{"id":759,"date":"2021-09-04T12:24:08","date_gmt":"2021-09-04T05:24:08","guid":{"rendered":"https:\/\/cdha.edu.vn\/cdha\/?p=759"},"modified":"2022-09-01T15:17:53","modified_gmt":"2022-09-01T08:17:53","slug":"tong-hop-covid-19","status":"publish","type":"post","link":"https:\/\/cdha.edu.vn\/cdha\/tong-hop-covid-19\/","title":{"rendered":"T\u1ed5ng h\u1ee3p Covid-19"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>B\u00c0I THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/drive.google.com\/file\/d\/1POcpjjzVM3vlPEpoG_9_BbowG4bQ0mvg\">Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb Covid-19 &#8211; B\u1ed9 Y T\u1ebf 14-07-2021<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1zPH1ngMrXR4EhvRNyY0ELHNRy9wcOUgM\/view\" target=\"_blank\">S\u1ed5 tay \u0111i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c covid<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/docs.google.com\/document\/d\/1AbYMnd759HgDJr4v6E19cb3Nu43xvJRb\/edit?usp=sharing&amp;ouid=100891371444110375417&amp;rtpof=true&amp;sd=true\" target=\"_blank\">\u0110\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb covid<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1JTwdckHaxhLaH0AKtgrbf1UlxYYCfa4N\" target=\"_blank\">Bi\u1ec3u hi\u1ec7n h\u00f4 h\u1ea5p trong Covid-19 v\u00e0 Covid k\u00e9o d\u00e0i<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1WYG6xZn6T52P3xwM8PcMpjRgUKyBiYoc\/view?usp=sharing\" data-type=\"URL\" data-id=\"https:\/\/drive.google.com\/file\/d\/1WYG6xZn6T52P3xwM8PcMpjRgUKyBiYoc\/view?usp=sharing\" target=\"_blank\">C\u00e1c c\u00f4ng c\u1ee5 d\u1ecbch ki\u1ebfn th\u1ee9c \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn ch\u0103m s\u00f3c b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n b\u1ecb b\u1ec7nh h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh trong \u0111\u1ea1i d\u1ecbch COVID-19<\/a><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>SINH L\u00dd B\u1ec6NH<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/drive.google.com\/file\/d\/1zS39rsi9nPt2dy1RRyF2oaBMCJ29twPA\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">C\u00e1c con \u0111\u01b0\u1eddng t\u00edn hi\u1ec7u v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u01a1n b\u00e3o cytokine trong COVID-19<\/a> (<a href=\"https:\/\/drive.google.com\/file\/d\/1w0reMbIevUQ5i8t5gQRVJ8FKfhZ45Niq\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">LINK 2<\/a>)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>TRI\u1ec6U CH\u1ee8NG&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>1. L\u00e2m s\u00e0ng<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Th\u1eddi gian \u1ee7 b\u1ec7nh: t\u1eeb 2-14 ng\u00e0y, trung b\u00ecnh t\u1eeb 5-7 ng\u00e0y.<\/li><li>Kh\u1edfi ph\u00e1t: Tri\u1ec7u ch\u1ee9ng hay g\u1eb7p l\u00e0 s\u1ed1t, ho khan, m\u1ec7t m\u1ecfi v\u00e0 \u0111au c\u01a1. C\u00f3 th\u1ec3 b\u1ecb \u0111au h\u1ecdng, ngh\u1eb9t m\u0169i, ch\u1ea3y n\u01b0\u1edbc m\u0169i, \u0111au \u0111\u1ea7u, ho c\u00f3 \u0111\u1eddm, n\u00f4n v\u00e0 ti\u00eau ch\u1ea3y. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ec3u hi\u1ec7n r\u1ed1i lo\u1ea1n kh\u1ee9u gi\u00e1c ho\u1eb7c t\u00ea l\u01b0\u1ee1i.<\/li><li>Di\u1ec5n bi\u1ebfn:<ul><li>H\u1ea7u h\u1ebft ng\u01b0\u1eddi b\u1ec7nh (kho\u1ea3ng h\u01a1n 80%) ch\u1ec9 s\u1ed1t nh\u1eb9, ho, m\u1ec7t m\u1ecfi, kh\u00f4ng b\u1ecb vi\u00eam ph\u1ed5i v\u00e0 th\u01b0\u1eddng t\u1ef1 h\u1ed3i ph\u1ee5c sau kho\u1ea3ng m\u1ed9t tu\u1ea7n. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng n\u00e0o.<\/li><li>Kho\u1ea3ng g\u1ea7n 20% s\u1ed1 b\u1ec7nh nh\u00e2n di\u1ec5n bi\u1ebfn n\u1eb7ng, th\u1eddi gian trung b\u00ecnh t\u1eeb khi c\u00f3 tri\u1ec7u ch\u1ee9ng ban \u0111\u1ea7u t\u1edbi khi di\u1ec5n bi\u1ebfn n\u1eb7ng th\u01b0\u1eddng kho\u1ea3ng 5-8 ng\u00e0y. C\u00e1c bi\u1ec3u hi\u1ec7n n\u1eb7ng bao g\u1ed3m: vi\u00eam ph\u1ed5i, vi\u00eam ph\u1ed5i n\u1eb7ng c\u1ea7n nh\u1eadp vi\u1ec7n\u2026Trong \u0111\u00f3 kho\u1ea3ng 5% c\u1ea7n \u0111i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c v\u1edbi c\u00e1c bi\u1ec3u hi\u1ec7n h\u00f4 h\u1ea5p c\u1ea5p (th\u1edf nhanh, kh\u00f3 th\u1edf, t\u00edm t\u00e1i, \u2026), h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS), r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, t\u1ed5n th\u01b0\u01a1ng vi m\u1ea1ch g\u00e2y huy\u1ebft kh\u1ed1i v\u00e0 t\u1eafc m\u1ea1ch, vi\u00eam c\u01a1 tim,&nbsp; s\u1ed1c nhi\u1ec5m tr\u00f9ng, suy ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan bao g\u1ed3m t\u1ed5n th\u01b0\u01a1ng th\u1eadn v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim, d\u1eabn \u0111\u1ebfn t\u1eed vong.<\/li><li>T\u1eed vong x\u1ea3y ra nhi\u1ec1u h\u01a1n \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch v\u00e0 m\u1eafc c\u00e1c b\u1ec7nh m\u1ea1n t\u00ednh k\u00e8m theo. \u1ede ng\u01b0\u1eddi l\u1edbn, c\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng t\u0103ng nguy c\u01a1 t\u1eed vong l\u00e0 tu\u1ed5i cao, <strong>\u0111i\u1ec3m suy \u0111a t\u1ea1ng SOFA<\/strong> cao khi nh\u1eadp vi\u1ec7n v\u00e0 <strong>n\u1ed3ng \u0111\u1ed9 Ddimer &gt; 1 mg\/L<\/strong>.<\/li><\/ul><\/li><li>Th\u1eddi k\u1ef3 h\u1ed3i ph\u1ee5c: Sau giai \u0111o\u1ea1n to\u00e0n ph\u00e1t 7-10 ng\u00e0y, n\u1ebfu kh\u00f4ng c\u00f3 ARDS b\u1ec7nh nh\u00e2n s\u1ebd h\u1ebft s\u1ed1t c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng d\u1ea7n tr\u1edf l\u1ea1i b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u1ecfi b\u1ec7nh.<\/li><li>Ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng kh\u00e1c bi\u1ec7t v\u1ec1 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a COVID-19 \u1edf ph\u1ee5 n\u1eef mang thai.<\/li><li>\u1ede tr\u1ebb em, \u0111a s\u1ed1 tr\u1ebb m\u1eafc COVID-19 c\u00f3 c\u00e1c c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng nh\u1eb9 h\u01a1n ng\u01b0\u1eddi l\u1edbn, ho\u1eb7c kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. C\u00e1c d\u1ea5u hi\u1ec7u th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em l\u00e0 s\u1ed1t v\u00e0 ho, ho\u1eb7c c\u00e1c bi\u1ec3u hi\u1ec7n vi\u00eam ph\u1ed5i n\u1eb7ng d\u1eabn t\u1edbi t\u1eed vong. Tuy nhi\u00ean m\u1ed9t s\u1ed1 tr\u1ebb m\u1eafc COVID-19 c\u00f3 t\u1ed5n th\u01b0\u01a1ng vi\u00eam \u0111a c\u01a1 quan gi\u1ed1ng b\u1ec7nh Kawasaski: s\u1ed1t; ban \u0111\u1ecf ho\u1eb7c xung huy\u1ebft gi\u00e1c m\u1ea1c, ho\u1eb7c ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c mi\u1ec7ng, b\u00e0n tay, ch\u00e2n; suy tu\u1ea7n ho\u00e0n; c\u00e1c bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng ch\u1ee9c n\u0103ng tim v\u00e0 t\u0103ng men tim; r\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a; r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u v\u00e0 t\u0103ng c\u00e1c ch\u1ec9 s\u1ed1 vi\u00eam c\u1ea5p.<\/li><li>Tri\u1ec7u ch\u1ee9ng gi\u1ea3m oxy m\u00e1u:<ul><li>T\u00edm \u1edf da v\u00e0 ni\u00eam m\u1ea1c nh\u01b0 \u0111\u1ea7u ng\u00f3n tay, ng\u00f3n ch\u00e2n, d\u00e1i tai (t\u00edm khi Hb &gt; 5g\/L)<\/li><li><span style=\"color:#cf2e2e\" class=\"tadv-color\">(h\u1ecfi l\u1ea1i nghi\u1ec7m ph\u00e1p nh\u1ea5n \u0111\u1ea7u ng\u00f3n tay bao l\u00e2u th\u00ec th\u1ea3 ra&#8230;)<\/span><\/li><li>Thi\u1ebfu oxy n\u00e3o: b\u1ee9t r\u1ee9t v\u1eadt v\u00e3 l\u01a1 m\u01a1 h\u00f4n m\u00ea&#8230;<\/li><\/ul><\/li><li>C\u00e1c tri\u1ec7u ch\u1ee9ng t\u0103ng CO2: xem trong video c\u1ee7a h\u1ed9i y h\u1ecdc c\u1ee7a th\u1ea7y V\u0169, b\u00e0i cu\u1ed1i.<\/li><li>L\u01b0u \u00fd t\u00ecnh tr\u1ea1ng thi\u1ebfu oxy im l\u1eb7ng:<ul><li>Kh\u00f4ng than kh\u00f3 th\u1edf<\/li><li>N\u00f3i chuy\u1ec7n b\u00ecnh th\u01b0\u1eddng<\/li><li>Nh\u01b0ng SpO2 v\u1eabn t\u1ee5t<\/li><\/ul><\/li><li>Kh\u00f3 th\u1edf:<ul><li>Th\u1edf &gt; 24 l\u1ea7n\/ ph\u00fat: ch\u1eafc ch\u1eafn c\u00f3 kh\u00f3 th\u1edf th\u1edf nhanh, g\u1ee3i \u00fd vi\u00eam ph\u1ed5i. M\u1ed9t s\u1ed1 n\u01a1i l\u1ea5y nh\u1ea1y h\u01a1n l\u00e0 20 l\u1ea7n\/ ph\u00fat. (th\u1edf ch\u1eadm n\u1ebfu &lt; 12L\/p)<\/li><li>Co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5: c\u01a1 \u1ee9c \u0111\u00f2m ch\u0169m, c\u01a1 thang, c\u01a1 gian s\u01b0\u1eddn (h\u00edt v\u00e0o), c\u01a1 th\u1eb3ng b\u1ee5ng, c\u01a1 ch\u00e9o b\u1ee5ng ngo\u00e0i (th\u1edf ra)<\/li><li>Th\u1edf ngh\u1ecbch \u0111\u1ea3o ng\u1ef1c b\u1ee5ng, th\u1edf ng\u1eaft qu\u00e3ng, th\u1edf ng\u00e1p&#8230;<\/li><li>Tim nhanh, <span style=\"color:#cf2e2e\" class=\"tadv-color\">m\u1ea1ch ngh\u1ecbch<\/span><\/li><li>T\u0103ng huy\u1ebft \u00e1p, v\u00e3 m\u1ed3 h\u00f4i, ti\u1ec3u \u00edt&#8230;<\/li><\/ul><\/li><li>SpO2 \u1ede b\u1ec7nh nh\u00e2n covid, SpO2 &lt; 94% l\u00e0 ph\u1ea3i th\u1edf oxy.<\/li><li><span style=\"color:#cf2e2e\" class=\"tadv-color\"><strong><em>Suy h\u00f4 h\u1ea5p khi c\u00f3:<\/em><\/strong><\/span><ul><li>B\u1ea5t th\u01b0\u1eddng kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch khi \u0111ang th\u1edf kh\u00ed tr\u1eddi (PaO2 &lt; 60mmHg &#8211; gi\u1ea3m Oxy m\u00e1u ho\u1eb7c PaCO2 &gt; 45mmHg k\u00e9m pH &lt; 7.35 &#8211; \u01b0u th\u00e1n). <strong><span style=\"color:#cf2e2e\" class=\"tadv-color\">Coi l\u1ea1i b\u1ea3ng t\u01b0\u01a1ng quan gi\u1eefa SpO2 v\u00e0 PaO2<\/span><\/strong>.