CHO BNH NHN DNG THUC

MC TIU
1. K c nhng yu cu cn thit trong vic dng thuc. 2. Nu c nguyn tc chung khi cho bnh nhn dng thuc. 3. Trnh by c cc ng dng thuc, tai bin v cch phng trnh tai bin. 4. Nu c mc ch, nguyn tc, cc ch s tim an ton.

I. I CNG
- Cho bnh nhn dng thuc l mt phn trong cng tc iu tr, v vy khi thc hin cho thuc bnh nhn phi nhn thc r trch nhim v phi ch cc im quan trng trnh s nhm ln v nhng hu qu tai hi. - Thuc vo c th BN qua nhiu ng: ung, tim, ngai da, nim mc.

II. NHNG YU CU CN THIT TRONG VIC DNG THUC

1. iu dng c kin thc c bn v thuc - Cng dng ca thuc - Tnh cht ca thuc - Yu t hp thu v bi tit - Dng thuc - Liu dng - Qui ch v thuc c - Cch bo qun 2. Tc phong lm vic ca ngi iu dng - Tc phong lm vic phi chnh xc, khoa hc v c trch nhim - Tuyt i khng c thay i y lnh, nu nghi ng phi hi li - Sp xp thuc theo th t d tm, trnh nhm ln - Thuc c A, B phi ngn ring c kha - Thuc dng ngai da phi xa thuc ung - Kim tra thuc hng ngy, nu c thuc km cht lng phi i ngay khoa dc - Kim k, bn giao thuc cn thn sau mi ca t m bng s sch

III. NGUYN TC CHUNG KHI CHO BN DNG THUC

1. m bo an tan tnh mng cho ngi dng thuc 2. Thc hin 3 kim tra, 5 i chiu, 5 ng - 3 kim tra H tn BN Tn thuc Liu dng - 5 i chiu S phng, s ging Nhn thuc Cht lng thuc hin ti ng dng thuc (ng tim) Thi gian dng thuc - 5 ng ng BN ng tn thuc ng liu lng ng ng dng ng thi gian

3. Khi pht thuc cho BN c nhn 3 ln Ln 1: trc khi ly thuc ra khi t Ln 2: trc khi rt thuc hoc thuc ra Ln 3: trc khi b ng thuc hoc ct chai thuc 4. Phi tp trung t tng cho vic dng thuc, thc hin y lnh phi tht chnh xc, trnh nhm ln .

IV. CC HNH THC A THUC VO C TH

1. Ung thuc a. nh ngha: l a thucvo c th bnh nhn bng ng tiu ha vi mc ch gip c th chng li vi bnh tt hoc nng cao th trng. b. u v khuyt im u im: tin li, thng thng, t nhin

 Khuyt im

Tc dng chm trong cp cu Thuc b ph hy bi dch d dy Thuc d hi d dy Phi cho ung lc i hoc lc no

c. Nguyn tc cho bnh nhn ung thuc - Cho bnh nhn ung ngay sau khi pht Khng thuc u ging cho BN Khng a thuc trn ngy cho Bn Khng gi thuc BN ny cho Bn khc - Nn pht ng qui nh, khng nn sm hoc tr u c nh hng n BN 2. Tim thuc a. nh ngha: tim thuc l dng bm tim a mt s lng thuc di dng dung dch ha tan trc tip vo c th BN.

Hnh 1: Cc loi bm tim thuc v kim tim b. Mc ch iu tr Phng bnh

Hnh 2: Cc dng thuc tim

 Gy phn ng nht nh V d: th PNC c. Cc ng tim thuc Tim trong da: l tim thuc vo lp thng b, thuc c hp thu rt chm. Tim di da: l a mt lng thuc vo m lin kt lng lo di da. Tim bp: l a mt lng thuc vo trong bp tht (trong c) Tim tnh mch: l a mt lng thuc vo c th BN theo ng tnh mch d. Bin c tim thuc Gy kim, cong kim Sc (do au, s, phn ng thuc, tim nhanh ) p xe Hai t: do tim thuc chng ch nh tim bp Lit: do tim nhm dy thn kinh hng to Tc mch: do tim thuc chng ch nh tim tnh mch BN au: do tim ra ngai mch mu e. Nhim v ca D khi tim thuc - Phi hiu r tnh trng tinh thn BN, gii thch an i cho BN khng s. - Chun b tt t th nm, ngi khi tim thuc, tt nht l cho BN nm c thoi mi. - Thc hin y qui tc, k thut tim vi tinh thn t gic, trch nhim cao, v khng t pha ln thuc vi nhau tr khi c ch th. 3. Thuc dng ngoi da v nim mc: cc thuc dng ngoi da v nim mc nhn thng c hng ch <khng c ung> a. Thuc dng ngoi da - Cc lai thuc bi ngoi da: hay dng khoa da liu, khoa phng - Cc thuc xoa: du nng Trng Sn, Thin Long

b. Thuc ngm qua nim mc - Thuc ngm di li: thuc thm qua nim mc, mao mch, tc dng nhanh

