NGOẠI KHOA THỰC HÀNH ppt

NGOẠI KHOA THỰC HÀNH
TÀI LIM  TNG HP  DCH
Gii thiu Information Mc lc


Biên son ebook : Lê Đình Sáng
I HC Y KHOA HÀ NI
Trang web : www.ykhoaviet.tk
Email : ,
n thoi : 0973.910.357

THÔNG TIN

THÔNG BÁO VỀ VIỆC XUẤT BẢN BÁCH KHOA Y HỌC 2010 :
Theo yêu cu và nguyn vng ca nhiu bc, khác vi Bách Khoa Y Hc các phiên bc,
bên cnh vic cp nht các bài vit mi và các chuyên khoa mi cách thc trình
bày, Bách Khoa Y Hc chia ra làm nhiu cun nh, mi cun bao gm mt ch  ca Y
H s giúp bc tit kic thi gian tra cu thông tin khi cn. Tác gi xin chân
t c nhng ý kic gi trong thi gian qua. Tt c các
cun sách ca b sách Bách Khoa Y Hc 2010 bc có th tìm thy và ti v t trang web
ng và phát trin.
ỦNG HỘ :
Tác gi i s ng h v m giúp cho Bách Khoa Y Hc
phát trin t
Mi tm lòng ng h cho vic xây dng mt website dành cho vic ph bin tài liu hc tp và ging
dy Y Khoa ca các cá nhân và Doanh nghip xin gi v :
N VIT NAM
Tên tài kho
S tài khon : 5111-00000-84877

CẢNH BÁO :

TÀI LIU NÀY CH MANG TÍNH CHT THAM KHO nhm mc u bit v Y khoa.
Tuyc t ý áp d ch u tr bnh,
nht là vi nhi không thuc nghành Y . Tác gi ebook này không chu bt c trách nhim gì
n vic s dng thông tin trong cu áp dng vào thc tin ca b
tài lim t nhiu tác gi khác nhau, nhiu cuc kim chng , vì
th mi thông tin trong cuu ch mang tính chi . Cun sách nc phân
phát min phí vi m di, bt c n vic mua bán,
i, chnh sa, in n cun sách này vào bt c thu là bt hp l . Ni dung cun
ebook này có th i và b sung bt c lúc nào mà không cc.

GIỚI THIỆU

Bm , biên dch và tng hp vi mp mt ngun tài liu
tham kho hu ích cho các bn sinh viên y khoa, và tt c nhng ai có nhu cu tìm hiu, nghiên cu,
tra cu , tham kho thông tin y hc.
 sách mng da trên ngun tài liu ca cng , không mang mc
 li, không gn vi mi bt k hình thc khi s
dng b sách này bn phng ý vi nhu kin sau . Nng ý , bn không nên tip
tc s dng sách :
Bn tay bn , hoàn toàn da trên tinh thn t nguyn ca bn. Không có
bt k sc, mi gi hay liên kt nào gia bn và tác gi b sách này.
Ma b  phc v công tác hc tp cho các bn sinh viên Y khoa là chính, ngoài ra
nu bn là nhi t s dng b 
liu tham kho thêm .
Mi thông tin trong b u ch m chng
bi bt c t, Nhà xut bn hay bt c m liên quan nào . Vì
vy, hãy luôn cn trc khi bn chp nhn mc cung cp trong b sách
này.
Tt c các thông tin trong bm, tuyn chn, phiên dch và sp xp theo trình
t nhnh . Mi bài vit dù ngn hay dài, dù hay dù d u là công sc ca chính tác gi bài

viLê Đình Sáng ch m và phiên dch, nói mi giúp chuyn ti
nhng thông tin mà các tác gi bài vin tay các bn .

