l

SOC

l. Al CONG:
Soc u tnh trung soy toun houn cup guy gum too muo mo so vo nho cuo, huo
qou gum cong cup oxygon vu gocoso cong nho gum uy d nhong chut bon
doong to buo nho: ucd uctc, CO
2
. Noo khong doo tr kp tho so don ton ton
thoong to buo, ton thoong du co qoun dou don to vong.
Fban Ioai soc:
Soc gum tho tch: thoong gup nhut o tro om, do tho tch muo oo thong
gum nho too chuy, mut muo, phong, nhom trong hoyot.
Soc phun bo: gun much, khung oc much muo gum: nho shock phun vo
vu nhom trong hoyot.
Soc tm: t gup o tro om, do soy yoo choc nung co bop co tm nho: tm bum
snh, vom co tm, ro oun nhp tm, trun dch mung tm.
ll. CHAN OAN:
1. Cong vicc cban doan:
a) Hoi bcnb:
1on cun tm bum snh, thup tm.
onh so: sot, too chuy, o nhom trong, chun thoong, xout hoyot too hou.
1on cun d ong vu cuc thooc dong trooc do, con trong dot.
b) kbam Iam sang:
Cho y duo hoo tm much vu ho hup do xuc dnh moc do soc vu ou tro
ngoyon nhun soc tm. Duo hoo ngh ngo soc tm: Cuop, um tho, tm to,
gun to, tnh much co no.
Dunh gu much, hoyot up, nhp tho, muo du, tuy chun um huy unh, tho
gun phoc ho muo du, tr guc, nooc too. O tro om duo hoo too t gop
thoo do dup ong doo tr nhoo hon u dunh gu bun duo.
Khum toun don to duo don chun. Duc bot cho y cuc duo hoo nho duo
mut nooc, thoo muo, o nhom trong, to bun, hong bun.
c) c ngb| can Iam sang:
Cong thoc muo, dong tch hong cuo, dom too cuo.
lon do, doong hoyot.
Noo ngh soc nhom trong: lhot muo ngou bon, cuy muo, Ckl, choc nung
gun thun, 1l1N1, cuy nooc too tnoo co troo chong tot noo), so cuy phun
tnoo co too chuy).
Noo soc tm do LCC, X qoung tm pho, soo um tm tm ngoyon nhun houc
dunh gu choc nung co bop co tm.
Choc nung dong muo trong troong hop soc nhom trong, soc koo du, um
sung co boo hon ro oun dong muo.
2

