Tài liệu ôn tập cho kỳ thi tuyển viên chức ngành y tế năm 2017 giao trinh gay me gay te II flie 3 het

Truong Cao dang Ky thudt Y te jj JJ¢ man Gay me Hoi sue ~~~~.i"iMiAi~~r.7~'A;'-Zr,x.'~,~;':~I~.:c'1~~ffi'ir.~7:i~i~~~,;.~~w~~~,a~~:W~jo'E~~A~UTtcilri!ffl~~~~!f>tJ)liS1~;w;rr~~;i.;~I~~~~~'\!:~i Khi thai tir h~ thong me duoc n6i voi h~ thong hut trung tam vi tri g~n van giam ap tren dirong tho d§ tranh nguy co nhicm phong me, /(-$ B(J phdn lam izm va lam )rB(J phdn him am tha soat h6 hap may gay me: MC)tmay tho duoc g~n tnrc tiep VaG may gay me d§ ki§m soat ho h~p thay cho bop tay Trong tnrong hop can thi~t v~n co th§ chuyen sang chS dC)tv tho hoac bop tay voi bong du trfr V V~N HA.NH MAY GAY ME Chuan hi trtnrc sir dung may gay me o Ki§m tra binh voi soda, l~p binh cho kin, n~u voi khong dam bao ch~t luong phai thay voi, l~p cac 6ng d~n va 6ng noi, mat na cho vira khit, Ki§m tra t~t ca cac bong mern, bong ambu, dam bao khong bi thung, hu hong o Mo nguon oxy hoac nen o D?t cac chi s6 h6 h~pphu h9P vm th§ tr911gb~nhnhan thea chi diM cua bac S1 o V~n h~mhthu va ki§m tra xem h~ th6ng co kin khong o Ki§m tra cac binh thudc me va b6 sung n~u c~n o KiSm tra t~t ca cac d\lng C\l, phuong tic;n d6 d~t nQi khf quan, gay te vlmg, thu6c gay me, thu6c h6i suc, dich truy@n, bam tiem, catheter t~t ca dSu phai duQ'c chu~n bi s~n sang tren may gay me V~n hanh o B~t cong t~c ho?t dC)ngcua may o Mo diSu chinh lUll lU9'11gk~ oxy d§ cho b~nh nhan tho o Mo tu tu cac num diSu khi§n thu6c me b6c hoi dS gay me cho b~nh nhan Trong qua trinh gay me c~n: + Theo d6i b~nh nhan v@dC)me (d§ b6 sung thu6c) va cac tri~u chUng sinh t6n d§ co th§ c~p Clmkip thai nhUng tai bi€n co th~ xay + Theo d6i ho hap cua b~nh nhan d§ cho b~nh nhan ch~ d9 tV'tho ho?c h6 trQ',di@u l:~i~n h6 h~p cho tUng b~nh nh8.n va chi dinh cua bac sy gay o Khi me -cuQc:rrie-s·~p·kSftEuc ho~c- Y l1.i·h~rih-riliarico ·tarbT~n~ t~i-tnli6cineh~I1g each: khoa cac 11um diSu chlnh thu6c ho?c kh6 lUll luqng ke thu6c me (n€u Ia thu6c me khi) truac ngLmg ph§u thu~t ~!!~.F~l-1U7iii:; m,'OOC'"i! ~~~1iiii"""!1i7~.;nn1;lIIJmli.'l!r."'J.6~~~.\~4:n/W'r."iU;.,!iO :AI;(!i_;~i)t!rlU',r:ll 'ilJ,'.!!l.:.~'~~u,~I.l1~a~~l(U'.n;;r/t'-;Of~"-~.301l~an.:.a.~~!lII=!iIt~~!~ Gi60 trinhGNj(rTCB 1- Cao- dtllig-CM p()~~-65· Tnrong Cao aang 1\'y tttuat I te U lYV rrcc/r c V("IY rris: UV' L>L'''_ •.ilY.Elr"M.!ifflfll~~&':~I1ZZ::fimiR~~lllii~_'ii."""_~~"-~~1~~~!a.·.aw,~ ~~~~I!l"'iii:iiti='il:u~~~.Q.~i:'.':T.-li&>riiiiii~i~~i~~Ol'~.;u:Ql "4ij~W , ,rvs ) v J _."I\ " a tho quan h';1"'I'h 1"'Ih U~il11 1,1.11 "1"'1 J.l L11' L : yy,";" 111U) hoac c.; .11 th'; tll' l.11V ~ nhien tuiJ 1.11 J.'