Trung Tm Y T D Phng ng Thp

V SINH LAO NG V S CP CU

PHN I: V SINH LAO NG

I. QUY NH CHUNG
Quy trnh ny c son tho ph hp vi lut bo v sc kho nhn dn, bo h lao ng, Nhng qui nh c bn v t chc cng tc bo h lao ng trong XNLDVSP, cp nht vi kin thc, k thut cp cu ban u vi y khoa th gii c tnh n hon cnh thc t ca XNLD VSP. Qui trnh ny km theo Bn ph lc, l ti liu chnh thc dng cho vic hun luyn trong chng trnh trin khai HSE. MS ti XNLD VSP .

II. NGUYN TC CP CU BAN U

II. NGUYN TC CP CU BAN U

II.1. KHI NIM CHUNG

Muc tiu cua cp cu ban u: Duy tr s sng. Khng lam nng thm, han ch sc chn thng. Gip nan nhn bt lo s, bt au. ao iu !in tt cho tri liu chuyn mn tip th"o.

II. NGUYN TC CP CU BAN U

II. . TIP CN NN NH!N CHN THNG T"ONG TAI NN Khi phi ng x trc mt tai nn khn cp - cp cu vin (CCV) phi bnh tnh, khn trng, thao tc chnh xc, hiu qu. Tun theo cc bc c bn sau:

II. NGUYN TC CP CU BAN U

II. . TIP CN NN NH!N CHN THNG T"ONG TAI NN II.2.1. Xem xt hin trng: Trc ht, CCV phi c an ton khng bin mnh tr thnh nn nhn. Xem xt hin trng xc nh cn tn ti yu t gy tai nn khng Nu hin trng khng an ton phi gi ng cu, CCV phi dng phng tin bo h hoc chuyn gp nn nhn ra ni an ton khi cn thit.

II. NGUYN TC CP CU BAN U

II. . TIP CN NN NH!N CHN THNG T"ONG TAI NN II.2.2. Xem xt nhanh nn nhn k u: Nhanh chng gi to: Cu! Cu! Cu! C ngi b nn. Xc nh nn nhn cn tnh khng? Xem xt nhanh nn nhn theo th t u tin A-B-C (ng th - H hp Tim mch). A: Airway - ng th c b tc nghn khng. B: Breathing H hp c b ngng khng. C: Circulation Tim c b ngng hoc mu c chy t khng

II. NGUYN TC CP CU BAN U

II. . TIP CN NN NH!N CHN THNG T"ONG TAI NN II.2.3. Cp cu ban u: theo th t u tin A-B-C nu: II.2.3.a. Tc nghn ng th: II.2.3.b. Ngng h hp M v tai ca CCV khng cm thy hi th ra ca nn nhn, khng thy ngc nn nhn php phng: h hp nhn to mimg qua ming: thi 2 hi y II.2.3.c. Ngng tim, chy mu t Khi mch c ca nn nhn khng cn, lp tc p tim ngoi lng ngc kt hp vi thi trc tip ming qua ming. Nu chy mu ngoi t phi lm ngng chy mu ngay

II. NGUYN TC CP CU BAN U

Cu !, Cu !, co ngi b nan

II. NGUYN TC CP CU BAN U

Anh c sao khng ?

II. NGUYN TC CP CU BAN U

II. NGUYN TC CP CU BAN U

II. NGUYN TC CP CU BAN U

II. NGUYN TC CP CU BAN U

II. NGUYN TC CP CU BAN U

II. NGUYN TC CP CU BAN U

II. . TIP CN NN NH!N CHN THNG T"ONG TAI NN II.2.4. Xem xt nn nhn k hai Ch : Khng di chuyn hoc xoay tr nn nhn nu khng cn thit, khi cha xc nh cc tn thng. Nu cng lc c nhiu nn nhn, u tin cp cu nn nhn nng trc theo th t A-B-C. Bo c quan y t gn nht cng sm cng tt

III. CP CU NGT TH# NGNG TH

III. CP CU NGT TH# NGNG TH

III.1. KHI NIM CHUNG Ngt th, ngng th l tnh trng cp cu ti khn v cc t bo no s cht sau 5 pht do thiu oxy Mt s tai nn c th gy nn ngng th, ngt th: in git, ngp nc, nhim hi kh c, bng, rn cn.

