1. IU TR TC RUT Bs L Hng

2. Mc tiu Chn on tc rut iu tr tc rut 3. Chn on tc rut 1. Chn on c HC tc rut 2. Chn on tc cp, mn hay mn din tin cp 3. Chn on c tht nght hay tc rut quai kn 4. Chn on tc rut cao, tc rut non hay rut gi 5. Chn on tc hon ton hay bn tc 6. Chn on nguyn nhn 4. Chn on hi chng tc rut T chng: au, nn ,b, chng Nghe m rut tng Du quai rut ni Du rn b 5. Chn on tc cp, mn, hay mn din tin cp Cp tnh: din bin trong khong thi gian vi gi n mt vi ngy Mn tnh: din tin nhiu tun, thng, nm Ba giai on tc rut mn: khng triu chng, c triu chng cn b v c triu chng mt b (mn din tin cp) 6. Chn on tc quai kn hay tht rut au bng nhiu au lin tc St Tiu mu bm Khi u (lng) Vim phc mc 7. Chn on tc rut cao Triu chng tng t nh hp mn v nhng nn nhiu hn v nn dch mt Bng xp Ni g vng thng v hay ngang rn 8. Chn on tc rut non hay rut gi Tc rut non au qun cn, c nhp iu, cn ko di 1-2 pht, cch nhau 3-5 pht. au ni tri hn chng Tc rut gi au m , thnh thong au qun km cm gic mc cu Chng bng ni tri hn au bng 9. Chn on tc hon ton hay bn tc Ch p dng cho tc rut cp hay mn din tin cp (mt b) Da vo trung tin v i tin, tc rut non hay rut gi Tc rut non: cn trung tin l bn tc Tc rut gi: khng i tin c l tc hon ton 10. Chn on nguyn nhn C so m: dnh, thot v vt m (1) Tr em, ngi tr: rut xoay bt ton Khi phng au vng bn: thot v bn (2) Ngi gi, thiu mu: u i trng (3) Tiu mu bm: tht nght, lng rut Khi u: lng rut, u tn sinh N ln tui, gy , du hiu Howship-Romberg: thot v bt N ln tui, bo: tc rut do si mt m sc t khoang ming: HC Peutz-Jeghers Rng rng, ni tt ng tiu ha: b thc n Dng thuc khng ng: t mu thnh rut 11. Chn on phn bit tc rut n thun Lit rut Hi chng gi tc i trng cp (HC Ogilvie) HC gi tc rut non cp (?) 12. Chn on phn bit bn tc rut To bn Vim d dy-rut cp Vim rut T dch/p-xe tn lu sau m Vim rut tha th tc rut 13. Chn on phn bit tht nght rut Vim phc mc Vim ty cp Nhi mu mc treo rut 14. Chn on phn bit tht nght rut Vim phc mc Vim tu cp Tc mch mc treo rut 15. IU TR 16. Nguyn tc iu tr Bnh l ngoi khoa Tt c c ch nh can thip phu thut. Tuy nhin, iu tr bo tn c cn nhc cho mt s trng hp Phu thut khn n cp cu c tri hon 17. iu tr ban u t mt ng truyn ln Truyn dch, bt u vi dung dch LR Khng sinh, nu BN ln tui, gim sc khng hay chun b trc m Gim co tht: nu tt rut mn hay tt quai kn Gim tit d dy, nu c nn i t thng d dy, nu d dy c ng 18. Xt nghim Cng thc mu toan b PT, PTT, INR Nhm mu BUN, creatinin, ion X-quang ngc in tm , nu BN trn 50 tui Siu m tim, men tim, nu BN c bnh l tim mch 19. Ch nh iu tr bo tn Nguyn nhn lnh tnh n thun Bn tc hay tc hon ton n trc 12 h C iu kin (nhn lc, trang thit b) theo di v x tr kp thi 20. Ni dung iu tr bo tn Nhn n ung Truyn dch Thm khm mi 6 gi, X-quang mi 6-12 gi 21. iu tr bo tn c hiu qu: Bt au (cn au gim v tn sut v cng ) Bng xp hn C trung tin BN i bng X-quang: rut bt chng, hi xut hin bn di ch tc 22. iu tr bo tn tht bi: Triu chng khng ci thin sau 48 gi i vi bn tc rut non do dnh. Thi gian ny ngn hn nu tc rut non hon ton do dnh v di hn nu bn tc rut do vim rut 23. Phu thut bt k thi im no trong qu trnh iu tr bo tn nu xut hin triu chng nghi ng tht nght rut! 24. iu tr phu thut 25. Chun b trc m Khng sinh phng nga Thng d dy Thng tiu Gy m ton thn vi ni kh qun v dn c tt 26. Nguyn tc phu thut: ng gia Khi vo xoang bng, ghi nhn mu sc dch (vng trong, hng, bm) v mi (hi thi) Tm manh trng: xc nh tc rut non hay rut gi Tm v tr tc: gii hn gia on rut phnh v on rut xp 27. X tr tn thng: Tc rut do dnh: g dnh Khng g ht tt c cc dy dnh Khu che cc ch mt thanh mc Ct ni rut: rut mt thanh mc din rng Nu dnh cht v phc tp: ni tt U rut: Ct on rut, ni k u hay a ra ngoi Khng ct rut, ni tt hay a rut ra ngoi lm HMNT 28. Tc rut do b thc n: B mm: bp y b xung i trng B cng: y dn b ln on rut trn, m rut ly b Tc rut do si mt: y dn si ln on rut trn, m rut ly si 29. Xon rut: Rut cn sng: tho xon Rut hoi t tht s: khng tho xon ct on rut, ni k u hay a ra ngoi lm HMNT Nghi ng kh nng sng ca on rut hoi t qu di: yn rut, m bng k hai (second look) sau 24 gi Ct rut gii hn, m bng k hai sau 72 gi 30. Chm sc hu phu Tip tc ht thng d dy v bi hon nc v in gii. Tip tc dng khng sinh 3-5 ngy nu cuc phu thut c m rut hay ct ni rut (5-7 ngy nu c hoi t rut). 31. Cho bnh nhn vn ng sm. Khng dng cc loi thuc c tc dng ph gy lit rut (thuc gim au nhm morphine, thuc chng trm cm ba vng, verapamil, phenothiazin) Khi c trung tin, rt thng d dy, bt u cho bnh nhn n ung vi ch thch hp. 32. Cc bin chng c th xy ra sau m: Tc rut hu phu p-xe tn lu X d ming ni Cc bin chng ca hu mn nhn to 33. iu kin iu tr tc rut bng phu thut ni soi Do dy dnh BN n sm, bng khng chng nhiu Dy dnh khng nhiu (sau ct rut tha, cc phu thut sn ph khoa) 34. HT