-'.11 f l t,', ,.,n h,;.,.,h nh.Jn L.t :.J l6 UVIJ l.l !1J.J.'~J ?v \0 ' giai doan thoat me o T~t may sau sir dung, BANG KIEM TRU'OC KHI SIT DlJNG MAy GAY ME Cam di~n bat nguon t~t ca cac may N6i nguon oxy veri may gay me Ki~m tra d~ ch~c rang binh oxy d~y Kiern tra d~ chac ring van an toan bao dong ap lire oxy xuong th~p Ki~m tra d~ chac rang chat hap thu CO2 chua bi bao hoa Ki~m tra hru luong k€ va binh b6c hoi Ki~m tra d~ chac ring h~ thong me khong ro ri Kiem tra t~t ca cac duong n6i voi nguon va h~ thong bong tho lai duoc n6i chinh xac Xac dinh cac van mc)t chiSu ho~t dQng t6t 10 Xac dinh khong co mui l~ thO'vao 11 Ki~m tra h~ th6ng hut thai ho~t dQng 12 Chu~n hoa phan tfc.hn6ng at? oxy 13 Ki~m tra may thong ho~t dQng 14 I(i~m tra h~ th6ng may hut ho~t dQng 15 B?t may, d~t cac thong s6 cho may va dli d~t cac bao dQng cho may me va may thea d6i VI BAO QUAN TRANG THIET Bl SA U KHI GAY ME N€u khong co sv ki~m ira va bao qmln thuemg xuyen cling nhu utah ky cae phuang ti~n, dt,mg Cl,l gay me thi vi~c gay me se tra nen nguy hi~m, kho khan va co th~ khong thlJc hi~n duQ'c Nguai gay me phai chiu trach nhi~m ki~m quan cac may moc thiSt Lra va bao bi gay me rna minh dang su dVng MQt s6 bi~n phap bao quan phuong ti~n, d\1ng C\l nhu sau: Sau gay me t~t t~t ca cae khoa ap llJc cua cae binh nen, v~n nut lUll lugng kS y~ l11Crczero,thao rqi cae day d~n oxy~N20 kh6i binhnen _ Binh b6c hai: Khoa c~n diSu ehinh vS mue zero Thao, db ether kh6i binh, binh b6c hoi c~n dUQ'esue rua bing dung dich thu6e me b6c hai sau tu§.n khong stf dVng ho~c thu6e binh aa dbi mau ~~?~~~~!~!.!H:.~~';!~ a-~~~~~~~~~~E~~?_~~~~~~~~-:~?~~~~~~~.iL'.,W'?t~~~K'~~"!!~~~~~~:?§E~~~~(1.';(m:r.l Giao tr2nh G]ldGTCB J- Cao ()ilin,?;Glv! Page 66 Truong Cao dang KjJ thudt Y te Il Bo man Gay me Hoi SLC'C ~icil~.ciUt.~"ir ;-,;.:. m:£'!:~a~-f/:-i:~~~~{~~;i,iirM;i'f£i;i~~~~~;mi;'.i~jj!,r.;:i~:JWT,zE~~j~mLi~~'ia;mw;-~',J·~~"lilTt ';'I~~~ :iF-fiii&~~~e~~i"~~~ n0 _ rrmn ky iau ' 1 " CJ1Ul , ' J l' u\lng cu may moe oang cae cung Glen SaTknuan, lam sacn'/ r i , t ' t , 11 /'- bui b~n khoi h~ thong _ Cac 6ng cao su (ch~t deo) va cac be)ph?il khac cua dirong tho phai dtroc thao roi ra, ngam VaGdung dich cloramin 2-3 gio, sau nra mroc 2l§n va phai kho _ N~u benh nhan mac benh truyen nhiem phai ngarn VaG dung dich formol 2-3 gio, sau d6 fila sach va phai kho _ Cac 6ng b9 phan kim loai, thuy tinh phai nra bang nuoc xa phong r6i xa mroc, phai kho - Binh voi soda neu h~t tac dung phai thay - D6 mroc a b~y nuoc duong d~n Ki@m tra cac be) ph?n nhu day d~n, b6ng, van n~u c6 hong, thung thi d§ nghi thay, sua chua _ D6ng h6 ap lvc luu luqng k~ n~u chi sai c~n phai bao sua kip thai truac dLmg