MOT SO NGO OC THONG GAF O TkF FM

l. NGO OC ACFTAMlNOFHFN:
Suo kh oong, Acotumnophon dooc choyon hou o gun thunh nhong chut guy
doc vu hou to to buo gun. oo hon um sung: soy gun, hu doong hoyot, soy
thun, ro oun nhp tm.
Loo doc cou Acotumnophon > l50 mg/kg.
1. Cban doan:
a) Hoi bcnb:
! 1ho dom oong thooc.
! on phup so coo.
b) kbam Iam sang:
! 1rooc 24 go: bong un, non o, duo bong, xunh tu, ngo m.
! Suo 24-48 go: tm cuc troo chong hoy to buo gun: vung du, gun to vu duo.
! 1o 3 6 nguy suo: tm cuc duo hoo:
. Soy gun: ro oun tr guc, hu doong hoyot, ro oun dong muo.
. Soy thun cup.
c) c ngb| can Iam sang:
! Choc nung gun, thun. Cun thoo do choc nung gun
! Doong hoyot.
! Dong muo toun bo.
! Ammonuc muo.
! Acotumnophon trong muo: ch dnh oong uctumnophon muo suo oong 4
go tkh nong do trong muo dut moc cuo nhut) txom boo do komuck
Muthov).
2. ico tr|:
a) koa da day
b) Tban boat: cun cho thun hout cung som cung tot nguy suo rou du duy.
Khong cho thun hout kh dong thooc do khung N-ucotycyston doong oong.
c) N-acctyIcystcinc:
Cun cho N-ucotycystono trooc kh bonh nhun co ton thoong gun
! Ch dnh:
+ Nong do Acotumnophon muo co tho guy ton thoong gun txom boo do
komuck-Mutthov ) houc > 20 "g/mL noo khong ro go ngo doc
+ Noo khong dnh oong dooc Acotumnophon muo, oo ucotumnophon >
l50 mg/kg houc oo > l00 mg/kg kom ton cun bonh y gun houc khong
xuc dnh dooc oong oong vuo.
+ Co ro oun choc nung gun trong 24 go duo suo ngo doc.



1000
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m
L

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500
400


















komack-Mattbcw nomogram
anb gia ton tboong gan doa vao nong do Acctaminopbcn trong mao


! Loo oong:
- Nucotycystono 1nh much:
Loo duo l50 mg/kg phu trong l0 m/kg Doxtroso 5%. om tom trong l go.
Suo do l0 mg/kg/go phu trong Doxtroso 5% troyon chum trong 20 go.
Co tho troyon koo du thom trong troong hop nhup von tro > l0 go houc co
ton thoong nuo
- Nucotycystono oong:
Loo duo l50 mg/kg phu vo nooc houc nooc tru cuy t o l/4, oong.
Suo do 75 mg/kg mo 4 go do l7 oo. Noo non mou trong l go suo kh
oong, phu oong up u houc do sung dung chch
d) ico tr| trico cbong:
! Hu doong hoyot: Cocoso oo troong.
! ko oun dong muo: Vtumno Kl.
ll- NGO OC CHAT AN MON:
Com cuc chut ucdo nho ucd soorc, ucd chorhydrc vu buso nho nooc uvo,
thooc tuy, sot tNuOH), nooc tro tuo tKOH)....
1. Cban doan Iam sang:
! lhong nom muc doong too hou: Duo vong mong huo, noot kho, chuy nooc
mong, duo vong suo xoong oc, xout hoyot too hou, thong thoc qoun #
vom trong thut, thong du duy # vom phoc muc.
! Soy ho hup do pho thunh qoun houc suc vuo kh qoun.
! on chong moon: cht hop thoc qoun, do thoc qoun - kh qoun.
2. ico tr|:
! Khong rou du duy v um nung thom ton thoong nom muc thoc qoun co tho
guy thong
! Khong dong chut trong hou.
! Khong dong thun hout.
! Soc mong vo thut nhoo nooc such. onh nhun con oong dooc co tho cho
oong nooc houc sou do phu oung nong do hou chut un mon.
! Doo tr soy ho hup noo co.
! Lup doong troyon tnh much, bo houn nooc vu don gu.
! X ngoc do phut hon thong thoc qoun.