Hnh 3: Dng thuc ngm di li

- Kh dung (xng): thuc thm qua ng h hp lm gin co tht c trn, gim vim hng, thng xng cc thuc khng sinh khi BN vim ng h hp trn, vim cc xoang vng mt.

Hnh 4: Kh dung

- Thuc nh mt, nh mi, nh tai: NaCl 0,9%, Osla... - Thuc t m o, hu mn: hay dng sn khoa, h nhit tr em b st cao co git. Hnh 6: t thuc ng hu mn

Hnh 5: t thuc ng m o

V.
-

CC NHM THUC D GY D NG
Thuc khng sinh Dch truyn c protein Thuc gy t, gy ng, gin c Vaccin v huyt thanh Vitamin: B1, B12, vitamin C Cht cn quang c iode

VI. HNG DN TIM AN TON

1. Mc ch Thc hin tim an ton nhm m bo cho ngi bnh, nhn vin y t v cng ng khng b mc cc bnh ly v trnh c cc bin chng do cc dch v tim truyn gy nn. 2. Nguyn tc - Dng bm tim, kim v khun ring cho mi ln tim truyn - Tun th tuyt i cc qui trnh k thut tim v chun mc v v khun - Khng nn lm dng dng thuc bng phng php tim truyn - Phn loi v c lp ngay cc vt sc nhn sau khi tim theo qui ch x l cht thi 3. Tiu chun xc nh mi tim an ton a. Tiu chun cu trc - Bm tim, kim tim v khun. - Khi tim thuc, trn xe tim c hp thuc chng sc c s, hp ng vt sc nhn. b. Tiu chun quy trnh - Ra tay hoc st khun tay trc khi tim. - Khng lu kim pha thuc trn l thuc. - Xc nh v tr tim ng.

m bo kim tim v khun trc khi tim. Rt nng kim tra trc khi bm thuc. Tim thuc ng ch nh (5 ng). Khng dng tay y li np kim tim sau khi tim. C lp kim tim nhim khun trong hp cng.

VII.

HP THUC CP CU CHNG SC PHN V

(Do BYT qui nh) Trong hp thuc cp cu chng sc phn v gm c: Thuc Adrenalin 1mg 1ml: 2 ng Nc ct 10ml: 2 ng Bm kim tim v khun (dng 1 ln), loi 10ml: 2 ci, loi 1ml: 2 ci - Hydrocortisone hemisuccinate 100mg, hoc Solumedrol 40mg, hoc Depersolon 30mg: 2 ng Phng tin kh trng (gn, gc, bng, cn) Dy ga r Phc cp cu sc phn v Ngoi ra, ty iu kin v trnh chuyn mn k thut ca tng tuyn nn c thm cc thit b sau: Bm xt Salbutamol hoc Terbutalin Bng Ambu v mt n ng ni kh qun Than hot

VIII. -

PHC CP CU SC PHN V
1. Triu chng Cm gic khc thng (bn chn, ht hong, s hi). Ni m ay, ban , ph Quincke, mn nga. Kh th (kiu hen thanh qun), nght th. au qun bng, tiu tiu khng t ch. Mch nhanh nh kh bt, huyt p tt c khi khng o c. au u, chng mt, i khi hn m. Chong vng, vt v, giy gia, co git.

