MUC LUC BENH AN 1. Hanh chinh I, Hoi bénh 1. Ly do vio vign, 2. Bénh si = 3. Bénh tinh hign ta... 4. Tién sit - Céc yéu t6 nguy co - Cée thoi quen anh hung dn size khie UL Khim bénh.... a) Toan than... BY Cée 0 quan IV. Cée xét nghigm.... ms J. Xét nghiém huyét hge té bio ~ it woh Xét nghigm sinh héa mau. ‘Do chite ning phoi Xét nghiém huyét hoc déng mau... Xét nghigm vi sinh mién dich Xét nghigm vi sinh, vi khudin, Chup CTseanner - MRI - Angiography. Siéu am 6 bung een ahawn ‘Gi soi tai mai hong s Sigu am Doppler tim. Soi phé quan... | | | ‘Xt nghigm t& bio hoc 13. Bign tim niioleo V. Két lun 1, Tom tit bénh dn. 2. Chin dan. 3. Tién luong. 4, Theo doi — Dieu tr) CASE LAM SANGBENH AN Ma bénh dn: 220049550 I. Hanh chinh Ho tén: DOAN THIL Tudi: 65 Gigi tinh: Nv Dain toe: Kinh Naghé nghigp: Nong din Dia chi: Thon 6, Xa Son Tru’mg, Huyén Huong Son, Tinh Ha Tinh Negay vo vign: 10/11/2022 Il. Hoi bénh do vio vign ~ Ho kéo dai. nhigu dot ho kéo dai | nam, di bgnh vign chin dodn viém phé quan man tinh, ~ Khodng | thang (01/10-26/10) Bénh nhan ho khan, sau c6 dim tring trong, chi yéu vao chiéu tdi, kém sét cao (cao nhit 39°C), rét run, dau ngue phai, khong hd thé, khéng nén khéng budn nén, n kém, khéng sit edn, - Ngiy 27/10: Chuyén Bénh vign phdi Ha Tinh chan doan Xep phéi - bénh phéi ké, diéu trj khang sinh 2 tun (khOng r5 logi) kém nding cao thé trang. ~ Ngiy 09/11: Bénh nhén ho, dau ngye phai, st cao, mét méi, in ng kém, gay sut cn chuyén dén ‘Trung tim H6 hap Bénh vin Bach Mai gu tr tiép. - Hign tai, bénh nhan eft sdt duge 4 ngay, con ho khae dim tring trong. 3. Bénh tinh hign tai 9h ngay 16/11/2022 ~ Bénh nhan tinh, tigp xiic tt - Da niém mac hong ~ Bénh nbn cdn ho, dom it, tring, trong ~ Chua phat hign bat thudng 4, Tidn sir - Cac yéu 6 nguy co'- Céc théi quen anh hwéng dén site khée + Dj ting thude, thite an hoc cdc chit khéc: Chua phét hién. + Bain th ~ Vigm phé quan man tinh - Nghé nghiép: Nong dan, c6 nuéi ga vit, ché méo nhigu nim nay, khdng ¢6 tién sir tigp xtic voi khéi bui. ~ Khidng cé ri logn lipid mau, khong sir dung ma ty, rrgu bia, thude l khéng an man. ~ Khéng c6 tién sir COVID-19, da tiém 3 mai vaccine, mai gan nhét 4/2022, chong tiép xtc v6i nguiti mic lao. + Gia dinh: Chua phat hign bénh ly de bit. 1IM. Khim benh 1, Toan than (Nhin, sir, g6, nghe) Tink, tgp wie tét Da niém mac hong — Khéng cé déu higu thiéu mau * Ho nhiéu, khéng 06 hoi chimg khé this * Khong xuit huyét duréi da, khéng ving da, 06 hoi chimg nhiém tring + Khong sét + Khong 06 phi Hach ngoai vi khéng sumg dau + Tuyén gidp khong to in sO tim: 78 chu kj/phait + Nhigt d6: 37°C + Huy ip : 120/60 mmHg ‘+ Nhip thé: 18 lan/phit + SpO2: 100% (khi trisi) + BMI: 17,5 (Gay) + Kham mach mau: Mach ndy déu, 1, thanh mach mém, dn hoi tt 2. Cie eo quan = Tuan hod: + Tim nim léng ngye cn déi, tham gia nhip the 6 + Tim déu, sis mom tim dp 6 KLS V, dudng gitta don trdi, dign dap 1 x 1,5 m2 + Mau sic da binh thing, kh6ng xudt huyét duséi da, khéng twin hoan bing hé, khong phi +TL,T2 déu, 16, nhip tim déu: 78 chu ky/phiit, khong c6 tiéng théi bénh ly + Mach ngoai vi bit 16 Ho hap: + Lang ngue 2 bén edn déi, di dng theo nip thé, khéng eo trin Kh dudi da + HC déng dic (-), héi chimg suy hé hap cap (-) + Rale n6, rale am rai rac hai trrimg phdi = Tiéu hoa: + Bung mém, khong ching, di dng theo nip the io + Miu