]ng lam s;ng k6o dAinhi6u tuan.
S6ialudng nieu: tidu miiu at4ithd ho?cvithd vdicdn dau quin
than,dau hdng lungva sieu am thSy hinh dnh s6i.
os. DtEuTRt
s.t. Nguyen rr( atiiu rri
- Didutrikhdngsinh.
Phat ']iFn vd djeu tricac dr l;t tier arau kem rheo.
Didu tridLrphonq.
s.2. oidu trt iti( hiau
d. Khdnq tinh:
- Budc ]i
+ Trimethroprim sulfamethoxazote (TMP-SMX): 6-12 m9
TMP/30-60m9 SMX/ngaychia 2 tdn.
+ Amoxiciltin, AmoxiciIin ctavuctanarer 40 mg/kg/n9ay
Budc 2:sau khibud.I thdt b?i3 nq;y.
CHt'ONG 5:fHAN NIEU T 37
+ Cephalexine:s0 mq/kg/ng:rvchia3 l6n'
+ cefixime:s ms/kg/ngly chia 2l5n
- Bddc 3: sau khibtldc 2th:t b?i3 ngey.
+ N itrofu rantoin: 5_7mglkg/n giv chia 4lBn'
- Ciproflo^acin.20 3omg/kghgdvchra 2 l'6n'
b. Sau khi .6 kdt qud cdv nn1c ridu: xem x& lqi khdng sinh'
L Thdi gian diAu tri khdng sinh: thbng thndng d 5 Adn 7 ngAv'
5.3. TiEu.hudn nhaP vien
- Nhiamtrnng tidu kAm:
+ Bi6u hiCn toin than,
+ TrA dudi l2 th6ng tudi,
+ Kh6ng thi u6ns dugc,
+ Dau th6t l(ng.
Nhiamtrnng tidu kAm d!tat ti6t nieu quan trong'
NhiEm trnn; tidu th6tbaivdidi€u trikheng sinh u6nq'
NhiEm trnngtidu taiph6t 3len/6 th6ng'
5.4. Hudng d6n chim s6ciheo d6ltei nha
- tl6no nhi6u nudc.
- Ve s;h coquan sinh duc ngoiisau khi
'li
ticu' tidu'
5,5. Hent5i kh6m: sau 3-s ng;Y
O 6. PHONG NGUA
6,1. Chitlnh kh6ng stnh d{Pha'ng-'
- D, t;r tiet nieu-chua d;o( qi6r qJv6t hoac khong t rE q'5i quv't'
- r;o nquqc L:,nq quans nieu quan dO l,ll,lll
- Nhiimtrung ti6u dudit;,phat nhidu l:n.
- Rdiloan chnc fing dudng tidu dudirkhi'6tlnh tlqng nud' tidu
tdn ltru.
- B:nq quang th:n kinh.
6-2. Khiino sinh lua chon
- rA4iSl'ax,:.q tVp,rg arng I lan duv nhil t'uo( hhi nqir' t6i
da 320 moTMP.
- Nitrofura;toin: l-2 mg/ks dirng I len duv nhdt tnldc khi ngi'
t6i ala loo mg.
irro, qlan..hoa;n khi ai tat duoc giii quvEt hodcrhh trang ror
toan:hu( nanq duonq tidu duocci;' lhien'

45. VIEM MUI DI I/NG
O T. DINH NGHIA
, Viem rni di unq ta bidu t ien tinh tldng v,em rd, ch6 o mn, cUa mor
benh d,
'Jng
loi.l ll-;n don,er mdr rni lro ran qu; nhay cdm do ph;;ungCua lrufg q,an cua tgt vdi mor hay nh,eu Ljc rh"n gay benu r6:gng
Ouocchrathdnhhditoai:viemmntd:rngtt^eomua.viem_nidirng
O2. oANH GIA BENH NHAN
2.1. H6ib€nh
Yeu_ro dk h ta:lheo mr:a ndv qurnh n;il. khictihoc hdy crinhi rre
khrnep rnc vdidiLlnq nquyen.
Ti6nJi bcnh: c6 benh khiic tien quan d6n di rns nhd: suyEn,
- Ddu hiau t6m sanq v) di6n tidn b6nh:
drreen co bon lrie! r hlrlg (h,nh: chly nudc mn, r,ong va nhiaJ,
nghpt mni. ng.ra mLji. nhiiy muinhreu, (o rhe kem th." nq,r" .ar.