2. X tr Ngng ngay ng tip xc vi d nguyn. Cho ngi bnh nm ti ch. - Thuc Adrenaline l thuc c bn chng sc phn v. Tim di da Adrenaline dung dch 1/1000, ng 1ml = 1mg ngay khi xut hin sc phn v vi liu nh sau: 1/2 1 ng ngi ln. Khng qu 0,3 ml tr em (ng 1ml (1mg) + 9ml nc ct = 10ml, sau tim 0,1 ml/kg) Hoc Adrenaline 0,01 mg/kg cho c tr em ln ngi ln. Cho BN nm u thp chn cao, m, theo di huyt p 10 15 pht/ln (nm nghing nu c nn) Nu sc qu nng e da t vong, ngoi tim di da c th tim Adrenaline dung dch 1/10000 (pha long 1/10) qua tnh mch, bm qua ng ni kh qun, hoc tim qua mng nhn gip. - Tip theo x tr suy h hp. - Lp ng truyn tnh mch Adrenaline. - Cc thuc khc: methylprednisolon 1- 2 mg/kg/4 gi hoc hydrocortisone hemisuccinate 5mg/kg/gi tim tnh mch. - iu tr phi hp Lu : iu dng c th tim di da adrenaline theo phc khi c sc xy ra m khng cn y lnh ca bc s

TI LIU C THM

X L TAI NN DO KIM M
I. MC CH
Phng nga HIV v vim gan cho nhn vin y t Ngay lp tc a ngay ni b kim m ra di vi nc sch, x nhiu v mnh K tip ra vi x bng Sau st khun vng vt thng bng alcool t nht 5 pht

II. CCH X L

 Lin h khoa chng nhim khun - Lp bin bn tai nn - Ly n thuc d phng: dng lamzidinvir 1vin x 2 /N (u) cng sm cng tt (trong 2-3 gi sau tai nn) Ly phiu XN Nhn vin y t: - Test nhanh HIV - HbsAg Bnh nhn: - Test nhanh HIV - Sau khi c kt qu XN khoa chng nhim khun han tt h s qun l phi nhim cho nhn vin y t gii thiu sang BV Nhit i tip tc theo di v x l TI LIU THAM KHO iu dng c bn II B Y t - Nh xut bn y hc 2007 iu dng c bn II B Y t - Nh xut bn gio dc 2007 Thng t s 08/1999 TT BYT, ngy 04/5/99 - Potter Perry, Fundamentals of Nursing, 2005. - www.google.images.com

K THUT: CHO BNH NHN UNG THUC

MC TIU
1. K c mc ch, trng hp p dng, khng p dng khi cho BN ung thuc. 2. Lm ng cc bc ca k thut cho BN ung thuc. 3. thc c vic cho ung thuc phi cn thn v chnh xc.

I.

MC CH
Tr bnh.

Nga bnh.

II. TRNG HP P DNG

Cho tt c BN c th ung c.

III. TRNG HP KHNG P DNG

Bnh nhn hn m. Bnh nhn b nn ma lin tc. Bnh nhn b bnh thc qun: K thc qun, teo thc qun Bnh nhn b tm thn khng chu ung.

IV. DNG C
1. V khun - Tt c cc lai thuc: vin, nc, git. 2. Sch - Mm. - Ly ng thuc, giy gi thuc. - Ly nc ung thuc (bnh nc). - Dng cu o lng: ly c khc , mung canh, mung c ph, ng m git. - Dao ca (nu cn). - ng ht (nu cn). - Phiu thuc. - Dng c tn thuc (nu cn). - Vi ming gc sch t. Ti rc lm sng.

V. K THUT TIN HNH

Sau khi nhn y lnh, D mang khu trang kim tra: s phng, s ging, tn, tui BN, bo v gii thch cho BN bit vic sp lm ng thi ng vin BN an tm. D v phng ra tay v thc hin phiu thuc.

PHIU THUC H tn BN: S phng: Tn thuc: Hm lng: Liu lng: Gi: Tui: S ging:

Ngy thng nm D k tn

- Thc hin ly thuc: Thc hin 3 kim tra, 5 i chiu. LY THUC VIN - c nhn thuc ln 1. - M np l thuc ra. - c nhn thuc ln 2. - thuc vo np chai hoc mung, hay ly hng thuc (khng dng tay bc thuc). - m s lng thuc cho vo giy gi. - Gi thuc li v ghi trn gi thuc: tn BN, tn thuc, hm lng, liu lng. - y l thuc li. - c nhn thuc ln 3. - Ct thuc vo ch c. LY THUC NC - c nhn thuc ln 1. - Cm chai thuc lc nh cho thuc trn u, m chai thuc v t nga np chai thuc ln mt bn. - c nhn ln 2. - Cm ly dng thuc a ngang tm mt, t ngn tay ci ngang mc ly thuc cn ly. - nhn chai thuc hng ln trn v rt thuc khng ming chai thuc chm vo ming ly.

