G£y hai x°ng c³ng ch¢n

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GY HAI XNG CNG CHN

GY HAI XNG CNG CHNNhm 1 T 5 Y3B HMU

OVER VIEWGii phu

Khm v x tr ban u

Phn loi v iu tr

Bin chng v x tr

I. Gii phu: Xng: - Xng chy: 2/3 trn l hnh lng tr tam gic, 1/3 di l hnh tr trn ( im yu)- Mch nui xng th ngho nn nht 1/3 di ( kh lin)Xng mc: l xng ph

I. Gii phuC: phn b khng uMt trc trong khng c c ( khi gy d l xng ) Mt sau: khi c khe

I. Gii phu: Khoang: - C 4 khoang ngn cch nhau bi mng gian ct v vch gian cCu to cc khoang hp, thnh khoang chc>> khi b ph n chy mu d b HC C.E.K

II. Khm v x tr ban u

X tr cp cu ban u: ( ABCDEs) A- ng th v bt ng ct sng c ( airway maintenance with cervical spine protection)

B- H hp v thng kh ( Breathing and ventilation)

C- Tun hon v kim sot chy mu (Circulation with hemorrhage control)

D- Tri gic ( Disability: Neurolagic status)nh gi thc ( Glasgow)nh gi ng t ( Kch thc, Phn x )

E- Bc l v khm ton thn ( Exposure/Environmental control: Completely undress the patient, but prevent hypothermia)Ni rng qun oPhng h thn nhit

2. X l cp cu b sung:F. Sonde tiu (Foleys Catheter)

G. Sonde d dy (Gastric Tube)

H. Siu m (Hertz - Trauma Ultrasound)etc

3. Hi bnh:Hon cnh xy ra: Thi gian, a imC ch: Trc tip- Gin tip- C ch chn thng (Mechanism of injury):ng dp (Blunt)m xuyn (Penetrating)N (Blast)Nhit (Thermal)Tin s:

ng gip ( Blunt )Tai nn giao thng- Ngi ngi trong xe t- Ngi i b b xe m- Ngi i xe p, xe my

nh nhau

Ng

4. Khm: Nhn: Mu sc v ti mu, vt thng, bin dng, sng ty, bm tm S: S nn nh nhng, vut dc theo mo chy( b trc v trong xng chy nm ngay di da) thy:+ch mt lin tc ca xng+u xng gy g ln di da +s im au chi ti ch gyo: CDTg: Mu chuyn ln ti mt c trongCDT: li cu trong xng chy ti mt c trong

Du hiu lm sngSau tai nn bnh nhn rt au vng gy xng, c th gy sc.Mt c nng ca cng chn.Gp gc cng chn.S thy u xng gy di lch ngay di da, c ting lo xo xng.Cng bn chn xoay ra mt ging.Cng chn c ng bt thng

X-quangChp X quang chn on loi gy ( n gin hay phc tp), s di lch ca ca gy.Phim chp phi ly c c 2 khp (khp gi v c chn).

III, Phn loi:Gy xng kn( theo Oestern v Tscherne (1982): 0: Gy xng khng c tn thng m mm hoc tn thng nh khng ng k. Thng l cc gy xng gin tip khng di lch hoc t di lch.

1: Gy xng c xy xt da nng hoc do on gy gy chm thng m mm. Xng gy n gin hoc mc trung bnh( Gy xng c bm mu di da).

2: Xy xt da su hoc chm thng da v c khu tr do chn thng trc tip gy ra. nu c e do hi chng chn p khoang cng xp vo gy xng II. Thng l do chn thng trc tip, mc trung bnh hoc nng. 3: Chm thng da hoc xy xt da lan rng, lc da kn hoc dp nt c. C khi c hi chng chn p khoang thc s hoc t mch mu chnh. Thng l do chn thng trc tip, mc trung bnh hoc nng. Vic x tr vt thng phn mm loi gy ny cn cn kh khn hn gy xng h III.Gy xng h theo GUSTILO (1984) : 3

iu trCp cu ban u: Bt ng chi gy bng npPhng v chng sc: b dch, gim auGy kn: iu tr bo tniu tr phu thut: Gy h: Nguyn tc- C nh xng chc chn.- X tr tt da v phn mm- Phng nhim khun bng khng sinh- Phng un vn (SAT)

