I - CHAM SOC BENH NHAN SOC:

1-DINH NGHIA:La tinh trang tut huyet ap va giam tuoi mau cac to chuc gay roi loan chuyen hoa te bao

2-TRIEU CHUNG

-Tut huyet ap

+huyet ap toi da duoi 90mmHg

+hoac huyet ap giam 30-40mmHg so voi  con so truoc khi co soc

-dau hieu  thieu oxi to chuc

+vat va  giay giua , lo mo do giam the tich tuan hoan  nao

+dai it ,. duoi   30ml/h

+dau chi lanh

3-PHAN LOAI

-Soc giam the tich mau

-so9c tim

-soc nhiem khuan

-soc phan ve

3.1-sOC  Giam The Tich Tuan Hoan

3.1.1-khai niem :la tinh trang soc giam dot ngot  the tich tuan hoan luu hanh , gay ra

+giam tuoi m au pham vi  te bao (thieu mau to chuc)

+gay roi loanchuyen hoa te bao

3.1.2-Nguyen Nhan

-chay mau n goai : dap nat co  , dut mach mau , gay xuong ho....

-chay mau trong : vo gan , lach , dap phoi , vet thuong sau chay mau da day ...

-tan mau cap tinh  do sot ret ac tinh , nhiem khuan cap tinh ,  ruyen nham nhom mau

-mat huyet tuong : cac truong hop bong rong

-benh cap cuu nhiem khuan . nhiem dic , khong duoc an uong

-ia chay cap tinh gay mat nuoc nang

 3.1.3-Trieu chung lam sang

-Do mat mau  : +chay mau ro nhu non ra mau , ia phan den , chay mau amdao . dut mach mau

+mach nhanh nho , huyet ap ha

+ap luc tinhmach trung tam ha

+chong mat ,u tai  , vat va, roi loan y thuc

+da niem mac nhot nhat ,dau goi co mang tim neu mat mau nhieu

+roi loan ho hap , tho nhanh , tim moi , dau chi

+khat nuoc . dai it .vo nieu

-Do mat huyet tuong

+ngoai cac trieu chung tren con co cac bieu hien cua roi loan nuoc , dien giai

3.1.4-Bien chung

-suy than cap tinh

-sung huyet  phoi hoac suy ho hap cap tinh tien trien

-suy tim

-hoai tu te bao gan

-tuy phu hoac hoai tu

-hoai tu cac tuyen noi  tiet ( tuyen yen )

3.1.5-Xu tri

-a- Noi khoa

+truyen dich : dung dich Glucose 55 ,Natriclorua 9%0, Ringerlactat, Natricacbonat 14%0(trong soc nhiem toan do mat HCO3), Haeseril

+Huyet tuong

+truyen mau

+thuoc : dopamin,dobutamin

-b-Ngoai khoa : giai quyet cac o chaymau : cat da day , khau gan , cat lach , khaum ach mau ...

3.2-SOC NHIEM KHUAN

3.2.1-Khai niem : la tinh trang soc gay nen thuong do cac noi doc to cac hop chat cau truc  vo vi khuan gram am

3.2.2-Nguyen nhan

-cac nhiem khuan khu tru hoac toan than hay gap do vi khuan gram am :

+duong tiet nieu : soi , cac thu thuat , phau thuat

+ tieu hoa : viem duongmat . viem ruot thua , phau thuat

+sinh duc : de, saythai , nao pha thai

+tinhmach : tuyen dich, tham do huyet dong

+da: viem . loet

-cac thu thuat  cap cuu

-cac truong hop nhiem khuan mau

-Co dia lam so the suy yeu

3.2.3-Trieu chung

-sot cao ret run , (co khi ha than nhiet )

-mach nhanh nho , huyet ap ha , ket. daodong

-mang tim o dau goi . ngontay

-chan tay lanh

-nuoc tieu it

-tho nhanh

-con y thuc , giay giua , lo au

-dau co , co khi co cung co ham \

3.2.4-Bien chung

-tan mau , ha duong mau , giam bach cau , suy  than xuat huyet tieu hoa , , phu phoi cap , roi loan dong mau ( hoi chung dong mau noi mach rai rac )

3.2.5-Xu tri

-Truyendich : haesteril ,cac dung dich caophan tu . , natriclorua9%0, glucose5%,  natricacbonat14%0, ringerlactat

-Truyen mau va cac che phamcua mau : albumin, plasma

-Thuoc : dopamin, dobutamin, adrenalin, noadrenalin,  corticoid. depersolon, solumedron

-Khang sinh :

+lua chonkhang sinh  tuy theo duong vao cua o nhiem khuan

+kho co ket qua kahng sinnh do se dieu chinh theo khang sinh do

-Cac bien phap khac

+Benh nhan hon me ; an qua sonde , dat sonde bang quang , thong khi nhan tao neuco suy ho hap ,tho oxy....