B sách này là tài lim và dch bi mt sinh viên Y khoa ch không phi là m tin
hay mt chuyên gia Y hc dày dn kinh nghi có rt nhiu li và khim khuyt
c , ch quan hay khách quan, các tài liu b trí có th p lý , nên bên cnh
vic thn trc khi thu nhn thông tin , bc k phn mc lc b sách và phn
ng dn s dng b  s dng b sách này mt cách thun tin nht.
Tác gi b n t này không chu bt c trách nhin vic s dng sai mc
u qu không tt v sc khe, vt cht, uy a bn và bnh nhân ca bn .
Không có chuyên môn , không phi là nhân viên y t , b s dng nhng
thông tin có trong b  chu tr. T c ti này, các thy thuU TR
BNH NHÂN ch không phi là U TR BNH. Mi bnh là mt thc th c lp hoàn toàn
c bê nguyên xi tt c mi thông tin trong b sách này vào thc tin s là mt sai
lm ln . Tác gi s không chu bt c trách nhim gì do s bt cn này gây ra.
Vì là b sách cng, to ra vì mng, do cng , b sách này có phát tri
t phn rt ln, không ch da vào sc lc, s kiên trì ci to ra b sách
này , thì nhng, góp ý, b sung, hiu chnh ci ng lc to
l bn. Vì mt mc tiêu tr thành mt b sách tham kho y khoa tng
hp phù hp vi nhu cu và tình hình thc tic y t nói riêng và trong cuc sng nói
chung . Tác gi b sách mong mi  bc nhng lng,
nhng tài liu quý mà bn mun san s cho cng , vì mt c
nim mong mi mà khi bu xây dng b sách này , tôi vi .
Ni dung b sách này, có th ch t thm nhnh trong quá kh và hin ti hoc
n. Trong thi cách mng khoa hc công ngh tin
nay, không ai biu nhng kin thc mà b áp d
 tr li câu hi này, ch có chính bn thân bn , phi luôn luôn không ngng-T
MÌNH-cp nht thông tin mi nht trong mc ci sc y khoa.
Không ai có th, tt nhiên b sách này không th, n.
Nghiêm cấm s dng b i bt k mu nào, i hóa

sn phi bt c  b sách này không phi là tác gi bài vit ca b
t rt nhiu công sc, thi gian, và tin b to ra nó, vì li ích chung ca cng
ng. Bn phi chu hoàn toàn trách nhim vi bt k vic s dng sai m
ni dung b sách này nêu ra.
Mi lý thuyu ch là màu xám, mt cun sách hay vn cung ch là lý thuyt, ch có
thc t cuc sng mi là cun sách hoàn ho nht,  n không phc gi mà là din viên
chính. Và Bách Khoa Y H là mt ht thóc nh, vic s d xào nu hay nhân ging
là hoàn toàn tùy thuc vào bi to ra ht thóc này s vui mc truyn thêm
ng l tip tc c gng nu bit rng chính nh bn mà bii không còn phi xp
 ch cu tr.
Mn b sách xin gi v cho tác gi a ch trên. Rt mong nh
phn hi t các bc gi  các phiên b
Kính chúc bc, gia quyn và toàn th i Vic sng trong khe mnh, cuc
sng ngày càng m no hnh phúc.
Đô Lương, Nghệ An. Tháng 8/2010



ABOUT

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MỤC LỤC

CHƯƠNG 1. KIẾN THỨC CƠ BẢN
1. VÔ KHUN NGOI KHOA
2. VÔ TRÙNG TRONG NGOI KHOA
3. VN CHUYI B 
4. GÂY TÊ
5. GÂY MÊ
6. CHUN B C M
7. 
8. QUÁ TRÌNH LIN V
9. KIM VÀ KÌM KP KIM KHÂU PHU THUT
10. CÁC LOI NG THÔNG VÀ NG D
11. CÁC THAO TÁC PHU THUT
12. CÂN BN GII
13. CP CU NGNG TIM PHI
14. CM MÁU TM THI
15. KHÁM CH NÃO
16. NG
17. TA, TK TR
18. TI
19. G
CHƯƠNG 2. KỸ NĂNG
20. 1-K N THN TRONG PHÒNG M:
21. 2-K N THN TRONG PHU THUT:
22. 3-CÁC K U THUT NÂNG CAO:
CHƯƠNG 3. PHẪU THUẬT
23. PHU THUT CT GAN TRÁI
24. K THUT TÌM VÀ X LÝ TÚI THOÁT V BN
25. PHU THUT MILES
26. PHU THUT HELLER QUA NI SOI
27. K THUT LÀM HU MÔN NHÂN TO

