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CHAM S C BNH NH N

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CHAM S C BNH NH N

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    1. CHAM SC B?NH NHN R?I LO?N NH?P TIM

    2. I. ?I CUONG L tri?u ch?ng c?a nhi?u b?nh: T?i tim. B?nh ton thn (r?i lo?n nu?c-di?n gi?i, cng giap, suy ho hap..) Nh?p tim c th? d?u ho?c khng d?u. Mu?n bi?t r th? lo?n nh?p ph?i do di?n tim.

    4. II. NGUYN NHN Benh tim: nh?i mau co tim, tim bam sinh, th?p tim Benh toan than: Nhi?m khu?n: thuong hn, b?ch h?u. Nhi?m d?c: digitalis, quinidine, reserpine, ch?n beta. R?i lo?n di?n gi?i B?nh n?i ti?t: Cu?ng gip, di tho du?ng. Khc: lao, ung thu, ch?n thuong, phau thuat, roi loan than kinh thc vat, d? ?ng thu?c

    5. III.TRI?U CH?NG LM SNG V X? TR

    6. nh ngha ien tam o T la ng cong bieu dien hoat ong ien cua tim, c ghi lai bang cac ien cc be mat c the.

    7. Phan tch 1 ECG bnh thng

    8. : ?c di?m: - T?n s?: d?u, nhanh theo tu?i. - ECG: nh?p nhanh, d?u, c sng P di tru?c QRS, QRS h?p.

    9. 1.1. Nh?p nhanh xoang Nguyn nhn: S?t, thi?u mu c?p, con cu?ng gap c?p, suy h h?p c?p, dau X? tr: Ty theo nguyn nhn gy nn. An th?n. Gi?m dau. H? s?t.

    10. 1.2. Con nh?p nhanh k?ch pht trn th?t ?c di?m: Tr? l?n: nh tr?ng ng?c, th? g?p, kh ch?u, dau ng?c. Tr? nh?: Kh ch?u qu?y khc, b km, th? nhanh, kch thch, da ti xanh, nn i. C th? t?ng con, ti pht nhi?u l?n. C th? t? h?t ho?c sau dng thu?c. C th? gy suy tim, r?i lo?n huy?t d?ng. Nguyn nhn: - B?m sinh(c du?ng d?n truy?n b?t thu?ng trong tim). - B?nh TBS(Ebstein, chuy?n v? d?i d?ng m?ch), sau m? tim.

    11. 1.2. Con nh?p nhanh k?ch pht trn th?t

    12. 1.2. Con nh?p nhanh k?ch pht trn th?t X? tr: -An th?n. -?n nhn c?u, xoa xoang c?nh(nghi?m php Valsalva)?ch t?n thuong nhn c?u khi ?n, ngung th? khi xoa xoang c?nh -Adenosin(ATP)(TM nhanh). - Aminodarone(Cordarone-TM) hay Digitalis(Digoxin-TM). - V?n m?ch: khi huy?t d?ng h?c khng ?n d?nh. - C th? s?c di?n.

    13. 1.3 Rung nhi ?c di?m: - TCLS tuong t? con nh?p nhanh k?ch pht trn th?t. - ECG: Sng P thay b?ng sng P(hnh d?ng khc sng P), t?n s? : 350-600 l/p,QRS h?p,

    14. 1.3 Rung nhi Nguyn nhn: - T?i tim: h?p hai l, suy m?ch vnh, sau m? tim, tim b?m sinh. - Ngoi tim: basedow, b?nh ph?i mn tnh. X? tr: Digoxin (TMC), ho?c Aminodarone. S?c di?n n?u khng c suy tim,r?i lo?n huy?t d?ng. D? phng t?c m?ch: Heparin, Aspirin. Duy tr nh?p xoang b?ng Digoxin, Aminodarone

    15. 1.4 Cu?ng nhi ?c di?m: C?m gic kh ch?u, dau ng?c Kh th? hon rung nhi. Nghe tim nhanh d?u 240-360 l?n/pht ECG: m?t sng P thay b?ng sng F d?ng rang cua, QRS h?p.

    16. 1.4 Cu?ng nhi Nguyn nhn: Cc b?nh van tim nh?t l van hai l. Thi?u mu co tim c?c b?, tm ph? m?n Nhi?m d?c digitalis. X? tr: S?c di?n. Digoxin, ?c ch? beta, di?u tr? ty theo nguyn nhn.

    17. 1.5 Nh?p nhanh th?t ?c di?m: R?t m?t, bu?n nn, ng?t, co gi?t Nh?p tim nhanh theo tu?i, d?u. M?ch nhanh, nh?, HA h?, s?c. ECG: nh?p th?t v?i QRS gin r?ng , khng th?y sng P.

    18. Nh?p nhanh th?t

    19. 1.5 Nh?p nhanh th?t: Nguyn nhn: Tim b?m sinh ho?c sau ph?u thu?t tim ho?c th?c hi?n cc th? thu?t trn tim. Suy m?ch vnh, vim co tim, b?nh co tim. H?i ch?ng QT di. R?i lo?n di?n gi?i(tang Kali mu, h? Canxi mu, h? Magnesium mu). Ng? d?c Digitalis.

    20. 1.5 Nh?p nhanh th?t: X? tr: C?p c?u ABC. Lidocain(TMC),Cordarone(TMC). V?n m?ch khi c?n. S?c di?n c hi?u qu? nh?t.