<\/li><li>Ho\u1eb7c kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch b\u00ecnh th\u01b0\u1eddng nh\u1edd \u0111i\u1ec1u tr\u1ecb suy h\u1ed1 h\u1ea5p (bn \u0111ang th\u1edf oxy ho\u1eb7c \u0111ang s\u1eed d\u1ee5ng m\u00e1y th\u1edf).<\/li><li>\u1ede nh\u00e0 ph\u01b0\u01a1ng ti\u1ec7n t\u1ed1t nh\u1ea5t l\u00e0 SpO2.<\/li><li>Ch\u1ea9n \u0111o\u00e1n SHH c\u1ea7n can thi\u1ec7p s\u1edbm h\u01a1n v\u1edbi SpO2 &lt; 94%<\/li><li>\u0110\u1ebfm nh\u1ecbp th\u1edf g\u1ee3i \u00fd vi\u00eam ph\u1ed5i khi &gt; 24 L\/p<\/li><\/ul><\/li><li>Th\u1edf Oxy \u1edf bn covid<ul><li>C\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ea3m oxy m\u00e1u v\u00e0 SpO2 &lt; 94%<\/li><li>Gi\u1ea3m oxy m\u00e1u kh\u00f4ng tri\u1ec7u ch\u1ee9ng SpO2 &lt; 90%<\/li><li>Ph\u1ee5 n\u1eef c\u00f3 thai SpO2 &lt; 92%<\/li><\/ul><\/li><li>D\u1ea5u hi\u1ec7u k\u00edch ho\u1ea1t oxy \u1edf tr\u1ebb em:<ul><li>T\u00edm t\u00e1i trung \u01b0\u01a1ng<\/li><li>Ph\u1eadp ph\u00f2ng c\u00e1nh m\u0169i<\/li><li>Kh\u00f4ng th\u1ec3 \u0103n u\u1ed1ng<\/li><li>Th\u1edf r\u00ean t\u1eebng h\u01a1i th\u1edf<\/li><li>Thay \u0111\u1ed5i t\u00ecnh tr\u1ea1ng tri gi\u00e1c<\/li><li>R\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c n\u1eb7ng, th\u1edf &gt;= 70 chu k\u1ef3\/ ph\u00fat&#8230;<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>PH\u00c2N LO\u1ea0I M\u1ee8C \u0110\u1ed8 L\u00c2M S\u00c0NG<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B\u1ec7nh COVID-19 c\u00f3 c\u00e1c m\u1ee9c \u0111\u1ed9 nh\u01b0 sau:<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\" start=\"1\"><li><strong>Kh\u00f4ng tri\u1ec7u ch\u1ee9ng<\/strong>: l\u00e0 ng\u01b0\u1eddi nhi\u1ec5m SARS-CoV-2 \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh b\u1eb1ng x\u00e9t nghi\u1ec7m realtime RT-PCR d\u01b0\u01a1ng t\u00ednh, nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/li><li><strong>M\u1ee9c \u0111\u1ed9 nh\u1eb9: Vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean c\u1ea5p t\u00ednh<\/strong>: <ul><li>Ng\u01b0\u1eddi b\u1ec7nh nhi\u1ec5m SARS-CoV-2 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u nh\u01b0 nh\u01b0 s\u1ed1t, ho khan, \u0111au h\u1ecdng, ngh\u1eb9t m\u0169i, m\u1ec7t m\u1ecfi, \u0111au \u0111\u1ea7u, \u0111au m\u1ecfi c\u01a1, t\u00ea l\u01b0\u1ee1i. <\/li><li>Kh\u00f4ng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a vi\u00eam ph\u1ed5i ho\u1eb7c thi\u1ebfu \u00f4 xy, nh\u1ecbp th\u1edf \u2264 20 l\u1ea7n\/ph\u00fat, SpO<sub>2<\/sub> \u2265 96% khi th\u1edf kh\u00ed tr\u1eddi.<\/li><\/ul><\/li><li><strong>M\u1ee9c \u0111\u1ed9 v\u1eeba: Vi\u00eam ph\u1ed5i<\/strong><ul><li><em>Ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb l\u1edbn<\/em>: b\u1ecb vi\u00eam ph\u1ed5i (s\u1ed1t, ho, kh\u00f3 th\u1edf, th\u1edf nhanh &gt;20 l\u1ea7n\/ph\u00fat) v\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam ph\u1ed5i n\u1eb7ng, SpO<sub>2<\/sub> \u2265 93% khi th\u1edf kh\u00ed tr\u1eddi.<\/li><li><em>Tr\u1ebb nh\u1ecf<\/em>: tr\u1ebb c\u00f3 ho ho\u1eb7c kh\u00f3 th\u1edf v\u00e0 th\u1edf nhanh. Th\u1edf nhanh \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi nh\u1ecbp th\u1edf \u2265 60 l\u1ea7n\/ph\u00fat \u1edf tr\u1ebb d\u01b0\u1edbi 2 th\u00e1ng; \u2265 50 l\u1ea7n\/ph\u00fat \u1edf tr\u1ebb t\u1eeb 2 &#8211; 11 th\u00e1ng; \u2265 40 l\u1ea7n\/ph\u00fat \u1edf tr\u1ebb t\u1eeb 1 &#8211; 5 tu\u1ed5i) v\u00e0 kh\u00f4ng c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a vi\u00eam ph\u1ed5i n\u1eb7ng.<\/li><li>Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng, tuy nhi\u00ean, h\u00ecnh \u1ea3nh X-quang, si\u00eau \u00e2m ho\u1eb7c CT ph\u1ed5i th\u1ea5y h\u00ecnh \u1ea3nh vi\u00eam ph\u1ed5i k\u1ebd ho\u1eb7c ph\u00e1t hi\u1ec7n c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/li><\/ul><\/li><li><strong>M\u1ee9c \u0111\u1ed9 n\u1eb7ng &#8211; Vi\u00eam ph\u1ed5i n\u1eb7ng<\/strong><ul><li><em>Ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb l\u1edbn:<\/em> s\u1ed1t ho\u1eb7c nghi ng\u1edd nhi\u1ec5m tr\u00f9ng h\u00f4 h\u1ea5p, k\u00e8m theo b\u1ea5t k\u1ef3 m\u1ed9t d\u1ea5u hi\u1ec7u sau: nh\u1ecbp th\u1edf &gt; 30 l\u1ea7n\/ph\u00fat, kh\u00f3 th\u1edf n\u1eb7ng, ho\u1eb7c SpO<sub>2<\/sub> &lt; 93% khi th\u1edf kh\u00ed ph\u00f2ng.<\/li><li><em>Tr\u1ebb nh\u1ecf:<\/em> ho ho\u1eb7c kh\u00f3 th\u1edf, v\u00e0 c\u00f3 \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau \u0111\u00e2y: t\u00edm t\u00e1i ho\u1eb7c SpO<sub>2<\/sub> &lt; 93%; suy h\u00f4 h\u1ea5p n\u1eb7ng (th\u1edf r\u00ean, r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c);<\/li><li>Ho\u1eb7c tr\u1ebb \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n vi\u00eam ph\u1ed5i v\u00e0 c\u00f3 b\u1ea5t k\u1ef3 d\u1ea5u hi\u1ec7u n\u1eb7ng sau: kh\u00f4ng th\u1ec3 u\u1ed1ng\/b\u00fa \u0111\u01b0\u1ee3c; r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c (li b\u00ec ho\u1eb7c h\u00f4n m\u00ea); co gi\u1eadt. C\u00f3 th\u1ec3 c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u kh\u00e1c c\u1ee7a vi\u00eam ph\u1ed5i nh\u01b0 r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c, th\u1edf nhanh (t\u1ea7n s\u1ed1 th\u1edf\/ph\u00fat nh\u01b0 tr\u00ean).&nbsp;<\/li><li>Ch\u1ea9n \u0111o\u00e1n d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng, ch\u1ee5p X-quang ph\u1ed5i \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh c\u00e1c bi\u1ebfn ch\u1ee9ng.<\/li><\/ul><\/li><\/ol>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"556\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-1-1024x556.jpg\" alt=\"\" class=\"wp-image-775\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-1-1024x556.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-1-300x163.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-1-768x417.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-1.jpg 1250w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><strong>L\u01b0u \u00fd: SpO2 kh\u00f4ng ch\u00ednh x\u00e1c khi huy\u1ebft \u00e1p t\u1ee5t, co m\u1ea1ch, SaO2 &gt; 8-%, m\u00f3ng tay gi\u1ea3 hay s\u01a1n, kh\u00f4ng ph\u00e2n bi\u1ec7t COHb v\u00e0 MetHb. <\/strong><br><strong>B\u1ea3ng \u01b0\u1edbc t\u00ednh PaO2 d\u1ef1a tr\u00ean SpO2 nh\u01b0 h\u00ecnh tr\u00ean.<\/strong><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Ph\u00e2n \u0111\u1ed9 Covid t\u1ea1i nh\u00e0<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"724\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/0001-1024x724.jpg\" alt=\"\" class=\"wp-image-780\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/0001-1024x724.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/0001-300x212.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/0001-768x543.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/0001-1536x1086.jpg 1536w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/0001-2048x1448.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">\u0110\u1ecdc th\u00eam b\u00e0i<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/drive.google.com\/file\/d\/1d2GFh4FUCG4dT0aUWUfe93IByqjt64IS\/view\">Thi\u1ebfu oxy kh\u00f4ng tri\u1ec7u ch\u1ee9ng \u1edf COVID-19 c\u00f3 li\u00ean quan \u0111\u1ebfn k\u1ebft c\u1ee5c x\u1ea5u<\/a><\/p>\n\n\n\n<ol class=\"wp-block-list\" type=\"1\" start=\"6\"><li><strong>M\u1ee9c \u0111\u1ed9 nguy k\u1ecbch<\/strong><ol><li><strong><em>H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS)<\/em><\/strong><ul><li><em>Kh\u1edfi ph\u00e1t: <\/em>c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p m\u1edbi ho\u1eb7c x\u1ea5u \u0111i trong v\u00f2ng m\u1ed9t tu\u1ea7n k\u1ec3 t\u1eeb khi c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng.<\/li><li><em>X-quang, CT scan ho\u1eb7c si\u00eau \u00e2m ph\u1ed5i<\/em>: h\u00ecnh \u1ea3nh m\u1edd hai ph\u1ebf tr\u01b0\u1eddng m\u00e0 kh\u00f4ng ph\u1ea3i do tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, x\u1eb9p th\u00f9y ph\u1ed5i ho\u1eb7c c\u00e1c n\u1ed1t \u1edf ph\u1ed5i.<\/li><li><em>Ngu\u1ed3n g\u1ed1c c\u1ee7a ph\u00f9 ph\u1ed5i<\/em> kh\u00f4ng ph\u1ea3i do suy tim ho\u1eb7c qu\u00e1 t\u1ea3i d\u1ecbch. C\u1ea7n \u0111\u00e1nh gi\u00e1 kh\u00e1ch quan (si\u00eau \u00e2m tim) \u0111\u1ec3 lo\u1ea1i tr\u1eeb ph\u00f9 ph\u1ed5i do \u00e1p l\u1ef1c th\u1ee7y t\u0129nh n\u1ebfu kh\u00f4ng th\u1ea5y c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1.<\/li><li><em>Thi\u1ebfu \u00f4 xy m\u00e1u:<\/em> \u1edf ng\u01b0\u1eddi l\u1edbn, ph\u00e2n lo\u1ea1i d\u1ef1a v\u00e0o ch\u1ec9 s\u1ed1 PaO<sub>2<\/sub>\/FiO<sub>2<\/sub> (P\/F) v\u00e0 SpO<sub>2<\/sub>\/FiO<sub>2<\/sub> (S\/F) khi kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3 PaO<sub>2<\/sub>:<ul><li>ARDS nh\u1eb9: 200 mmHg &lt; P\/F \u2264 300 mmHg v\u1edbi PEEP ho\u1eb7c CPAP \u2265 5 cm H<sub>2<\/sub>O.