l~n sau so SANH MAy GAY ME HI~N D~I Val MAy GAY ME CO BIEN )0> Giang nhau: V§ nguyen tftc du ~o va me)t s6 be)ph?il tuang d6i gi6ng )0> Khac nhau: May gay me hi~n May gay d~i I me c6 dien -~ _ ~ ~ + C6 h~ thong bao de)ng xay nhfrng - Khong c6 may tha nen khong Lim b~t thuang tren b~nh nhan cung nhu tren ho h~p nhan t~o duqc 11lay moc - Khung co pin til! tru + C6 may tha nen lam ho h~p nhan ~o duqc - Khong danh gia duqc Vt + N6 c6 th@ cai duqc cae thong s6: liE, Vt, - Danh gia ouqc n6ng 09 thu6e me it ehinh xac Peep - C6 pin dv trfr nen c6 th@su dvng m~t di~n - Danh gia n6ng 09 thu6c me eho chfnh xac - ~6 th~_giin kSt v6i monitoring h~nh nhan ., ' ' , dS theo d6i I - i _' '_" _:I !,:y!~~~E:~~?~~~~2e-~~~'~~~.::::.:~~~l~~¥~'3!!~~~~~"!l~~'~~ml1!~J.M_~71i(llJf3JiMGJWIi~~rJillJilliirif:lrIm~~~~ GZllO trlnh Glv[GTCB J.- Cao ddng GA1 Page 67 J' Lruong Lao.aang Ay rnU(ll I te 11 mti~~!'llJ~1.~!\filJi?i119.t!!P-!~t~lli;:t!M~"l'~e.lJ'1'1i!m,gr.::.'::,~!4.~'1i~~,;.i7Ui.'!J',X!.\.,!,.5.!lI!;,'3$:l'~~'»"'l'1I'UI~"tl1y ''','-' ~'' uv~'- .'tO!~~~oiUf.-~~~i~i-~jo~~ Paze ,OJ 68 B9 mon Gay me Hoi sue Truong Cao aang K_vthudt Y te 11 ,.",:.m~,;;;~~",""""",~",.m:~""''':'>iiiii?~%;''''',,,,,,~~'''~mii\.mi'i~~.iirei'.:~.W; ~~5ii.-:r·"',,=""""~~7cE~§~'''''''~ r> ~ r-< ;;._ n.iL, TlrP llL • "TYlfTA.11! T"" ,r-; ~ "'1\./ i n v nu \J l-i I M'-A k-/nl·Q'\\.,· ,~'r::; 1.in - ~ L.";, ,,1 (V3Ll3liJ '11 r.\oclI· Gill HuC' , r Muc tieu hili hoc: ' (,-j-.~ i H Nhucc diem: o C6 th~ gay Uti than ll(~U binh voi soda hoat dong kern o Tang than nhiet neu gay me a moi truong c6 than nhiet cao III PHAN LO~I H~ THONG GAY ME THEO QUAN NI~M HltN NAY Theo quan niem hien nguoi ta gioi thieu mot s6 h~ thong gay me nhir sau: H~ thBng bam me Trong h~ thong nay, me va tho duoc th5i hay phun qua m~t na cua benh nhan, y Uu tlidm: o Don gian, sire can it >- Nhuoc ilidm: o Lang phi me o Khong lam h6 hap h6 tro hoac chi huy duoc o N6ng dQthu6c me khong 6n dinh, khong di§u chinh duoc tho vao, o Gay nhiern moi tnrong Gay me nho giQt mo' (gay me mask hY) o Thuc chat cua phuong phap la gay me h~ th6ng o Uu va nhuQ'c di~m gi6ng nhu gay me h~ th6ng Cae h~thBng gay me ooi hoi hfU hfgng cao Trong cac h~ th6ng ki§u mlY, vi~c lo~i tru CO2 d~t duQ'Cla nha cac 16 thong vai quy~n (qua van tha ho~c khe h~ th6ng) va Sl.l' d~y dli luu lUQ'ng khf maio Chi khoang ch§t th~p, ltru luqng m6i du m6i co kha nang c1a,m Q~Q_vi~~.lo~itry CQ2 3.1 H~ th6ng Maplepson (MagHO Duqc Mapleson mo ta 1954:, h~ th6ng khong co cac van illQt chi~u nen kh6ng k11i tn,.rcti~p van va khoi b~nh nhan -(_;;;;;;·trinh -GJvfGTCB -1- Ca;{1dng-(~vJ . -. -.-. . . -. . -}~;~g,~ 7i- i:".lrr~c~~1!:!Pfu~1N't.:.,!1S!l1.'J~~~'''t.3\';C11.'