! Khum choyon khou 1u mo hong do no so thoc qoun du duy nhum dunh
gu thoong ton vu cho hoong xo tr thch hop: thoc hon som trong vong l2-
24 go suo kh oong. Chong ch dnh noo bong do 3 vong hu thunh mon,
thunh qoun houc bonh nhun dung b soy ho hup.
! Ch dut sondo du duy noo un suo khum vu co y kon cou choyon khou 1u
mo hong.
! Noo ton thoong rong houc suo non cho khung snh.
lll- NGO OC CHl:
1. Cban doan:
1ro co top xoc vo ch: gu dnh um bnh uc qoy, nuo ch, son duo, ngum do
cho co son ch.
a. tam sang:
! Ngo doc mun: duo bong, kom un soy dnh doong, von rung don tdoong von
orton), thoo muo, cuo hoyot up, vom thun mo ko.
! onh y nuo cup: ro oun tr guc, co gut, hon mo, tung up oc no so.
b. Can Iam sang:
! lhot muo: thoo muo nhooc suc, busophc stppng tron hong cuo, tung
hong cuo oo.
! X qoung duo xoong du: doong von ch o duo xoong, vong son tung troong.
! ALA / nooc too > l3 mg/L.
! Dch nuo toy: do ngoy co tot nuo non ch choc dch nuo toy trong cuc cu
bonh nuo cup khong co pho gu th cun chun doun phun bot vom mung
nuo. Dch nuo toy: up oc $, protono $, to buo bnh thoong houc tung nho
<l00 / mm
3
.
! Nong do ch trong muo tnh much: > 25 "g/dL. tHon chou do dooc nong do
ch trong muo).
! 1ho choc nung thun trooc kh dong LD1A tCuctotrucomuto dsodqoo),
LD1A chong ch dnh kh co soy thun).
2. ico tr|:
Ngoycn tac dico tr|:
! Cuch y bonh nh ru kho mo troong top xoc vo ch.
! 1hooc tung thu ch.
! Doo tr bon chong.
Ngo doc man: kh % ALA / nooc too > l3 mg/L:
! Khong troo chong um sung: ch cun cuch y kho mo troong top xoc ch.
! Co troo chong um sung: D-loncumno t1rovo 0,3g) oo l00mg/kg chu
nguy 3 un, oong 30 phot trooc bou un. 1ho gun doo tr trong bnh u 3
thung.
! Nong do ch / muo qou cuo > 70 "g/dL co ch dnh doo tr LD1A. Nhong do
khong dnh oong ch /muo non cuc bonh nhun co boo hon um sung nung
houc co bon chong nho cuo HA cun gum nhunh nong do ch /muo th cun
doo tr LD1A.
cnb nao cap do ngo doc cb:
! LD1A kh khong soy thun:
Loo l500 mg/m
2
du/nguy, chu um 4 un, phu vo Normu suno troyon 1M
trong l go, trong 5 nguy mo dot. Ngh 2 nguy, tho u ch trong muo huy % ALA
/nooc too trooc kh qoyot dnh doo tr dot ko top.
! Chong pho nuo: tung thong kh nhum go luCO
2
25-30 mmHg, lorosomdo,
Munnto, Doxumothusono.
! Chong co gut: Duzopum tom tnh much.
! Hun cho dch, doo chnh ro oun don gu.
! Kh bonh nhun on dnh choyon sung D-loncumno oong.
lV- NGO OC HYDkOCAkONF:
1hoong do oong um xung, duo ou, duo guso, duo bong, purun.
1. Cban doan:
a) tam sang:
! Ho suc sou nguy suo kh oong, kho tho, ho tho co mo duo.
! Lo do, houc hon mo, co gut trong troong hop nung.
! Sot vu go suo kh oong, houc kh co bon chong vom pho.
b) Can Iam sang:
! X qoung pho: ton thoong pho mo 2 pho troong, nhoo nhut o 2 duy houc 2
ron pho xout hon nguy suo ngo doc houc tho phut suo l 2 nguy houc
vom pho bo nhom.
! Kh muo trong troong hop co soy ho hup.
2. ico tr|:
u) Dunh gu vu xo tr tnh trung soy ho hup:
! Cong cup oxy qou mo go SuO
2
> 94%.
! 1ho NClAl.