sfc da binh thudng, khéng c6 seo mé efi, khdng xuat huyét dui da, khéng tuan hoan bing hé, khéng cé trréng + Gan, lich khéng sir thay + An ving bung khéng dau +TM cé néi, phan hdi gan - TM c6 (-), Rung gan (-), Murphy (-) + Khdng 6 tiéng théi bit thug ¢ DMC bung, DM than hai bén. = Than, tiét nigu, sinh due: + HG than 2 bén khéng sung dau* Cham thin () , Bap bénh thin (2), Rung thin () + Khong cé cau bang quang + Khéng 06 diém dau nigu quan, trén, gita 2 bén + Khong c6 si Than kink; + Bénh nhéin tinh, tgp xic tt + Khéng c6 dau higu than kinh khu tri + Giy cimg (-), Kemig (), Vach ming bung (-) + Coxncong khép: * Cokhéng teo, xuong khép khéng bién dang + Van dng trong gigi han binh thuromg -Khée + Tai, mii, hong 4 ie par Chua phat hign bat +Noi tis, dinh dung Daas, vi céc bn Iy Khe(an IV. Cée xét nghigm 1. Xe huyét hoc té bi Két qua Yeu clu xét nghigm — ——_|_Kholng | on vj a —__[n22 | istivanz2 | oe ie Tong phiin tich té bao mau ngogi vi (bing may aém laser) | RBC ($6 luong hong cau) 437 [sas] as-s9 | Tm HGB (Hemoglobin) | 0 Sato 135-175 | gL HT (Hematocrit) 0408 [033 oat-os3 | La | MCV (Thétich trang binh HC) | 93.4 gs | 80-100 | © MCH (Lyng HGB. ‘trung binh HC) 29.7 29.3 26-34 ps HEC Mig ac trungbinh | 5,9 aap | 315-368 " Z| pcr em kich thie - = 10-15 a NRBC¢# (Sé lung HC cé nan) 0.0 0.0 GL PLT (S6 luong tiéu céu) 489) 310 150-400 | G/L MPV (Thé tich trung binh TC) 68 89 5-20 fL WBC (S6 lung bach cau) 88 11.69] 40-100 | GL YEUT% (Ty 16 % BC trung tinh) | 59.4 79.1| 45-15 | % 30% (Ty 1é % BC wa acid) 49 32 0-8 % 3ASO% (Ty Ié % BC ua base) 06 03 0-1 % AONO% (Ty 16 % BC mono) 62 39 0-8 % YM% (Ty 18 % BC lympho) 289 |12.9 25-45 | % IEUT# (Sé lugng BC trung tinh) 52 932| 1875 | GL (OH (Sé Iuong BC wa acid) 04 037 008 =| GL ‘ASO# (S6 ltngng BC wa base) 0 0.03 001 | GL {ONO# (S6 lung BC mono) os 0.46 oos | GLi toas | Gu ‘| o — —__—____.. ° GL LUC% (TY Ie % BC lin khong esis | ma) ee a) a % | oer | Té bio bét thug 7 : 5 Te bao kich thich 0 0 fz 2, Xétmghiém sinh héa miu srr] Yet et nghien Kétqua xét nghigm | Khodng tham | Don vi roniaen2|isivzo2| ‘Sinh héa 1 | Dinh lugng Glucose (*) 52 S/P(fasting): | amoVL 41-59 2. | Dinh lung Creatinin (*) 65 56 58-96 | pmol/L 3. | Bo hoat dg AST (GOT) (*) 28 7 <35 UL Do hogt dg ALT (GPT) (*) | _ 34 15 <35 UL ‘Dinh lugng CRP.bs (C- 5. | Reactive Protein high 449} 11.06, <0.5 | mg/dL sesitivity) (*) ign gid 6 | Dign giai ad (Na, K, C1) (*) Natri 138 138 136-146 | mmol/L Kali (P) 44 37 34-45 | mmol/L Clo 102 102 101-109 | mmol/L. Mign dich | Pinh beans ‘Troponin T hs aa ea wt “ 5. Do chire ning phbi (10/11/2022) Results Pred Pre “Prd sve (ly 2.22 1 68 16% FVC (L) 19 86% FEVI (L) *1.69 1.28 16% FEVI/FVC 0.76 | 0.67 89% FEVO(L) 2.26 1.89 uh FEF25-75% (Us) e 0.88 50% | | ven : is fi i ica ie PEFR (Us) 499 12.24 45% i Exp time (8) 671 : FIVC(L) 222 0.88 40% FIVI (L) 0.61 ie FIVI/FIVC 0.69 Insp time (8) 19 Kétludn: Réi loan thong Khi tic nghén mite 46 trang binh. 4, Xét nghigm huvét hoe déng miu stt| Yéu clu xét nghigm eee Kholtg =| Son vi 11/11/2022 | 15/11/2022) tham chiéu 1, | Thai gian prothrombin (PT: Prothrombin Time), (Cae t@n khée Prothrombin) bing may ty dng PT) 2 giay PT (%) 100 7-140 | % PT-INR 1.00 085-12 2. | Binh lugng D - Dimer 2.148] 24125] <048 | me/ FEU-_ ae §. XéLamahidin vi sinh mid dich (11/11/2022) Ten xét nghigm Ket qui | HIV Ag/Ab mién dich ty dong? | Am tinh 6. Xét nghigm vi sinh, vi khufin (15/11/2022) ‘Ten xét nghigm Influenza virus A, B test nhanh Dengue virus NSIAg Loai bénh phim Yéu clu VS Két qua | AFB tryc tiép nhugm Ziehl - Nelsen | Am tinh Dich phé quan iv nm soi tuoi Chua thay vi nam Vikiwin mdi cy vad dan | gh thong ty dong ‘AFB truc tiép nhudm Ziehl - Neelsen | Am tinh Vi ndm soi tuoi Chua thdy vi nm om ae i F Clu khudn Gram(+) xép ‘Vi khudn nhugm soi 46i, xép day: 2(+) Bach cau da nhan: (++) 7, Chup CT scanner - MRI - Angiography (10/11/2022) Phai hai bén: céc dam, nét t6n thuong dng dic, tgo hang lan toa nhu m6 phoi hai bén, wu thé thiyy trén nhu mé phdi. Khong thay gifin phé quan - phé nang. ‘Mang phi hai bén: khéng thay day bat thuimg, Khoang mang phdi hai bén: kh6ng thay dich - Kh. Trung tht cin déi. Khéng thay hach to hay khdi chodn ch6 trong trung that. ‘Xwong va phan mém thanh ngye khdng thiy hinh dnh bat thutmg. 41 luén: Hinh anh céc dam, nét tén thuong dang déng dc, tao hang nhu mo phdi hai bén - theo doi viém phdi. L aeons. eeeu dm 4 bung (10/11/2022) hong to, nhu mé gan du, khé thay khdi khu tri. + huyét khdi Dug mt: trong gan khong Khong 06 s6i. OMC khéng gain. ‘Tiii mt: thanh day binh thuémg, dich mat trong, khdng c6 séi. Ty kich thuée binh thumg, nhu mé tuy déu, dng tuy khéng gin. Lach: khéng to, nhu mé déu, ‘Than phi ‘ch thurde binh thurimg, nhu mé diy va déu binh thudng, Dai bé thin khéng gin, khéng c6 séi. Nigu quin khong gin. Than trdis kich thude binh thumg, nhu m6 1/3 gitta o6 nang duéng kinh 19mm. Dai bé thn khing gin, Khdng c6 s6i. Nigu quan khéng gin, Bang quan; thnh nhin déu, nude tiéu trong, khéng 06 s6i, Tet cung nhé theo tubi. Khéng 6 dich ty do 6 bung. Kétiudn: inh anh nang thén ti 9. NGi soi tai mai hong (10/11/2022) Tai: Ong tai hai bén sgch, ming nbi hai bén binh thudng. ‘Mii: Cudn mii hai bén binh thudng, khe va san miii hai bén sgch, ‘Vom: Nhiin, sach, cfin d6i jiém mac né dd. vy thanh hai bén nbn, di dOng binh thing, Chdn dodn: Viém hong cap. 10, Siéu im Doppler tim (10/11/2022) Kétluén: Kich thude va chite nang tim thu that tri trong gidi hgn binh thuéng Hé cht nhe, 1 Soi phé quim (11/11/2022) Phé quan trai: Gée trai Binh thuong Dinh trai Dich mo ling phé quan Diy tri Binh thuimg Phé quan phai: Géc phai Binh thudng Dinh phai Binh thuomg Gitta phai Dich mi long phé quan Diy phai Binh thuong Két ludn: C6 dich mii trong Tong phé quan 2 bén. Long phé quan 2 bén théng thong. 82,Xét nghiém té bao hoe (11/11/2022) (Mau bénh phim: Dich rica phé quén) ~ Phién dé thay nhiéu té bao biéu m6 try phé quiin nhiin nhé, déu link tinh, xen ké dai thye bao va nhiéu bach cdu da nhan trung tinh chua thodi héa. ~ Khong thi Kétludn: Dich viém cép. 13.Dign tim nao/co (10/11/2022) Kétluén: Dign tim binh thuong V. Két lugn 1, Tém tit bénh an - Bénh nhan nt, 65 tudi vio vign vi ho kéo dai, Qua hdi va khim thay bgnh nha 6 tién str Viém phé quan man tinh, Mot thing gin day, bénh nhin ho kéo dai, dom tring trong, dau ngye phai, sét cao, rét run chuyén tuyén 2 chan do’in Xep phdi - Bénh phdi ké va diéu tri khding sinh (kh6ng 16 logi) 2 tuan thi trigu chimg c6 gidm, nh§p vign Bach Mai ngiy 09/11/2022 tiép tye diéu tri. - Bénh dién bién véi céc trigu chimg va héi chimg sau: + Hi ching nhiém khudn (+) + Rales né, rale 4m rai réc hai trudmg phoi 4+ Trigu hig viém