~;ltij_i;~Ii{i~im'E"""lW~~~~!:i~~~~i;:~o.~i:~1i!i.i:r;:Tr.7.ti.i1::~i?(~~~;i:t]~~~'i~~~~:~~.;:m;r~~E!!.~:'·~~·~1f'~~'~~l~~-£i.:.!EP~.E!-~~;;?.':~_JfgL.~~~'~~"'!:i!!:~Ir~~ wr.D!~'!!i."'oiI!~.! Giil~ tfinh GlllfGTCBJ- Cao aimg GAl Page 87 t, It r te u hien b6i phu mroc di~n giai, thang bang kiern toan 3.2 Phfiu thu~t co chuan b] (rnf k~ hoach) Cac ph~u thuat co thai gian dS chuan bi benh nhan tnroc mo, giup benh nhan a trang thai t6t nhit tren ca hai phuong dien tinh than va co thS S\I cong cua ph~u thuat mot phan nho vao sir chuan bi benh nhan wac m6 va n~u chuan bi t6t co th~d6i kip thai nhirng tai bi~n co thS xay va sau m6 Hien nguoi ta c6 gang dira nhieu ph~u thuat truce la c~p ciru hoac cAp elm tri hoan phau thuat co chuan bi nhir c~t tui mat, soi mat, sci nieu quan dS dam bao m9t cuOc m6 an to an va ho~mthi~n han H cAe BTJOC CHUAN BJ B~NH NHAN f)6i vai cac truOng hgp me, co kS hO';1chb~nh 11ha11c~n dugc kham toan di~n ti mi, l~n lUQi tUng co quan Quan h~giU'a th~y thuSe va b~nh nhan Klli phjl1 thll~t ail c{) chi dinh tIll quan h9 gifi'a thfty thu6c va bc;nh nhfm dugc d~t fa mOt cach nghiem tuc B~ng sv giaj thich, th~y thu6c phai t';10cho b~nh nhan rnOt long tin, N6i chuy~n v~ diSn ti@ncUQC 1116,cach dung d§n lUll, 6ng n(_)i quan mOt cach chi ti@tdS b~nh nhan hi~u 1'6ttl' d6 vi;itnay t6t hon v€ tam 1y cling nhu sinh co th~ chAp nh~n nhfrng lY Nhfrng kinh nghi~m cua l~n m6 trmSc, thai ky h6i tinh duQ'c nh~c 10i d§ tr2n an b~nh nhal1 them D6i v6i nhfrng phliu thu~t lam thay d6i hinh d';lng a d~u, cb, VU, co quan sinh d\lc, h~u mon nllan t;;l.O, ti@ura Quang h~u mon phai giai thich r6 va c~n 8;,1 d6ng y eua b~n}l nh3.n Cling c~n phiii n6i eho b~l111nhan bi~t nhung tai bi~n co th~ Page 88 Tnrong Cao cldng Ky thudt Y te If B(3man Gay me Hoi sue i.iiTil?Ji~iii"",.$,'S:riM~~m-;rem:~~}.~~.;(~-£:t'{ii~-m.c.r,1r«nlr~~~.iii"JJi~i~i~.;i.04.:::r;"~~~:Cbi.~:m-%i:n;r.iiiii:ilnl.~~~iii:"~~U;-~~~-iG~W~~~~'ll!s~~~n~;.i'")~ , xay 1L' kni " rno~ va'1nnung IL'II~' 1'010 ,., , L"I'L~ L~ KJlaD cua tum xy nau pnau 1'1 '-leUgiai tmCl1 UC ~T~ _ol~ ? benh nhan ro, tin tuong thi se hieu qua han mot tien me Kham b~nh nhan 2.1 Hoi b?nh - Ti~n sir benh noi khoa: + Benh tim mJl~h: Hoi tien sir dau nguc, nh6i rnau ca tim, loan nhip, benh ' • , v 12 r ~" ~ v ~ ?" ,v1'1({l van t1111,tang huyet ap, viem tac dong mach I;J)' Ccl' {tX'1L ttA ~ / nOf'l ,y /) -f, ~1.Ct c_ caW (2 • 1/ / CD / I4)cu· IJI fluW r (J + B~nh~p: TiSn sir hen, benh ph6i t~c man tinh, lao ph6i cii Ngoai ta c~n phai khai thac them G~ biSt benh nhan co cac benh khac kern theo nhir gan m~t (vi em gan virus B,C), tieu hoa (loet d:;t day ta