&nbsp;<\/li><li>ARDS n\u1eb7ng: P\/F \u2264 100 mmHg v\u1edbi PEEP \u2265 5 cmH<sub>2<\/sub>O<\/li><li>Khi kh\u00f4ng c\u00f3 PaO<sub>2<\/sub>: S\/F \u2264 315 g\u1ee3i \u00fd ARDS (k\u1ec3 c\u1ea3 nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng th\u1edf m\u00e1y)<\/li><\/ul><\/li><li><em>Thi\u1ebfu \u00f4 xy m\u00e1u<\/em>: \u1edf tr\u1ebb em d\u1ef1a v\u00e0o c\u00e1c ch\u1ec9 s\u1ed1 OI <em>(ch<sub>\u1ec9<\/sub> s<sub>\u1ed1<\/sub> Oxygen h\u00f3a:<\/em> <em>OI\u2009=\u2009MAP*\u2009\u00d7\u2009FiO<sub>2<\/sub>\u2009\u00d7\u2009100\u2009\/\u2009PaO<sub>2<\/sub>) (MAP*: \u00e1p l\u1ef1c \u0111\u01b0\u1eddng th\u1edf trung b\u00ecnh)<\/em> ho\u1eb7c OSI <em>(ch\u1ec9 s\u1ed1 Oxygen h\u00f3a s\u1eed d\u1ee5ng SpO<sub>2<\/sub>:OSI\u2009=\u2009MAP\u2009\u00d7\u2009FiO<sub>2<\/sub>\u2009\u00d7\u2009100\u2009\/SpO<sub>2<\/sub>)<\/em> cho ng\u01b0\u1eddi b\u1ec7nh th\u1edf m\u00e1y x\u00e2m nh\u1eadp, v\u00e0 PaO<sub>2<\/sub>\/FiO<sub>2<\/sub> hay SpO<sub>2<\/sub>\/FiO<sub>2<\/sub> cho th\u1edf CPAP hay th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp (NIV):<ul><li>NIV BiLevel ho\u1eb7c CPAP \u2265 5 cmH<sub>2<\/sub>O qua m\u1eb7t n\u1ea1: PaO<sub>2<\/sub>\/FiO<sub>2 <\/sub>\u2264 300 mmHg ho\u1eb7c SpO<sub>2<\/sub>\/FiO<sub>2<\/sub> \u2264 264<\/li><li>ARDS nh\u1eb9 (th\u1edf m\u00e1y x\u00e2m nh\u1eadp): 4 \u2264 OI &lt;8 ho\u1eb7c 5 \u2264 OSI &lt;7,5<\/li><li>ARDS v\u1eeba (th\u1edf m\u00e1y x\u00e2m nh\u1eadp): 8 \u2264 OI &lt;16 ho\u1eb7c 7,5 \u2264 OSI &lt; 12,3<\/li><li>ARDS n\u1eb7ng (th\u1edf m\u00e1y x\u00e2m nh\u1eadp): OI \u2265 16 ho\u1eb7c OSI \u2265 12,3<br><\/li><\/ul><\/li><\/ul><\/li><li><strong><em>Nhi\u1ec5m tr\u00f9ng huy\u1ebft (sepsis)<\/em><\/strong><ul><li><em>Ng\u01b0\u1eddi l\u1edbn<\/em>: c\u00f3 d\u1ea5u hi\u1ec7u r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan:<ul><li>Thay \u0111\u1ed5i \u00fd th\u1ee9c: ng\u1ee7 g\u00e0, l\u01a1 m\u01a1, h\u00f4n m\u00ea<\/li><li>Kh\u00f3 th\u1edf ho\u1eb7c th\u1edf nhanh, \u0111\u1ed9 b\u00e3o h a \u00f4 xy th\u1ea5p<\/li><li>Nh\u1ecbp tim nhanh, m\u1ea1ch b\u1eaft y\u1ebfu, chi l\u1ea1nh ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p, da n\u1ed5i v\u00e2n t\u00edm<\/li><li>Thi\u1ec3u ni\u1ec7u ho\u1eb7c v\u00f4 ni\u1ec7u<\/li><li>X\u00e9t nghi\u1ec7m c\u00f3 r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, gi\u1ea3m ti\u1ec3u c\u1ea7u, nhi\u1ec5m toan, t\u0103ng lactate, t\u0103ng bilirubine\u2026<\/li><\/ul><\/li><li><em>Tr\u1ebb em: <\/em>khi nghi ng\u1edd ho\u1eb7c kh\u1eb3ng \u0111\u1ecbnh do nhi\u1ec5m tr\u00f9ng v\u00e0 c\u00f3 \u00edt nh\u1ea5t 2 ti\u00eau chu\u1ea9n c\u1ee7a h\u1ed9i ch\u1ee9ng \u0111\u00e1p \u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng (SIRS) v\u00e0 m\u1ed9t trong s\u1ed1 \u0111\u00f3 ph\u1ea3i l\u00e0 thay \u0111\u1ed5i th\u00e2n nhi\u1ec7t ho\u1eb7c s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u b\u1ea5t th\u01b0\u1eddng.<br><\/li><\/ul><\/li><li><strong><em>S\u1ed1c nhi\u1ec5m tr\u00f9ng<\/em><\/strong><ul><li><em>Ng\u01b0\u1eddi l\u1edbn<\/em>: h\u1ea1 huy\u1ebft \u00e1p k\u00e9o d\u00e0i m\u1eb7c d\u00f9 \u0111\u00e3 h\u1ed3i s\u1ee9c d\u1ecbch, ph\u1ea3i s\u1eed d\u1ee5ng thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ec3 duy tr\u00ec huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh (MAP) \u2265 65 mmHg v\u00e0 n\u1ed3ng \u0111\u1ed9 lactate huy\u1ebft thanh &gt; 2 mmol\/L.<\/li><li><em>Tr\u1ebb em<\/em>: s\u1ed1c nhi\u1ec5m tr\u00f9ng x\u00e1c \u0111\u1ecbnh khi c\u00f3:<ul><li>B\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng h\u1ea1 huy\u1ebft \u00e1p n\u00e0o: khi huy\u1ebft \u00e1p t\u00e2m thu &lt; 5 b\u00e1ch ph\u00e2n v\u1ecb ho\u1eb7c &gt; 2SD d\u01b0\u1edbi ng\u01b0\u1ee1ng b\u00ecnh th\u01b0\u1eddng theo l\u1ee9a tu\u1ed5i, ho\u1eb7c (tr\u1ebb &lt; 1 tu\u1ed5i: &lt; 70 mmHg; tr\u1ebb t\u1eeb 1-10 tu\u1ed5i: &lt; 70 + 2 x tu\u1ed5i; tr\u1ebb &gt; 10 tu\u1ed5i: &lt; 90 mmHg).<\/li><li>Ho\u1eb7c c\u00f3 b\u1ea5t k\u1ef3 2-3 d\u1ea5u hi\u1ec7u sau: thay \u0111\u1ed5i \u00fd th\u1ee9c, nh\u1ecbp tim nhanh ho\u1eb7c ch\u1eadm (&lt; 90 nh\u1ecbp\/ph\u00fat ho\u1eb7c &gt; 160 nh\u1ecbp\/ph\u00fat \u1edf tr\u1ebb nh\u0169 nhi, v\u00e0 &lt; 70 nh\u1ecbp\/ph\u00fat ho\u1eb7c &gt; 150 nh\u1ecbp\/ph\u00fat \u1edf tr\u1ebb nh\u1ecf); th\u1eddi gian l\u00e0m \u0111\u1ea7y mao m\u1ea1ch k\u00e9o d\u00e0i (&gt; 2 gi\u00e2y); ho\u1eb7c gi\u00e3n m\u1ea1ch \u1ea5m\/m\u1ea1ch n\u1ea9y; th\u1edf nhanh; da n\u1ed5i v\u00e2n t\u00edm ho\u1eb7c c\u00f3 ch\u1ea5m xu\u1ea5t huy\u1ebft ho\u1eb7c ban xu\u1ea5t huy\u1ebft; t\u0103ng n\u1ed3ng \u0111\u1ed9 lactate; thi\u1ec3u ni\u1ec7u; t\u0103ng ho\u1eb7c h\u1ea1 th\u00e2n nhi\u1ec7t.&nbsp;<br><\/li><\/ul><\/li><\/ul><\/li><li><strong><em>C\u00e1c bi\u1ebfn ch\u1ee9ng n\u1eb7ng- nguy k\u1ecbch kh\u00e1c:<\/em> <\/strong>nh\u1ed3i m\u00e1u ph\u1ed5i, \u0111\u1ed9t qu\u1ef5, s\u1ea3ng.&nbsp;&nbsp;C\u1ea7n theo d\u00f5i s\u00e1t v\u00e0 \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh khi nghi ng\u1edd v\u00e0 c\u00f3 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<br><\/li><\/ol><\/li><li><strong>H\u1ed9i ch\u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng li\u00ean quan t\u1edbi Covid-19<\/strong> <strong>\u1edf tr\u1ebb em<\/strong> (Multisytem Inflammatory Syndrome in Children- MIS-C). <em>Ch\u1ea9n \u0111o\u00e1n khi c\u00f3 c\u00e1c ti\u00eau chu\u1ea9n sau: <\/em>Tr\u1ebb 0 \u2013 19 tu\u1ed5i c\u00f3 s\u1ed1t \u2265 3 ng\u00e0y V\u00c0 c\u00f3 2 trong c\u00e1c d\u1ea5u hi\u1ec7u sau:<ol><li>Ban \u0111\u1ecf ho\u1eb7c xung huy\u1ebft gi\u00e1c m\u1ea1c ho\u1eb7c ph\u00f9 n\u1ec1 ni\u00eam m\u1ea1c mi\u1ec7ng, b\u00e0n tay, ch\u00e2n;&nbsp;<\/li><li>H\u1ea1 huy\u1ebft \u00e1p ho\u1eb7c s\u1ed1c;&nbsp;<\/li><li>Suy gi\u1ea3m ch\u1ee9c n\u0103ng tim, t\u1ed5n th\u01b0\u01a1ng m\u00e0ng tim, vi\u00eam m\u00e0ng ngo\u00e0i tim, b\u1ea5t th\u01b0\u1eddng m\u1ea1ch v\u00e0nh x\u00e1c \u0111\u1ecbnh qua si\u00eau \u00e2m, t\u0103ng proBNP, Troponin;&nbsp;<\/li><li>R\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u (PT, APTT, D-Dimer cao); R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a c\u1ea5p t\u00ednh (\u1ec9a ch\u1ea3y, \u0111au b\u1ee5ng, n\u00f4n)<br><span style=\"text-decoration: underline\" class=\"underline\">V\u00c0 <\/span>c\u00f3 t\u0103ng c\u00e1c markers vi\u00eam (CRP, m\u00e1u l\u1eafng, procalcitonin)<br><span style=\"text-decoration: underline\" class=\"underline\">V\u00c0<\/span> kh\u00f4ng do c\u00e1c c\u0103n nguy\u00ean nhi\u1ec5m tr\u00f9ng kh\u00e1c<br><span style=\"text-decoration: underline\" class=\"underline\">V\u00c0<\/span> c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a nhi\u1ec5m vi r\u00fat SARS-CoV-2 ho\u1eb7c ti\u1ebfp x\u00fac g\u1ea7n v\u1edbi ng\u01b0\u1eddi m\u1eafc COVID-19.<\/li><\/ol><\/li><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u0110I\u1ec0U TR\u1eca<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C\u00e1c bi\u1ec7n ph\u00e1p theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb chung<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Ngh\u1ec9 ng\u01a1i t\u1ea1i gi\u01b0\u1eddng.<\/li><li>V\u1ec7 sinh m\u0169i h\u1ecdng.<\/li><li>Gi\u1eef \u1ea5m<\/li><li>U\u1ed1ng \u0111\u1ee7 n\u01b0\u1edbc, \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng d\u1ecbch, \u0111i\u1ec7n gi\u1ea3i.<\/li><li><em>Th\u1eadn tr\u1ecdng khi truy\u1ec1n d\u1ecbch cho ng\u01b0\u1eddi b\u1ec7nh vi\u00eam ph\u1ed5i nh\u01b0ng kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a s\u1ed1c<\/em>. <\/li><li>\u0110\u1ea3m b\u1ea3o dinh d\u01b0\u1ee1ng v\u00e0 n\u00e2ng cao th\u1ec3 tr\u1ea1ng, b\u1ed5 sung vitamin <\/li><li>\u00c1p d\u1ee5ng <a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1Cvx3FaHzW4eRPQxhNwk6SENliDSR04JU\/view?usp=sharing\" target=\"_blank\">h\u01b0\u1edbng d\u1eabn dinh d\u01b0\u1ee1ng c\u1ee7a H\u1ed9i H\u1ed3i s\u1ee9c c\u1ea5p c\u1ee9u v\u00e0 ch\u1ed1ng \u0111\u1ed9c<\/a> \u0111\u00e3 ban h\u00e0nh.<br><\/li><\/ul>\n\n\n\n<ul class=\"wp-block-list\"><li>H\u1ea1 s\u1ed1t <strong>paracetamol li\u1ec1u 10-15 mg\/kg\/l\u1ea7n, kh\u00f4ng qu\u00e1 60 mg\/kg\/ng\u00e0y cho tr\u1ebb em v\u00e0 kh\u00f4ng qu\u00e1 2 gam\/ng\u00e0y v\u1edbi ng\u01b0\u1eddi <\/strong>l\u1edbn.<\/li><li>Gi\u1ea3m ho b\u1eb1ng c\u00e1c thu\u1ed1c gi\u1ea3m ho th\u00f4ng th\u01b0\u1eddng n\u1ebfu c\u1ea7n thi\u1ebft.<\/li><li>\u0110\u00e1nh gi\u00e1, \u0111i\u1ec1u tr\u1ecb, ti\u00ean l\u01b0\u1ee3ng c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd m\u00e3n t\u00ednh k\u00e8m theo (n\u1ebfu c\u00f3).<\/li><li>T\u01b0 v\u1ea5n, h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd, \u0111\u1ed9ng vi\u00ean ng\u01b0\u1eddi b\u1ec7nh.&nbsp;<\/li><li>Theo d\u00f5i ch\u1eb7t ch\u1ebd c\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng, ti\u1ebfn tri\u1ec3n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i tr\u00ean phim X-quang v\u00e0\/ho\u1eb7c CT ph\u1ed5i, \u0111\u1eb7c bi\u1ec7t trong kho\u1ea3ng ng\u00e0y th\u1ee9 7-10 c\u1ee7a b\u1ec7nh, ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u ti\u1ebfn tri\u1ec3n n\u1eb7ng c\u1ee7a b\u1ec7nh nh\u01b0 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n \u0111\u1ec3 c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p k\u1ecbp th\u1eddi.