phdi khéng dién hinh = Xét nghigm: + XN vi khuan nhudm soi dom : +XN vi sinh min dich (Influenza virus A,B test nhanh): Am tinh Am tinh Am tinh Khang phat hign Gram (+) (4) 4+ XN Dengue virus NSIAg: + XN AEB Ziehl - Neelsen: + XN vi ndm soi tuoi: jém phoi dp xe hoa nghi lao + Bénh mac kém: Viém phé quén man tinh, Gidn phé quan, Vim hong cap at ill 3. Tin long Dé dit4. Theo doi ~ Didu tr} Nady Theo dai nh nin tinh, khong sé = Chim sée ep 2 ~Panigm mac hing oa cana ~ Ho c6 dim, so Iugng it - Theo doi mach, huyét dp, nhigt 46 toa “tim déu, T1T200 ee eee aaa ~ Phdi théng khi r3, rale né ran Thude: 4m rai rac 2 trudmg phéi Ceftazidime Gerda (Truyén tinh mach) 10/11 J-Byng mém Pha véi NaCl, test mii ddu, 18h: Khang ~ Gan lich khong sé thay sinh beta-lactam nhém Cephalosporin ~ Dai tiéu tign binh thudng. Sodium cloride (Thudc pha truyén) z ein mmHg Ding pha véi Ceftazidime es Pp Medovent (Vién uéng) = $pO2: 100% (khi tr) Biel oe ba ae caked atin - Bénh nhén tinh, khéng sét, = Chim sée cdp 2 khéng khé th = Com ty tic - Tim déu Thu - Phdi rale né rai rie Ceftazidime 1.13/11) "Bung mem Sodium cloride ~ HA: 120/60 mmlg Medovent =M: 80 lip Vinphaeine (Truyén tinh mach) Khang sinh nhém Aminoglycosid, phéi hop ting tic dung Ceftazidime Gerda - Bénh nhan tinh, khéng sét, - Cham séc clip 2 Kh6ng khé thé - Com ty tic - Bénh nhan dau ving man thinh | Thud ngye mgn suén phai Ceftazidime Gerda 14/11 |. Tim déu Sodium cloride - Phdi rale né rai ric ‘inphacine - Bung mém, khéng chung Partamol (Vién ung khi dau) Giim dau, ha sot - Bénh nhan tinh, s6t cao (cao | - Chim s6e cap 2 nhat 39°C), khéng khé tho - Com ty tiie - Bénh nhén dau nguc phai, dau Thude: viing man sun phai ting khi | Ceftazidime Gerda thay ddi tu thé VAS 7/10 Sodium cloride 51 | - Tim déu Vinphacine - Phi rale n6 2 bén, RRPN gidm | Partamol bén phai Chiu sit eao, bé sung: - Bung mém, khong chuéng Paracetamol Kabi (Truyén tinh mach) - HA: 130/80 mmHg Ha sot, gidm dau -M: 100 Up 1016/11 ~ Bénh nhan tinh, sdt cao (cao nhat 39°C, khéng khé thor ~ Bénh nhan dau man suén phai, dau ngue phai, dau nhiéu -Timdéu = Ph6i rale né rai ric, ri rao phé nang gidm bén phai - Bung mém, khéng chung - HA: 130/80 mmHg : 100 ip = SpO2: 93% (kh tri) = Sigu am: : Tran dich mang phdi phai ~ Cham sée cp 2 = Com ty tie ~ Thé oxy kinh 31ip cloride (Thudc pha truyén) Bi nude - dign gi Medovent Paracetamol Kabi ‘Tienam (Truyén tinh mach) Khang sinh loai beta-lactam nhom CarbapenCASE LAM SANG (khong 1 loai) 2 tuan thi trigu ching giém 9/11/2022 tiép tue digu tri. Qua héi va thaim kh chimg nhap vién Bach Mai nj vim thay bénh nhin cé cdc trigu + BN tinh, tiép xie tt, da niém mac hong + Ho nbiéu, dau man sum phai, khong tim, khong c6 HC khé thé + Khong c6 phi, thin nhigt én dinh, khong xuét huyét dudi da, Khong vang da, 6 HCNT, hach ngoai vi khong to, tuyén gidp khéng si thdy + Gan, lich kh xéc din + Tan s6 tim : 78 chu ky/phit + Nhigt d6 : 37°C + Huyét dp : 120/60 mmHg + Nhip tho: 18 1an/phit + BME 17,5 (Gay) + Khém mgch méu: Mach nay déu, 19, thanh mach mém, dan héi Sau khi nhap vign Bach Mai, bénh nhan da duuge thye hign: + Thé oxy kinh 31/p; SpO2: 93% > Thue hign cée xét nghigm phét hign bét thuing sau: Céng thie mau: Ké qua Don vi Ae ae 10/11/2022 | 15/11/2022 Téng phn tich ¢é bao mau ngoai vi (bing may dém laser) RBC (Sé lugng héng cau) 437 |3.75 