trang), tiSt ni~u; b~nh (;'LIU~)([dl ntn-? ) th~n kinh (ti§n su G9ng kinh, tai biSn m:;tch mau nao ), n9i tiSt (buou c6, dai Guang ), b~nh h~ th6ng, s6t set, s6t cao ac tinh, porphyrin tit vll6i)f;~ i'LCtl) d~ll.b,f 13= I6:u AD;' ? - Ti~n su br?nhngoq.i khoa: TiJn_suph,du.thug,t, logj_p_h.4YJbug,t,cae bdn chUng, thai gian n~m h6i suc cua l~n m6 truoc - Ti~n su dt img: + Ca dia di ling voi thm tiSt, thuc + Di Ung thu6c: Di ling an, hoa ch~t, ph~ hoa, l6ngth~:'nhva latex khang sinh hQ Penicilin, thu6c te, thu6c me, giam dau, vaccin - 'j 'i~n suogia clinh: B¢nh If; vd mint, Porphyrin, hen phd quan, s6t cao ac tinh, b~nh v@ca - Cae thoi quen: Thu6c la, bia ru(yu, nghi¢n ho¢e su d~tng thu6c phi¢n - Ti~n su cld va clang dung va clang cldu trt thu6c: Truac m(3t b?nh nhan clZf m9t s6 th1l6c keo dai rna c~n phai m6 thi chung ta c~n can nh~c c~n th~n nen dung lo?i thu6c n~iOva c~n phai tri lo:;ti mio dva tren ca ch~ va thai gian bim huy .-.- ~~. -.~ ~~~gJ2_Si,i~~.~_,6c , + B~ih~nEan tang huySt ap (RA) dang di~uti'rthu~ ti~p t\lC ~E'! ho~c c~h~ giam li@~,,~,~tranh gay cucmg _. nhanl1, Jl&'1!P-~~~ tang tLt\ ho~c nh6i mau ca tim Cae thu6c ch~n(-adreiiegicrc~ri giao cam hIm nhip tim irc ch~ canxi (nifedipin, 'mti: ~~~~~.!'!~,!!.Ri:rtJ;r&~'~'~31:O'".lu& ~6'~1tl1?c.~a~ffiU'JY;rn~~mm.'16[iJ:}~~-paSfll;f :!.UiiMJ6\lri1il.,~~T" :lWJ~lli.~~~~~ Giao trinh G1I1GTCBI- Cao {]iing GlVl Page 89 t~ nicardipin) dung di~u t1'1 suy vanh can EA." C&nduy tri tnroc, va sau m6 c6 tac dung giam hau ganh + Cac thuoc uc ehS men ch~kn nen ngung tru6'c va manh cham khoi me Nh~t la benh nhan m6 24 gi~ uS tranh co thieu tut HA kh6i luong tu~n hoan hoac gay te song, + Thu6clstiJi~unen ng~:6'_G.JJl6._24_gia d~tranh giarn kh6i lUQ11g tuk hoan va m~t kali mau, -I- !i_§El tue dl1.y_ttid@ duong ~ ~illl_1l16 Cac thu[lc dieu tri dai_illLcmgJh~ufmg nen ngim~i£l:l'r,ii:'':;~'~1·i.ili;iJ.i~:;:;.p,1~;;iz-;U;ffi~;;;lii"r.:.s;:;~·~mii~i;?Fa ~i.m:tji.~-f,~fGrniOaiji~-;;·i~t;:iirt~.p 1iii:.-1::til~UiP',,~ • - ~." r/ien urn r (l::'" ,~'\ \.J._A_AJ r /" "'1 \ ,110 G1L ca ~'''.L 11"\ "L/' · '1" ocnn1 11113n tren OVtuoiA·l 110~Ccac oenn1 ruh"an co ' _,., r tien sir tim mach, cao huyet ap, lao phoi, loan nhip, dai duong, r&i loan nuoc dien giai d§ diSu chinh truce m6 4.2 Xet nghiem bJ sung thea b¢nh - Cac benh nhan mach v~mh: lam KG, X quang ph6i b~t buoc a moi J~a ? tu6i, sieu am tim " - - Cac benh nhan Pb6i~ Nhu ung thu, lao, hen phe quan phai ~h1!p~J2h9i, ~ £h~ quan, tharn chirc nang_hQ_b§p hoac chup - ~oi ii_o:mtim vi trung, phan trng -. n~u c~n thi chup c~t lap d~ eh~n doan, l~~ - Cac benh nhan gan mat, da day, dai trang v.v xet nghiem bilirll_QiI'l_, va n:Ll'