III. CP CU NGT TH# NGNG TH

III.2. Xc nh ngng th, ngt th

Th rt yu hoc ngng th khi p m hoc tai st mu nn nhn, m khng cm nhn c c lung hi th ra va khng thy ngc php phng.

III. CP CU NGT TH# NGNG TH

III.3. K thut cp cu h hp nhn to (ming - ming) Gi h tr cp cu. t nn nhn nm nga trn mt phng cng Khai thng ng th Mt tay nga u, bp mi nn nhn; tay kia nng cm nn nhn, thi hai hi y trc tip vo ming nn nhn (trong khi thi, mt quan st lng ngc nn nhn).

III.4. nh gi hiu qu, theo di

III. CP CU NGT TH# NGNG TH

III. CP CU NGT TH# NGNG TH

III. CP CU NGT TH# NGNG TH

Ch : Thi gian thi ming - ming phi lin tc cho n khi bn giao nn nhn cho nhn vin y t.

IV. CP CU NGHN NG TH DO SC THC $N HOC D VT

IV. CP CU NGHN NG TH DO SC THC $N HOC D VT

II.1. KHI NIM CHUNG Nghn ng th do sc thc n hay d vt l tai nn ti khn cp, thng xy ra trong cc tnh hung sau: Va n va ni chuyn, ci a. n khng nhai k, nut vi. Ngm vt trong ming khi chy nhy, chi a. p tr n ung thuc khi tr ang khc.

IV. CP CU NGHN NG TH DO SC THC $N HOC D VT

IV.2. Xc nh nn nhn b ngn ng th IV.3. K thut cp cu T th ng: T th ngi: T th nm:

IV. CP CU NGN NG TH DO SC THC $N HOC D VT

V. CP CU NGNG TI%

V. CP CU NGNG TI%
V.1. Khi nim chung Khi xem xt nhanh nn nhn k u pht hin nn nhn khng c mch c p, lp tc phi tin hnh p tim ngoi lng ngc kt hp v thi ming qua ming. Ngoi cc nguyn nhn bnh v tim, trong chn thng, ngng tim thng gp cc tai nn sau: in git. Ngp nc. Nhim c, kh c, rn cn.

V. CP CU NGNG TI%
V.2. Xc nh nn nhn b ngng tim Sc mt tm ti, ng t gin to c th bt tnh hn m. Nhng xc nh nn nhn b ngng tim th: Khng cm nhn c mch c, mch bn, mch c tay. Khng nghe c ting tim vng ngc tri.

V. CP CU NGNG TI%
V.3. K thut p tim ngoi lng ngc v h hp nhn to V.3.1. p tim ngoi lng ngc Khi pht hin tim ngng p, cp cu vin m mnh 2 ci trc ngc nn nhn, thi ming qua ming 2 ln; nu mch c vn khng bt c, bt u tin hnh p tim ngoa lng ngc. p tim ngoi lng ngc cn thc hin u n, nhp khong 60-80 ln/ pht, vi p lc ph hp tim y c mu n cc c quan trong c th. Tng bc thao tc:

V. CP CU NGNG TI%
V.&. ' (hu( )p (*m ng+,* -ng ng. /, h0 hp nhn (+ V.&.1. 2p (*m ng+,* -ng ng. V.&. . '( hp h0 hp nhn (+ Nu c 2 cp cu vin: 5 ln p tim 1 ln thi ming - ming. Nu c 1 cp cu vin: 15 ln p tim 2 ln thi ming - ming.

5 ln p tim 1 ln thi ming - ming.

15 ln p tim 2 l n thi ming ming.