! Dut no kh qoun gop tho.
b) Khong rou du duy, khong dong thun hout. 1rong troong hop ngo doc oong
nhoo co tho dut sondo du duy dun oo.
c) Dong khung snh noo bonh nhun co tnh trung soy ho hup nung cun ho tro
ho hup houc X- qoung co hnh unh vom pho + sot + buch cuo cuo.
V- NGO OC kHANG HlSTAMlNF.
1hoong do oong um cuc thooc thooc nhom khung Hstumno: lromothuzno,
1horuono, Chorphonrumno...
1. Cban doan Iam sang:
! Ngo gu, thut doo, houc uo guc, no sung, co gut, hon mo.
! 1roo chong untchonorgc: Sot, do mut, do du, kho mong, tm nhunh,
dong to dun.
! 1roo chong ngou thup.
2. ico tr|:
! kou du duy.
! 1hun hout.
! Doo tr troo chong:
- Co gut: Duzopum 0,25-0,3 mg/kg 1M.
- 1roo chong ngou thup: Dphonhydrumno tLNADkYL) 2 mg/kg 1M, 1,
oong.
- Sot cuo: Luo mut hu sot co hoo qou hon thooc hu nhot. Kh dong thooc hu
nhot lurucotumo, trunh cuc cho phum co chou thooc khung hstumno
nho Agotropn.
Vl- NGO OC MFTOCtOFkAMlDF.
1hoong gup o tro < l too, do oong qou oo houc oong um cuc cho phum co
chou Motocoprumdo: lrmporun, Motocoprumdo. Loo thoong dong 0.l mg/
kg/ oo, oo ngo doc & 0.5 mg/ kg
1. Cban doan Iam sang:
! 1roo chong ngou thup: tron mut, gong, oon co.
! Co gut, hon mo.
! Mothomogobn o tro so snh
Cun chun doun phun bot hu Cucom/muo houc vom mung nuo.
2. ico tr|:
Ch rou du duy, thun hout noo oong oong nhoo.
Doo tr troo chong: thoong ch cun thoo do. Noo co co gut dong Duzopum
1MC.
Doo tr Mothomogobn noo co.
Vll- NGO OC MOkFHlNF.
1hoong gup o tro nho nh co oong cuc cho phum co chou Morphno nho thooc
cum too chuy: su u phon, lurogorc, lmodom, thooc con rong, Loporumdo
tLomot), houc thooc ho co codono: Noocodon, 1orpncodono, houc dup ron,
ro mong bung su u phon.
1. Cban doan:
a. tam sang: tum chong:
! Lo do, hon mo.
! 1ho chum, tho khong doo, ngong tho.
! Dong to co nho.
b. Can Iam sang:
! Dnh oong Morphn trong muo.
! Dnh tnh Morphn trong nooc too.
! Doxtrostx do ou tro hon mo do hu doong hoyot.
! Soo um nuo xoyon thop kh cun phun bot xout hoyot nuo.
2. ico tr|:
! Dunh gu vu xo tr soy ho hup: cong cup oxy, dut NK gop tho.
! kou du duy vu thun hout: trong troong hop nung thon mo, ngong tho) non
dut sondo du duy dun oo vu co tho rou du duy vo oong dch nho, nhoo
un do trunh ngoy co ht suc.
! Nuoxon 0,l mg/kg/oo 1M, co tho up u 30 phot suo.
! 1rong troong hop hon mo ngh ngo ngo doc Morphno co tho dong tost
doo tr vo Nuoxon 0,l mg/kg/oo 1M.
! Cun thoo do sut ho hup v ngoy co pho pho do ngo doc Morphno.
Vlll- CAC CHAT GAY MFTHFMOGtOlNFMlA :
nh thoong oong Mothomogobno tlo
3+
) trong hong cuo to l-2%.
Ngoyon nhun thoong do oong cuc thooc vu hou chut guy Mothomo-gobnomu,
thoong gup:
! Ntrtos tnooc gong, co don).
! Chorutos tthooc song).
! Dupsono
! Anno tphum nhoom).
1. Cban doan:
u. Lum sung:
! 1oy thoo moc do Mothomogobno trong muo:
l5-20%: tm mo vu duo ch
30-40%: tm mo vu duo ch kom un kom houc bo un, o do houc vut vu.
