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MC TIU

Bit cc t th thm khm lm sng Cch o v tnh ch s BMI Du hiu sinh tn

Tnh trng da nim


Tnh trng mt nc Tnh trng ph Khm hch ngoi vi

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

T TH THM KHM

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

T TH THM KHM

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

NH GI TRI GIC: GLASGOW


Glasgow 12 13: hn m I Glasgow 9 11: hn m II Glasgow 5 8: hn m III Glasgow 3 4: hn m IV

Cch tnh im: (E + V + M):

Min: 3 Max:15

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

CH S C TH

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

CH S C TH

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DNG I

Bnh thng: i li d dng, thoi mi, thng bng tt, t tin. Bt thng: i khp khing, mt thng bng, dng i cng , bc chm chp (Parkinson), dng i pht c tay co qup trn

ngc (yu-lit na ngi), hay i m vng au.

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN
M NHP TH

Chm Nhanh
Ko di (Sighs) Chenye Stokes Tc nghn Nhanh su (Kaussmaul) Biot

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN
O HUYT P

Phng: yn tnh, m BN: ngh ngi ti ch 05 pht, khng s dng cht

gy kch thch trong vng 30 pht trc

Dng c: chiu rng bao hi 12-14cm

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN
O HUYT P

T th ngi hoc nm Tay c t trn bn, ngang mc tim Bm p lc thm 30 mmHg k t khi khng nghe c mch Tc x p lc 2-3mmHg/giy cho n khi khng cn p lc (0 mmHg)

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

TIU CHUN HUYT P


(NGI TRN 18 TUI) (THEO JNC VII-2003)
Huyt p tm thu
(mmHg) < 120 LOI Bnh thng

Huyt p tm trng
(mmHg) <80

Tin tng huyt p


Tng huyt p 1

120 139

80 89

140 159

90 99

160

100

TNG HUYT P: TM THU 140mmHg hoc TM TRNG 90mmHg


BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN
NHIT

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN

Nhit bnh thng o ming l 37C

trc trng cao hn 0.5C


nch thp hn 0.5C.
Ming > 37.8C Trc trng hoc tai > 38.3C

Nguyn nhn

Nhim trng: thng gp nht


Thuc: khng sinh, khng histamin, narcotics, Chn thng nng: bng, stroke, Mt s bnh l khc: cng gip, vim khp, ung th phi, gan,
BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN
H THN NHIT

Tui: nh hoc ngi gi km bnh suy gip trng, Parkinson

Chc nng thn kinh: bnh Alzheimer, tn thng tuyn h i

Lm dng cht Alcohol hoc thuc: dn mao mch di da gy thot nhit, hoc hiu qu c th run c sn sinh nhit

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN
BT MCH

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

DU HIU SINH TN
MCH NHANH Hot ng th lc Thiu mu Thuc: decongestants v cc thuc dng trong hen ph qun St Mt s bnh tim Cng gip trng Cht kch thch caffeine, amphetamines, thuc l Nghin ru Stress

MCH CHM Some types of heart disease and medicine to treat heart disease Nhng ngi thng xuyn tp th lc Suy gip trng
MCH YU Tc hp mch mu (x va, huyt khi) Suy tim
BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

MU SC DA NIM
CHNG TM TI (cyanosis)

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

MU SC DA NIM
TM TRUNG NG

TM NGOI VI

Gim bo ha O2 mu ng mch Gim p sut kh quyn do cao Gim chc nng phi

Gim cung lng tim Nhim lnh Ri lon phn b ti mu chi

Gim thng kh ph nang


Mt cn bng thng kh ti mu Gim khuch tn O2 Bnh tim bm sinh (t chng Fallot,)

Tc nghn ng mch (huyt khi, x va, co


tht)

Tc nghn tnh mch (huyt khi) Frost bite

Thng ng tnh mch phi


Nhiu shunt nh trong nhu m phi Bt thng v Haemoglobin

Shock gim th tch


a u ty, a hng cu Hp van 2 l Cryoglobulinemia (mu cha nhiu Eryoglobulins
- proteins # immunoglobulins)

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

MU SC DA NIM
TM TRUNG NG

TM NGOI VI

Gim bo ha O2 mu ng mch do gim hm lng O2 trong mu (PaO2 gim)

bo ha O2 trong mu ng mch bnh thng, gim bo ha O2 trong cc mao mch ngoi vi

Gim cung lng tim co mch ngoi vi gim vn tc dng mu ti cc chi

V TR

V TR

Vin v mt di li Vin trong ca mi Nim mc li, m, vm ming

Chp mi Vnh tai Vin ngoi ca mi Ging cc mng tay, mng chn Lng bn tay, bn chn

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

MU SC DA NIM
TM KT HP

Sc tim + ph phi Suy tim xung huyt dn ti suy tim (T) Bnh phi mn tnh do kh ph thng Polycthemia (him)