45-59 | TL HGB (Hemoglobin) 130 | 110 135-175 | gL HCT (Hematocrit) 0.408 | 0.33 041-053 | LiL MCV (Thé tich trung binh HC) 93.4 88.8 80-100 | fL MCH (Luong HGB trung binh, 29.7 293 26-34 | pg HC) MCHC (Néng 46 HGB trung binh | 318 330 | 315-363 | g/L HC) 2 Ss <<= Phin bd kick therde 142 gpavey cen 136 Tar er Ww) prs tage 489| 319 Boar] : te Gn, gp cet tile en binh TC) 68 89 a eee fL vac (88 leans bach elu) 88 1169] 40-100 | oa uuT@ (TY 18% BC trung tinh) 594 eal ass i. | zs te E a pon (ly 18.96 BC ua acid) 49 32 | oa ts | 5 as 2 rl 4x90 (TY #96 BC ut base) yoNO% (TY 16% BC mono) Lynne (TY 16 % BC lympho) NEUT# (S6 long. BC trung tinh) aa 9.32] 18-75 GL oH ($6 lung BC wa acid) 04 0.37 0-08 GL |aso# (Sé long BC wa base) 0 0.03 oor | a |\tONO# (Sé lusgng BC mono) 05 046 Roeeae LYM# (Sé long BC lympho) 2.5 11 1045 | GL inh héa miu: Poe Kétquixétnghiém |, | -yéu cdu xét nghiém joing amt, eas 10/11/2022 | 15/11/2022 tham ehigu | P°™! | Sinh _ | Binh lugng Glucose (*) $2 2 | Dinh Iugng Creatinin (*) 65 (|56 3 | Bo hogt do AST (GOT) (*) 28 "7 <35 | UL 4 | Do hoat dg ALT (GPT) (*) 34 15 <35 un | Dinh lugng CRP.hs (C- 449 11.06} <05 — | mg/dl Reactive Protein high Sesitivity) (*) oo — 13 —————_—_——=e ie 38 136-146 | mmov 3 34-45 | mmovt. 101 109 |mmou, caw 1: Dya vio cdc trigu ching lam sing vi cn lam sing tén, hay chin dosn so pp trén b@nh nhain ny: ‘A. Lao phot C. Viém gan 5 vViem phdi D. Suy tim AvaB Giai thich: ‘A. Bénh nha ho kéo dai, sét, chan &n, sit cn, nghe phi o6 rale nd. “=> Bénh nhan c6 nguy co mic lao. B, Bénh nhén €6 trigu ching s6t cao, ho o6 dsm tring, nghe phi orale nérale Jim bén ruong phdi. Tam chimng viém phéi bao gm: sé cao rét run, dau ngue kigu ming phéi va ho khac dom mii. = Bénh nhiin e6 nguy co viém phi . Bénh nhdn c6 biéu hign dau mgn sum phai kém trigu chimg chén in, Tuy nin, qua thaim Khém. thay da, niém mac héng, khéng vang da, kh6ng sé thy gan, byng mém, khéng chuéng, khong phi, khéng tun hoan bang hé. => Bénh nhan khOng o6 déu higu viém gan D. Nhip tim bénh nhén déu, bénh nhén khéng cé biéu hign phi, da niém mac hong hio, huyét 4p bénh nhén binh thudng. => Bénh nhéin khéng cé dau hiéu suy tim Ci 2: Bénh nhin ho kéo dai, ho 06 dim, gay sit cin, nghe phoi e6 rale i, rale 16 rai re 2 trutmg phéi. Xétnghiém cng thire méu thay s6 Iugng bach cdu trung tinh ting. Két qua xét nghiém vi sinh: Ten xét nghiém Influenza virus A, B test nhanh Dengue virus NSIAgKé qua Am tinh Vi nam soi tuoi Gram(+) xép i, xép diy: 264) Bach cu da nhan: (+) Vi khuan nhuém soi xétquichup CT seannet~ MRI Angiography: Pit hig hinh nh ce dm, dt tn thuong dang, déng dic, tao hang nhu mé phéi hai bén - theo doi viém phai, ray chin don xée dinh bénh nbn mac bénh gi? étnghiém vi khudin: phét hign vi khudn gram duong 6 dich dim => Viém phéi. + Chup CT Scan cé hang nhu mé phéi hai bén => Hinh thinh dp xe. + Xétnghim vi Khun lao: dm tinh. Tuy nin thi gan i Bénh ei Ino pi e6 Ciu 3: Cho bing xét nghiém sau: Khoang tham . en « 4 5 Yéu cau xét nghiém Két qua eid jon vi RBC (S6 lurong héng cau) 3.15 45-59 TH HGB (Hemoglobin) 110 135 - 175 gil HCT (Hematocrit) 0.33 0.41 - 0.53 fee ee chin don ben nha bj thiéu méu Khong? Néu 06, bin Inga nguyen shin fu miu? 15men nt duge chin doan thiéu mau khi c6 2-3 trigu chimg sa ", RBC gi dud mite trung binh 1g sau 1 GB gidm dud mie trung binh HT gidm