    21. 1.6 Rung th?t: ?c di?m: L m?t d?ng c?a ng?ng tu?n hon ECG: sng lan tan v?i 2 d?ng: rung th?t sng l?n v rung th?t sng nh?. Nguyn nhn: vim co tim, r?i lo?n di?n gi?i, ng? d?c thu?c (digoxin, quinidine), gi?m oxy mu n?ng, sau m? tim. X? tr: H?i s?c tim ph?i(ABC), s?c di?n.

    22. Rung th?t

    23. 2. Nh?p ch?m: ?c di?m: Nh?p ch?m < 70 l/p(tr? l?n),< 80 l/p(tr? nhu nhi). C th? bi?u hi?n con ng?t km theo co gi?t ki?u d?ng kinh (vim co tim do virus, b?ch c?u th?p tim).

    24. 2. Nh?p ch?m: Nguyn nhn: B?m sinh : Block nhi th?t(m? Lupus khi mang thai). M?c ph?i : H? oxy mu,ng? d?c,r?i lo?n di?n gi?i, nhi?m trng, suy gip, tang p l?c n?i s?.

    25. 2. Nh?p ch?m: X? tr: Xoa bp tim ngoi l?ng ng?c n?u ngung tim ph?i. Truy?n tinh m?ch Isuprel 1mg/Glucose 5% n?u nh?p ch?m l b?m sinh khng gy r?i lo?n huy?t d?ng. N?u khng k?t qu? d?t my t?o nh?p t?m th?i.

    26. Nhp cham xoang

    27. Loan nhp xoang

    28. Ngng xoang

    29. IV.CHAM SC B?NH NHN C R?I LO?N NH?P

    30. Cham sc: L?p ngay du?ng vein g?n tim(TM khu?u tri). Th?c hi?n thu?c ch?ng lo?n nh?p. Ch rt thu?c dng, chnh xc li?u lu?ng, dng ?ng tim 1ml d? rt thu?c. Th?c hi?n dng k? thu?t tim, n?u tim ATP ph?i tim th?t nhanh v d?y nu?c c?t nhanh.

    31. Cham sc: Chu?n b?: my s?c di?n, my t?o nh?p, dy oxy, ambu, d?ng c? n?i kh qu?n, vn c?ng d? p tim, my monitoring. o ECG. N?m tu th? tho?i mi, d?u cao ( Fowler). N?u b?nh nhn m?t, kh th? th cho BN th? oxy.

    32. Cach o ECG

    33. Cach o ECG

    34. Cham sc: Cho b?nh nhn ngh? ngoi t?i giu?ng, h?n ch? v?n d?ng, trnh ti?ng d?ng m?nh, trnh kch thch. Khi bn c s?t cao ph?i lau mt b?ng nu?c ?m, lau ton thn v d?p khan vng nch & b?n.Cho u?ng thu?c h? s?t theo y l?nh.

    35. Cham sc: Tr? nh? km b?nh du?ng h h?p nn cho tr? u?ng s?a b?ng mu?ng ho?c d?t sond feeding d? gavage s?a ch?m t? t? theo y l?nh. Tr? l?n cho an l?ng d? tiu, an nhi?u b?a, khng an qu no.

    36. Cham sc: V? sinh thn th? m?i ngy, thay qu?n o khi ?m u?t. Tun th? s? theo di v di?u tr? cho d?n khi tnh tr?ng th?c s? ?n d?nh. Gi?i thch tnh tr?ng b?nh cho TNBN, BN l?n hi?u d? h?p tc di?u tr? c k?t qu?.

    37. V. THEO DI B?NH NHN R?I LO?N NH?P

    38. Theo di: ?m nh?p tim trong 1 pht, theo di st lin t?c nh?p tim trn monitor cho d?n khi nh?p tim ?n d?nh. Theo di st m?ch, huy?t p, nhi?t d? 15-30 pht/l?n . Sau d m?i 1h/ l?n khi sinh hi?u ?n d?nh.

    39. Theo di: Theo di tri gic. Theo di nu?c ti?u / 24 gi?. Theo di ch? d? an.

    40. VI. HU?NG D?N THN NHN CHAM SC TR? SAU KHI XU?T VI?N

    41. Hu?ng d?n: - Khi xu?t vi?n d?n d thn nhn cho tr? u?ng thu?c dng theo toa. - Hu?ng d?n nh?ng tri?u ch?ng c th? g?p (ng?t, h?i h?p, c?m gic tim d?p nhanh v m?nh, l? d?, v?t v ho?c kch thch,). - Ti khm dng h?n, ho?c khi BN tr? n?ng. - Cho tr? ho?t d?ng nh? nhng trnh ch?y nh?y.

    42. Hu?ng d?n: Hu?ng d?n thn nhn cch b?t m?ch cho tr? Bi?t cch x? tr t?i nh khi c con nh?p nhanh: tr? th?y h?i h?p lo l?ng, qu?y khc v th?y tim d?p m?nh, nhanh th dng d l?nh cho vo khan hay ti nu?c d?p ln m?t trong 2-3 pht, n?u v?n khng ra con th lm l?i sau 5 pht, d?ng th?i dua tr? t?i co s? y t? g?n nh?t d? c?p c?u k?p th?i.

    43. Hu?ng d?n: V?i tr? b? nh?p tim ch?m: tr? th?y m?t v ng?t, thn nhn dua tr? t?i ngay co s? y t? g?n nh?t . V?i tr? c d?t my t?o nh?p ph?i theo di ho?t d?ng c?a my, h?n dng c?a pin, gi? gn v? sinh th?t t?t cho tr?, ki?m tra my theo h?n d?nh k?.

    44. CHN THNH CM ON S? L?NG NGHE!

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