Ly thuc. Lau ming chai thuc bng gc t. y np chai thuc li. c nhn thuc ln 3. Ct chai thuc vo t.

LY THUC GIT - c nhn thuc ln 1. - Cho 1 t nc chn vo ly lm lang thuc. - Tay thun cm thng ng ht, c nhn thuc ln 2, tay khng thun cm ly ngang tm mt. - a u ng ht vo l thuc v ht thuc. - Nh tng got thuc cn thn vo ly v m s git theo ch nh (khng c ni chuyn trong lc m). - y l thuc li. - c nhn thc ln 3. - Ct thuc vo ch c. - t thuc vo mm km phiu thuc (mi lai thuc l 1 phiu thuc).

VI. K THUT CHO BN UNG THUC

-

Mang mm n ging BN kim tra s phng, s ging, tn, tui BN, bo cho BN bit n gi ung thuc. Cho BN t th thch hp (ty tnh trng BN). Kim tra li thuc trc khi cho BN ung. a thuc v nc cho BN ung. Lau ming, cho BN nm li tin nghi. Thu dn dng c v phng.

I VI TR EM - Nu tr em phi ng vin, thuyt phc tr t gic ung l tt nht, hoc hng dn ngi nh cho tr ung nu tr thch. - Tr qu nh th D phi ha tan thuc thnh dng nc (c th thm 1 t ng tr d ung). D b tr nm nga, u tr hi cao v p st vo ngi. Dng tha c ph ly thuc t st ming tr gi hoc pha cnh m, t t thuc vo cho tr ung.

Trng li bng nc chn. Lau ming cho tr.

CCH CHO BN UNG VI LAI THUC C BIT - Digitalin phi lu m mch BN trc khi cho ung. - Aspirin phi cho ung lc no, khng ung chung vi cc lai thuc c cht kim. - Cc lai thuc c tnh acid lm hi men rng cn phi pha lang thuc v cho BN ung qua ng ht. - Mi v ca 1 s thuc c th lm cho BN nn, nn cho BN ngm nc trc khi ung vi pht. - Thuc du sau khi dng xong cho BN ung nc chanh hay nc cam.

VII. DN DP DNG C
-

X l rc ng theo quy nh. Gch gi ung vo phiu thuc. phiu thuc vo gi k tip. Ngy, gi cho BN ung thuc. Tn thuc, liu lng. Trng hp BN khng ung c BN vng mt. BN khng chu ung. BN nn i. Phn ng BN (nu c). Tn D thc hin. c k y lnh ca Bc s trc khi cho BN ung thuc. Ch khi ly thuc. Thc hin 3 kim tra, 5 i chiu cn thn. Nu c sai xt hay l lm phi tht th bo co ngay. Theo di tc dng, tc dng ph ca thuc. Nn ghi vo h s khi chnh tay D cho BN ung.

VIII. GHI H S
-

IX. NHNG IM CN LU
-

K THUT TIM THUC

MC TIU
1. K c mc ch, trng hp p dng ca cc ng tim thuc. 2. Thc hin ng quy trnh cc k thut tim. 3. thc c k thut tim thuc l v khun.

NI DUNG
C 4 ng tim - Tim trong da - Tim di da - Tim bp - Tim tnh mch

A. TIM TRONG DA I. MC CH
-

Phng bnh. Chn on bnh. Tim thuc BCG phng lao. Tm phn ng IDR chn on lao. Th phn ng ca c th i vi thuc.

II. TRNG HP P DNG

-

III. DNG C
1. V khun - Bm tim 1ml c khc t m. - Kim tim di 1,5cm, s 26 27 - Kim pha thuc - Bm tim 5ml, hoc 10ml. - Thuc tim theo y lnh

Nc ct pha thuc Hp ng gn c dung dch st khun (cn 700, cn iod 10/00). Hp gn kh hoc gc kh. Km Kelly st khun da + bnh ng kim. Hp thuc chng sc.

2. Sch - Mm - Phiu th test - Ti giy - Dao ca (nu cn) - Gng tay (nu cn) - Hp ng vt bn nhn. - Thng ng rc y t, rc sinh hot - DDSK tay nhanh (clincare) PHIU TH TEST H tn bnh nhn: Tui: S phng: S ging: Tn thuc th: Liu lng: Ngy, gi th: Kt qa: K tn iu dng

IV. TIN HNH K THUT

1. Chun b bnh nhn - Sau khi nhn c y lnh, iu dng mang khu trang n kim tra s phng, s ging, h tn bnh nhn - Bo v gii thch cho bnh nhn bit cng vic sp lm ng thi ng vin bnh nhn an tm. - Hi xem bnh nhn phn ng vi loi thuc no cha? - iu dng v phng lm vic ra tay v thc hin phiu th test.