dudi mae trung binh pnt nn bi thigu mu do €6 e833 trgu ching, in thiéu mau 66 thé d hoat déng ciia nhigu cor quan bj gidm si nhan an uéng kém, trong a5 co xomg, gam, thin, wong kém, kha nang hp thu chit kém,.... dn i se thigu hut cf yeu t8tgo mau nhu sit, vitamin BI2, acid foie, ‘- Vigm man tinh during hé hap va nhiém khudn kéo dai: Thai gian dai khién cw thé phan b6 Iai tf log t blo méu duge bit héa, ting bigthéa bach clu tidy du din dn gidm tiIé hdng chu trong mau ; oP Thuée :- Vige diéu tr bing thud thai qua than thé hai cho thin, gy gm kha nang tiét Eryhthropoietin kich thich ty xuong to mau - Vige phdi hop Cephalosporin (Ceftazidime) cing Aminoglycoside Wi sa hacin) cé déc tinh trén thin, - Sir dyng gidm dau, ha sot la Paracetamol cin eé tac dyng phy giy thiéu méu do tic dng Ién gan va than => Két hop nhiéu yéu #6 trén din dén biéu hién thiéu mau 6 bénh nhén, tuy nhién do ‘nh huog didu tr} cia thude nén cin theo doi thém vé trigu chimg thigu méu & bénh nhan nay. Cau 4: ‘Tén xét nghiém 10/11/2022 | 15/11/2022 at Don vi chiéu Binh lugng CRP.bs 5 | (C-Reactive Protein 4.49 11.06 <05 mg/dL high sesitivity) (*) Hay cho biét ¥ nghfa cia xét nghigm trén tai bénh nhin nay, tai sao néng 46 CRP.hs lai ting di trong thi gian diéu tri bang khdng sinh? Dap : d CRP la mét glycoprotein durge gan sin xuat 06 dae idm 1a két hgp voi polysaccharide C ciia phé cau, binh thuimg khéng thay protein ny trong mau, Tinh trang viém cép véi pha hity mé trong co thé sé kich thich sn xuat pro‘ein niy va gay ting nhanh néng 46 protein phan img C trong huyét thanh:_ protein ph ap chat oe f cia nhi sean CRP C20 the hign tinh trang xuat hign vi gin re mono Mang nbng 40 hs ~CRP dt bdo beh nhane6 nguy co ting va eH wr ae sr, Vi gy sax nnigm ny doe ding 4° dh Bi ce nguy eg gage lam dong tho vice xét ng fur dinh twang none 49 cholesterol miu, T, véi bénh nhin 65 tuoi, ngoti vige mguy co cao mic bénh Bees nay edn 66 ¥ nghia theo dai v8 mite dg ahi nam chi nghi ngt Lao tin trign, AC Si 65 tim mach kj UY CO mach vt khig danh gid n, im mach, thi vige em tring do yi sou Pas ng trong tho gan du ting King sin ih hig air bing Khing sinh Ceftazidime va Vaphacin kg oige yo tien qu, 06 thé do vi Khuan khing habe hoe o thém sye6 matin sree dn pai hay €6i loa Khng sinh ing ti inh eee rind sien cing i Khun, ie bit ph hignsém nse sy eb mitcn | n phuong phip hua lao. can: Gi thich sao enh nn Guge chi din kim x8 nhigm dn lene D Dimer, Troponin T hs? én. enh nhdn bj viém man tinh duimg ho hp, 06 hi chimg nhiém tring va xét aghigm vi Khuén drong tin, Hé min dich hoat dong lim ing boch cjudén ving viem dé thy hign chitc nlng bio vé, dng nghia tiéu chu méu ting ‘ceo do kha nang hinh thanh huyét khéi ting. ~ Xét nghiém D-dimer la xét nghigm sinh héa giip phat hign chi s6 D-dimer, :m6t sin phdm duge tgo ra trong qua trinh pha vo cue mau déng, = Xétnghiém troponin T hs durge ding dé do ndng dé protein troponin T trong ‘mau, Nhimng protein nay duge giai phéng khi co tim c6 du higu bi tén thong. + Ci 2.xét nghiém két hgp danh gid kha nang hinh thinh huyet ‘khdi, tinh trang rmgch vinh, nhim phong ngira nhiéu bién chimg nguy hiém vé hep, tic mach miushim kha gin nbat (16/11) phat hign: cin an tinh, sOt cao (cao nhat _——— an ~ Chim sée efp 9 39°C, khons: khé tho ~ Com ty, i oe 3 pain da man sui phil, dau | Tg ogy ge pid, daw