BS. CKI.

TRNH TRUNG TIN

CHN THNG NGC

THNH NGC XNG MNG PHI PHI TIM-MCH TRUNG THT C HONH

PHN MM

XNG SN

XNG C

TRN MU MNG PHI

TRN KH MNG PHI

DP PHI

TIM

MCH MU

CHN THNG KH QuN

CHN THNG THC QuN

V C HONH

THOT V HONH

GY XS N THUN

MNG SN DI NG

TKMP N THUN

TKMP H

TKMP P LC

DP C TIM

TRN MU MNG TIM

CHN THNG M CH

O. Genc, M. Dakak, S. Grkk, A. Gzbyk, K. Balkanli: Thoracic Trauma And Management. The Internet Journal of Thoracic and Cardiovascular Surgery . 2000 Volume 4 Number 1

Khan MLZ, Haider J, Alam SN, Jawaid M, Malik KA. Chest Trauma Management:Good outcomes possible in a general surgical unit. Pak J Med Sci 2009;25(2):217-221.

NGUYN NHN TH 2 GY T VONG SAU CHN THNG S NO CHIM T L 20% TRONG CC TH T VONG DO CHN THNG

KHM LM SNG
NHN

Cn th khng?
Nhp th v mc th

C ng thnh ngc vi nhp th

Vt thng tch (bm, xy st) trn thnh ngc

Phi hp h hp ngc bng

Xng c? Vng nch? (@_@)

KHM LM SNG
S
Xng sn Xng n Xng b vai Ct sng

NGHE
m kh qun ph phn ph nang

Ting tim (c m khng?, lon nhp?)

m rut?

GY XNG SN

GY XNG SN
DNG CHN THNG THNG GP NHT

TR EM < NGI TRNG THNH < NGI GI

V TR
XS I, II THNG DO LC TC NG MNH XS V XS IX (V TR T C BO V) XS VIII-XII C TH TN THNG MT S C QUAN C TRONG

BNG: GAN, LCH, THN,

CUNG BN > CUNG SAU > CUNG TRC

10

GY XNG SN
TNG THNG M HoC KH QuN 30% T VONG

TN THNG PHI HP:

Dp phi Rch ng mch tnh mch lin sn trn mu mng phi

11

MNG SN DI NG
N:
XQ: GY 2 HoC NHIU V TR TRN 1 XNG SN NHIU XNG SN
(>2) LIN TiP LS: THY C S NGHCH THNG CA MNG SN THEO NHP H HP

THNG GP NGI GI
DO LC TC NG MNH V DiN RNG

14

TRN KH MNG PHI

LS: PB(-), RUNG THANH (-), G VANG

CLS:
XQ: Hnh nh trn kh hnh nh xp phi th ng

S ngc: lung sliding (-)

CT Scan: Hnh nh trn kh hnh nh xp phi th ng

1993
T: c vnh kh bao xung quanh phi

2003
Tnh khong cch t mng phi thnh ti

TB: y lch kh qun

NHIU: phi mt thng kh, y phi khng p st c honh

mng phi tng

<2cm: trn kh lng t > 2cm : (>50%) trn kh lng nhiu

Estimation of size of pneumothorax under the new BTS guidelines. Thorax 2004;59:355-359

X TR
THEO DI KHNG CN H TR OXI
TKMP t (15-20% - <1cm), khng kh th

OXI H TR
Oxi qua mi 3l/pht

GII P
Chc ht kh bng kim catheter t vale 1 chiu (Heimlich valve) t dn lu mng phi M ngc khu phi thng

TRN KH MNG PHI P LC

KH I VO KHOANG MNG PHI V KHNG TH THOT RA C LS: AU NGC THNH LNH, TH NHANH NNG, D MT, DA TI XANH DO THIU OXI, HUYT P GiM, NHP TIM NHANH, TM C NI CLS: XQ NGC THNG, KH MU, iN TIM XT: (TC THI) CHC HT KH MNG PHI

28

TRN KH DI DA
GP C TRONG CHN THNG NGC V VT THNG NGC NN: KH RA T PHI-KH PH QUN KHI C TN THNG HOC T NGOI DA VO KHI C VT THNG H DA TRN KH DI DA C TH XUT HIN NGC C - U MT BNG BU T CHI

TRN KH DI DA + TRN KH TRUNG THT ~ Hamman's syndrome

LS: LP XP DI DA KHI N, ST SOT KHI NGHE XT: T KHNG CAN THIP. NHU DN LU KH BNG CATHETER

KH DI DA NHIU NHIM TRNG, HOI T DA DNG KH

Hamman's syndrome
Postpartum pneumomediastinum Louis Hamman (18771946), the physician who described pneumomediastinum in association with subcutaneous emphysema during pregnancy in 1945 Typically occurs in young, healthy, primiparous women Rupture of marginal alveoli with air entering into the mediastinum is the most

likely mechanism. It can be provoked by any Valsalva manoeuver that increases

intrathoracic pressure Treatment of postpartum Hamman's syndrome is supportive. Most cases have a benign, self-limiting course, and recurrence is uncommon.