1ro on thun mot, nhoc duo, chong mut, yoo ch
> 55%: kho tho, ro oun nhp tm, hon mo, co gut
! 1u tm trong tum khong dup ong vo tho oxy.
b. Cun um sung:
! 1ost nhunh: Dong ong tom l0 mL rot l mL muo, go km, rot thom 9 mL
khong kh, uc nho nhoo un do hong cuo top xoc vo oxy cou khong kh.
Noo muo vun go muo don: tost Mothomogobn doong tnh.
! Co-oxymotry: Mothomogobn >l5%.
! X-qoung tm pho, do LCC, soo um tm kh cun chun doun phun bot vo
cuc bonh tm pho guy ru tm tu.
2. ico tr|:
! Ngong top xoc vo cuc chut guy Mothomogobno.
! 1ho oxy um.
! Mothyono boo l%:
Ch dnh kh:
+ Mothomogobnomu > 30%.
+ Houc duo hoo um sung nung: ro oun tr guc, kho tho, tm tu, co
thuy do duo hoo snh ton.
Loo l-2 mg/kg/11M chum trong 5 phot, noo con tm tu co tho up u oo tron
suo l go vu suo do mo 4 go, tong oo to du cou Mothyono boo 7 mg/kg.
! 1huy muo trong troong hop nung khong dup ong vo oo Mothyon
lX- NGO OC FHFNOAklTAt:
lhonoburbtu u thooc ngo co tuc dong chum t3 6 go)
|ong um houc qou oo. Loo doc > 30 40 mg/kg.
1. Cban doan Iam sang:
! oon ngo, o do, hon mo dung oc cho thun knh trong oong.
! |c cho trong tum ho hup: tho chum, tho yoo.
! Dong to co nho.
! Hu hoyot up tsoc thun knh), gum thun nhot trong troong hop nung.
2. ico tr|:
! kou du duy, thun hout.
! Kom hou nooc too: lhonoburbtu dooc thu o thun suo do dooc tu hup
tho o ong thun gun. So tu hup tho nuy b oc cho kh pH nooc too kom
txom phun ngo doc tong qout)
! Cuc troong hop soy ho hup nung: dut no kh qoun tho muy.
! Hu hoyot up: do up oc tnh much trong oong: bo dch houc dong
Dopumno houc Norudronuno.
! Dong homoduyss do uy thooc ru kho co tho trong troong hop ngo doc
oong nhoo, kom boo hon um sung nung.
X. NGO OC FAkAQAT:
luruqout tCrumoxono) u mot ou thooc dot co, khu houng.
Ngo doc luruqout thoong do to to. Loo doc toong ong 4 5 m dong dch 20%
o tro om, l0-l5 mL dong dch 20% o ngoo on. Doc chut vuo muo suo vu phot
nhunh chong gun vuo nho mo pho um hou to to buo, guy xo pho but phoc
ho vu to vong. Ngou ru con co tho guy soy thun vu soy gun. luruqout dooc thu
qou thun, khoung 90% dung khong do dooc thu qou thun suo 24 go.
1. Cban doan:
tam sang:
! |ong Crumoxono hootc thooc dot co muo xunh.
! Duo hoo som nguy kh oong:
Loot nom muc mong, noot duo.
Nung: ton thong du co qoun: soy ho hup, troy much, hon mo. 1o vong suo
vu go don vu nguy&
! Duo hoo moon thoong suo l toun.
Soy ho hup do xo pho.
Soy thun cup: thoo noo.
Soy gun: vung du, gun to.
Can Iam sang:
! Dnh tnh nhunh puruqout trong dch du duy, nooc too bung sodom
dthonto l% vo luruqout kt tost houc uy l tho tch nooc too dong trong
chu nhou, thom vuo 0,5 tho tch dong dch l% sodom dthonto vo l tho
tch normu sodom hydroxydo t0,lN NuOH), kot qou doong tnh noo guy
houc dong dch bon thunh muo xunh.
! Dnh oong puruqout muo: t o song cuo kh nong do trong hoyot toong
khong qou 2.0, 0.9 vu 0.l mg/L o cuc tho dom 4, 6, 24 go suo kh oong.
! Choc nung gun, thun.
! X-qoung pho.
! Soo um tm do up oc dong much pho.
! Kh muo kh co soy ho hup.
! LCC kh ro oun nhp tm.
2. ico tr|:
! Hon chou co chut do khung.