28. PHU THUT CNG MT RN GAN
29. PHU THUT CT KHI TÁ TU BO TN MÔN V
30. PHU THUT CT TÚI MT NI SOI
31. PHU THUT CT TOÀN B D DÀY
32. PHU THUT CT THN KINH X
33. PHU THUT CT RUT THA NI SOI
34. PHU THUT CT RUT THA
35. PHU THUT CT GAN PHI
36. PHU THUT CI TRÀNG XÍCH-MA NI SOI
37. PHU THUT CI TRÀNG PHI NI SOI
38. PHU THUI BIÊN
39. PHU THUNG MCH CH BNG
40. DI
41. PHU THUT TUYN GIÁP
42. PHU THUT CT THU GIÁP
43. PHU THUT CT THC QUN KHÔNG M NGC
44. PHU THUT IVOR LEWIS
CHƯƠNG 4. BỆNH LÝ NGOẠI Ổ BỤNG
45. B
46. THNG D DÀY - TÁ TRÀNG
47. THOÁT V BN
48. CHNG KÍN
49. VIÊM RUT THA CP
50. CH CA
51. I TRÀNG
52. K TRC TRÀNG
53. HI CHNG TC RUT
54. VIÊM TY CP
55. XOI TRÀNG
56.  DÀY

57. SA TRC TRÀNG
58. SI NG MT CH
59. SNG MT
60. THOÁT V BN
61. THOÁT V NGHT
62. THOÁT V SAU M
63. 
64. VIÊM RUT THA CP
65. 
66. NG MT NGOÀI GAN
67. U TY
CHƯƠNG 5. PHẪU THUẬT LỒNG NGỰC
68. CHC
69. VIÊM M MÀNG PHI
70. ÁP XE PHI
71. GIÃN PH QUN
72. K PH QUN
73. U TRUNG THT
74. HP VAN 2 LÁ
75. 
76. N VÚ
CHƯƠNG 6. CHẤN THƯƠNG CHỈNH HÌNH
77. GÃY H NG CHÂN
78. 
79. 
80. GÃY C 
81. U TRÊN 
82. 
83. NG TAY
84. V

85. 
86. PHU THUT TÁI TO DÂY CHNG CHÉO SAU
CHƯƠNG 7. BỎNG NGOẠI KHOA
87.  BNG
88. DIN TÍCH -  SÂU TNG
89. LÂM SÀNG SC BNG
90. U TR SC BNG
91. BNG HOÁ CHT
92. BN
93. BNG NG HÔ HP
94. BNG CHIN TRANH
95. X TRÍ VNG K U
96. THI K II CA BNG
97. THI K SUY MÒN CA BNG
98. THUU TR TI CH BNG
99. THUU TR BNG
100. PHU THUU TR BNG
101. NH NHÂN BNG
102. U TR BNG  TR EM
CHƯƠNG 8. THẬN-TIẾT NIỆU
103. CHN
104. TU QUN
105. CH
106. V NIU ÐO
107. CH
108. CHO
109. CHN KÍN
110. SI NIU
111. SNG TIT NIU
112. U BÀNG QUANG

113. I LÀNH TÍNH TIN LIT TUYN
114. CN LÂM SÀNG CHN TIT NIU
115. VIÊM THN  B THN CP
116. VIÊM BÀNG QUANG CP
117. VIÊM NIO CP
118. VÀI KHÁI NIM V GHÉP THN
CHƯƠNG 9. GÂY MÊ HỒI SỨC
119. C V GÂY MÊ HI SC
120.  CÁC THUC MÊ
121. CH
122. THU
123. THUC GI
124. THUC GI
125. CH TOÀN B
126. THUC MÊ HÔ HP
127. THUC AN THN
128. VÔ CM TRONG PHU THUT  BNG
129. T NI KHÍ QUN KHÓ
130. GÂY TÊ TY SNG - NGOÀI MÀNG CNG
131. I
132. I THN KINH CÁNH TAY
133. GÂY TÊ THN KINH GIA
134. GÂY TÊ THN KINH TR
135. GÂY TÊ THN KINH TR
136. GÂY TÊ THI
137. HN CH TRUYN MÁU TRONG NGOI KHOA
138. GÂY TÊ TY SNG  TR EM
139. PHI HP THUC TÊ VI CÁC THUC H TR TRONG GÂY TÊ CC B
140. CHUN B C M NH NHÂN SAU M
141. QUN LÝ BNH NHÂN CH NÃO  TUY