Chun b dng c y ln xe tim v y xe n phng bnh. Kim tra li s phng, s ging, tn h BN.

2. Chun b thuc *Phng php trng ng - c nhn thuc ln th 1 - St khun dao ca - Dng dao ca khui np l thuc - St khun nt cao su - St khun ng nc ct - Ca ng nc ct (nu ng t b c th khng cn ca) - St khun li ch ca - B ng nc ct bng gn kh (hoc gc kh) - Dng bm tim 5 ml c thay kim pha thuc - Rt 4,5ml nc ct - Bm 4,5 ml nc ct vo trong l thuc bt ng thi ko nng bm tim ly mt lng kh tng ng vi lng nc pha - Rt bm tim v kim ra khi l thuc - Lc u l thuc cho tan - c nhn thuc ln 2 - Thay bm tim: dng bm tim 1ml c gn kim pha thuc m kim vo nt cao su rt thuc ra, sau bm tt c thuc vo l, rt bm tim ra - c nhn ln 3 - Rt khong 0,3ml nc ct vo bm tim 1ml v trng ng - Thay kim tim thch hp v y np kim - t bm tim ln mm km theo phiu th test - Bo qun l thuc. 3. V tr tim - Cng tay: 1/3 trn mt trc trong, v tr ny thng th phn ng. - C b vai, c delta: tim phng. 4. K thut tim - Mang gng (nu cn). - Cho bnh nhn nm t th thch hp. - Phi by v tr tim.

St khun v tr tim t trong ra ngoi theo chiu xon c rng ra xung quanh khong 5cm. ui kh trong ng tim. St khun tay li. Tay khng thun ly mt sau cng tay cng da ni sp tim, tay thun cm bm tim nga mt vt ca kim ln trn v a kim vo lt mt da 10 150 cho ngp ht mt vt.

Hnh 1: Gc tim trong da

Ngn ci tay khng thun gi chui kim, tay thun bm thuc t t v nhn thy: Ni tim ni bng ht bp. Ni tim c mu hng chuyn sang trng. Ni da cam. Khi bm thuc vo c cm gic nght kim.

Hnh 2: Ni tim ni bng ht bp

Sau khi bm thuc xong, rt kim ra.

Ly bt v vng trn quanh ch tim ng knh 3 cm nh du theo di (ghi tn thuc, gi tim). Dn bnh nhn khng s gi ni tim, nu c du hiu bt thng, kh chu trong ngi hoc nga phi bo ngay. Ch 15 pht sau c kt qa. Tho gng tay. Kt qa: Kt qa c gi l m tnh khi ni tim khng thy g. Kt qa gi l dng tnh khi ni tim c mng ng knh rng hn 10mm v c km theo cc du hiu nh: Cm gic kh chu. Ni m ay. Chng mt, hoa mt, tai. Bun nn, xanh ti. i ma, vt v kh th phi bo bc s v ghi vo h s.

Trng hp nghi ng th phi th li bng nc ct vi tay kia i chng. BNG I CHNG THUC Khng t NC CT Khng Khng t KT QA Khng tim c Tim c Tim c

CCH PHA THUC TH PHN NG Loi 200.000 n v 500.000 n v Ln 1 Pha 2ml nc ct Pha 5ml nc ct Rt 1/10ml thuc dung dch 1 Ln 2 Pha vi 99/10m Rt l nc 1/10ml ct thuc Pha vi dung 99/10m dch 2 l nc Ln 3 Pha vi Rt 1/10 9/10ml = 10v nc ct em tim cho Pha vi bnh 9/10ml nhn nc ct

1.000.00 0 n v

Pha 10ml nc ct

ct Pha vi 99/10m l nc ct

Pha vi 9/10ml nc ct

Cp cu bnh nhn b phn ng vi thuc - Ty theo cc triu chng c th tng dn a n mch nhanh, huyt p tt, ngng tim, ngng th cn cp cu ngay. - Hnh ng iu dng: La to nhiu ngi n gip. Nu ang tim rt kim ra ngay. Nu bnh nhn ngng tim, ngng th lm h hp nhn to v xoa tim ngoi lng ngc. Tim Adrenalin theo phc chng chong. Bo bc s ngay. y xe cp cu n. Thc hin ngay ch nh cp cu. Cn cho ngi oxy.

