- Khi nghi ngd HC C.E.K phai cho benh nhan vao vien de theo doi hang gid Bat dong nep tam thd
2.CHAN DOAN BENH NHAN OA CHAN THUONG CO THUONG TON COT SONG
6 benh nhan da chan thtfdng, trtfdc het la phat hien va xii tri nguy cd de doa tinh mang. Can lo den:
A: Dtfdng thd B: Ho hap C: Tuan hoan
Khi co nguy cd toan than thi co them thtfdng tdn cot song la rat quan trong. Tuy nhien nhd hdi stfc cung cap du oxy va ttfdi mau nuoi to chtfc thi tuy song cung dtfdc ttfdi mau nuoi tot, dd bi thtfdng tdn tien trien.
M oi benh nhan da chan thtfdng deu co nguy cd thtfdng tdn cot song cd, c in tim cach phat hien va loai trtf.
Trong cap ctfu, c i n kham liet van dong va cam giac c$t song cd d i bi de doa
nhat trong tai nan. N eu thay co nghi ngd, can bat dong ngay c$t song cd: d$t vong nhtfa dm cd, gitf dau ngay n g ln gitfa cac tui cat. Khi bgnh nMn^uong rtfdu, khi da
cho thuoc giam dau thi kham cam giac dau se kh6. B$nh nh&n bi m £t 'frf'gific,
• Can ch u y trildc benh nh an da ch a n thUdng:
Khi kham, hoi benh nhan ndi dau, sd bo cd 2 ben ndi dau cang cting la co nghi ngd. Kham mat van dong, cam giac phan xa, ke ca ndi kho nhu cam giac quanh hau mon, trUdng luc cd that hau mon, phan xa da biu, phan xa hanh hang.
• K h i kh am tuy so n g ca n ch u y :
- Benh nhan co tri giac, kham d i dang
- Bi m at van don g tren C5, thUdng se gay suy ho hap
- Soc than kinh do thUdng ton tuy song bieu hien bang tut huyet ap, mach cham. - Xem la con tinh trang soc tuy, khi khong co phan xa hanh hang
- Kham va tien liidng se khong chac chan cho den khi soc tuy qua di - Phat hien co liet van dong, mat cam giac la nang, can dieu tri cap ctiu - B enh n h an m at tri giac, ben h nhan k h on g con g tac phai nghi ngd co thUdng ton cot song, ch o den khi dUdc loai trti.
- Bi thUdng ton tuy song se che dau cac thUdng ton khac d than minh va d chi. Chan doan X quang d cot song co, co 2 ndi hay bi thUdng ton nhat la mom nha C2 va than dot song C5-C6.
Chup co th in g , m uon ro mom nha can tu the ha mieng.
Chup co nghieng can lam lo doan co ngUc. Bong dai vai hay che lap ndi nay. Can chup tu the bdi trUdn hay chup CT. Chup CT tot khi benh nhan tinh, khong co trieu chting khong can nhat loai chup co, song d benh nhan da chan thUdng nen chup phim co de loai trti.
Khi X q u a n g thUdng da khu tru thUdng ton thi CT ph at hien ro cac nghi ngd. Vi du vdi X q u a n g thUdng co nghi ngd gay m om nha thi CT vdi lat cat 1m m se thay ro thUdng ton m om nha.
N goa i ra, co n g hUdng tti con lam ro ca u true p h an m em , cau true tu y son g, cho th ay ro ca c thUdng ton d a y ch a n g. T u y n h ien , d ben h n h a n da ch a n thUdng can m ay thd, ca n d a t n ep d chi, co m ay bdm tin h m a ch thi k h o n g the lam con g hUdng tti.
• Xti tri: Khi co dau hieu liet than kinh thi co chi dinh sau:
Keo nin cap ctiu cho cot song thing hang, dd bi chen ep tuy
Cho lieu cao Methylprednisolone khi bi chen ep re than kinh, chen ep duoi ngtia thi khong can dung thuoc nay.
Bi gay co cho keo ngay Halo vdi ta nang tang dan. Nen xem la cot song mat vting ve cd hoc khi bi gu tren 30° hoac bi lun dot song qua 50% be cao than dot.
Khi bi liet tuy, co g&ng mo sdm, giai ep va co dinh cot song. Nhat la doi vdi