các nguyên tắc chẩn đoán và xử trí ngộ độc cấp

c¸c nguyªn t¾c chÈn ®o¸n
vµ xö trÝ ngé ®éc cÊp

Nguyªn t¾c chÈn ®o¸n Ngé ®éc cÊp
(tiÒn sö, hái bÖnh)



 !" 
 !" 
#$%&'(&)))**+,-
#$%&'(&)))**+,-
.+/)
.+/)

0'1&/2*34-56
0'1&/2*34-56
7890%:.+;.
7890%:.+;.
&<*+= >.-&?
&<*+= >.-&?
(&%!/@*+
(&%!/@*+
/AB)))
/AB)))
Nguyªn t¾c chÈn ®o¸n Ngé ®éc cÊp
(héi chøng l©m sµng cña N§C)
-09 C D E F

 G6 9H


0- DH

I'
I((
FI
↑

↑

↑

↑

J K?
↑

↑

L1
M1M*+=
NFI
Σ
O
↓

↓

↓


↓

J 0
↓

↓

↓
P@
CAM*
N*O
±

↑

±

↑

J K?
↓

↓

BL
6)Q
0AM*
NR0
*O
±


±

J J J 0
L
↑

↑

FST18
';
U1 
↓

↓

↓

↓

J 0
L
↓

↓

↓
)P@
FV1 
↑


↑

↑

W J K?
↑

↑
 
↑
)
1?
FVM1M
*+=
↑

↑

↑

↑

J K?

↑

↑

*M*




Nguyªn t¾c chÈn ®o¸n Ngé ®éc cÊp
(
xÐt nghiÖm trong N§C
xÐt nghiÖm trong N§C)
–
X
X


+/Y2
+/Y2
0FD*A M9Z96
0FD*A M9Z96
S&)
S&)
–
X.
X.
28A+=[8(*
28A+=[8(*
' 18 \ ) 0' +; ' - Q A
' 18 \ ) 0' +; ' - Q A
M  ]BGA,L ]BGB(…
M  ]BGA,L ]BGB(…
–
0' A :  2
0' A :  2

' N^AO 18 1@
' N^AO 18 1@
1+,QN_``AO;a!A+A@
1+,QN_``AO;a!A+A@
':.T)
':.T)



nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
A.
A.
§¶m b¶o c¸c chøc n¨ng sèng
§¶m b¶o c¸c chøc n¨ng sèng
B.
B.
§¸nh gi¸ møc ®é nguy hiÓm cña N§C
§¸nh gi¸ møc ®é nguy hiÓm cña N§C




T]A@ >A+=/
T]A@ >A+=/
QTP<B/TP<+/T
QTP<B/TP<+/T
P<N>(S)))O
P<N>(S)))O
C.

C.
BÖnh nh©n cã triÖu chøng N§C
BÖnh nh©n cã triÖu chøng N§C




KbT*QM1@!''
KbT*QM1@!''
P*(6)
P*(6)

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
(h«n mª)
(h«n mª)
W
$+=A,'
$+=A,'
2\!*+=
2\!*+=
Mc>*!
Mc>*!
W
F
F
2126TFF [4]
2126TFF [4]
/
/

↓
↓
B(R46'
B(R46'
→
→
&+
&+
/aNIdOB(!\NFIFaPO
/aNIdOB(!\NFIFaPO
W
0!62
0!62
•
@+/TNM A Me`f^`AFDO
@+/TNM A Me`f^`AFDO
•
&*+=-KK[Ng``FD0O
&*+=-KK[Ng``FD0O
•
UNAP`hW_FDa>O
UNAP`hW_FDa>O

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
(co giËt)
(co giËt)
W
90
90

>Fd?i
>Fd?i
RR0
RR0
0Aj;
0Aj;




k
k
M  *A
M  *A
?1Mc
?1Mc
MAA
MAA
*A
*A
1M*M  MA1)
1M*M  MA1)
W
0
0
≠
≠
2
2
↓

↓
P@9D@P'@*'
P@9D@P'@*'
0FNl?O?&BmV*+
0FNl?O?&BmV*+
=V>!%&
=V>!%&
–
0Bn1
0Bn1
→
→
TPQ'S%
TPQ'S%
&;N O
&;N O

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C


(co giËt)
(co giËt)
W
§iÒu trÞ cÊp cøu co giËt ngay b»ng :
§iÒu trÞ cÊp cøu co giËt ngay b»ng :
–