IV. BIN CHNG:

Bin chng ngay: Sc chn thng: Gy h 2 xng cng chn mt 500-1000ml mu ( i: 1l-1,5l ; chu: 1l- 2.5l)c t ca t chc gip nt>> Bt ng tt, b dchTn thng ca mch mu, thn kinhHi chng chn p khoang:

Hi chng chn p khoang cng chn gi l HC bp chn cng, hay gp gy kn5 triu chng lm sng ca HC C.E.K ( Matsen):1. au qu mc thng thng ca 1 gy xng mc d c bt ng chi gy.2. Cng cng ton b chn3. T b v c cm gic kin b u ngn, v sau khng nhn bit c cm gic ngn4. au tng khi vn ng th ng, cng gin c bp.5. Lit vn ng cc ngn.

Bng chn on phn bit HC CEK vi tn thng mch mu- thn kinhHC CEKTn thng mch muTn thng thn kinhau khi cng th ng c bp++_T b+++Lit vn ng+++Mch p+/--+p lc khoang cao+--

Hi chng chn p khoangC ch: Thn kinh: chn p vi qun nui thn kinh, thn kinh b thiu mu>> du hiu sm nht v quan trng nht ca HC C.E.K: t b, tng au, lit vn ngMch mu: chn p mao mch >> hoi t t chcThiu mu m; chuyn ha ym kh; sinh ra c t; i vo mu >> gim pH mu- L mt vng lun qun bnh l

Hi chng chn p khoang

Hi chng chn p khoangX tr: phu thut rch cn, gii phng khoang

2. Bin chng sm:Nhim khun: - Ngay sau chn thng: Din bin nhim trng vt thng trong gy xng h ( theo Friedrich): >>6h>>12h>>( vk hoi th sinh hi)- Sau khi c x tr:

Ri lon dinh dng kiu Sudex

Phn loi nhim trngDa vo thi gian nhim trng, ta c:

Nhim trng sm

Nhim trng mun

Nhim trng mn tnh

Phn loi ca Cierny theo gii phu chc nng

Ri lon dinh dng kiu Sudex/n: L mt hi chng bao gm cc du hiu au, ri lon vn mch v dinh dng mt chi hay mt on chi do phn x, tin trin ko di c th li di chng.Hi chng Sudeck thng xut hin sau mt s nguyn nhn nh chn thng, b bt, c nh, bnh ni tng (nhi mu c tim, bnh phi cp v mn, tai bin mch no..), sau phu thut (lng ngc, tiu khung), dng thuc (barbiturat, thuc chng lao..), c a (nghin ru, tng ng huyt, tng a uric mu..) Nhng nguyn nhn ny thng qua ng phn x ngn tu tc ng vo h thng thn kinh thc vt gy nn cc ri lon v thn kinh cm gic, vn mch v dinh dng mt chi hay mt on chi.

Ri lon dinh dng kiu SudexTriu chng: Cng chn sng n, nhiu nt phng nc da. T cc nt phng nc ny c th dn n nhim trng su trong xng

Ri lon dinh dng kiu SudexNi chung Sudeck l mt hi chng c triu chng rt rm r, tin trin ko di; c th li di chng nng n, mt kh nng vn ng. Cn chn on sm, iu tr sm v tch cc; kt hp nhiu loi thuc, vt l v phc hi chc nng; phi c s cng tc v kin tr ca bnh nhn; qu trnh iu tr trung bnh vi thng c khi ti 1 2 nm.

3. Di chngChm lin: sau 4-5 thng m xng khng linKhp gi: sau 6 thng m xng khng linCan lch: gy ngn chi, lch trc chi, lm BN ko i li cVim xng: nht l sau gy h, iu tr phc tp tn km