V. DN DP DNG C
Ra sch v em i tit trng cc dng c cn thit. X l rc ng quy nh.

VI. GHI H S
Ngy gi tim thuc. Loi thuc tim. Liu lng. ng tim. Phn ng ca bnh nhn. K tn iu dng. Gch b gi tim vo phiu thuc v b phiu vo gi k tip.

VII. NHNG IM CN LU
Khng rt bm tim ra xem c mu khng?

Khng st khun li sau khi tim xong. 15 pht sau mi xem phn ng. Khng cho bnh nhn s ni tim. K thut hon ton v khun.

B. TIM DI DA I. MC CH
Tr bnh. Phng bnh. Tc dng ti ch.

II. TRNG HP P DNG

Gy t. Chng nga. iu tr ton thn.

III. DNG C
1. V khun - Bm tim tu theo lng thuc. - Kim tim di 2,5 3cm, s 24 26. - Thuc tu theo y lnh. - Hp ng gn c dung dch st khun (cn 700, cn iod 10/00). - Hp gn kh hoc gc kh - Km Kelly st khun da + bnh ng kim. 2. Sch - Mm - Phiu tim thuc - Ti giy - Dao ca (nu cn) - Gng tay (nu cn). - Hp ng vt bn nhn. Thng ng rc y t, rc sinh hot.

DDSK tay nhanh (clincare)

PHIU TIM THUC H tn bnh nhn: S phng: S ging: Thuc: -Tn thuc: -Hm lng: -Liu lng: -ng tim: Gi tim:

Tui:

Ngy thng nm iu dng thc hin

IV. TIN HNH K THUT

1. Chun b bnh nhn - Sau khi nhn c y lnh, iu dng mang khu trang n kim tra s phng, s ging, tn h bnh nhn - Bo v gii thch cho bnh nhn bit cng vic sp lm ng thi ng vin bnh nhn an tm. iu dng v phng lm vic ra tay v thc hin phiu tim thuc. Chun b dng c y ln xe tim v y xe n phng bnh nhn. Kim tra li s phng, s ging, tn h BN. 2. Chun b thuc - c nhn thuc ln 1. - St khun dao ca v u ng thuc. - Ca ng thuc. - St khun li ch ca. - B ng thuc bng gn hoc gc kh. - c nhn thuc ln 2.

Rt thuc: tay khng thun kp ng thuc bng ngn tr v gia, tay thun cm bm tim lp sn kim. Rt s lng thuc cn dng. c nhn thuc ln 3. B v thuc ht hoc bo qun thuc d ri em ct. t ng tim ln mm km phiu thuc.

3. V tr tim - C delta: phn cui c delta. - C i: 1/3 gia mt trc ngoi i. (ng ni t gai chu trc trn n u gi ) - C b vai - C thng bng 4. K thut tim - Mang gng (nu cn). - Cho bnh nhn nm, ngi theo t th thch hp. - Phi by v tr tim. - St khun v tr tim t trong ra ngoi theo chiu xon c rng khong 5cm. - St khun tay li. - ui kh ra khi bm tim. - Tay khng thun vo da ch tim. - Tay thun cm bm tim a kim vo chch 1 gc 300 - 450so vi mt da. - Tay khng thun tr li gi chui kim. - Tay thun ko nh nng xem c mu vo bm tim khng? Nu khng c mu l ng cn c mu phi m su hn hoc rt kim ra 1 t cho dn khi khng c mu mi tim. - Bm thuc t t v quan st nt mt bnh nhn. - Ht thuc rt kim nhanh ng thi dng km c gn cn n nh vng tim. - Gip bnh nhn li tin nghi. - Tho gng. - Thu dn dng c v phng lm vic.

V. DN DP DNG C
Ra sch v em i tit trng cc dng c cn thit. X l rc ng quy nh.

VI. GHI H S
Ngy gi tim. Tn thuc. Liu lng. ng tim. Phn ng ca bnh nhn (nu c). K tn iu dng. Gch gi tim vo phiu thuc v phiu thuc vo gi k tip.