KcM^Wg`FD

KcM^Wg`FD
–
$*cM_WeFD
$*cM_WeFD
–
D1cA^Wg`FD
D1cA^Wg`FD
NÕu cßn tiÕp tôc co giËt :
NÕu cßn tiÕp tôc co giËt :
–
RM*Ag^W_`mBm*iFDme`<
RM*Ag^W_`mBm*iFDme`<
B(%@
B(%@
–
F.'>[&N(12k.
F.'>[&N(12k.
1l*1PO
1l*1PO

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
(h¹ huyÕt ¸p)
(h¹ huyÕt ¸p)
–
K2>
K2>
↓
↓
CMAA ]Mc

CMAA ]Mc
**>*!1M0U
**>*!1M0U
1*M AE* M)
1*M AE* M)
–
0;T2
0;T2
↓
↓
<(@
<(@
→
→
?@)
?@)
↓
↓
C
C
TP[1Bn1)
TP[1Bn1)
–
F*i
F*i
_``A0A`ofg`<1*.gW_A(mhWp
_``A0A`ofg`<1*.gW_A(mhWp
/
/
>@

>@
1^Wg`
1^Wg`
µ
µ
mBm<FD)
mBm<FD)
–
0U
0U
e
e
gW_qYmB*9>>*!
gW_qYmB*9>>*!
e"
e"
A
A
m*9WABM*
m*9WABM*
00A
00A
_
_
g^W_`mBm*9>rP)
g^W_`mBm*9>rP)


nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C

(
(Rèi lo¹n nhÞp tim
)
)
–
8P2MWABM*ARR01A 
8P2MWABM*ARR01A 
A 11 A1>!\)
A 11 A1>!\)
–
.
.
ABs2MWAB'A 1M>*!
ABs2MWAB'A 1M>*!
e"ArP)
e"ArP)
–
8P2MAAEMM
8P2MAAEMM
B((MN AAOB' AM*
B((MN AAOB' AM*
>>*! ])
>>*! ])
–
R6d#1?*2>>*!e"
R6d#1?*2>>*!e"
Y1>>#$8Mc
Y1>>#$8Mc
N\!OSI
N\!OSI

t
t
–
0-QY\TP#$&+S@
0-QY\TP#$&+S@
BA'@D
BA'@D


nguyên tắc xử trí NĐC
nguyên tắc xử trí NĐC
C. Các biện pháp loại bỏ, tăng đào thải chất độc
1. Làm sạch da, tóc bằng n!ớc ấm xà phòng
2. Rửa mắt : cần rửa liên tục vào mắt bằng n!ớc sạch
hoặc n!ớc NaCl 0,9% từ 10 đến 15 phút. Nếu chất
độc là acid hay base, cần duy trì pH ở mức 6,5-7,5
và đ!a đến chuyên khoa mắt cấp cứu.

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
G©y n«n :
 !"#$%&''()
&
 )**+,-.&/0)
1/0)!2.3
4501+
6 /%&1788)29:688);<=>?
7 @"A>.A%+/BC%C/%&1D
&/DA>%+/-EE+4+F
%&1<DB/G

1. Röa d¹ dµy :
u082
-
0!T'A@90>*"_We/)
-
#KKaB%+=N009BO
-
$ 18 1@ 1 Q .   +  @  1@ 1 1b
1)
u0>82
-
I#KKA//.P@]
Y v [4)R[Id;-V*+,,

-
I>'S"21Bi@NTBw
*'T6.-
Q*1@1>QO)
nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
* Kü thuËt :
-
9[5*'!
-
9[Id*+, a*>A@G6>>
T-;)

-
9+>#KK-*;rYxH
N>yezWh`{a+/A,|_pWe^{a*3O1@1
+,> AG+, @>}A!
_``Aa+/A,^`AN*31+,^4O1@1
*HA@A*)06+,B+,1@1 @-
Q*A@ eh/T!)

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
^)0@
F@'S*a'')
Bn2]AI1M1>*+=
u082!T'>~7-*1@1*)
u0>82
WI@a&%*•+=[Id
;-V1l>>*+,)
Wa>'S".B-BSB ~Y1@1)
uIw2
g) 0gW_mB,g``A+,>;Y>1@1)
_) 0- Q  i Ai _`  We` } e W h/mgA!*90'
Q >A+=A,|'a1@1
*  " S    > > N1PM  MAAM
M*AO)

nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
Thuèc nhuËn trµng:
u0821lB((*'B+=,
@*M%)

u0>82
Kl>*1!>B')
WF*'1lA@*-a&% FC 
-Da- )
uIw2
W*Az`fgW_AmB-Q*,@)
WDM  EMg`f_WeAmB)


nguyªn t¾c xö trÝ N§C
nguyªn t¾c xö trÝ N§C
D. Thuèc gi¶i ®éc (Antidote)
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6HC<&I-D.J2#)'9DD.JK
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Xin tr©n träng c¶m ¬n