142. CH TRUNG TÂM
143. T NG NI KHÍ QUN
CHƯƠNG 10. NGOẠI KHOA THỜI CHIẾN
144. 
145. CM MÁU TM THI
146. C NH TM TH
147. 
148. SC CH
149. NHIM KHUN VN TRANH
150. HÔ HP NHÂN TO
151. CT CT CHI CP CU
152. VN MM
153. VP
154. VT SNG-TY SNG
155. VA KHÍ
156. VT BNG DO NHIM CHC QUÂN S
157. X 
158. X U CHC
159. X U VU BNG
160. X U CH NÃO
161. TCH MÁU NGOI VI
162. T
163. HI CHNG VÙI LP
164. THM HA VÀ CÔNG TÁC PHÒNG CHNG
165. CHT
166. CHT
167. CHNG
168. U TR VT BNG BNG THUC NAM
TÀI LIỆU TRA CỨU

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CHƯƠNG 1. KIẾN THỨC CƠ BẢN


1. VÔ KHUẨN NGOẠI KHOA



khoa.




-  

- 





nh











-  



0




- 

0

- 

-   


 
- C- NH
4
:

4




-  


- 

-  có clo:




- 
- 

- 





- 180
0
C)



- 
- 

0
C) nên


- 20 


- 





0



- 







 



1 kg/cm

2
(1 atmotphe) = 120
0
C.
2 kg/cm
2
(2 atmotphe) = 134
0
C.
3 kg/cm
2
(3 atmotphe) = 145
0
C.

2

1,5 - 2 kg/cm
2

2



- 2 kg/cm
2
- 60




- 
- 55
0
 60 - 80
0
trong



 





 


- 
- 


0
C.
- 

0
C.
- 



Coban chlorur : 20g.
Axit chlohydric 30% : 10ml
 : 88ml.

- 



- 
 :





 




- 0 - 180
0
C trong vòng 40 - 60

- 

0
C trong vòng 15 phút.


0
C trong vòng 30 phút.
 
0
C trong vòng 40 - 60 phút.
- 
0
C trong vòng 15 phút.
- 
- 
- 

2. VÔ TRÙNG TRONG NGOẠI KHOA






- 

-



tràn vào.
- 
- 



-  trùng.








- 



 
- 










- 

và 
này.
- , bao trùm


- 


- 70%) trong vòng 20





- 



- 
- 



- 





-  



-  




3. VẬN CHUYỂN NGƯỜI BỊ THƯƠNG

1. Đại cương.



 





.




















 












- 
-  

Hình 1
- 


- 


3.2. Bò cõng người bị thương trên lưng (hình2):

- 
-  

- 

- 






 









- 
- 
- 
- 
-  
- 
- 
 - 


- 

- 

- 
- 

4. GÂY TÊ




nhân.


- 
- Gây tê vùng (regional anesthesia).
2.1. Gây tê 
- 


- 
tê lên b

- 


- 
- 


- 




. Chi trên 90 phút.

2.2. Gây tê vùng (regional anesthesia):




- Gây t
- 
- 
- 
- 
- 


- 


-

chúng k
- 

- 

- 
- 
- .
- 


- 
- 
- 
- 



4.1. Phân 


- 
- 

- 
- 










1/100.000 - 1/200.000 (1 - 

- 
- 
- Gây tê các ngón tay, ngón chân.

4.2.1. Cocain:

- 
- 
- - 200mg.
- 
4.2.2. Novocain (procain):
- 
- - 45

axit para aminobenzo
- 

- 
- 
- 1%.
4.2.3. Chloroprocain (nescain):
- 
- - 
- 75 phút khi 
- -
3%.
- - 
4.2.4. Tetracain (pontocain):

- 
- 

- - 6

- 
4.2.5. Lidocain (xylocain, lignocain):
- 
- 
trung bình (60 - 90 phút khi - 



- 
4.2.6. Mepivacain (carbocais):
- 
- 

- 

4.2.7. Prilocain (citanest):
- 
- 


- 
 

- 
- 

4.2.8. Marcain (bupivacain, sensoreain):
- 
- 

- 

- - - 0,3mg/kg).
4.2.9. Etidocain (duranest):
- 

- 
- - 
- 
- 
4.2.10. Dibucain (nupercain):
- 
-15mg).
4.2.11. Ropivacain (naropin):
- 
- Tác d
- 





- 
- 
- 
- - 

- 
- 
-  
- 
- 






- 

- , co

- 

- 
hoàn toàn.
- 
- 
- 

- 

. Thiopental.
n.
- 
- 


- 
- 
- .
- Corticoid: depersolon, prednisolon.
- Calcigluconat.

- 