<\/li><li>T\u1ea1i c\u00e1c c\u01a1 s\u1edf \u0111i\u1ec1u tr\u1ecb c\u1ea7n c\u00f3 c\u00e1c trang thi\u1ebft b\u1ecb, d\u1ee5ng c\u1ee5 c\u1ea5p c\u1ee9u t\u1ed1i thi\u1ec3u: m\u00e1y theo d\u00f5i \u0111\u1ed9 b\u00e3o h\u00f2a \u00f4 xy, h\u1ec7 th\u1ed1ng\/b\u00ecnh cung c\u1ea5p \u00f4 xy, thi\u1ebft b\u1ecb th\u1edf \u00f4 xy (g\u1ecdng m\u0169i, mask th\u00f4ng th\u01b0\u1eddng, mask c\u00f3 t\u00fai d\u1ef1 tr\u1eef), b\u00f3ng, m\u1eb7t n\u1ea1, v\u00e0 d\u1ee5ng c\u1ee5 \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n ph\u00f9 h\u1ee3p c\u00e1c l\u1ee9a tu\u1ed5i.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u0110i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p&nbsp;<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><strong><em>Li\u1ec7u ph\u00e1p \u00f4 xy v\u00e0 theo d\u00f5i<\/em><\/strong><\/li><\/ol>\n\n\n\n<ul class=\"wp-block-list\"><li><em>C\u1ea7n cho th\u1edf \u00f4 xy ngay v\u1edbi b\u1ec7nh nh\u00e2n vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ea5p n\u1eb7ng c\u00f3 suy h\u00f4 h\u1ea5p, thi\u1ebfu \u00f4 xy m\u00e1u, s\u1ed1c \u0111\u1ec3 \u0111\u1ea1t \u0111\u00edch SpO<sub>2<\/sub> &gt; 94%<\/em>. <\/li><li>Theo b\u00e0i c\u1ee7a trung t\u00e2m \u0111\u00e0o t\u1ea1o nh\u00e2n l\u1ef1c y t\u1ebf theo nhu c\u1ea7u x\u00e3 h\u1ed9i: cho th\u1edf oxy khi SpO2 &lt; 94%. <\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"916\" height=\"468\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-2.jpg\" alt=\"\" class=\"wp-image-776\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-2.jpg 916w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-2-300x153.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-2-768x392.jpg 768w\" sizes=\"auto, (max-width: 916px) 100vw, 916px\" \/><figcaption>Thao kh\u1ea3m l\u01b0u \u0111\u1ed3 th\u1edf Oxy<\/figcaption><\/figure>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"647\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-1-1024x647.png\" alt=\"\" class=\"wp-image-778\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-1-1024x647.png 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-1-300x189.png 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-1-768x485.png 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-1.png 1447w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>\u1ede ng\u01b0\u1eddi l\u1edbn n\u1ebfu c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea5p c\u1ee9u (g\u1eafng s\u1ee9c n\u1eb7ng, r\u00fat l\u00f5m l\u1ed3ng ng\u1ef1c, t\u00edm t\u00e1i, gi\u1ea3m th\u00f4ng kh\u00ed ph\u1ed5i) c\u1ea7n l\u00e0m th\u00f4ng tho\u00e1ng \u0111\u01b0\u1eddng th\u1edf v\u00e0 cho th\u1edf \u00f4 xy ngay \u0111\u1ec3 \u0111\u1ea1t \u0111\u00edch SpO<sub>2<\/sub> \u2265 94% trong qu\u00e1 tr\u00ecnh h\u1ed3i s\u1ee9c. Cho th\u1edf \u00f4xy qua g\u1ecdng m\u0169i (1-4 l\u00edt\/ph\u00fat), ho\u1eb7c mask th\u00f4ng th\u01b0\u1eddng, ho\u1eb7c mask c\u00f3 t\u00fai d\u1ef1 tr\u1eef, v\u1edbi l\u01b0u l\u01b0\u1ee3ng ban \u0111\u1ea7u l\u00e0 5 l\u00edt\/ph\u00fat v\u00e0 t\u0103ng l\u00ean t\u1edbi 10-15 l\u00edt\/ph\u00fat n\u1ebfu c\u1ea7n. Khi b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh h\u01a1n, \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 \u0111\u1ea1t \u0111\u00edch SpO<sub>2<\/sub> \u2265 90% cho ng\u01b0\u1eddi l\u1edbn, v\u00e0 SpO<sub>2<\/sub> \u2265 92-95% cho ph\u1ee5 n\u1eef mang thai.<\/li><li>Theo b\u00e0i c\u1ee7a \u0110HYD TPHCM th\u00ec m\u1ee5c \u0111\u00edch l\u00e0 duy tr\u00ec SpO2 t\u1eeb 94 &#8211; 96% kh\u00f4ng n\u00ean cao qu\u00e1. \u1ede b\u1ec7nh nh\u00e2n b\u1ecb suy h\u00f4 h\u1ea5p m\u1ea1n th\u00ec duy tr\u00ec &gt; 90% l\u00e0 \u0111\u01b0\u1ee3c. <strong>(B\u1ed5 sung th\u00eam m\u1ee5c ti\u00eau FiO2 v\u00e0 SpO2 \u1edf bn HFNC trong video c\u1ee7a trung t\u00e2m \u0111t)<\/strong><\/li><li>V\u1edbi tr\u1ebb em, n\u1ebfu tr\u1ebb c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea5p c\u1ee9u nh\u01b0 kh\u00f3 th\u1edf n\u1eb7ng, t\u00edm t\u00e1i, s\u1ed1c, h\u00f4n m\u00ea, co gi\u1eadt.., c\u1ea7n cung c\u1ea5p oxy trong qu\u00e1 tr\u00ecnh c\u1ea5p c\u1ee9u \u0111\u1ec3 \u0111\u1ea1t \u0111\u00edch SpO<sub>2<\/sub> \u2265 94%. Khi t\u00ecnh tr\u1ea1ng tr\u1ebb \u1ed5n \u0111\u1ecbnh, \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 \u0111\u1ea1t \u0111\u00edch SpO<sub>2<\/sub> \u2265 96%.<\/li><li><em>Theo d\u00f5i s\u00e1t t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u n\u1eb7ng, th\u1ea5t b\u1ea1i v\u1edbi li\u1ec7u ph\u00e1p th\u1edf oxy \u0111\u1ec3 c\u00f3 can thi\u1ec7p k\u1ecbp th\u1eddi.<\/em><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u0110\u1ecdc b\u00e0i <a href=\"https:\/\/drive.google.com\/file\/d\/1g24JQH91yPJfmNMMtRmWXAZ4O9deZE6j\/view\">H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p kh\u00f4ng x\u00e2m l\u1ea5n \u1edf b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n v\u1edbi COVID-19: \u0111\u1ec1 xu\u1ea5t thu\u1eadt to\u00e1n<\/a> (r\u1ea5t hay)<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"900\" height=\"330\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-2.png\" alt=\"\" class=\"wp-image-792\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-2.png 900w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-2-300x110.png 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-2-768x282.png 768w\" sizes=\"auto, (max-width: 900px) 100vw, 900px\" \/><figcaption><a href=\"https:\/\/drive.google.com\/file\/d\/1g24JQH91yPJfmNMMtRmWXAZ4O9deZE6j\/view\">Link<\/a><\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"681\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-3-1024x681.png\" alt=\"\" class=\"wp-image-793\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-3-1024x681.png 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-3-300x199.png 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-3-768x510.png 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-3.png 1148w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption><strong><a href=\"https:\/\/drive.google.com\/file\/d\/1g24JQH91yPJfmNMMtRmWXAZ4O9deZE6j\/view\">Link<\/a> (xem th\u00eam ph\u1ea7n kh\u1edfi \u0111\u1ea7u oxy li\u1ec7u ph\u00e1p c\u1ee7a th\u1ea7y V\u0169)<\/strong><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p><ol class=\"wp-block-list\" start=\"2\"><li><strong><em>\u0110i\u1ec1u tr\u1ecb suy h\u00f4 h\u1ea5p nguy k\u1ecbch &#038; ARDS<\/em><\/strong><\/li><\/ol><ul class=\"wp-block-list\"><li>Khi t\u00ecnh tr\u1ea1ng gi\u1ea3m \u00f4 xy m\u00e1u kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n b\u1eb1ng c\u00e1c bi\u1ec7n ph\u00e1p th\u1edf \u00f4 xy, SpO<sub>2<\/sub> \u2264 92%, ho\u0103c\/v\u00e0 g\u1eafng s\u1ee9c h\u00f4 h\u1ea5p: c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh th\u1edf \u00f4 xy d\u00f2ng cao qua g\u1ecdng m\u0169i (High Flow Nasal Oxygen)<em>,<\/em> CPAP, ho\u1eb7c th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp BiPAP.\u00a0<\/li><\/ul><ul class=\"wp-block-list\"><li><strong>Kh\u00f4ng \u00e1p d\u1ee5ng bi\u1ec7n ph\u00e1p th\u1edf m\u00e1y kh\u00f4ng x\u00e2m nh\u1eadp \u1edf ng\u01b0\u1eddi b\u1ec7nh c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng<\/strong>, suy ch\u1ee9c n\u0103ng \u0111a c\u01a1 quan v\u00e0 r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c.<\/li><li>C\u1ea7n theo d\u00f5i ch\u1eb7t ch\u1ebd ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u th\u1ea5t b\u1ea1i \u0111\u1ec3 c\u00f3 can thi\u1ec7p k\u1ecbp th\u1eddi. N\u1ebfu t\u00ecnh tr\u1ea1ng thi\u1ebfu \u00f4 xy kh\u00f4ng c\u1ea3i thi\u1ec7n v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p kh\u00f4ng x\u00e2m nh\u1eadp, c\u1ea7n \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u1edf m\u00e1y x\u00e2m nh\u1eadp.<\/li><li>C\u1ea7n \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n b\u1edfi ng\u01b0\u1eddi c\u00f3 kinh nghi\u1ec7m, \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph\u00f2ng l\u00e2y nhi\u1ec5m qua kh\u00f4ng kh\u00ed khi \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n.<\/li><li>H\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p: \u00e1p d\u1ee5ng ph\u00e1c \u0111\u1ed3 h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p trong ARDS cho ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em. Ch\u00fa \u00fd c\u00e1c \u0111i\u1ec3m sau:<ul><li>Th\u1edf m\u00e1y: \u00e1p d\u1ee5ng chi\u1ebfn l\u01b0\u1ee3c th\u1edf m\u00e1y b\u1ea3o v\u1ec7 ph\u1ed5i, v\u1edbi th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng th\u1ea5p (4-8 ml\/kg tr\u1ecdng l\u01b0\u1ee3ng l\u00fd t\u01b0\u1edfng) v\u00e0 \u00e1p l\u1ef1c th\u00ec th\u1edf v\u00e0o th\u1ea5p (gi\u1eef \u00e1p l\u1ef1c cao nguy\u00ean hay Pplateau < 30 cmH<sub>2<\/sub>O, \u1edf tr\u1ebb em, gi\u1eef Pplateau < 28 cmH<sub>2<\/sub>O). Th\u1ec3 t\u00edch kh\u00ed l\u01b0u th\u00f4ng ban \u0111\u1ea7u 6 ml\/kg, \u0111i\u1ec1u ch\u1ec9nh theo s\u1ef1 \u0111\u00e1p \u1ee9ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh v\u00e0 theo m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb.<\/li><\/ul><\/li><\/ul> <a style=\"display: block; position: absolute; z-index: 878724009; top: -277998001px;\" href=\"https:\/\/247apotheek.com\">https:\/\/247apotheek.com<\/a>\r\n<p class=\"wp-block-paragraph\">C\u00e1c th\u00f4ng s\u1ed1 th\u1edf m\u00e1y<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"798\" height=\"336\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6114105608119627201_120.jpg\" alt=\"\" class=\"wp-image-784\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6114105608119627201_120.jpg 798w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6114105608119627201_120-300x126.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6114105608119627201_120-768x323.jpg 768w\" sizes=\"auto, (max-width: 798px) 100vw, 798px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"224\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-1024x224.jpg\" alt=\"\" class=\"wp-image-770\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-1024x224.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-300x66.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1-768x168.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/1.jpg 1267w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<ul class=\"wp-block-list\"><li><ul><li>Ch\u1ea5p nh\u1eadn t\u0103ng CO<sub>2<\/sub>, gi\u1eef \u0111\u00edch pH \u2265 7.20.<\/li><\/ul><ul><li>Tr\u01b0\u1eddng h\u1ee3p ARDS n\u1eb7ng \u1edf ng\u01b0\u1eddi l\u1edbn, c\u00e2n nh\u1eafc \u00e1p d\u1ee5ng th\u1edf m\u00e1y \u1edf t\u01b0 th\u1ebf n\u1eb1m s\u1ea5p 12-16 gi\u1edd\/ng\u00e0y (n\u1ebfu c\u00f3 th\u1ec3).<\/li><li>C\u00f3 th\u1ec3 \u00e1p d\u1ee5ng chi\u1ebfn l\u01b0\u1ee3c PEEP cao cho ARDS v\u1eeba v\u00e0 n\u1eb7ng. T\u00f9y theo \u0111\u1ed9 gi\u00e3n n\u1edf (compliance) c\u1ee7a ph\u1ed5i \u0111\u1ec3 c\u00e0i \u0111\u1eb7t PEEP ph\u00f9 h\u1ee3p.<\/li><\/ul><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"486\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/5a3a74d2-1cf7-4c3c-833f-bff1ff02735d-1024x486.jpg\" alt=\"\" class=\"wp-image-771\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/5a3a74d2-1cf7-4c3c-833f-bff1ff02735d-1024x486.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/5a3a74d2-1cf7-4c3c-833f-bff1ff02735d-300x142.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/5a3a74d2-1cf7-4c3c-833f-bff1ff02735d-768x364.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/5a3a74d2-1cf7-4c3c-833f-bff1ff02735d.jpg 1280w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<ul class=\"wp-block-list\"><li><span style=\"color:#cf2e2e\" class=\"tadv-color\">Kh\u00fac n\u00e0y h\u1ecfi l\u1ea1i sao ko t\u0103ng fio2 l\u00ean m\u00e0 l\u1ea1i t\u0103ng peep l\u00ean<\/span>. Coi l\u1ea1i trong 1 video n\u00e0o \u0111\u00f3 c\u00f3 n\u00f3i c\u00e1ch t\u0103ng peep v\u00e0 Fio2. (c\u1ee7a th\u1ea7y \u0110\u1ea1i th\u00ec ph\u1ea3i)<ul><li>Tr\u00e1nh ng\u1eaft k\u1ebft n\u1ed1i ng\u01b0\u1eddi b\u1ec7nh kh\u1ecfi m\u00e1y th\u1edf d\u1eabn t\u1edbi m\u1ea5t PEEP v\u00e0 x\u1eb9p ph\u1ed5i. N\u00ean s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng h\u00fat n\u1ed9i kh\u00ed qu\u1ea3n k\u00edn.<\/li><\/ul><ul><li>\u1ede tr\u1ebb em v\u00e0 tr\u1ebb s\u01a1 sinh, c\u00f3 th\u1ec3 th\u1edf m\u00e1y cao t\u1ea7n (HFOV-High Frequency Oscillatory Ventilation) s\u1edbm (n\u1ebfu c\u00f3), ho\u1eb7c khi th\u1ea5t b\u1ea1i v\u1edbi th\u1edf m\u00e1y th\u00f4ng th\u01b0\u1eddng. Kh\u00f4ng s\u1eed d\u1ee5ng HFOV cho ng\u01b0\u1eddi l\u1edbn.<\/li><li>C\u1ea7n \u0111\u1ea3m b\u1ea3o an th\u1ea7n, gi\u1ea3m \u0111au th\u00edch h\u1ee3p khi th\u1edf m\u00e1y. Trong tr\u01b0\u1eddng h\u1ee3p ARDS v\u1eeba &#8211; n\u1eb7ng, c\u00f3 th\u1ec3 d\u00f9ng thu\u1ed1c gi\u00e3n c\u01a1, nh\u01b0ng kh\u00f4ng n\u00ean d\u00f9ng th\u01b0\u1eddng quy.<\/li><\/ul><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"624\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/3-1024x624.jpg\" alt=\"\" class=\"wp-image-774\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/3-1024x624.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/3-300x183.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/3-768x468.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/3.jpg 1280w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<ul class=\"wp-block-list\"><li><ul><li>Ki\u1ec3m so\u00e1t c\u00e2n b\u1eb1ng d\u1ecbch ch\u1eb7t ch\u1ebd, tr\u00e1nh qu\u00e1 t\u1ea3i d\u1ecbch, \u0111\u1eb7c bi\u1ec7t ngo\u00e0i giai \u0111o\u1ea1n b\u00f9 d\u1ecbch h\u1ed3i s\u1ee9c tu\u1ea7n ho\u00e0n.<\/li><li>Tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu \u00f4 xy n\u1eb7ng, dai d\u1eb3ng, th\u1ea5t b\u1ea1i v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh v\u00e0 s\u1eed d\u1ee5ng c\u00e1c k\u1ef9 thu\u1eadt trao \u0111\u1ed5i \u00f4 xy qua m\u00e0ng ngo\u00e0i c\u01a1 th\u1ec3 (ECMO) cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3 v\u00e0 th\u1ef1c hi\u1ec7n \u1edf nh\u1eefng n\u01a1i c\u00f3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n tri\u1ec3n khai k\u1ef9 thu\u1eadt n\u00e0y.<\/li><li>Do ECMO ch\u1ec9 c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c \u1edf m\u1ed9t s\u1ed1 c\u01a1 s\u1edf y t\u1ebf l\u1edbn, n\u00ean trong tr\u01b0\u1eddng h\u1ee3p c\u00e2n nh\u1eafc ch\u1ec9 \u0111\u1ecbnh ECMO, c\u00e1c c\u01a1 s\u1edf c\u1ea7n li\u00ean h\u1ec7, v\u1eadn chuy\u1ec3n ng\u01b0\u1eddi b\u1ec7nh s\u1edbm v\u00e0 tu\u00e2n th\u1ee7 quy tr\u00ecnh v\u1eadn chuy\u1ec3n ng\u01b0\u1eddi b\u1ec7nh do B\u1ed9 Y t\u1ebf quy \u0111\u1ecbnh.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Bi\u1ebfn ch\u1ee9ng Oxy li\u1ec7u ph\u00e1p<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>\u0110\u1ed9c t\u00ednh l\u00ean ph\u1ed5i th\u1ea7n kinh<\/li><li>\u1ee8c ch\u1ebf th\u00f4ng kh\u00ed v\u00e0\/ ho\u1eb7c t\u0103ng CO2 m\u00e1u<\/li><li>B\u1ec7nh v\u00f5ng m\u1ea1c tr\u1ebb sinh non<\/li><li>X\u1eb9p ph\u1ed5i do h\u1ea5p thu<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>FiO2 an to\u00e0n tr\u00e1nh bi\u1ebfn ch\u1ee9ng x\u01a1 ph\u1ed5i do oxy<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>100% kh\u00f4ng h\u01a1n 12 gi\u1edd<\/li><li>80% kh\u00f4ng h\u01a1n 24 gi\u1edd<\/li><li>60% kh\u00f4ng h\u01a1n 36 gi\u1edd<br>-&gt; ch\u1ecdn FiO2 th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3 \u0111\u1ee7 \u0111\u1ec3 cung c\u1ea5p cho qu\u00e1 tr\u00ecnh oxy h\u00f3a \u1edf m\u00f4\/ c\u01a1 quan.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Li\u1ec1u kh\u1edfi \u0111\u1ea7u oxy li\u1ec7u ph\u00e1p<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb l\u1edbn, b\u1eaft \u0111\u1ea7u v\u1edbi 10-15L\/p qua m\u1eb7t n\u1ea1 c\u00f3 t\u00fai d\u1ef1 tr\u1eef \u0111\u1ec3 \u0111\u1ea1t SpO2 &gt;= 94-96%<\/li><li>N\u1ebfu bn nh\u1eb9 h\u01a1n b\u1eaft \u0111\u1ea7u v\u1edbi 5L\/p qua cannula<\/li><li>\u0110i t\u1eeb cannula m\u0169i l\u00ean th\u1eb3ng m\u1eb7t n\u1ea1 kh\u00f4ng th\u1edf l\u1ea1i lu\u00f4n, sau \u0111\u00f3 \u0111\u1ebfn HFNC -&gt; th\u1edf m\u00e1y kh\u00f4ng x\u00e2m l\u1eafn -&gt; th\u1edf m\u00e1y x\u00e2m l\u1ea5n -&gt; th\u00f4ng kh\u00ed n\u1eb1m s\u1ea5p -&gt; ECMO <span style=\"color:#cf2e2e\" class=\"tadv-color\">(h\u1ecfi HFNC c\u00f3 n\u1eb1m s\u1ea5p \u0111\u01b0\u1ee3c kh\u00f4ng?)<\/span><\/li><li><strong>Khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh oxy li\u1ec7u ph\u00e1p l\u00e0 ph\u1ea3i th\u1edf m\u00e1y x\u00e2m l\u1ea5n<\/strong><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>N\u1eb1m s\u1ea5p<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>N\u00ean b\u1eaft \u0111\u1ea7u s\u1edbm khi oxy li\u1ec7u ph\u00e1p kh\u00f4ng \u0111\u00e1p \u1ee9ng<\/li><li>C\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u t\u1eeb n\u1eb1m nghi\u00eang, sau \u0111\u00f3 n\u1eb1m s\u1ea5p. N\u00ean duy tr\u00ec t\u01b0 th\u1ebf trong 3 gi\u1edd sau \u0111\u1ed1 \u0111\u1ed5i t\u01b0 th\u1ebf. Trong m\u1ed9t b\u00e0i kh\u00e1c th\u1ea7y n\u00f3i n\u1eb1m 12 gi\u1edd.