CHUONG 1: BENH NHAN NGO DOC 

I- NGO DOC  THUC AN

1-DINH NGHIA :  NDTA chi cac truong hop nhiem doc hoac  nhiem khuan cho thuc an gay ra .Thuc an co the bi nhiem khuan trong  qua trinh bao quan , pha che  hoac ban than thuc an chua doc chat

2-NGUYEN NHAN

-2.1-Thuc an bi nhiem doc

-kim loai nang , cac hoa chat huu co , thuoc diet contrung , vat hai ,cac chat phong xa ,alkyl thuy ngan

2.2-virus , vi khuan hoac nam moc co trong thuc pham,

-tu cau ., ly truc trung , phay khuan ta , vi trung song trong thit hop

-andenovirus , rota virus , norwarlk virus

2.3-cac chat doc co trong tu nhien

-ca doc duoc, nam doc , la ngon , ca doc ,mat ca tram ,..

-da coc , gan , trung coc chua chat doc bufotoxin gay roi loan nhip tim

2.4-su dap ung cua co the thay doi

-voi cac thuc pham chua tyramin (sua ), monosodium glutamat(bot ngot )

3-TRIEU CHUNG

-sau khi an uong thuc an bi nhiem doc ,cac trieu chung cap tinh xay ra sau vai phut ,vai gio 1 ngay ,tuy thuoc  nguyen nhan  gay nhgo doc , -

-benh nhan  thay buon non va non

+ dau bung

+ia chaynhhieu nuoc co khi co mau

+co the sot hoac khong

-cac trieu chung nang nguy hiem : dac biet  o nguoi cao tuoi va tre nho duoi 1 tuoi : mat nuoc, dien giai truy tim mach co the bi soc nhiem khuan

-cac dau hieu mat nuoc :dai it , nuoc tieu vang sam , kho mieng , khat nuoc ,truong hop nang khong co trieu chung khat

+da nhan nheo , do chun gian da giam

+mat trung sau ,

+mach nhanh , tho nhanh ,sau

+sot , met la ,co giat

4-XU TRI

-Neu benh nhan con tinh tao ,ngan chan chat doc vao mau bang cach : gay non , cho uong than hoat 20-30g, thuoc nhuan trang sorbitol20g

-chong mat nuoc va dien giai : uong oresol hoac cac dung dich thay the oresol, truyen cac dung dich dang truong

-cac bien phap khac :  tuy theo tinh trag cua  benh nhan

+rua da day khi luong chat doc nhieu

+cho uong thuoc kjhang doc khi biet ro doc chat

+Hoi suc tim mach , tuan hoan , hay ho hap neu cac chat doc gay ra suy ho hap , tuan hoan

II-NGO DOC THUOC  NGU

1- TRIEU CHUN G

-ngo doc thuoc ngu  thuong gap la ngo doc gardenan  ,thuong do tu tu hoac uong nham thuoc , uong qua lieu

1.1-Hon ,me

- muc do hon me ti le thuan voi  lieu luong thuoc da uong ,co the chia 4 giai doan tuong ung 4 muc do

+ Do 1: goi to con tr loi , nong do barbituric trog mau 20mg/l

++Do 2 : cau veo con dap ung dung , nong do barbituric trong mau 40mg/l

+Do 3 : Cau veo dap ung hon don , chua co roi  loan TKTV

+dO 4: cau veo khong con dap ung , roi loan TKTV  , roi loan ho hap ngung tho , truy mach , sot cao hoac ha than nhiet .Nong do barbituric trong mau 100mg/l

1.2-Roi loan ho hap

-Giam thog khi  phe nang do bi uc che trung tam ho hap

-tac ghen duong ho hap do hon me sau : tut luoi ve phia sau ,m u dong dom dai , hit phai dich da day ....

1.3-Roi loan tuan hoan

-tut huyet ap, truy mach

1.4-Roi loan dieu hoa than nhiet

-co the sot cao , co the ha than nhiet

1.5-Boi nhiem

-do u dong dom dai, xep phoi

-do loet muc

1.6-suy than cap tinh

-thieu nieu hoac vo nieu

-tang cao ure va creatininmau

2- BIEN CHUNG

-viem phoi , xep phoi , loet muc

-tac mach do huyet khoi

-suy than cap tinh do tieu co van

3-XU TRI

-3.1-Benh nhan tinh

-Rua da day bang nuoc co pha muoi 5g/l luongnuoc rua toi da la 10lit

-Bom than hoat 20g cach 2h /lan  cho den khi du 120g(tre em 1g/kg)vao da DAY

-bom thuoc nhuan trang sorbitol 1-2g/kg  chia 6 lan cung than hoat

3.2-Benh nhan hon me

-Dat NKQ truoc khi rua da day

-bop bong hoac tho may

-truyen dich nham thai tru chat doc qua duong tiet nieu 1 cah  cuong buc .luong dich truyen rat lon nen phai dua vao ap luc  tinh mach trung tam de trah gay phu phoi cap

+Natricolorua 9%0

+Glucose  5%

+natribicacbonat0 14%0 1-2mEq/kg

+Kali clorua pha vao moi chai dich (tru dich kiem )

-Lasix tiem tinh mach

-Dopamin  neu co tut huyet ap

-Loc mang bung hoac chay than nhan tao trong turong hop ngo doc nang 

-Dung khang sinh phoi hop khi co nhiem khuan

-Chong dong fraxiparin  ong 0.3ml tiem duoi da bung

-bao dam dinh duong  30.-40kcal /ngay

-Ve sinh chong loet

III-NGO DOC THUOC TRU SAU

1-NGO DOC THUOC TRU SAU PHOSPHO HUU CO

-Xuat hien trieu chung cuong cholin cap tinh bao gom

+benh nhan tuc nguc ,cam giac chen nguc , kho tho

+dau bung buon non , ia chay ,dai ia  khong tu chu

+ kham thay tinh trang suy ho hap ,long nguc kem di dong . ri rao phe nang giam co nhieu ral am , doi khi co ral rit

+co the thay nhip cham xoang ,giam dan truyen nhi that , roi loan nhip that

+ Dong tu co

-Hoi chung Nicotin

+giat co ,  may co , co cung , liet co bao gom ca ca co ho hap

+kich thich   he than kinh giao cam ,  da lanh ,xanh tai (do co mach )

+mach nhanh huyet ap tang

+va  mo hoi , gian dong tu

-Hoi chung than kinh TW

+lo lang , bon chon , roi loan y thuc , noi kho , that dieu , nhuoc co toan than .

+hon me , mat phan xa

+ngo doc nang : uc che trung tam ho hap va tuan hoan dan den suy ho hap , truy mach  , co  giat , hon me sau

2-NGO DOC THUOC TRU SAU CLO HUU CO