VII. NHNG IM CN LU
Phng php phi hon ton v khun. Phi p dng 3 kim tra 5 i chiu trnh nhm ln cho bnh nhn. Lc no cng quan st bnh nhn trong lc tim. Thc hin 2 nhanh, 1 chm. 2 nhanh: m kim nhanh Rt kim nhanh. 1 chm: Bm thuc chm S dng gng tay nu v tr tim b nhim.

C. TIM BP I. MC CH
iu tr ton thn.

II. TRNG HP P DNG

Bnh nhn khng ung c. Thuc du, thuc sa, khng sinh, hormon

III. DNG C
1. V khun - Hp chng sc. - ng tim theo lng thuc. - Kim tim di 4,0 6,0cm, s 19 23. - Kim pha thuc. - Nc ct pha thuc (nu cn)

Thuc tim theo y lnh. Hp ng gn c dung dch st khun (cn 700, cn iod 10/00). Hp gn kh hoc gc kh Km Kelly st khun da + bnh ng kim.

2. Sch - Mm - Phiu tim thuc - Ti giy - Dao ca (nu cn) - Gng tay (nu cn) - Hp ng vt bn nhn. - Thng ng rc y t, rcsinh hot. - DDSK tay nhanh (clincare)

IV. K THUT TIN HNH

1. Chun b bnh nhn Ging nh tim di da nhng nu trng hp thuc c th test th xem kt qa th test m tnh mi tim c. 2. Chun b thuc Thuc ng: Ging nh tim di da. Thuc bt: Thc hin cch pha thuc bt nh sau - c nhn l thuc ln 1 - St khun dao ca - Khui nt l thuc - St khun nt cao su - St khun ng nc ct, b u ng nc ct - Dng bm tim lp kim pha thuc rt nc ct pha thuc * Rt nc pha ng: Ging nh rt thuc ng * Rt nc pha chai: Trc khi rt nc pha chai phi ko nng bm tim ly mt lng kh tng ng vi lng nc cn rt - Bm ht nc pha vo l thuc bt ng thi ko nng bm tim ly mt lng kh tng ng vi lng nc pha - Rt bm tim v kim ra khi l thuc - Lc u l thuc cho tan

c nhn thuc ln 2 Cm bm tim rt thuc: bm khng kh vo l thuc (lng kh tng ng vi lng thuc cn rt) ri rt s lng thuc cn tim c nhn thuc ln 3 Thay kim pha thuc bng kim tim thch hp v y np kim t bm tim ln mm km phiu thuc B l thuc ht hoc bo qun l thuc cn d v em ct.

3. V tr tim - C delta: cch vai 5cm - C vng i: 1/3 gia mt trc ngoi i (ng ni t gai chu trc trn n u gi). - C vng mng: Khong gia 1/3 trn ngoi mng. (ng ni t gai chu trc trn n xng cng ct) 1/4 trn ngoi mng.

Hnh 3: v tr tim trn ngoi mng

Hnh 4: v tr tim bp c delta

Hnh 5: v tr tim bp c vng i

Hnh 6: v tr tim bp c vng mng

4. K thut tim - Mang gng (nu cn) - Cho bnh nhn nm, ngi theo t th thch hp. - Phi by v tr tim. - St khun v tr tim t trong ra ngoi rng 5cm. - St khun tay li. - ui kh ra khi bm tim. - Tay khng thun cng da ni tim. - Tay thun cm bm tim a kim nhanh vo vng tim Tim bp nng: Kim hp vi da 1 gc 450 - 600 Tim bp su: Kim hp vi da 1 gc 900 v kim vo su khong 2/3.

Hnh 7: Gc tim bp nng v su

Tay khng thun tr li gi chui kim. Tay thun ko nh nng xem c mu vo bm tim khng? Nu khng c mu l ng cn c mu phi m su hn hoc rt kim ra 1 t cho n khi khng c mu mi tim. Bm thuc t t v quan st nt mt bnh nhn. Ht thuc rt kim nhanh ng thi dng km c gn cn n nh vng tim. Gip bnh nhn li tin nghi. Tho gng Thu dn dng c v phng lm vic.

V. DN DP DNG C
Ra sch v em i tit trng cc dng c cn thit.

X l rc ng quy nh.

VI. GHI H S
Ngy gi tim. Tn thuc. Liu lng. ng tim. Phn ng ca bnh nhn (nu c). K tn iu dng. Gch gi tim vo phiu thuc v phiu vo gi k tip.