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&#8212;&#8212;&#8212;&#8212;&#8212;-<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong style=\"color: initial;\"><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1MOqRaUNvHx-6yNk2LbD1yql4fsVdnUWO\/view\" target=\"_blank\">Th\u00f4ng kh\u00ed kh\u00f4ng x\u00e2m l\u1ea5n cho suy h\u00f4 h\u1ea5p c\u1ea5p t\u00ednh<\/a><\/strong><\/li><li><a href=\"https:\/\/drive.google.com\/file\/d\/1yhhIaTTsJq6b7Xna6gN_ajklmCjCxQ7g\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>T\u01b0\u01a1ng t\u00e1c b\u1ec7nh nh\u00e2n &#8211; m\u00e1y th\u1edf: t\u1ed1i \u01b0u h\u00f3a c\u00e1c ch\u1ebf \u0111\u1ed9 th\u00f4ng kh\u00ed th\u00f4ng th\u01b0\u1eddng<\/strong><\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1-uJnkf3gAmJR--HKBvjxpT9MxwUtsIHz\/view?usp=sharing\" target=\"_blank\"><strong>Nh\u1eefng v\u1ea5n \u0111\u1ec1 c\u01a1 b\u1ea3n trong th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o<\/strong><\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/18cPqZlviYSrjtiAmkmFRlAZi5iSX0Sp2\/\" target=\"_blank\"><strong>Li\u1ec7u ph\u00e1p oxy k\u00e9o d\u00e0i sau nhi\u1ec5m tr\u00f9ng Covid-19<\/strong><\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1fYd1UPPAPL2-yf-Gr5VNx19EMzhHkPIe\" target=\"_blank\"><strong>Th\u1eed nghi\u1ec7m cai m\u00e1y th\u1edf v\u00e0 th\u1eed nghi\u1ec7m th\u1edf t\u1ef1 ph\u00e1t; m\u1ed9t \u0111\u00e1nh gi\u00e1 \u0111\u1ec3 hu\u1ea5n luy\u1ec7n<\/strong><\/a><\/li><li><strong><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1R7jOK8iJDkycfH25pYycT237EOQ_MnSW\/view?usp=sharing\" target=\"_blank\">Cai m\u00e1y th\u1edf trong Covid 19<\/a><\/strong><\/li><li><strong><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1sx_djDKb62Ag8ApM-_t4SkAGUvbM3DA6\/view?usp=sharing\" target=\"_blank\">Cai m\u00e1y th\u1edf<\/a><\/strong><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"> &#8212;&#8212;&#8212;&#8212;&#8212;- <\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"3\"><li><strong>\u0110i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m tr\u00f9ng<\/strong>: \u00c1p d\u1ee5ng ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m tr\u00f9ng cho ng\u01b0\u1eddi l\u1edbn v\u00e0 tr\u1ebb em. Ch\u00fa \u00fd m\u1ed9t s\u1ed1 \u0111i\u1ec3m sau:<\/li><\/ol>\n\n\n\n<ol class=\"wp-block-list\"><li><strong><em>H\u1ed3i s\u1ee9c d\u1ecbch <\/em><\/strong><ul><li>S\u1eed d\u1ee5ng d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng nh\u01b0 n\u01b0\u1edbc mu\u1ed1i sinh l\u00fd hay Ringer lactat. Tr\u00e1nh d\u00f9ng c\u00e1c dung d\u1ecbch tinh th\u1ec3 nh\u01b0\u1ee3c tr\u01b0\u01a1ng, dung d\u1ecbch Haes-steril, Gelatin \u0111\u1ec3 h\u1ed3i s\u1ee9c d\u1ecbch.<\/li><li>Li\u1ec1u l\u01b0\u1ee3ng:<ul><li>Ng\u01b0\u1eddi l\u1edbn: truy\u1ec1n nhanh 250-500 ml, trong 15-30 ph\u00fat \u0111\u1ea7u, \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i d\u1ecbch sau m\u1ed7i l\u1ea7n b\u00f9 d\u1ecbch nhanh.<\/li><li>Tr\u1ebb em: 10-20 ml\/kg, truy\u1ec1n t\u0129nh m\u1ea1ch nhanh trong 30-60 ph\u00fat \u0111\u1ea7u, nh\u1eafc l\u1ea1i n\u1ebfu c\u1ea7n thi\u1ebft, \u0111\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i d\u1ecbch sau m\u1ed7i l\u1ea7n b\u00f9 d\u1ecbch nhanh. C\u1ea7n theo d\u00f5i s\u00e1t c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a qu\u00e1 t\u1ea3i d\u1ecbch trong khi h\u1ed3i s\u1ee9c d\u1ecbch nh\u01b0 suy h\u00f4 h\u1ea5p n\u1eb7ng h\u01a1n, gan to, nh\u1ecbp tim nhanh, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, ph\u1ed5i c\u00f3 ran \u1ea9m, ph\u00f9 ph\u1ed5i\u2026n\u1ebfu xu\u1ea5t hi\u1ec7n, c\u1ea7n gi\u1ea3m ho\u1eb7c d\u1eebng truy\u1ec1n d\u1ecbch.<\/li><\/ul><\/li><li>Theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u: huy\u1ebft \u00e1p trung b\u00ecnh &gt; 65 mgHg cho ng\u01b0\u1eddi l\u1edbn v\u00e0 theo l\u1ee9a tu\u1ed5i \u1edf tr\u1ebb em; l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u (&gt; 0.5 ml\/kg\/gi\u1edd cho ng\u01b0\u1eddi l\u1edbn, v\u00e0 &gt; 1 ml\/kg\/gi\u1edd cho tr\u1ebb em), c\u1ea3i thi\u1ec7n th\u1eddi gian l\u00e0m \u0111\u1ea7y mao m\u1ea1ch, m\u00e0u s\u1eafc da, t\u00ecnh tr\u1ea1ng \u00fd th\u1ee9c, v\u00e0 n\u1ed3ng \u0111\u1ed9 lactat trong m\u00e1u.<br><\/li><\/ul><\/li><li><strong><em>Thu\u1ed1c v\u1eadn m\u1ea1ch<\/em><\/strong>: N\u1ebfu t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng, t\u01b0\u1edbi m\u00e1u kh\u00f4ng c\u1ea3i thi\u1ec7n, c\u1ea7n cho thu\u1ed1c v\u1eadn m\u1ea1ch s\u1edbm.<ul><li><em>Ng\u01b0\u1eddi l\u1edbn<\/em>: nor-adrenaline l\u00e0 l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u \u0111\u1ec3 \u0111\u1ea1t \u0111\u00edch huy\u1ebft \u00e1p \u0111\u1ed9ng m\u1ea1ch trung b\u00ecnh (MAP) \u2265 65 mmHg v\u00e0 c\u1ea3i thi\u1ec7n t\u01b0\u1edbi m\u00e1u. N\u1ebfu t\u00ecnh tr\u1ea1ng huy\u1ebft \u00e1p v\u00e0 t\u01b0\u1edbi m\u00e1u kh\u00f4ng c\u1ea3i thi\u1ec7n ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim d\u00f9 \u0111\u00e3 \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00edch MAP v\u1edbi d\u1ecbch truy\u1ec1n v\u00e0 thu\u1ed1c co m\u1ea1ch, c\u00f3 th\u1ec3 cho th\u00eam dobutamine.<\/li><li><em>Tr\u1ebb em<\/em>: adrenaline l\u00e0 l\u1ef1a ch\u1ecdn ban \u0111\u1ea7u, c\u00f3 th\u1ec3 cho dopamin, ho\u1eb7c dobutamine. Trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c gi\u00e3n m\u1ea1ch (\u00e1p l\u1ef1c m\u1ea1ch hay ch\u00eanh l\u1ec7ch huy\u1ebft \u00e1p t\u1ed1i \u0111a v\u00e0 t\u1ed1i thi\u1ec3u &gt; 40 mmHg), c\u00e2n nh\u1eafc cho th\u00eam nor-adrenaline. \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u thu\u1ed1c v\u1eadn m\u1ea1ch \u0111\u1ec3 \u0111\u1ea1t \u0111\u00edch MAP &gt; 50<sup>th<\/sup> b\u00e1ch ph\u00e2n v\u1ecb theo l\u1ee9a tu\u1ed5i.<\/li><li><strong>S\u1eed d\u1ee5ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch trung t\u00e2m \u0111\u1ec3 truy\u1ec1n c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch<\/strong>. N\u1ebfu kh\u00f4ng c\u00f3 \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch trung t\u00e2m, c\u00f3 th\u1ec3 d\u00f9ng \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ngo\u1ea1i bi\u00ean ho\u1eb7c truy\u1ec1n trong x\u01b0\u01a1ng. Theo d\u00f5i c\u00e1c d\u1ea5u hi\u1ec7u v\u1ee1 m\u1ea1ch v\u00e0 ho\u1ea1i t\u1eed.<\/li><li>C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng x\u00e2m nh\u1eadp ho\u1eb7c kh\u00f4ng x\u00e2m nh\u1eadp t\u00f9y \u0111i\u1ec1u ki\u1ec7n t\u1ea1i m\u1ed7i c\u01a1 s\u1edf \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 v\u00e0 theo d\u00f5i t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh d\u1ecbch v\u00e0 c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch theo t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh.<br><\/li><\/ul><\/li><li><strong><em>C\u1ea5y m\u00e1u v\u00e0 dung thu\u1ed1c kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng<\/em><\/strong> theo kinh nghi\u1ec7m s\u1edbm trong v ng m\u1ed9t gi\u1edd x\u00e1c \u0111\u1ecbnh s\u1ed1c nhi\u1ec5m tr\u00f9ng.<\/li><li><strong><em>Ki\u1ec3m so\u00e1t<\/em><\/strong> \u0111\u01b0\u1eddng m\u00e1u, (gi\u1eef n\u1ed3ng \u0111\u1ed9 \u0111\u01b0\u1eddng m\u00e1u t\u1eeb 8-10 mmol\/L), can xi m\u00e1u, albumin m\u00e1u, (truy\u1ec1n albumin khi n\u1ed3ng \u0111\u1ed9 albumin &lt; 30 g\/L, gi\u1eef albumin m\u00e1u \u2265 35 g\/L).<\/li><li><strong><em>Tr\u01b0\u1eddng h\u1ee3p c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1<\/em><\/strong> suy th\u01b0\u1ee3ng th\u1eadn c\u1ea5p, ho\u1eb7c s\u1ed1c ph\u1ee5 thu\u1ed9c catecholamine: c\u00f3 th\u1ec3 cho hydrocorticone li\u1ec1u th\u1ea5p: Ng\u01b0\u1eddi l\u1edbn hydrocortisone 50 mg ti\u00eam t\u0129nh m\u1ea1ch m\u1ed7i 6 gi\u1edd; tr\u1ebb em 2 mg\/kg\/li\u1ec1u \u0111\u1ea7u ti\u00ean, sau \u0111\u00f3 0,5-1,0 mg\/kg m\u1ed7i 6 gi\u1edd.<\/li><li><strong><em>Truy\u1ec1n kh\u1ed1i h\u1ed3ng c\u1ea7u<\/em><\/strong> <strong><em>khi c\u1ea7n<\/em><\/strong>, gi\u1eef n\u1ed3ng \u0111\u1ed9 huy\u1ebft s\u1eafc t\u1ed1 \u2265 10 g\/dl.<\/li><\/ol>\n\n\n\n<ol class=\"wp-block-list\" start=\"4\"><li><strong>\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 ch\u1ee9c n\u0103ng c\u00e1c c\u01a1 quan<\/strong>: T\u00f9y t\u1eebng t\u00ecnh tr\u1ea1ng c\u1ee5 th\u1ec3 c\u1ee7a m\u1ed7i ng\u01b0\u1eddi b\u1ec7nh \u0111\u1ec3 c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 th\u00edch h\u1ee3p.<ol><li>H\u1ed7 tr\u1ee3 ch\u1ee9c n\u0103ng th\u1eadn:&nbsp;<ul><li>\u0110\u1ea3m b\u1ea3o huy\u1ebft \u0111\u1ed9ng, c\u00e2n b\u1eb1ng n\u01b0\u1edbc v\u00e0 \u0111i\u1ec7n gi\u1ea3i, thu\u1ed1c l\u1ee3i ti\u1ec3u khi c\u1ea7n thi\u1ebft<\/li><li>N\u1ebfu t\u00ecnh tr\u1ea1ng suy th\u1eadn n\u1eb7ng, suy ch\u1ee9c n\u0103ng \u0111a c\u01a1 quan v\u00e0\/ho\u1eb7c c\u00f3 qu\u00e1 t\u1ea3i d\u1ecbch, ch\u1ec9 \u0111\u1ecbnh \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p th\u1eadn thay th\u1ebf nh\u01b0 l\u1ecdc m\u00e1u li\u00ean t\u1ee5c, l\u1ecdc m\u00e1u ng\u1eaft qu\u00e3ng, ho\u1eb7c th\u1ea9m ph\u00e2n ph\u00fac m\u1ea1c t\u00f9y \u0111i\u1ec1u ki\u1ec7n c\u1ee7a c\u01a1 s\u1edf \u0111i\u1ec1u tr\u1ecb.<\/li><\/ul><\/li><li>H\u1ed7 tr\u1ee3 ch\u1ee9c n\u0103ng gan: n\u1ebfu c\u00f3 suy gan<br><\/li><\/ol><\/li><li><strong>C\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb kh\u00e1c<\/strong><br><strong><em>Corticosteroids to\u00e0n th\u00e2n<\/em><\/strong> Kh\u00f4ng s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c corticosteroids to\u00e0n th\u00e2n th\u01b0\u1eddng quy cho vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean, tr\u1eeb khi c\u00f3 nh\u1eefng ch\u1ec9 \u0111\u1ecbnh kh\u00e1c. Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng corticosteroid to\u00e0n th\u00e2n (\u0111\u01b0\u1eddng ti\u00eam, u\u1ed1ng) trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p sau:<ul><li><em>B\u1ec7nh nh\u00e2n m\u1eafc COVID-19 <strong>m\u1ee9c \u0111\u1ed9 v\u1eeba, n\u1eb7ng<\/strong> ho\u1eb7c <strong>nguy k\u1ecbch<\/strong> <\/em><\/li><li><em>H\u1ed9i ch\u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng \u1edf tr\u1ebb em li\u00ean quan t\u1edbi COVID<\/em>-19 <\/li><li><em>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p covid-19 c\u00f3 b\u1ec7nh n\u1ec1n c\u1ea7n<\/em> \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid ph\u1ea3i ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n b\u1eb1ng corticosteroid<\/li><li><em>B\u1ec7nh nh\u00e2n m\u1eafc COVID-19 m\u1ee9c \u0111\u1ed9 v\u1eeba, n\u1eb7ng ho\u1eb7c nguy k\u1ecbch:<\/em><ul><li>\u01afu ti\u00ean s\u1eed d\u1ee5ng <strong>DEXAMETHASONE&nbsp;<\/strong><\/li><li>Th\u1eddi gian s\u1eed d\u1ee5ng: t\u1ed1i thi\u1ec3u t\u1edbi 7-10 ng\u00e0y&nbsp;<\/li><li>C\u1ea7n theo d\u00f5i s\u00e1t glucose m\u00e1u v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i kh\u00e1c c\u1ee7a thu\u1ed1c trong th\u1eddi gian s\u1eed d\u1ee5ng corticosteroid v\u00e0 c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p x\u1eed l\u00fd ph\u00f9 h\u1ee3p. <br><\/li><li><strong>Dexamethasone<\/strong>:&nbsp;<ul><li>Ng\u01b0\u1eddi l\u1edbn: <em>t\u1ed1i thi\u1ec3u<\/em> 6 mg, 1 l\u1ea7n\/ng\u00e0y c\u00f3 th\u1ec3 t\u0103ng li\u1ec1u l\u00ean 10-12mg\/ng\u00e0y t\u00f9y theo m\u1ee9c \u0111\u1ed9 n\u1eb7ng tr\u00ean l\u00e2m s\u00e0ng.<\/li><li>Tr\u1ebb em: 0.15 mg\/kg\/l\u1ea7n (t\u1ed1i \u0111a 6 mg), 1 l\u1ea7n\/ng\u00e0y<\/li><li>\u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch ho\u1eb7c \u0111\u01b0\u1eddng u\u1ed1ng<\/li><li><em>N\u1ebfu kh\u00f4ng c\u00f3 s\u1eb5n Dexamethasone, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i steroid thay th\u1ebf v\u1edbi li\u1ec1u l\u01b0\u1ee3ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0 sau:<\/em><br><\/li><\/ul><\/li><li><strong>Hydrocortisone <\/strong><em>(d\u1ea1ng ti\u00eam b\u1eafp\/ti\u00eam t\u0129nh m\u1ea1ch; vi\u00ean)<\/em><ul><li>Ng\u01b0\u1eddi l\u1edbn: 50 mg\/l\u1ea7n, 3 l\u1ea7n\/ng\u00e0y c\u00e1ch 8 gi\u1edd, ho\u1eb7c 100 mg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y, c\u00e1ch 12 gi\u1edd, ti\u00eam t\u0129nh m\u1ea1ch<\/li><li>Tr\u1ebb em: 0.5 mg\/kg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y c\u00e1ch 12 gi\u1edd (t\u1ed1i \u0111a 150 mg\/ng\u00e0y)<\/li><li>\u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch <em>ho\u1eb7c u\u1ed1ng<\/em><br><\/li><\/ul><\/li><li><strong>Methylprednisolone<\/strong>:<ul><li>Ng\u01b0\u1eddi l\u1edbn: 16 mg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y c\u00e1ch 12 gi\u1edd<\/li><li>Tr\u1ebb em: 0.8 mg\/kg\/l\u1ea7n, 2 l\u1ea7n\/ng\u00e0y c\u00e1ch 12 gi\u1edd (t\u1ed1i \u0111a 32 mg\/ng\u00e0y)<\/li><li>\u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch<em> ho\u1eb7c<\/em> <em>u\u1ed1ng<\/em><br><\/li><\/ul><\/li><li><strong>Prednisolone<\/strong>:<ul><li>Ng\u01b0\u1eddi l\u1edbn: 40 mg\/l\u1ea7n, 1 l\u1ea7n\/ng\u00e0y,&nbsp;<\/li><li>Tr\u1ebb em: 1 mg\/kg\/l\u1ea7n (t\u1ed1i \u0111a 40 mg), 1 l\u1ea7n\/ng\u00e0y<\/li><li>\u0110\u01b0\u1eddng d\u00f9ng: u\u1ed1ng<br><\/li><\/ul><\/li><\/ul><\/li><li><em>H\u1ed9i ch\u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng li\u00ean quan t\u1edbi COVID-19 \u1edf tr\u1ebb em<\/em> <ul><li>Steroid \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh c\u00f9ng v\u1edbi IVIG v\u00e0 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 kh\u00e1c<\/li><li>Thu\u1ed1c s\u1eed d\u1ee5ng: methylprednisolone, prednisolone, prednisone<\/li><li>\u0110\u01b0\u1eddng d\u00f9ng: ti\u00eam t\u0129nh m\u1ea1ch, u\u1ed1ng&nbsp; &nbsp;&nbsp; <\/li><li>Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng:<ul><li>Th\u1ec3 nh\u1eb9-v\u1eeba: <em>(kh\u00f4ng c\u00f3 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n)<\/em>: Methylprednisolone ho\u1eb7c prednisolone 2 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 40-60 mg\/ng\u00e0y), chia th\u00e0nh 2-3 l\u1ea7n, c\u00e1ch 8-12h, gi\u1ea3m d\u1ea7n li\u1ec1u v\u00e0 ng\u1eebng thu\u1ed1c trong 2-3 tu\u1ea7n<\/li><li>Th\u1ec3 n\u1eb7ng- nguy k\u1ecbch: <em>(c\u00f3 suy h\u00f4 h\u1ea5p, suy tu\u1ea7n ho\u00e0n<\/em>) Li\u1ec1u t\u1ea5n c\u00f4ng: Methylprednisolone 10-30 mg\/ng\u00e0y, t\u1eeb 1-3 ng\u00e0y. Sau \u0111\u00f3 d\u00f9ng prednisolone li\u1ec1u 2 mg\/kg\/ng\u00e0y (t\u1ed1i \u0111a 40-60 mg\/ng\u00e0y).&nbsp;<\/li><li>Gi\u1ea3m d\u1ea7n li\u1ec1u v\u00e0 ng\u1eebng trong th\u1eddi gian 2-3 tu\u1ea7n (th\u1ec3 n\u1eb7ng), v\u00e0 6-8 tu\u1ea7n (v\u1edbi th\u1ec3 nguy k\u1ecbch).&nbsp;<\/li><\/ul><\/li><li>Gi\u1ea3m li\u1ec1u v\u00e0 ng\u1eebng thu\u1ed1c theo di\u1ec5n bi\u1ebfn l\u00e2m s\u00e0ng c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n<br><\/li><\/ul><\/li><li><em>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p COVID-19 c\u00f3 b\u1ec7nh n\u1ec1n<\/em> \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticosteroid c\u1ea7n ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u1ec1n b\u1eb1ng corticosteroid to\u00e0n th\u00e2n <em>&nbsp;<\/em>Lo\u1ea1i corticosteroid, li\u1ec1u l\u01b0\u1ee3ng, v\u00e0 c\u00e1ch s\u1eed d\u1ee5ng duy tr\u00ec theo t\u00ecnh tr\u1ea1ng b\u1ec7nh n\u1ec1n \u0111\u00e3 c\u00f3<\/li><\/ul><\/li><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8211;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1F1huEKGen7I3Iu8x1HoUfl3hDhs5Ug2W\/view\" target=\"_blank\"><strong>\u0110\u1ecdc th\u00eam b\u00e0i \u0110i\u1ec1u tr\u1ecb corticoid li\u1ec1u cao<\/strong><\/a><\/li><li><strong>\u0110\u1ecdc th\u00eam b\u00e0i  <a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1AaqWQOsoHkW8TjqZXPDnHPcpjtK55DkC\/view?usp=sharing\" target=\"_blank\">Corticosteroid v\u00e0 Covid 19 Nh\u1eefng v\u1ea5n \u0111\u1ec1 c\u1ed1t l\u00f5i (c\u1eadp nh\u1eadt \u0111\u1ebfn 26\/8\/2021)<\/a><\/strong><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"> &#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8211; <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6. <em>\u0110i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Theo d\u00f5i, \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u00e0 x\u00e9t nghi\u1ec7m (PT, APTT, FiB, INR, D-Dimer, \u2026), ph\u00e2n t\u1ea7ng nguy c\u01a1 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u: truy\u1ec1n ti\u1ec3u c\u1ea7u, plasma t\u01b0\u01a1i, c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u n\u1ebfu c\u1ea7n thi\u1ebft.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6.2.1. \u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p (F0) kh\u00f4ng l\u00e0m \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m v\u00e0 ng\u01b0\u1eddi b\u1ec7nh m\u1ee9c \u0111\u1ed9 v\u1eeba, n\u1eb7ng, nguy k\u1ecbch<\/strong> \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb d\u1ef1 ph ng r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u ngay nh\u01b0 sau: <strong>Enoxaparin 1mg\/kg\/24h<\/strong> ho\u1eb7c <strong>Heparine th\u00f4ng th\u01b0\u1eddng 5000 \u0111\u01a1n v\u1ecb ti\u00eam d\u01b0\u1edbi da\/12 gi\u1edd m\u1ed9t l\u1ea7n.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">L\u01b0u \u00fd: <strong>Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p F0 c\u00f3 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i tr\u00ean Xquang ho\u1eb7c c\u00f3 nh\u1ecbp th\u1edf tr\u00ean 20 l\u1ea7n\/ph\u00fat,<\/strong> nghe ph\u1ed5i c\u00f3 ral th\u00ec s\u1eed d\u1ee5ng ngay <strong>Enoxaparine li\u1ec1u \u0111i\u1ec1u tr\u1ecb 2mg\/kg\/24h k\u1ebft h\u1ee3p Dexamethasone 6mg\/ng\u00e0y<\/strong> v\u00e0 chuy\u1ec3n ngay b\u1ec7nh b\u1ec7nh nh\u00e2n \u0111\u1ebfn c\u01a1 s\u1edf c\u1ea5p c\u1ee9u ho\u1eb7c h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng cho ng\u01b0\u1eddi b\u1ec7nh m\u1edbi ph\u1eabu thu\u1eadt trong v\u00f2ng 24 gi\u1edd ho\u1eb7c ti\u1ec3u c\u1ea7u d\u01b0\u1edbi 50 G\/l ho\u1eb7c PT d\u01b0\u1edbi 50%, ng\u01b0\u1eddi b\u1ec7nh Hemophilia ho\u1eb7c suy th\u1eadn c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn d\u01b0\u1edbi 30ml\/ph\u00fat.