nhieu Tube YP Tim deus se rirto phé aoe : Tip le 18 i rc, ido phé nang |impyén lode (Thue pa CE Bu nus - di yoltt |" yng mém, khong chudng Medea oe le Paracetamol Kabj Tienam (Zruyén tink mach) Khang sinh loai beta-lacta hom Carbapen a eequa chu CF scanner thay c6 bat thudng sau: phéi hai bén: C8 dam, not ton thurong d6ng de, tgo hang lan ta nhu mé phdi ibe, um thé thay trén nhu mé phoi. Vige phit hign tinh trang tran dich mang phi nay e6 thé dua ra hung gai thich nur nto, dau higu nay cling 0 nhur thé nao dén digu tri sip téi cho bénh nbn nay ? én nhiin gay tran dich mang phdi: sh tigt; Bénh nhén duge chan don viém phéi do nhiém tring, mao szach phi bi viém sé lim tng tinh tham than mach dn dén sz kéo dich vio thoang ming phi. Phoi bj nhiém tring lan ra mang phéi hoge vit phéi tin thuong gan sat ming phdi, gay kich thich mang phdi ting tiét dich. Dap an: + Neuy' - Tran dich - Trin djch dich thm: Cé thé cé bat thurong sinh ly vé chite nang cia tim (suy iim kha nding tudn hodn cing sur cn trd cia cic 0 viem gay t mau tpi cde viém, dp Ive thiy tinh tai day tng lén khién dich eting bj kéo ra khoang ming phdi). Bén canh dé, vie gidm dp lye keo do that thoat qua than hode thiéu hyt protein do sinh hoat ciing gop phan gay trin dich ming phéi ~ Bénh nhin con duge chan doin ap xe héa va nghi lao, cé kha niing tinh trang niy lan dén khoang mang phdi ki ‘én cho céc thinh phén ciia Khoang c6 thé bi xohéa din d&n hinh than cae 6 tran dich khu tr. +qldutét audi bgnhtham gia tr liu sé hoi phe rong on vai win ode vi thé ie, y theo nguyén nha gay bénh. M6t s6 truimg hp tran dich mane phi cé cia we nhiing bién chimg nghiém trong, tiy thude vio mic d6 nghiém trons Da Tate, neuyén nhan va phuong php dieu ti dae fp dung ki nha fan tis nh nn ny, cn 6 theo div kiém chic ning than 8 ng sng act xi ve trigu chimg TDMP ny. Bén cca d, tgp t¥e di Gap ith 4 lai bo vi khudn, gidm kha ning nhiém tring va vem, O° OE n lum dich néu edn, theo doi dinh kj, d phng va kiém sot fe be ching a 18ig phoi, gay han ché ho hi 16 hap, bién dang lin , bién dang lng ham khim thdy bénh nhan thinh thodng ¢6 nhtng com day nh spe, da eng Ken Ki thay 46 tu thé, dau man sucim phai, Hay " su “ igure ai ai thich n djch mang PI la hu qué ciia qué trinh viém tién tién, dich bi kéo va phdi qué trinh nay kéo dai sé lim & dich ti khoang min a vo cinimg kim sing nh khé thé dau ngye do dich i dong Aes a ich cho phi t80 461 Kh, din dn & pen ce 6viem, co &, i en pc Kho tho va daw te ngye ce dy thin tinh gay om Bl bt ye a i ‘pau thudmg durge cam nhan xung quanh vi tri viém, nhung cé thé yjtri viém. i : im gic dau dén man suén phai. Céic phin sau va ngoai vi cia hhodnh duge chi phdi boi céc day thin kinh lin suém dudi 6, va sy né gay dau 6 thinh nguc dudi ho%e byng c6 thé gidng cde béah ng, ming phdi co ich thich et | trong 4 bung |. Ngoai ranguy’ | yacde co quan v | Gian quan dén gan, thas khuén hoe nguy co ic nguyen nbn ny Kh6 06 indu, chife nding than... én nhan gay dau man surim phai cé thé lign twéng dén cdc bénh fing, 46 nhu: gan, thn . Tuy nhién chura 06 Au higu bat thuéng than dit c6 sy xuat hign cia nang nho, trong hop nang nhiém nghén do huyét khéi cé thé biéu hign dau nhung cd hai thé xdc dinh duge ngay, van can dé phong va xét nghiém Cu 8: Phin tch tac dung ciia Ceftazidime, Vinphacin vi Tienam, Tai sao trong quittinh