V. CP CU NGNG TI%
V.4. Theo di nh gi

V. CP CU NGNG TI%

C h u y : E p ti m n g oai l o n g n g c ke t h p th o i m i e n g -m i en g l i e n tu c tre n n g ch u ye n e n b e n h vi en .

VI. CP CU CHY %3U

VI. CP CU CHY %3U

VI.1. CHY MU TRONG VI.1.1. Quan nim chung Ngi ta phn bit hai loi chy mu: chy mu trong v chy mu ngoi. Chy mu trong: kh nhn bit, d b b qua.

VI.1.2. X tr

Hn ch, phng nga sc chn thng.

VI. CP CU CHY %3U

VI.2. CHY MU NGOI ( S CU VT THNG PHN MM) VI.2.1. Quan nim chung Chy mu ngai c th biu hin theo 3 dng: Chy mu ng mch Chy mu tnh mch Chy mu mao mch Mc tiu cp cu chy mu ngoi: Ngng chy mu Phng v hn ch Sc chn thng. Phng v hn ch nhim trng VI.2.2. X tr

Ch nh lm Garo rt him !

VI. CP CU CHY %3U

Ch : Khng nn c ra , st trng vt thng ang chy mu t, vt thng h rng. Khng t vo vt thng si thuc l hoc c nhai dp. Khng c rt d vt ra khi vt thng nu c. Gar c ch dnh s dng rt hn ch! Khi t garo phi tun th qui tc an tan

VII. D PH4NG V HN CH SC CHN THNG

VII. D PH4NG V HN CH SC CHN THNG

VII.1. Khi nim chung Sc l mt bin chng nng thng xy ra sau chn thng nng gy au n, mt nhiu mu hoc bng nng, mt nc, ng c Nguyn nhn thng do ng c cp, rn cn, cc bnh ni khoa cp tnh.... trong chn thng sc thng xy ra khi b a chn thng, vt thng mt nhiu mu, bng nng, gy xng.

VII. D PH4NG V HN CH SC CHN THNG

VII.2. Xc nh sm sc chn thng VII.3. X tr VII.4. Mt s t th hn ch sc Nn nhn nm nga chn k cao hn u khong 40 cm. T th khi nghi ng chn thng u, gy xng chn, ct sng T th khi nn nhn b nn T th khi nn kh th, nghi ng chn thng vng ngc, gy xng sn

VII. D PH4NG V HN CH SC CHN THNG

VII. D PH4NG V HN CH SC CHN THNG

VII. D PH4NG V HN CH SC CHN THNG

VII.5. Ch : Lm ngng chy mu t. Gi m, cho nn nhn, c th cho ung nc m. Cc ng tc cp cu phi nh nhng thn trng trnh gy au n cho nn nhn. Trnh di di nn nhn khi khng tht cn thit

VIII. CP CU IN GIT

VIII. CP CU IN GIT
VIII.1. Khi nim chung in git thng lm tim ngng p, d a n t vong. Khi b in git nn nhn c th b tn thng thm nu ng t trn cao xung. Nn cp cu in git phi: Cp cu ngay lp tc. Cp cu ti ch Cp cu kin tr lin tc. Tch nn nhn ra khi ngun in l vic u tin VIII.2. K thut cp cu: p dng II, III v V

I5. NGP NC

I5. NGP NC
IX.1. Khi nim chung Nn nhn b ngp nc thng trong tnh trng bt tnh, ngng th, ngng tim, h thn nhit do lnh. IX.2. X tr: tham kho II, III v V nh gi v tin hnh cp cu nn nhn theo A-B-C ng thi m cho nn nhn Ch : Khng mt thi gian cho cng vic lm nc ra khi phi

X. BNG

X. BNG
X.1. Khi nim chung Bng l mt loi tn thng rt phc tp do cc tc nhn khc nhau gy nn ,c th dn n nhiu bin chng nghim trng, thm ch t vong. Cc yu t gy bng: Do nhit. Do lnh. Do ho cht Do phng x, bc x. Do in.