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

SO SNH TM TRUNG NG VI TM NGOI VI


V TR TM LNG BN TAY APPLICATION OF WARMTH,COLD H TR O2
LI, KHOANG MING M KHNG NH HNG LN LI LNH WARMTH-CYANOSIS INCR,COLD-DECREASES KHNG P NG

KHNG THAY I

C CI THIN

CLUBBING,POLYCYTHAEMIA

THNG C

KHNG

MCH DYSPNOEA

THNG MNH

THNG YU KHNG C VN V H HP

DU HiU KH TH

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

Bilirubin l sn phm cui cng ca qu trnh d

ha hemoglobin

Do s lng ng bilirubin m di da, khi lng bilirubin trong huyt tng > 3mg/dl

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

Trc gan: do tn huyt - St rt - Thalassemia - Thiu mn G6PD Ti gan: khng chuyn ha c bilirubin - Thuc, mt s c cht - Vim gan do virus, do ru - Ri lon t min - X gan - Hi chng Crigler-Najjar, Gilbert - Ung th

Sau gan: do tc mt - Si ng mt trong gan, si ng mt ch - U u ty, u ti mt, u ng mt ch - Vim ng mt


BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

TNH TRNG THIU MU


GIM SN SUT HNG CU MT MU - Vim lot DD-TT - Tr - Ung th - Thuc NSAIDs

(S lng HC t hoc gim cht lng HC)


- Thiu mu do thiu st - Thiu mu do thit vitamin B12, a.folic - Thiu mu do thiu men G6PD - Thiu mu do tn thng ty hoc tb gc - Thallasemia

- Ri lon kinh nguyt


TNG PH HY HNG CU - Hng cu hnh lim

- Thallasemia
- Nhim trng, thuc - c t: nc rn, nc nhn, - c cht t gan, thn - Min dch - Ri lon ng mu, tn huyt - Lch to
BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

NH GI PH
DO S NG DCH CC M XUNG QUANH NGOI BO
1. 2. 3. 4. 5. 6. Tng p lc thy tnh Gim p lc keo trong lng mch Tng p lc keo trong t bo Tng tnh thm thnh mch Tc nghn h thng dn dch thng qua h thng lympho changes in the water retaining properties of the tissues themselves

NGUYN NHN
- Thai - Thuc: steroids, uc chn calcium,NSAIDs, estrogens,.. - Bnh gan, thn: x gan, suy thn cp , suy thn mn - Suy tnh mch - Suy tim: + Suy tim phi ph tay, chn, bn chn, mt c chn + Suy tim tri ph phi - V cn
BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

NH GI PH
PH CNG (Non - Pitting Edema)

PH MM (Pitting Edema)

PH BCH HUYT

Ph cp: < 3 thng <40s gim albumin mu

Khng au, khng cng Khng thay i trong ngy Him khi lot Dy da, tng sng

Gim tng hp: gim a vo (ch n), gim hp thu (tiu chy), do gan (vim gan, ru, ng c gan,)

Tng mt: da (bng, lot), nc tiu (hc thn h), phn (bnh ng rut)

>40s khng do albumin

Tng p h TM:

Suy tim xung huyt Bnh vale 3 l Thuyn tc TM Hi chng TM ch di Suy van TM chi di

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

NH GI PH

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

TNH TRNG MT NC

L tnh trng thiu nc hoc dch trong c th do cung cp nc khng

hoc do tiu chy, nn


Tr s sinh hoc tr nh d b mt nc hn ngi ln do th trng nh Ngi ln tui d b mt nc hn tr ln hoc ngi trung nin

Mt nc chia nhiu mc : nh - va- nng, v c kh nng nh hng


n tnh mng

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

TNH TRNG MT NC
GIM NHP
CHN N
AU HNG L LOT BUN NN
(I THO NG, DNG THUC LI TiU,)
RA M HI NHIU (HOT NG TH LC)

TNG XUT
NN
TIU CHY ST TIU NHIU

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

TNH TRNG MT NC
DU HIU:

MI KH HOC DNH NC TIU VNG SM, LNG NC TIU GIM

TRNG MT
GIM TIT NC MT HN M TR NH: THP LM, DU HIU HO HC NC, MT KH

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

TNH TRNG MT NC
DU HIU LM SNG

GIM HUYT P T TH, HUYT P THP NHP TIM NHANH

DA KM N HI, NHN
DU VO DA PHC HI CHM THI GIAN Y MAO MCH GIM

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

BS.CKI. TRNH TRUNG TIN I HC Y KHOA PHM NGC THCH BNH VIN NHN DN 115 TP.HCM

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