! kou du duy som houc guy non nguy kh phut hon ngo doc trooc kh
luruqout vuo muo. 1on oong pho thooc vuo tho gun to oc ngo do don
kh dooc ou bo chut doc.
! loor's ourth l5-30%, oo l-2 g/kg pho hop thooc nhoun troong thum
thuo nho Munnto l0% oo 0,2 g/kgbom qou sondo du duy mo 4-6 go
cho don kh xout hon cuc chut nuy trong phun. Noo khong co loor's
ourth th dong thun hout.
! 1ung thu doc chut qou thun: 1royon dch doy tr oong nooc too tron 2
m/kg/go. Noo thoo noo cho lorosomdo l-2 mg/kg 1MC.
! Lou bo doc chut to muo: ch hoo qou trong 6 l2 go duo.
Loc muo tHomoporoson): vo cot oc thun hout tnh houc thuy hoyot toong
to ru co hoo qou. Loc mung bong huy chuy thun nhun tuo khong hoo qou,
ch co ch dnh kh co soy thun cup.
1huy muo: kh khong co oc muo houc thuy hoyot toong, tho tch muo thuy
to 2 3 un tho tch muo bonh nhun.
! Soy ho hup: v oxy um tung nhunh qou trnh xo pho o bonh nhun ngo doc
puruqout non hun cho dong oxy trong ho tro ho hup o cuc bonh nhun nuy.
V tho co tho chup nhun luO
2
o moc 60mmHg. Noo soy ho hup non cho
tho NClAl vo lO
2
2l%.
! Doo tr hun cho xo pho: con bun cu.
Antoxydunt: Vtumno C l000-2000 mg/nguy 1M.
Vtumno L 250 mg/nguy.
Antbross: lrodnsono l0mg/nguy.
3. Tbco doi:
! Duo hoo snh ton, SuO
2
, oong nooc too, choc nung thun.
! Xqoung pho suo 7 nguy, soo um thoo do up oc dong much pho.
Xl- NGO OC THOC DlFT CHOT:
Xl.1. Ngo doc Fbospbo kcm:
1ro un phu thoc un co tron thooc dot choot houc soc vut b ngo doc.
1. Cban doan:
1hoong nho, tro ch non o, duo bong do un um thoc un do buy choot non
oong doc chut t.
Noo ngo doc oong nhoo tto to bung phosphou kom ngoyon chut): hu hoyot up,
kho tho, pho pho, ro oun nhp tm, co gut, hon mo, soy gun, soy thun vu to
vong trong 4 nguy - 2 toun.
2. ico tr|:
u. kou du duy bung Souto dong: lhu l go Souto dong 0,5g vo 5 t nooc
chn, do co dong dch l/l0.000. Suo do rou top bung dong dch Nur Corou
0,45% cho don kh nooc trong khong mo. Hon nuy rou du duy bung dong dch
thooc tm dong dch l/5.000 khong co bung chong vo hoo qou non khong con
dooc khoyon cuo.
b. Doo tr bon chong soy gun, soy thun, soy ho hup.
Xl.2. Ngo doc Sodiom FIooroacctatc va FIooroacctamidc (Tbooc dict cboot
Trong qooc)
1hooc dot choot 1rong qooc co hu dung: dong dch muo hong trong ong nhou
huy dung hut guo nhoom hong. Doc chut u looroucotuto huy
1rooroucotumdo oc cho cho trnh Krobs um ngong ho hup to buo. Cuc co
qoun dch b ton thoong u nuo tco gut), tm tro oun nhp) vu thun.
1. Cban doan:
! |ong houc un nhum thooc dot choot 1rong qooc.
! Nung: ro oun nhp, soc, toun choyon hou, soy ho hup, co gut vu hon mo,
soy thun.
! Xot nghom: on do, doong hoyot, kh muo, choc nung thun
2. ico tr| :
! kou du duy.
! 1hun hout.
! 1royon dch.
! Doo tr bon chong: co gut, soy ho hup, soc, soy thun

Van dc Moc do cbong co
O bonh nhun ngo doc
Acotumnophono nhong chong ch
dnh dong N-ucotycyston doong
oong, doong tnh much cong co hoo
qou toong doong vo tho gun dong
thooc ngun hon
ll
CA1 o Mchgun |nvorsty
l998