X. BNG
X.1. Khi nim chung Mc trm trng ca bng tu thuc vo su, rng, v tr tn thng v thi gian tip xc vi ngun gy bng. Bc u tin trong Cp cu ban u bng do mi yu t l tch ngun bng ra khi c th nn nhn. Mc tiu chung trong x tr bng l gim au, hn ch sc, nga nhim trng.

X. BNG
X.2. BNG NHIT X.2.1. Bng 1 X tr: Ngm phn b bng vo nc mt hoc chm lnh, khng cn can thip bi y t. X.2.2. Bng 2: Bng gy rp da: X tr: Nh bng 1, tho cc vng eo nu chng lin h vi tn thng bng. Chm lnh, ra sch vt bng v bng p nh bng bng thun

X. BNG
X.2. BNG NHIT X.2.3. Bng 3: Bng su c lp da hay su hn Biu hin: Da b bng trt, tr m di da, tht. X tr: Kim tra A-B-C. Nu bng nhit kh, hn ch ci qun o b chy xm ca nn nhn, ch nn ct l phn bng, tho vng eo. Dng vt liu chng dnh che ni b bng. Bng che nh nhng. Nga v hn ch sc, cho nn nhn ung nc mui hoc dung dch ORS cng nhiu cng tt v nhanh chng chuyn nn nhn n c s y t sm nht.

Bng 2

Bng su do in

X. BNG
X.3. BNG LNH

X tr: Ngm ra vng bng trong chu hay di vi nc m nhit 35 40 trong thi gian 10-15 pht. Sau thm kh vt bng, bng che nh nhng v chuyn nn nhn n c s y t.

X. BNG
X.4. BNG DO HA CHT X tr: Ct, ci qun o dnh ho cht ra khi nn nhn. Xi ra lin tc vng c th b bng bng nc sch trn 20 pht. bng che p nh nhng. Ch : Phi thm, lau dung dch ho cht m c trc khi xi, ra nc.

X. BNG
X.5. BNG DO IN Bng do h quang in l bng rt su, kh nh gi ngay k u. Ra sch vt thng, chm lnh v bng p nh nhng. X.6. BNG MT DO BC X HN: Loi bng ny thng gp th ph hn. Mt b bng au nhc, sng, kt mc sung huyt X tr: Chm mt vng mt, ra nh mt bng nc sch, ngh ngi ni phng ti.

X. BNG
Ch : Khng chm tay trc tip vo ni b bng. Khng thoa du, m, kem nh rng, nc mm.. vo ni bng. Khng ph v cc bng nc. Chn gc hoc vt liu chng dnh k ngn khi x tr bng ti bn tay, bn chn.

5I. G6Y 5NG# T"T 'HP# BONG G!N

5I. G6Y 5NG# T"T 'HP# BONG G!N

XI.1. GY XNG
XI.1.1. nh ngha: Gay #ng la mt tinh trang mt tinh lin

tuc cua #ng, no co th biu hin $i nhiu $ang !hac nhau t %& 't gay cho n gay hoan toan
XI.1.2. Phn loi: Gy x !ng kn: Gy x !ng h": XI.1.3. Bin ch#ng au v mt mu c th gy sc. u xng gy sc nhn c th gy tn thng mch mu, thn kinh, c, da

5I. G6Y 5NG# T"T 'HP# BONG G!N

XI.2. TRT KHP nh ngha: u xng lch khi khp do lc chn thng tc ng gy tn thng dy chng, rch bao khp. Biu hin: au, sng bm tm, di lch,mt chc nng vn ng, u xung c th cm thy c qua s nn di da.

5I. G6Y 5NG# T"T 'HP# BONG G!N

XI.3. BONG GN nh ngha: Bong gn l tn thng cc phn mm quanh khp, ch yu l dy chng vi nhiu mc khc nhau. Biu hin: i khi rt kh phn bit gia gy xng, trt khp v bong gn. Vng khp bong gn au, sng n, bm tm, nn nhn ngi c ng v au. Bong gn thng xy ra khp c chn do va chm th thao hoc do t th vo lch khi di chuyn nhanh, dy chng b cng dn qu mc chu ng.