:
Kh muo kh co soy ho hup.
2. Cban oan soc:
Soc:
- 1m nhunh, much nhunh, hoyot up tot, kop.
- 1ho gun phoc ho muo du > 3 guy.
- Lo do, bot rot.
- 1oo t tnooc too < l m/kg/go).
Soc nung:
- 1uy chun unh co houc khong du no bong.
- Much = 0, hoyot up = 0.
- Vut vu, hon mo.
- 1oo t houc khong co nooc too.
3. Cban doan ngoycn nban soc:
Soc phun vo: top xoc d ngoyon nho thooc, thoc un u, con trong dot.
Soc mut muo: vot thoong dung chuy muo, chun thoong ngoc bong, guy
xoong, o, too muo, kom dong tch hong cuo gum.
Soc gum tho tch: too chuy mut nooc, phong, CVl thup.
Soc nhom trong:
Lum sung: sot, vo mut nhom trong, o nhom trong, noo co bun muo
ngh nuo mo cuo.
Cun um sung: buch cuo tung choyon tru, hut doc, khong buo, Ckl
tung, cuy muo doong tnh.
Soc sot xout hoyot: soc nguy tho 4-5, xout hoyot du nom, gun to kom dong
tch hong cuo tung, too cuo gum.
Soc tm:
Lum sung: ton cun bonh tm, tm nhunh, guop, gun to, tnh much co
no.
Cun um sung: X-qoung co bong tm to, soo um co but thoong tm houc
much muo on, choc nung co bop co tm gum.
lll. lF Tk]:
1. Ngoycn tac dico tr|:
Doo tr thoo oxy mo.
lhoc ho cong oong tm.
Doo tr bon chong.
Doo tr ngoyon nhun.
2. ico tr| cbong soc:
ico tr| cbong
- 1ho oxy qou cunou, dut no kh qoun tho muy noo tro soc nung kom tm
tu, ngong tho.
3
- Dut bonh nhun num phung chun cuo do tung oong muo vo tm, khong non
dut tro num duo thup v co tho chon op co hounh guy kho tho.
Ngou tro soc tm cho num to tho nou num nou ngo.
- Cum muo noo dung chuy muo tdo op houc bung op).
- 1hot up l houc 2 doong troyon 1M: chon 1M on o ch, dong km oon on
nhut co tho dooc, noo suo 5 phot chou thot up dooc doong troyon cun boc
o tnh much o co chun houc o tro < 6 too, co tho troyon toy xoong bung
km l8, tum tho trong kh cho boc o tnh much.
Soc nbicm trong, soc giam tbc tcb:
u. Doo tr bun duo:
1royon nhunh Normu suno houc Luctuto kngor 20 mL/kg/go. Noo much=0
vu HA = 0 troyon nhunh trong l5 phot houc bom troc top.
Noo suo do thut bu mu khong co duo hoo qou tu th troyon dong dch cuo
phun to tCoutno, Doxtrun) l0-20 mL/kg/go.
Noo soc mut muo th cun nhunh chong xo tr cum muo vu troyon muo toun
phun l0-20 mL/kg/go, trong kh cho muo cun troyon dch don gu Luctutod
kngor houc Normu suno 20m/kg/go.
b. Doo tr top thoo:
+ Noo hoyot dong hoc on dnh doy tr bung Doxtroso suno houc Doxtroso l/2
suno l0m/kg/go suo do gum dch dun.
+ Noo tong oong dch 60m/kg vu khong dup ong non co ch dnh do CVl:
.Noo CVl thup < 4cmH
2
O top toc troyon dch dong dch Dl1: Doxtrun 40
houc Doxtrun 70: l0-20 mL/kg/go.
.Noo khong duo qou tu + CVl bnh thoong t6-l0 cm H
2
O): tost dch troyon vo
Doxtrun toc do 5m/kg/30 phot. Suo do dunh gu u um sung, CVl. Noo dup
ong: top toc bo dch. Noo xuo hon, qou tu: cho Dopumno
.Noo co duo qou tu houc CVl cuo > l0 cm H
2
O: cho Dopumn oo but duo 2,5
g/kg/phot tung dun cho don kh co hoo qou, oo to du l0 g/kg/phot. Noo
khong dup ong Dopumno oo cuo thuy v tung Dopumno co tho pho hop vo
Dobotumno 3-l0 g/kg/phot kom Dopumno oo 3-5 g/kg/phot.
Cuch phu Dopumno vu Dobotumno:
Can nang N(kg) x 3 = so mg tbooc pba trong S0 mI Dcxtrosc S%
Toc do bom ticm: so mI/gio = so g/kg/pbot
+ 1rong troong hop soc nhom trong: noo thut bu Dobotumno+Dopumno: mot
so tuc gu do ngh so dong Noropnophrno but duo 0,l g/kg/phot 11M tung
dun don kh dup ong, to du lg/kg/phot. Cun oo y Noropnophrno guy co
much, gum too muo thun non ch so dong trong cuc tnh hoong do dou tnh
mung vu khong dong koo du.
Cong thoc phu Lpnophrno:
Can nang N(kg) x 0,3 = so mg tbooc pba trong S0 mI Dcxtrosc S%
Toc do bom ticm: 1mI/gio = 0,1g/kg/pbot
+ Noo dung oc bo dch nhunh xout hon duo hoo qou tu nho: ho, kho tho, 1M
co no, guop, run pho, gun to nhunh ngong troyon dch vu xo tr nho pho
pho cup.
too do xo tr soc nbicm trong:

Soc nbicm trong
Luctuto kngor / Cl1
20 m/kg nhunh




1ong oong dch
60m/kg





Soc kbong dap ong
bo d|cb


Soc dap ong bo
d|cb



Do CVl / HA xum un
Dopumno:5l0 g/kg/ph

1royon dch doy tr



Soc khong dup ong
bo dch vu Dopumno
Hoyor dong hoc on dnh
1op toc Dopumno
Xom xot Hydrocortsono 50mg/kg
tNhom trong hoyot)
Dobotumno 220g/kg/ph
Dopumno + Dobotumno
Dobotumno + Norudronun
t0,llg/kg/ph)
4
5

Soc tim:
- Dopumno: 3-l0 g/kg/phot qou bom tom
- Dobotumno: dooc ch dnh trong troong hop thut bu Dopumno huy soc
nung houc kom pho pho. Loo 3-l0 g/kg/phot.
Soc pban vc: Xom phuc do doo tr soc phun vo
3. ico tr| trico cbong va bicn cbong:
Hu doong hoyot: Doxtroso 30% 2 m/kg 1MC.
1oun bon doong nung: pH <7,l0 huy bcurbonuto < l0mLq/:
Nutrbcurbonuto 8,4% l m/kg/un 1MC.
ko oun dong muo:
DlC: troyon hoyot toong dong unh l0-20 m/kg.
Cum too cuo < 40.000/mm
3
: troyon too cuo l don v/5 kg.
4. ico tr| ngoycn nban:
Nhom trong hoyot: khung snh tnh much txom phuc do nhom trong
hoyot).
1m bum snh txom phuc do tm bum snh), thup tm txom phuc do bonh
thup).
Soc mut muo do chun thoong: phuo thout cum muo.
Xout hoyot too hou: xom phuc do xout hoyot too hou.
S. Tbco doi:
S.1. Tbco doi (TD):
1D Much, hoyot up, nhp tho, tr guc, tm tu mo l5-30 phot trong gu
doun ho soc soc vu suo do mo 2-3 go trong 24 go duo suo kh ru soc.
1D oong nooc too mo go. 1hoo do oong nooc too u thong so tot nhut
do dunh gu hoo qou doo tr soc, nhong do ngoy co nhom trong non ch dut
sondo too trong nhong troong hop soc koo du vu thuo bo kh tnh trung hoyot
dong hoc on dnh.
Kh soc nung cun do CVl, doy tr CVl to 6 -l0 cm H
2
O vu do hoyot up dong
much xum un.
1hoo do dong tch hong cuo, duc bot trong soc mut muo houc soc sot xout
hoyot vu doy tr dong tch hong cuo >30%.
Duo hoo ru soc: tnh tuo, much hoyot up nhp tho tro vo tr so bnh
thoong thoo too, tuy chun um, tho gun phoc ho muo du < 2 guy, nooc too >
l m/kg/go.

Tooi
(nam)
Nb|p tbo
(nb|p/pbot)
Hoyct ap tam tbo
(mmHg)
Macb
(nb|p/pbot)
<l
2-5
30-40
25-30
70-90
80-l00
ll0-l60
95-l40
6
5-l2
>l2
20-25
l5-20
90-ll0
l00-l20
80-l20
60-l00

S.2. kbam cboycn kboa:



onh y tm, soc tm: khum vu doo tr thoo choyon khou tm much.
Xout hoyot too hou: khum choyon khou too hou, no so, ngou.
Mut muo do chun thoong: khum ngou khou som trong oc ho soc soc do
cun thop phuo thout cum muo kp tho.

Van dc Moc do cbong co
Cortcodos khong co hoo qou mu co tho
um nung hon tnh trung soc nhom trong
l
Mundo: prncpo und pructco
o lnoctoos Dsouso 2000
Dch troyon don gu, hoyot toong vu cuo
phun to co hoo qou nho nhuo trong doo
tr soc nhom trong
ll
Crtcu Curo Modcno l999
Nong do Hb non doy tr o moc 8-l0g/dL
trong soc nhom trong.
lll
Crtcu Curo Modcno l999
Dopumn vu Dobotumn co hoo qou
trong soc nhom trong kh du bo do dch.
ll
Crtcu Curo Modcno l999
Noropnoprno non dong som trong soc
nhom trong suo kh thut bu vo
Dopumn
ll
Crtcu Curo Modcno l999