(X TR CAP CU CT NGC)

IEU TR HOC CHAN THNG NGC

PGS.TS. NGUYEN CONG MINH

NGOAI LONG NGC TIM MACH AI HOC Y KHOA PHAM NGOC THACH AI HOC Y DC TP. HO CH MINH BV. CAP CU TRNG VNG

THUAT NG THONG NHAT

CT ngc: CT kn & VT ngc. VT ngc: VT thanh ngc & VT thau ngc VT thau ngc: VT ngc h va kn Trong a thng: -Ton th ket hp: cung luc, 1 vung c the -Ton th phoi hp: nhieu vung khac / c the

PHAN M AU
My: hang nam co 16.000 chet do CT ngc. 94.000 chet do TNGT: 45-50% do CT ngc T vong cao nhat/NV: > 1-45t; do CT: -25% t vong o la do CT ngc: 75% do RLHH -Thieu Oxy gay t vong trong vong 4 phut CT ngc: TNGT, te cao, au a VT ngc: dao am, an ban

a dang: Gay sn ton th hoanh, tim, TQ -Thng gap: gay sn, TMMP, TKMP -Thc te: 85% ch T n gian, 10-25 m ng.

1. MOT BN CT NGC TONG TRANG ON

CT ngc: hn 80% TH ch can thu thuat cap cu (khai thong kh ao, DLMP la u). ng trc BN b CT ngc, phai nhan nh ngay: -Dien tien nang toi khan, khan. -Tnh trang huyet ong (on nh khong on nh). Vi nan nhan tnh trang on nh: -Phai kham ky (LS va CLS) -anh gia T thng ben trong (T doi va x ly tiep)

2. VI NAN NHAN NANG

gia chp nhoang phac o cu thng nang cao

(Advanced trauma life support; ATLS)

u tien trong s cap cu

A. (Airways): thong thoang kh ao, T/t CS co (ngng th ot ngot) B. (Breathings): T/t ng ho hap di (TMMP, TKMP) th oxy ngay/ giup C. (Cardiac & Circulation): *Giai phong Temponade.*Cam mau *Bao am tot khoi lng tuan hoan toi thieu (boi phu u) D. (Disability): kham ky, gia chet nao (hoi sc phung ph, ton kem) E. (Exposure: ci bo ao quan hoan toan): kham toan dien, tranh bo
sot th may.

TON THNG KET HP

GAY SN TMMP TKMP 1846 (73%) 1327 (52,5%) 900 (35,6%)

VT TIM
HC PURTSCHER CT KN V TIM VT THC QUAN CT V THC QUAN

24 (0,9%)
21 (0,8%) 3 (0,12%) 2 (0,08%) 1 (0,04%)

TIEN LNG NANG TRONG A THNG

ISS TRUNG BNH CHAN THNG KN VT THAU NGC 33,2 ISS (TB) SONG 29,2 ISS (TB) CHET 44,28

22,81

19,8

26,43

ISS CHUNG

27,6

23,91

41,1

GAY SN
CHAN OAN GAY SN - Tieng lao xao. Khong ep tren x c: lam soc nang - e anh gia ton thng ben trong. - Gay sn 1, 2, 3: Theo doi ton thng MM ln - Gay sn 11, 12: Theo doi ton thng lach, than. IEU TR GAY SN - Ch giam au va nam vien (ngi gia). - Khong bang thun: loet mong nc, H/ t bo ngc

MANG SN DI ONG
CHAN OAN MSD -Ch xac nh c tren LS: ci tran BN -X quang: ch tham khao & anh gia dap phoi. TIEN LNG NANG 1 MSD -Suy ho hap va truy mach ngay sau khi b thng -MSD trc ben: knh > 15 cm, B o di ong > 1,5 cm -Kem theo dap phoi nang (>1/3 phe trng) IEU TR MSD -Giam au hieu qua. Phuc hoi phoi dap -Khong bang thun co ien -Vat ly ho hap & Th may

CHUYEN ONG AO NGHCH

TRAN MAU MANG PHOI

CHAN OAN X quang: 3 mc o. Sieu am rat chnh xac t khi can en CT scan IEU TR Kham lam sang va B s: Q trong Dan lu mang phoi Phau thuat noi soi M ngc cam mau.

TRAN MAU MANG PHOI ONG

N: mau ong lai, ong banh trong KMP: 5-8%. YEU TO THUAN LI GAY NEN TMMP ONG:
-Vet thng thau ngc (dao am). -CT kn dap nat cau truc thanh ngc, MP,nhu mo phoi. -Trong ca CT ngc kn va VT ngc: nhieu vat la (mau cuc, manh xng vun, cac to chc hoai t). -Ch nh at DLMP qua muon hoac, DLMP qua lau. -Nhiem trung khong hoan chnh: TMMP c T khang sinh ba bai, khong ung / khong u lieu.

IEU TR TMMP ONG

Trong vong 7 ngay sau DL: phau thuat noi soi Sau 7 ngay, nen m ngc, v:
-Mau tiep xuc to chc hoa, -MP tang dan *X hoa bo chat nhu mo phoi *Can s n phoi. -Lau hn na: boc vo phoi kho khan, vat va, kho g, han che KQ cua s n phoi sau nay.

BIEN CHNG

BC nhiem trung, viem mu mang phoi chiem a so.

DAP PHOI & TU MAU NHU MO PHOI

Dap phoi: gap nhieu trong CT ngc kn Tu mau nhu mo P: VT thau phoi> Ap xe Dap phoi & Tu mau nhu mo P thng k hp Vai tro cua Oxy lieu phap/ T dap phoi: -> 5L/phut: giam hieu ng Mach tac SL - Phan biet: ARDS, Mendelson, Th tac m

TU MAU NHU MO PHOI

T DAP PHOI & TMNM PHOI

PHUC HOI PHOI DAP - Giam au hieu qua - Oxy lieu phap & thong thoang ho hap - Truyen dch tinh the ung u - Khang sinh d phong - Corticoid lieu phap

TON THNG THC QUAN

CHAN OAN -VT > CT kn -TQ co -TQ ngc IEU TR: Mo cang sm cang tot - 13% t vong, neu mo trc 24 gi - > 55% t vong neu mo sau 24 gi NG NHAN T VONG: Mo tre