5I. G6Y 5NG# T"T 'HP# BONG G!N

XI.4. X TR GY XNG TRT KHP BONG GN
V kh phn bit ba loi tn thng trn, nn CCV c th x tr theo nguyn tc chung nh sau: Chng sc, chng au, chm mt. Bt ng tm thi. Bng np c nh chc chn nhng khng qu cht gy chn p cn tr lu thng mu. Kim tra xem u chi c b t, tm ti v mch c tay hoc c chn c cn hay khng. i vi gy xng h, phi x tr vt thng, cm mu, chng sc trc khi thc hin thao tc bt ng tm thi.

5I. G6Y 5NG# T"T 'HP# BONG G!N

5I. G6Y 5NG# T"T 'HP# BONG G!N

5I. G6Y 5NG# T"T 'HP# BONG G!N

5I. G6Y 5NG# T"T 'HP# BONG G!N

5I. G6Y 5NG# T"T 'HP# BONG G!N

5I. G6Y 5NG# T"T 'HP# BONG G!N

5I. G6Y 5NG# T"T 'HP# BONG G!N

Ch : Khng c p, y xng b gy h vo v tr. Khng xoa bp, nn, ko chi th b tn thng

5II. CHN THNG CT SNG

5II. CHN THNG CT SNG

XII.1. Khi nim chung y l loi chn thng nghim trng. Bin chng nguy him ca chn thng ct sng l tn thng thn kinh tu.

XII. CHN THNG CT SNG

XII.2. X tr Khi chn thng ct sng c ngh n, CCV khng xoay tr nn nhn mt cch th bo, khng lm di ng ct sng. t v c nh nn nhn vo bng ca hoc tm g cng khi di chuyn. Di di v nng nn nhn nh mt khc g.

XII. CHN THNG CT SNG

XII. CHN THNG CT SNG

XII. CHN THNG CT SNG

XII. CHN THNG CT SNG

Ph hp khng ?

XIII. CP CU CHONG DO NNG V SAY NNG

XIII. CP CU CHONG DO NNG V SAY NNG

XIII.1. Khi nim chung Chong do nng thng xy ra do ri lon chc nng iu ho nhit ca c th lm tng thn nhit cp. Tnh trng sc nng c th ri lon thn kinh tri gicthm ch t vong. Say nng do nn nhn b mt nc v in gii qua m hi trong iu kin lao ng qu sc trong mi trng nng

5III. CP CU CHO3NG DO N7NG V SAY N7NG

XIII.2 X tr: a nn nhn ra ni thong mt, ci qun o ngoi, qut mt,lau, chm mt c th tch cc, cho ung nc ch xanh, nc hoa qu lnh, dung dch nc in gii ORS nu nn nhn cha b hn m, co git. Gi Y t khn cp.

5IV. %T S CHN THNG V TNL C BIT

XIV.1. Vt thng ct ct Sau khi s cu m bo sinh tn cho nn nhn, lm ngng chy mu, chng sc, CCV nh tm v bo qun on chi ri cho ng cch: ra bng nc sch, qun trong gc, cho vo ti nilon, t vo bnh Thi gian phu thut ni ghp ti u l 6 gi k t lc xy ra tai nn

5IV. %T S CHN THNG V TNL C BIT

XIV.2. Chn thng dp nt, vi lp y l loi a chn thng c bit nghim trng, thng gp trong cc s c sp hm l, ng tNn nhn d b sc, nhim c. CCV tun th nguyn tc s cu theo trnh t A-B-C. Lu ti chy mu trong, gy ct sng, chn thng lng ngc.

5IV. %T S CHN THNG V TNL C BIT

XIV.3. Vt thng li rut Khng c nht rut vo bng. Khng ra trc tip vo vt thng. Dng bt t p vo ni rut li ra v bng li. Phng v hn ch sc chn thng. Gi cp cu v a nhanh nn nhn n y t.