,r.
:l:I
,.,T:.1l,r,..*c rn, trons, ( uon m0idrdiphrdd,, niem _r.
mutla , nhot nhat, co thd.o potvo mui.
2.3. cin lim i:ng:Test dirng trcn da vA trong da,.linh t(qng tgE, ttm
bach cdu 6iroan tronq djch tj6t mnj, ndu c6 di6u ki6n. - -
O 3. cHAN DoAN
3,1. Chdn-ilo6n tam sing: dua tren bdn rrieu chung chrrh:chiry mui
nudt I ong. nghat mu,, ngua mui,nhdyhui,
.Hrr.iNc6: HO HiP r 39
3.2. Cha'n iloiin PhAn biet
Viem mUidii'ng +++
+ +++
Divat mni +lben
DV
+++
Viem h6 hdp ken
Vi6m muikhe'ng di + +
vi6m m0ivan m?ch + +++ +
o4. xurRl
4.1. Nsuyantec i €u tr!
- T,l'lh tar an;. vd moitrtlong gay d;Lrng.
- Di6u trltrieu chl1n9.
4.2. oi6u tid4. hicu: qi6im;n cam d?c hieu theo difns nguvan'
4.3. oiiu tritriau <htng
[i,[:ry**il#jil;,-
r, :H:::Till-: {(- Thudc xit corticoide ta i ch6: xem x6t chldinh trongtftrdns hgp
- Rrra m0lthudng xuy€n vdinudc mu6isinh ly.
Thudc nh6 mni: chdns nghet mni xvlornethazoline n6u tra
nghet mni nhi6u, dnng t6i .la 07 ngiv (xvlomethazoline 0,1%
dnng cho fta hon 7 tudij Xvlomethazoline o,o5% dlnq cho tlE
2 6 tudi, dnng ng;n h?nr3 ngay).

46. 90 r PHAN A: NOI(HOA
a.4. Ti6! dua'n nhip vtCn: viem mEidi fng .tdn thu6n kh6ng cen
nh;p vien, cl.l nhap vien khi vien, mui di Jng khdi diiu ( h;m6r
(6n suyEn do di ung nen9.
4.5. Hudng din rh:m s6(vA theo d6itqinhi: vC sinh mtith(dng
ruyCr voinud( mudis:nn ty.1,anh.;( ti;c nh;n g.ly di !h9 nh;
bui.lonq tnu v6r nuor. phjn hoa. rhft ar dE q;y d-itng1,u;c do.
4.6, Hen tiikh6m
- Thdigian thudng quy:7-30 nqAy.
- Diu hieu n-;ng ( 5r kham ngay: ngheL -ni Feo daivd tien .uc.
co.on suyEn do dr Ltnq khdiohit.
O 5. PHdNG NGUA
Khons c6 vlc-xin phdng nqtra.
, Bien phiipphong nqua khijcrriinh t;€ nhanve m6itrudng q6y
d: unq:bui ohijn hoa.khoi, mor irudng c. <no tu6, ta.v;s;;
cl'6 o, ve,inh .nn19 mdn 9oi, jd tri Lt"uong xuyen. ve.inh rnu
nuOi, tr;nh nhrhg thrc an at5 g6y dirng trLjd. d6 v.v...
VIEM MOI HONG
O1. DINH NGHiA
- Vi6m mrli hong thudng xay ra cho tr6 em vA nqddi ldn vio tU.
I,ditrd 'dnh. thuo.g rd tnang rO ctF4 thang r LUa ru6r d6 bi
thj,lalJ?.6ru.ji
, C6nhi6u toaivirusg;ycem tanh nhuc[m,;.nm, Adenovirus,
, Benh lay_lan ra'r nhanh, nhung it nguyhi6m,thudngtugi6ihan
trong 7 t4 ng:ly.
O 2. DANH 614 BENH NHAN
2.1. H6i banh
Ydutd dicht6:h6ixem rrong nh; haynh) n6,trudng hoc c5 tr6
em bicam 5d mnikh6ns?
cfLloNc 6: HO HAP . er
' Ti€n 5t benh:tre thudnq xuy6n bisd m0i, hay mdib!l tra c6 bi
ngra mni, irch xl v;o lu.trdil?nh hay ngnimuila khong?
- Cictri6u chl?ng:
+ Ird c6 cim 9i6c kh6 mni, hdi thd n6n9 trong ng)v deu, sau
d6l; sd mni)o ai.