didu tai thay Ceftazidime + Vinphacin bing Tienam? Dap dn: a) Tae dung = Ceftazidime cé tic dung tte ché mye dich chi yéu phong tre khudin mit xanh va 1 8b khdng sinh ké theo kinh nghiém. -Vinphacin ¢6 chita Amikacin 18 mot Aminoglycosid, ngin chin sit téng hop protein cia vi khudn, ¢6 tac dung hau khing sinh, nghia La hoat tinh diet kkhudn van cn sau khi ndng dé thude trong huyét thanh da xuéng dui ndng 46 ire ché toi thiéu, do 46 khi phéi hgp cing Ceftazidime ting higu qué khang digt khudn. ~ Tienam 1a chat tee ché manh su tong hop vach té bao vi khuan va c6 tac dung: i kehudn tin mt phd rng ede vi Khun, cd gram dong, gram dm, va Kh va ky ») Digu tj Tienam thay Ceftazidime vi: naete higu qua chéng Iai cde nhiém khuan do vi gram durong dé khang véi cephalosporin, trong, cae enzym téng hgp vach té bao vi khuan, VK Gram (-) khiée, 06 thé 1a kKktudn wa khi va ky khf, 6 06 Ceftazidime 9Vv ty, phn tom nhiém khuan do ede tae nh THOS TY Amikacin cia Vinphacin) yi/hoae 4: mene) cng S® 4p ting duge véi Tienam, tet gi sy 26 cia Bacteroides, fragilis la trye khuin ky hi gr = Map bin tanh nang chong dai thu bio gay p xe va thang ab : ra jycosid, cephalosporin vA penicillin. Tuy nhién, Bacteroides fyeinn ne sminoelyeosn say can vi THEA nda khang yéi ~sglycosid ( 3 khiing véi peniciltn cau 9: Vis00 phai sit dung khéng sinh duéng tiém trén bénh nhan? Peet nhin c6 Hi chimg nhigm tring, cin khdng ché tinh tang nhiém kuin sin tign nbanh nén can str dung Khang sinh durimg tiém truyén tinh mach 48 thud yp thu try tgp va hon ton vao mén, nhanh chéng dén duge 6 nhiém khuln dé co tic dung va dat higu qua cao. "pen nhin diing khéng sinh liéu cao nén ding dug tiém c6 4 gim thiéu phan tmg 06 hai vé tigu héa (khiing sinh ¢6 thé kich thich tre tip lén nigm mac Frgt non, ru6t gid Lim ting tit chat nhdy va phat sinh ra ede mang gii, tic dung hing khudn ciia khéng sinh lim dao l6n cn bing hé vi khudn 6 dudng tiéu héa, gu héa, tiéu chay) gay 16i loan Céu 10: Bénh nhan durge chin dodn Viém phéi ép xe héa nghi lao, kém gin phé quan, Néu khong duge diéu trj kip théi, bénh nhén c6 thé gap nhiing bién chimg a? ‘¢ Ap xe phdi ho ra mau: Do tinh trang vo mach méu, dc biét nghiém trong khi 6 4p xe 6 gin rén phdi. Néu khéng duge cp citu kip thoi c6 thé anh huéng t6i tinh 4p xe bi vo théng voi mang phéi. © Nhiém tring mau: Khi vi khudn trong 6 ap xe xm nhip vao mau, gay sée ahiém tring va cé thé tir vong. ‘© Ngoai ra, ap xe phéi cdn gay ra nhiing bién ching khée nhu: Xo phi, dp xe no, tm phé man, Cu 11: V6i vai trd 1a duge sf, hdy 48 xudt ché d6 sinh hoat, ché 49 dinh dung cho bénh nhan nay, ) Ché d6 sinh hoat: ~ Giit noi 6 théng thoang, giét Am tranh tiép xtie voi khng khi lanh. ~ Giitv@ sinh rang migng, git v@ sinh dug ho hip trén sach va thodng, ~ Duy tri tp thé duc hing ngay dé nang cao site khée, tap hit tho siu dé hai Phue chire ning cia phéi. 20rv “chong lam vige hot hoat déng qua sic, dim bio tha a ning cho et. cee yy che d6 dinh duéng: ” Chia nhd bit n,n thém 2-3 ba pha “Cung cdp day dit chat dam: thit, c, tring, da “Ubng nhieu nude (bao gdm nude canh, trai cay, nude uéng, sta.) "fbb rou xan ti oy: fa gun cong ef iain chi yea, ng thi angle mot ng cag cp cht, mg nue ing Kb cho cothé ’ ” Kiéng an thifc &n gidu mG, cl é bién sin, _Khéng nén nim Khi &n, ding dng hit 48 uéng muse, an timg miéng abo