5IV. %T S CHN THNG V TNL C BIT

XIV.4. Vt thng c d vt Khng c rt d vt ra. St trng quanh vt thng, bng li v khng p vt thng. Phng v hn ch sc. XIV.5. Vt thng nhn cu Bng kn c hai mt, trnh bng p. Phng v hn ch sc chn thng XIV.6. Vt thng do ch cn Ra sch vt thng bng nc v x phng Bng che p nh Ch : tim phng di

5IV. %T S CHN THNG V TNL C BIT

XIV.7. Vt thng do rn cn Ra sch vt thng bng nc v x phng St trng vt thng bng cn it hoc Btain Bng, c nh chi Trnh c ng nhiu Khng trch rch v ht mu bng ming Kim tra v m bo A, B, C. a n y t cng sm cng tt

5IV. %T S CHN THNG V TNL C BIT

XIV.7. Vt thng do cn trng chch C ly ngi ra khi vt thng Ra sch vt thng bng nc v x phng Bng che p nh, chm lnh Kim tra v m bo A, B, C. Gi y t gp nu nn nhn b sc phn v

XV. NG $C H S
2

XV. NG C H S
XV.1. Khi nim chung 2 H2S l kh rt c, nng hn khng kh C mi trng thi, nhng Nan nhan cha kp nhan ra H2 v! "a# $ n%& '(a) )*+ kh&* g,a&c-

XV. NGO OC H S
XV.2. Bieu hien
2

XV.2.a. Nong o thap Ton thng mat, mui, da. Ho, met moi, buon non Nong o cao

XV.2.b.

au au, chong mat, co giat Roi loan tim mach ho hap

XV. NGO OC H S
XV.3. X tr
2

Di di nan nhan en ni khong kh sach. anh gia va cap cu theo AB-C. Giup th vi Oxygen neu co the. Chu ya : mat vi dong chay nc R lanh. Cha tiep can nan nhan b ngo oc H2S cho en khi nao ban co phng tien bao ho ca nhan

5VI. VN CHUY%N NN NH!N

XV.1. Khi nim chung Nn nhn phi c s cu xong mi c chuyn i. Phi vn chuyn nn nhn nh nhng. Nn nhn b thng nngb chong khng c vn chuyn, phi gi xe cp cu n ngay. Cng thng: cng bt, vng, cnh ca, vn g, hoc c th dng chng tre.

5VI. VN CHUY%N NN NH!N

XV.2. t nn nhn ln cng Khng t tay vo vt thng. Nn nhn b gy ct sng, chn thng u, gy chn, vt thng lng ngc phi c t nht 3 ngi nhc ln cng. Mt ngi u v lng. Mt ngi nng thn. Mt ngi nng chi di. (Chi di gy th mt tay phn trn, mt tay phn di ch gy). Theo hiu lnh 1,2,3 ca CCV u ri cng nhc ln, ri cng t ln cng.

5VI. VN CHUY%N NN NH!N

XV.3. T th nn nhn nm trn cng Thng nm thng, hai tay bung xui, hai chn dui thng. Bnh nhn chy mu nng, chong nm u thp. Vt thng s no, hm mt, b m man bt tnh nm u nghing sang mt bn, u k gi. Vt thng bng k ngc hi cao, hai i gp nh. Vt thng lng ngc nn nhn na nm na ngi hoc k u v vai cao ln.

5V. VN CHUY%N NN NH!N

XV.4. Khing cng Hai hoc bn ngi Phi gi cng thng xuyn thng bng, khng lc l cng. Khi ln dc ngi i trc cm tay cng, ngi i sau nng cng. Khi xung dc ngi i trc nng cng ln, ngi i sau h cng xung cho thng bng vi ngi i trc.

5V. VN CHUY%N NN NH!N

5V. VN CHUY%N NN NH!N

Cach khi au bang cuon

C. ..h 89ng (h0ng :&ng

C. ..h 89ng (h0ng :&ng

C. ..h 89ng (h0ng :&ng

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CC TI LIU THAM KHO

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