+ Ng)ythl] 2 trd ali, tr6 b;t ddu nong lanh s6t 38 39'C.
+ Ngaythrl3, s6tgi;m, tt6 cbn sdt nhe.
+ sau 7 ngey tre se hdt sdt, doikhi 1O nq)ytrA mdih6t sdt.
+ Nghet mni, sd m!i, rat cd, ho 6i ra d;m, !d oai kh6ng chiu
choi, bidng 5n.
2.2. Kh6m l5m sang
- Mnisung ald.
- Di.h ti6t tronq d hai h6c mni, n6u v5o ng)y 2 v; 3 cna b=anh sc
- Haicu6n mrlisung to.
' Hgng d6.
2.3. cin lam sang: c6ng thnc miu.
O 3. CHAN OOAN
3.1. chdn A06n x5( dinh
- Tieu chudn lam sitng: Du.a v:ro deu hi-au l5m 5en9:s6t, sd mni
io at luc chuydn mira.
Ti6u chudn c5n lanr sang:cTM Lvmphocyttanq > 20%.
3.2. chdn.loin Phan biqt
- Viem moidifng:BN s,5 mninhuns khong sdt, c6tidn sn difng
mli(6ch xis6 m0i, dlnnq da, hen suy6n)
- vicm m0ivan mach:sd mni, hay nqhet mni, c6 Tc rdiloan giao
o4. ETEUTR!
4.1. Nguyen tl.
Didu tri chir y6u lA tri trieu chl]ng va nang dd thd trang: dirng
thu6c ha s6t, thu6c s6 mrli, thu6. ho, vitamlne C ....
4.2. gi6u titriCu (hfng
Parareldrol lo m9.k9 nau (o ol. ud oar
- chlorpheniramine 0,4 mg/kg cho trd > 10 kg.

47. 9] t PHAN A: NOI(HOA
- Vitamine C tO mg/kg.
4.3. ChSm s6ctainhi
- Gindm.
, An l6ng, nhe,dA ti€u, u6nq nhidu n(d..
Nghingdi.
Dung thudctheo chtdinh.na b5. si
O5. TAI KHAM:v;orgdythulv.Tridbent.
VIEM HONG
O 1. OINH NGHiA
- Vi6m hong ta bcnh $yra dmoitra t!di,thr.rdng 9?p d trrarudi
d. hoc. i ruiii den I 5 tu.i,,.i th, gap 6 r,e dJoi 3 tr,6i.
B;nh (o thd do virLs tch.em 80%l hdy do v khujn, v khudn
thudng s;p l; li6n cju khudn, viru! rhuang g;p ta rhinovirus,
(ox5ackie... ViCm hong do siCu vithudng tugi6ihan sau 7 tO
ngav.
o 2. oANH GIA BENH NHAN
2.1. H6ibenh
- liin t bent :ha;nq;y rudc (o dau h iu bi.dm
. Diuhieu ;m sanq:
+ s6t. udo;i.
+ Sd mrti, nshet m0i.
+ Ho rdt hons, atau khi nudt, atau tan t6n tai.
+ oau co, khdp.
2,2. Kh'im
. Ch;y nlroc mni. niem mac mU.sunq t-LypL, do.
- Nrdm mac honq viam atd.
- Ndiban dd (c6thd kh6n9.6).
- Hach cd mdm dau.
cHrrdNG Bq:
. _
2i. Can lam 5in9: khong co
^el
lghiem r-l.ronq qui ' :
aTM: kn, (;n.hdn doan Pnan brar.
' Test nhanh um lien cau khudn tan huvdr be ta n
dl6u kl-6n.
O3. CHAN DOAN
3.1. chdn do6nx6( ilinh: chn vdu dua vao lam sanq
3.2. chdn dorin Phan biet
- S,st xuat huyEt.
- Benh taychan miens.
- ViAm 1o6t hong.
Ap-xethanh sau hqng.
Divat vnng heu hqng.
o4. orEurR!
4.1. NquYAn t5<
- i.h;ng sinh khic6 bins ch(ng vlem hqns dovitlnnq
Diau triirieu chfng
a.2. Tiau chudn nhiP vien
' S6t cao kh6ng h? sdt b6ng thu6cduoc'
- Benh keo dai trdn l0 nqay.