TRN MU MNG PHI

LS: PB(-), RUNG THANH (-), G C

CLS:
XQ: ng cong Damoiseau

S mng phi: Dch mng phi (+)

CT Scan: Hnh nh dch mng phi (+)

CH NH M NGC
t dn lu ra > 1500ml mu Mu tip tc ra 150-200ml/gi trong 2-4 gi C du hiu tip tc chy mu (CTM) hoc c truyn mu nhiu ln.

Mu ng mng phi (c lng > 500ml)

Nathan T. Mowery, MD et al. Pratice management guidelines for management of hemothorax and occult pneumothorax. The journal of trauma. Vol70. No2. 2011: 510-18.

DP PHI
C S XUT HiN CA MU TRONG NHU M PHI, PH NANG GIM S TRAO I OXI SUY H HP NN: CHN THNG LC MNH, GY NHIU XNG SN, GY XNG C LS: HO, AU NGC (KHI HT TH SU, KHI HO, KHI DI CHUYN), SNG BM THNH NGC, KH TH, TH NHANH

DU HiU NNG: HO MU, BiN DNG THNH NGC, KH TH NNG

XT: TRUYN DCH NG TM, OXI LiU PHP, GiM AU NARCOTIC, TP VLTL. TRNG HP NNG TH MY

CHN THNG GY NGT

NN: LC TC NG MNH VO THNH NGC LM TRUYN LC Y DN MU T TIM PHI LN TM VNG C-U. (HIM GP) LS: SHOCK, THAY I DA VNG U-C-VAI, XUT HUYT KT MC, XT: KiM SOT NG TH BNG NP C, THNG KH VI NNG OXI CAO

CHN P TIM

CHN P TIM
KHI C DCH HOC MU TNG NHANH TRONG KHOANG MNG TIM NN: UNG TH PHI GIAI oN CuI, PHNH MC NGC V, VIM MNG NGOI TIM (VI TRNG HoC VIRUS), SAU PHU THUT TIM, NHI MU C TIM CP, VT THNG TIM LS: KH TH, TH NHANH NNG, TT HUYT P, GiM HoC MT MCH NGOI

BIN, DA TI XANH, KCH THCH VT V, M HI, NHP TIM NHANH, TiNG TIM
M, TM C NI XT: CP CU KHN CP

DP C TIM
NN: NHI TIM (QU SC), T CAO TRN 20FEET, TAI NN XE HI (V LNG P THNG VO NGC) LS: AU NGC SAU XNG C, LON NHP, HA TT, CLS: ECG (BLOCK NHNH P), XOANG NHANH, VN NG NGHCH THNG THNH THT, MEN TIM THAY I XT: OXI H TR, CHNG LoN NHP, GiM AU

V NG MCH CH
CHT NGAY TRONG VNG CHA Y 1 PHT DO KHNG TH CM MU THNG V V TR GN NG NG MCH

V KH PH QUN

T DN LU MNG PHI

NGUYN TC CHM SC DLMP

QUAN ST GHI NHN

HOT NG CA H THNG BNH DN LU
ng DL c gp gc, cun, cng?
Kn? Hot ng?

Dch trong bnh DL c ngp chn ng DL?

Lng dch ra/ngy, mu sc? Kh?

Ghi ch: Ngy t, ngy thay dch, vch mc dch

QUAN ST GHI NHN

HOT NG CA BNH NHN
Chc nng h hp (u,kiu th, co ko,) Chc nng tun hon (da nim, mch, HA,) Vt thng, vt m (NT, chy dch,) Hot ng vng bng: au bng? Chng bng? .

X TR CC BT THNG
H thng khng kn: Nhanh chng lm kn h thng

chp XQ kim tra

H thng khng hot ng:
ng dch trong ng tho dch (kp ng) ng dch trong bnh thay bnh (kp ng) Xoay ng chng dnh (*) XQ phi kim tra

X TR CC BT THNG
Chy dch chn ng:
m bo h thng kn, thng tt
Khu da kn (*)

Trn kh di da quanh chn ng DL

m bo h thng kn, thng tt Khu kn c quanh chn ng DL (*)

M rng da chn ng thot kh (*)

CHM SC
m bo chm sc chn ng dn lu chng NT

m bo h thng kn, v khun

Chng xp phi
Hng dn BN sm ngi, hn ch nm lu
Hng dn ngi nh cch v lng, tp VLTL h hp (ch cc TH chn thng ngc) Tp ht th su, thi bng hay dng c h tr tp ht th

NGUYN NHN NT NGC DNG

Khng v trng khi chm sc chn ng DL

Dung dch trong bnh khng v khun khi thay hay mu, m
H thng khng kn, a vi trng t mi trng ngoi vo qua ng DL

CH NH RT DN LU MNG PHI
ng dn lu tc, khng hot ng c.

Phi n tt
ODL qu 72 gi