VII. NHNG IM CN LU
p dng k thut v khun. Thuc tha phi c che bng gc v khun, dn bng keo ghi ngy, gi s dng thuc v hm lng (nu thuc pha) v c bo qun theo s ch dn ca nh bo ch. Khng c dng km b ng thuc. Khng m kim khi vng da st khun cn t cn cng nh khng dng gn tm cn qu nhiu n ln v tr tim khi rt kim ra. iu dng nn quan st vng da pht hin sm bnh nhn c b nhim trng ni tim khng? Nn thay i v tr tim nht l i vi thuc du. Khi tim thuc du nn tim su vo bp tht.

D. TIM TNH MCH I. MC CH

Tc dng nhanh trong trng hp cp cu. iu tr ton thn.

II. TRNG HP P DNG

Trong trng hp cp cu. Nhng thuc c tc dng nhanh nh: thuc t, thuc gy m, chng xut huyt.

Nhng thuc n mn cc m v c kh nng gy au, hoi t nu tim vo di da hay bp tht (Ouabain, thu ngn cyamin, calciclorua).

III. DNG C
1. V khun - Hp chng sc. - Bm tim tu theo lng thuc. - Kim tim di 2,5cm 3cm, s 20 25. - Kim rt thuc (nu cn). - Nc pha thuc (nu cn). - Thuc tim theo y lnh. - Hp ng gn c dung dch st khun (cn 700, cn iod 10/00). - Hp gn kh hoc gc kh - Km kelly + bnh km 2. Sch - Mm - Phiu tim thuc - Ti giy - Dao ca (nu cn) - Dy tht mch - Tm cao su nh (nu cn) - Gi nh k tay (nu cn) - Gng tay. - Hp ng vt bn nhn. - Thng ng rc y t, rc sinh hat. - DDSK tay nhanh (clincare)

IV. TIN HNH K THUT

1. Chun b bnh nhn Ging phn tim bp 2. Chun b thuc Ging nh tim bp 3. V tr tim

Tnh mch no cng c th tim c, thng tr con: tnh mch trn. ngi ln Tim tnh mch tay Khuu tay Lng bn tay C tay Cng tay Tnh mch chn Bn chn C chn

4. K thut tim - Mang gng. - Cho bnh nhn nm t th thoi mi. - Phi by v tr tim. - Chn tnh mch (to, r, thng, t di ng). - Lt tm cao su ni tim (nu cn). - K gi di ch tim (nu cn). - Ct dy tht mch pha trn cch ch tim 7-10cm. - Bo bnh nhn nm tay li. - St khun vng tim t trong ra ngoi theo chiu xon c rng khong 5cm. - St khun tay li. - ui kh ra khi bm tim. - Dng ngn ci tay khng thun ko cng da pha di ch tnh mch chn tim. - Tay thun cm bm tim nga mi vt ca kim ln, a qua da vo tnh mch kim chch 15 300 so vi mt da. Sau h thp bm tim ri lun kim ln dc tnh mch v vo su 2/3 kim. - Tay khng thun tr li gi chui kim. - Tay thun ko nh nng xem c mu vo bm tim khng? Nu c mu l ng, nu khng c mu th li kim ra mt t ri lun kim li n khi c mu mi tim. - M dy tht mch vo cho bnh nhn bung tay ra. - Bm thuc t t v quan st nt mt bnh nhn.

- Ht thuc rt kim nhanh ng thi dng km c gn cn n nh vng tim - Gip bnh nhn tin nghi - Tho gng - Thu dn dng c v phng lm vic * Lu : Nu trong khi tim bnh nhn ku au, ti ch tim phng ln th kim lch ra ngoi tnh mch phi iu chnh kim li hoc rt hn kim ra i sang v tr khc.

Hnh 8: K thut tim tnh mch

V. DN DP DNG C
Ra sch v em i tit trng cc dng c cn thit. X l rc ng quy nh.

VI. GHI H S
Ngy gi tim. Tn thuc. Liu lng. ng tim. Phn ng bnh nhn (nu c) K tn iu Dng. Gch gi tim vo phiu thuc, phiu thuc vo gi k tip.

VII. NHNG IM CN LU
K thut phi v khun. Phi chc chn kim vo tnh mch ri mi tim thuc vo cho bnh nhn. Thc hin bm thuc chm, quan st theo di v tr tim, nt mt bnh nhn.

TI LIU THAM KHO

iu dng c bn II B Y t - Nh xut bn y hc 2007 iu dng c bn II B Y t - Nh xut bn gio dc 2007