- co bidn cl_unq viem uy ph6n mem o s)r micng dp xe vunq
du6i dm, iiP-xe thanh sau hons'
4.3. Kh6ng sinh
- Chidinh:
+ Vlem hqng nghi do vi trirng: !6t cao kdm xudt huvdt vdm
hqng, qia m?c, mn, hqch ciidau'
, Bd(h cdu Ldo, cli YCu D4ch c;u da nh;n'
- T;st nhdnh t m lian c;u xhudn lan h.rvdt be td nho- A (')'
+ PenicillinV amoxicillin, amox/a.clav' hoac cephalosporin thd
hC t ho;c 2.
+ Nau d; (nq vdi nh6m betalactam, dnnq Macrolid
(erythromycin, clarithromvcin, azithromvcin) ho;c
clindamYCin.

48. 94. PHANA:NO (HOA
4.4. oiiu tritrt6u chdhg
, Ha sdt, qiirn dau: paraceramothoAc ibuprofen.
O 5. TAI KHAM
- T.ii lham m6i 3 ngay cho toi thi dn dinh.
- DiL hieuctntheod6,:sdt (ao (,cbldn(hrnS;p xe,vi6mtai
gina.dp.
- H(dns d;n ch;m s6c rai nh;: in nhe u6ng nhiiu nu6c, thuajc
theotoa.
VIeM MO AMDAN cAP
o1. glNH NGHiA
, 1rr9:: la 'd.ch*
ba:h hLy6t, dhaibin hons r;t d6 b,viam nhitrasrF dudr6 luoi, d. chjn dotn. phdt hiin. Benh lhLrdng do vi (hudn
nemopn us va 5treptoco..Us.
o2. oANH cIA BENH NHAN
2.1. H6ib6nh
C6 r l-uong bi viem dmictdn khdng. bao nhreu tEn mot n;m. srrt, r-o. ddL hong, khd nu6t.
2.2. Xh6lr'
- Amidan sung d6, c6 mn.
5d hach..j:mdm, !dng atau haiben.
Trm d5u hieu brea ( hnng viem tty, ap-re quanh dmidd.|.
2.3. Cen lam sing: CTt.4:bach da nhanting >75%.
O3. cHiN DoAN
3,1. Cha'n itoin x6c ilinh
. Tjeu chuJn tam !ang: Sor. aridal srng d6, co md, khjm,o
hach co nrdm atau.
Ti6u chudn can tam sinq:CTM: bach.ta nhan tdng >75%.
.HLJONG 6: HO HAP
' es
3.2. Chin tloin phan biet
Bqch h6u amidan: c6 gia ma<, treng xiim, dE chev mi,u khi cav
Benh tay chan micng:ldtren amidan, sdt cao li6n tqc, klm r6i
loan ti6u h6a.
- Vicm amidan do xoin khudnramidan c6 vdt lo6t don doc, c6
si3 mectr6ns kh6ng chey meu khicavtloc ra.
- Vicnr ami<lan do sieu vi:amidan sung huydt d6 trong hai ngiy
.ldu (hua c6 mn, bgnh nhan c6 kam n6ng ho s'5 moi, cTM
neulroph;le khdng tanq, lympho(vle lanq.
O4. DIEUTRI
4,1. Nguyan tlc
Kh6ng sinh.
Ci;m dau. ha sdl.
- Cit ami(lan khic6chidlnh:
+ Viem trCn 5 !antrong m6t nem
+ Vicm amidan.6t6c nghcn dddng th6, ng0 ng5}
+ c6 bidn.h(nq tim than khdp.
4.2, Ticu (hudn nhaP viin
- s6t caoao"cve kh6nq dip Llng didu tri.
- Kh6n9 en du]c.
C6 bi6n chtJng viem tiy,6p-xe quanh amialan.
4.3. gieu tri trieuchUhg
- odracetamo'15mq/<q neJ c6 ol. ud oai.
- Chdng ho b:ng thu6c ho an toen:sp Astex Pectol.
4.4. Diiu tri.I;c hieu
fl- Khirng sinh ban ddu: amox loomg/kg/nsav hoic amox/clav
somg/k9/ngly. Ndu di fnq thl dnng Ervthromvcin 30-50m9/
kqln9iy.
Ndu khong diip (ng:cefuroxim 20ms/kg/n9,v. Niu di fns thl
dirng clarithromydne 15mg/kg/ngav.
Thdigran sir dung kh;ng !inh tu 7_10 ng;v
- Nn,,;6.hi d,nn c;l amidan. thdi didm c;l '; sal khr di6u trr
kh6idqt(ep.