Chn on: xc nh nguyn nhn gy trn dch (dch thm dch tit)

iu tr: gim kh th v ci thin chc nng h hp (TH trn dch lng nhiu)

Nhim trng khu tr (vim da, herpes zoster)

Xut huyt khng cm

Ri lon ng mu vi PTT tng cao (<1.5 ln so vi gii hn trn bnh thng) The decision to use reversal agents in patients with severe coagulopathy or platelet transfusion in those with clinically significant thrombocytopenia must be made on an

individual basis
BN ang th my xm ln v th my c p lc dng (PEEP) Ri lon huyt ng nng hay ri lon chc nng h hp mt n nh

1. BN ngi st mp ging, nghing v pha trc, cnh tay ta ln bn t cnh ging. Nu BN khng th ngi, v tr nm

u cao c th thc hin c

2. Xc nh mc trn dch da trn khm lm sng 3. V tr chc kim xc nh di 1 hoc 2 khoang gian sn ca mc trn dch v khng di xng sn 9 trnh chc kim

vo c honh
4. St trng xung quanh v tr chc kim theo nguyn tc v khun

5. Gy t cc b quanh v tr chc kim vi lidocain 2% bng kim 25G (gy t da m di da, gy t mng phi thnh)

6. Dng kim catheter 22G m thng gc mt da vo khoang lin sn c xc nh ch i theo mt trn ca xng sn di

7. Thao tc ko piston ng tim to p lc m kt hp y kim vo khoang mng phi tht chm 8. Khi thy c mu ra theo kim, cn rt kim ra kim tra li (loi tr kh nng chm mch mu) 9. Nu l dch chy ra theo kim vo ng tim, xc nh u kim vo khoang mng phi. Nu kim i su m cha thy dch xc nh li bng siu m.

10. Khi u kim trong khoang mng phi, nh nhng rt nng st catheter ra kt hp y su phn u nha catheter vo su khoang mng phi. 11. Ni ui catheter vi h thng 3 chc kn vi bnh cha v bm tim 50cc nhm ht h tr.

11. Ni ui catheter vi h thng 3 chc kn vi bnh cha v bm tim 50cc nhm ht h tr.

The pleural fluid should be sent for the following investigations if its etiology is uncertain:
Cell block (m t bo v tm t bo l) Protein Lactate Dehydrogenase level (LDH) pH Cytology Nui cy dch Amylase Triglyceride

Trn kh mng phi (11%) Trn mu mng phi (0.8%) Tn thng gan lch (0.8%) Tn thng c hong
oau (22%)

M mng phi Gieo rc t bo c tnh (?)

oDry tap (13%) oHo (11%) oT mu di da(2%) oT dch di da (0.8%) oNgt do co mch (vasovagal)

CHN ON
Xut hin dch bng cha r nguyn nhn Nghi ng vim mng bng do vi khun th pht hoc nguyn pht

iU TR
Ri lon h hp th pht do dch bng bng au bng hoc tng p lc bng qu mc th pht do dch bng bng

au bng cp (bng ngoi khoa) Tiu cu thp < 20 X 103/L hoc < 50 X 103/L (Child-Pugh stage C, alcoholic
cirrhosis)

Ri lon ng mu (*INR+ >2.0)

Mang thai Bng quang y nc tiu Vim da vng bng Chng bng, hi chng tc rut Dch thnh bng ( c tin cn phu thut,)

2 to 4 cm medial and cephalad to the anterior superior iliac spine

2 cm below the umbilicus

Gii thch cho BN v thao tc s thc hin Bin chng c th gp s ng thun ca ngi thn v bnh nhn

Lm trng bng quang bng th thut t Foley Catheter

St trng xung quanh v tr chc kim theo nguyn tc v khun

T da- m di da bng lidocain 2%

T mng bng bng k thut va m kim va ht, khi c dch thot ra theo kim th li kim li v tin hnh t

K thut m kim hnh ch

Thao tc ko piston ng tim to p lc m kt hp y kim vo khoang bng tht chm - Khi thy c mu ra theo kim, cn rt kim ra kim tra li (loi tr kh nng chm mch mu) - Khi thy c kh thot vo ng tim d dng, cn rt kim tra kim tra li ( kh nng m vo rut) Nu l dch chy ra theo kim vo ng tim, xc nh u kim vo khoang bng. Nu kim i su m cha thy dch xc nh li bng siu m

Ni ui catheter vi h thng 3 chc kn vi bnh cha v bm tim 50cc nhm ht h tr.

Fluid may be sent for the following laboratory tests

Nhum Gram m t bo Tm t bo l Cy vi trng Protein ton phn Triglyceride Bilirubin Glucose Albumin, (tnh SAAG) Amylase Lactate dehydrogenase (LDH)

Nhim trng v tr chc T mu thnh bng Mu trong khoang bng nguyn pht (him xut huyt mc treo sau khi ly dch mng bng >4 L)

Tn thng tng rng (rut, d dy, bng quang)

Gy hoc tut Catheter vo bng Tng thng cc mch mu chnh (M ch bng, M mc treo trng, ng mch chu)

Tut huyt p sau chc dch mng bng (sau 12

H Natri mu Hi chng gan thn

gi lm th thut, vi lng dch ly ra qu nhiu)