+xu tri o nhiem khuan : dan luu o mu , rut ong thong bang quang ....

3.3-SOC TIM

3.3.1-Khai niem :  la tinh trang soc  do suc bop co tim giam dan den luu luong tim giam ro ret (mac du the tich tuan hoan binh thuong ).muc do soc thuong ti le voi do giam chuc nang that trai

3.3.2-Nguyen nhan

-Nhoi mau co tim

-Chan thuong tim

-cac benh co tim

-ton thuong van tim cap tinh

-roi loan nhip tim

-tran dich mau  mang ngoai tim cap tinh

-nhoi mau phoi

3.3.3-Trieu chung

-huyet ap tut

-mach nhanh nho . khong deu

-loan nhip tim

-dai it

-Da xanh , tai ,lanh

-vat va, kich thich *(do thieu oxy nao )

3.3.4-Xu tri

-tho oxy , dat NKQ .tho may

-Dat catheter tinh mach trung tam

-chong dau nguc

- chong roi  loan nhip tim

-mot so thuoc thuong su dung

+natri nitripussit truyen tinh mach

+phentolamin truyen tinh mach

+Nitroglycerin

+dopamin

+Dobutamin

-Mot so bienphap khac : soc dien , choc thao dich mang ngoai tim

3.4-SOC PHAN VE

"3.4.1-nguyen nhan :

-Nhom 1- do vaccin , huyet thanh , thuoc khang sinh va cac loai thuoc khac

-Nhom 2- do noc con trung ( ong mat. ong vove ....)

-Nhom 3- do thuc pham dong vat , thuc vat

-Nhom 4- Do lanh

3.4.2-Trieu chung

-Dien bien nhe : + benh nhanlo lang so hai

+dau dau ,chongmat , buonnon

+man ngua ,phu quinke

+ho , kho tho

+ daubung,dai tien ,tieu tien khongtu  chu

+huyet ap giam nhe , nhip tim nhanh

-Dien bien trung binh

+benh nhan hot hoang, choang vang

+noi may day khap n guoi

+kho tho

+chay mau mui , da day

+da  tai nhot

+mah khong deu ,huyet ap giam ro ret

-Dien bien nang

: thuong xay ra trong phut dau tien  voi toc do chop nhoang , huyet ap khong do duoc , benh nhan hon me , ngat tho  , da tim tai , co giat , huyet ap khong do duoc va tu vong trong vai phut

3.4.3-Xu tri

-Tai cho : +ngung ngay duong tiep xuc voi di nguyen

+cho Bn nam tai cho

+thuoc adrenalin la thuoc co ban chong soc phan ve:

*Adrenalin ong 0.1mg/1ml tiem n gay duoi da khi co soc phan ve voi lieu 1/2 -1 ong cho nguoi lon

* khong qua 0.3ml o tre em  (ong 1ml +9ml nuoc cat = 10ml ) roi tiem 0.1ml/kg

* hoac adrenalin  0.01mg/kg cho ca tre em va nguoi lon

+tiep tuc tiem adrenalin lieu nhu tren 10-15 p/lan cho toi khi huyet ap tro ve binh thuong

+neu soc qua nang co the tiem duoi da adrenalin 1/10.000(pha loang  1/10) hoac qua tinhmach hoac bom qua NKQ hoac tiemqua mang nhan giap

+u am , nam dau thap , do huyet ap 10-15p/lan

-o noi co dieu kien ky thuat

+ chong suy ho hap : tho oxy, bop bong , dat NKQ goac MKQ

-truyen tinhmach cham aminophylin 1mg/kg/h hoac terbutalin

-truyen tinh mach adrenalin de duy tri huyet ap o muc do binh thuong , toc do dieuchinh theo huyet ap benh nhan co the tu 1-2mg/h

-cac thuoc khac : methylprenisolon 1-2mg/kg/4h

-truyen dung dich cao phan tu va natri clorua 9%0 toc do truyen dieu chinh theo ap luc tinh mach trung tam  binh thuong

-Diphehydramin 1mg/kg (hocac promethazin 0.5-1mg/kg)tiem bap haoc tiem TM

- Dieub tri phoi hop : uong than haot neu soc qua duong tieu hoa

+ bang ep phia tren cho tiemhoac duong vao cua noc doc