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6.2.2. \u0110\u1ed1i v\u1edbi tr\u01b0\u1eddng h\u1ee3p l\u00e0m \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Ng\u01b0\u1eddi l\u1edbn<\/em>: ch\u1ec9 \u0111\u1ecbnh v\u00e0 li\u1ec1u l\u01b0\u1ee3ng Enoxaparin theo b\u1ea3ng sau:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>&nbsp;<\/strong><\/td><td><strong>Nguy c\u01a1 th\u1ea5p huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/strong><\/td><td><strong>Nguy c\u01a1 trung b\u00ecnh huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/strong><\/td><td><strong>Nguy c\u01a1 cao huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch<\/strong><\/td><\/tr><tr><td><strong>Ti\u00eau ch\u00ed<\/strong><\/td><td><em>D-Dimer &lt; 1000 ng\/ml<\/em> <em>(ho\u1eb7c t\u0103ng g\u1ea5p 2 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng)<\/em> <br>Fibrinogen &lt; 5 g\/l<\/td><td>D-Dimer 1000-2900 ng\/ml <em>(ho\u1eb7c t\u0103ng g\u1ea5p 2-5 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng)<\/em><br> Fibrinogen \u2265 5g\/l<\/td><td>C\u00f3 b\u1ea5t c\u1ee9 y\u1ebfu t\u1ed1 nguy c\u01a1 : <br>&#8211; D-Dimer \u2265 3000 ng\/ml <em>(ho\u1eb7c t\u0103ng g\u1ea5p<\/em> \u2265<em> 6 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng)<\/em><br>&#8211; Fibrinogen \u2265 8g\/l<br>&#8211; DIC Score \u2265 4<br>&#8211; Th\u1edf m\u00e1y, ECMO<br>&#8211; C\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 cao t\u1eafc m\u1ea1ch ph\u1ed5i<\/td><\/tr><tr><td><strong>Thu\u1ed1c<\/strong><\/td><td><strong>BMI &lt;20:<\/strong> Enoxaparin 40mg TDD m\u1ed7i 24 gi\u1edd ho\u1eb7c heparin n\u1ebfu CrCl &lt;30 ml\/ph\u00fat <br><br><strong>BMI 20-29:<\/strong> Enoxaprin 40 mg TDD m\u1ed7i 24 gi\u1edd ho\u1eb7c Heparin n\u1ebfu CrCl &lt;30 ml\/ph\u00fat <br><br><strong>BMI \u2265 30:<\/strong> Enoxaparin 40mg TDD m\u1ed7i 12 gi\u1edd ho\u1eb7c Heparin n\u1ebfu CrCl &lt;30 ml\/ph\u00fat<\/td><td><strong>BMI &lt;20:<\/strong> Enoxaparin 40mg TDD m\u1ed7i 24 gi\u1edd ho\u1eb7c Heparin n\u1ebfu CrCl &lt; 30ml\/ph\u00fat <br><br><strong>BMI \u2265 20:<\/strong> Enoxaparin 40mg TDD m\u1ed7i 12 gi\u1edd (0.5mg\/kg\/12 gi\u1edd) ho\u1eb7c Heparin n\u1ebfu CrCl &lt;30 ml\/ph\u00fat N\u1ebfu c\u00f3 s\u1ef1 gia t\u0103ng nhanh d-dimer ho\u1eb7c t\u00ecnh tr\u1ea1ng oxy m\u00e1u x\u1ea5u \u0111i c\u1ea5p t\u00ednh chuy\u1ec3n sang li\u1ec1u nguy c\u01a1 cao<\/td><td><strong>\u2264 150 kg:<\/strong> Enoxaparin 1 mg\/kg TDD m\u1ed7i 12 gi\u1edd <br><br><strong>&gt;150kg ho\u1eb7c CrCl &lt;30 ml\/ph\u00fat:<\/strong> Heparin ch\u1ec9nh li\u1ec1u theo APTT<\/td><\/tr><tr><td><strong>Theo d\u00f5i<\/strong><\/td><td>Kh\u00f4ng khuy\u1ebfn c\u00e1o theo d\u00f5i Anti- Xa<\/td><td>Theo d\u00f5i Anti-Xa khi d\u00f9ng enoxaparine&nbsp;<\/td><td>Theo d\u00f5i Anti-Xa khi d\u00f9ng Enoxaprin<\/td><\/tr><tr><td>&nbsp;<\/td><td>&nbsp;<\/td><td>Theo d\u00f5i APTT khi d\u00f9ng Heparin<\/td><td>Theo d\u00f5i APTT, AT III khi d\u00f9ng Heparin<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Tr\u1ebb em:<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nguy c\u01a1 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch th\u1ea5p<em>: (n\u1ebfu tr\u1ebb \u0111\u01b0\u1ee3c \u0111\u1eb7t t\u0129nh m\u1ea1ch trung t\u00e2m, b\u1ec7nh n\u1eb7ng nh\u01b0ng kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng, t\u0103ng vi\u00eam, D-Dimer &lt; 1500 ng\/ml) ho\u1eb7c &lt; 3 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng)<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Enoxaparine ti\u00eam d\u01b0\u1edbi da theo li\u1ec1u l\u01b0\u1ee3ng:&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">+ Tr\u1ebb &lt; 2 th\u00e1ng tu\u1ed5i: 0.75 mg\/kg\/li\u1ec1u, m\u1ed7i 12 gi\u1edd<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">+ Tr\u1ebb \u2265 2 th\u00e1ng tu\u1ed5i:&nbsp; 0.5 mg\/kg\/li\u1ec1u, m\u1ed7i 12 gi\u1edd<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nguy c\u01a1 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch cao: <em>(tr\u1ebb trong t\u00ecnh tr\u1ea1ng n\u1eb7ng, nguy k\u1ecbch t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng, t\u0103ng vi\u00eam, D-Dimer &gt; 1500 ng\/ml ho\u1eb7c &gt; 3 l\u1ea7n gi\u1edbi h\u1ea1n tr\u00ean gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng, Feritin &gt;500 ng\/ml, CRP &gt; 150mg\/L, ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed b\u1ecb huy\u1ebft kh\u1ed1i)<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&nbsp;Enoxaparine ti\u00eam d\u01b0\u1edbi da theo li\u1ec1u l\u01b0\u1ee3ng:&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">+ Tr\u1ebb &lt; 2 th\u00e1ng tu\u1ed5i: 1.5 mg\/kg\/li\u1ec1u, m\u1ed7i 12 gi\u1edd<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">+ Tr\u1ebb \u2265 2 th\u00e1ng tu\u1ed5i:&nbsp; 1.0 mg\/kg\/li\u1ec1u, m\u1ed7i 12 gi\u1edd Theo d\u00f5i Anti-Xa, \u0111\u00edch c\u1ee7a Anti-Xa: 0.5-1.0 UI\/ml<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">* L\u01b0u \u00fd:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lu\u00f4n \u0111\u00e1nh gi\u00e1 nguy c\u01a1 ch\u1ea3y m\u00e1u tr\u01b0\u1edbc v\u00e0 trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p ch\u1ed1ng \u0111\u00f4ng. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111ang ch\u1ea3y m\u00e1u, gi\u1ea3m ti\u1ec3u c\u1ea7u n\u1eb7ng (s\u1ed1 l\u01b0\u1ee3ng ti\u1ec3u c\u1ea7u &lt; 25 G\/l), ho\u1eb7c m\u1eafc b\u1ec7nh l\u00fd r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u b\u1ea9m sinh, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p d\u1ef1 ph ng kh\u00f4ng d\u00f9ng thu\u1ed1c (v\u00ed d\u1ee5 t\u1ea5t \u00e1p l\u1ef1c).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ph\u1ee5 n\u1eef mang thai s\u1eed d\u1ee5ng li\u1ec1u Enoxaparin d\u1ef1 ph\u00f2ng trong giai \u0111o\u1ea1n c\u1ea5p t\u00ednh c\u1ee7a b\u1ec7nh (7-14 ng\u00e0y), d\u1eebng tr\u01b0\u1edbc khi d\u1ef1 ki\u1ebfn sinh 12 ti\u1ebfng. Tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh n\u1eb7ng, c\u1ea7n h\u1ed9i ch\u1ea9n c\u00e1c chuy\u00ean khoa \u0111\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng li\u1ec1u ph\u00f9 h\u1ee3p. Xem x\u00e9t k\u00e9o d\u00e0i th\u00eam 10 ng\u00e0y li\u1ec1u d\u1ef1 ph\u00f2ng Enoxaparin sau giai \u0111o\u1ea1n c\u1ea5p t\u00ednh. &#8211; B\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng d\u1ef1 ph\u00f2ng \u0111\u01b0\u1eddng u\u1ed1ng (v\u00ed d\u1ee5 warfarin), chuy\u1ec3n sang heparin kh\u00f4ng ph\u00e2n \u0111o\u1ea1n ho\u1eb7c heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">N\u1ebfu c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi Heparine v\u00e0 Enoxaparin; s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p c\u01a1 h\u1ecdc.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Theo d\u00f5i b\u1ec7nh nh\u00e2n COVID-19 n\u1ebfu c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u nghi ng\u1edd t\u1eafc m\u1ea1ch nh\u01b0 \u0111\u1ed9t qu\u1ef5, t\u1eafc m\u1ea1ch s\u00e2u, nh\u1ed3i m\u00e1u ph\u1ed5i, h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p. N\u1ebfu c\u00f3 c\u00e1c d\u1ea5u hi\u1ec7u nghi ng\u1edd, c\u1ea7n \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kh\u00e1ng \u0111\u00f4ng COVID theo \u0110H Yale<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/scontent.fsgn5-3.fna.fbcdn.net\/v\/t1.6435-9\/241258792_1981616078665829_5468129365705502851_n.jpg?_nc_cat=110&amp;ccb=1-5&amp;_nc_sid=b9115d&amp;_nc_ohc=1-5_ES-GsZUAX_Td-9V&amp;_nc_ht=scontent.fsgn5-3.fna&amp;oh=93a70fc7c30506fa61c3fbfda7392501&amp;oe=616142F2\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/scontent.fsgn5-4.fna.fbcdn.net\/v\/t1.6435-9\/241234902_1981616115332492_3872625667559129759_n.jpg?_nc_cat=104&amp;ccb=1-5&amp;_nc_sid=b9115d&amp;_nc_ohc=JLF5is0s4kkAX-byQwW&amp;_nc_ht=scontent.fsgn5-4.fna&amp;oh=9cbfc2e70c241806267fd4e0ccbfce49&amp;oe=615ED68F\" alt=\"\"\/><figcaption><a href=\"https:\/\/www.facebook.com\/groups\/631408900536714\/permalink\/1534446870232908\/\" target=\"_blank\" rel=\"noreferrer noopener\">Ngu\u1ed3n<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.facebook.com\/100045982173323\/posts\/414670740075662\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>\u0110\u1ecdc th\u00eam b\u00e0i \u0110i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng<\/strong><\/a><\/p>\n\n\n\n<p class=\"has-vivid-red-color has-text-color wp-block-paragraph\">Xem th\u00eam b\u00e0i ch\u1ed1ng \u0111\u00f4ng \u1edf trang web c\u1ee7a huy\u1ebft h\u1ecdc<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6.3 <em>L\u1ecdc m\u00e1u ngo\u00e0i c\u01a1 th\u1ec3<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C\u00e1c tr\u01b0\u1eddng h\u1ee3p ARDS n\u1eb7ng v\u00e0\/ho\u1eb7c s\u1ed1c nhi\u1ec5m tr\u00f9ng n\u1eb7ng kh\u00f4ng \u0111\u00e1p \u1ee9ng ho\u1eb7c \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng. C\u00e2n nh\u1eafc s\u1eed d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p l\u1ecdc m\u00e1u li\u00ean t\u1ee5c ngo\u00e0i c\u01a1 th\u1ec3 b\u1eb1ng c\u00e1c lo\u1ea1i qu\u1ea3 l\u1ecdc c\u00f3 kh\u1ea3 n\u0103ng h\u1ea5p ph\u1ee5 cytokines. <em>&nbsp;<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6.4 <em>Immunoglobuline truy\u1ec1n t\u0129nh m\u1ea1ch (IVIG)<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">T\u00f9y t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng IVIG cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh n\u1eb7ng.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">H\u1ed9i ch\u1ee9ng vi\u00eam h\u1ec7 th\u1ed1ng li\u00ean quan t\u1edbi COVID-19 \u1edf tr\u1ebb em: T\u1ed5ng li\u1ec1u 2 g\/kg (t\u1ed1i \u0111a 100g), truy\u1ec1n t\u0129nh m\u1ea1ch trong 12-24 gi\u1edd, ho\u1eb7c 1 g\/kg\/ng\u00e0y x 2 ng\u00e0y<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>6.5. Thu\u1ed1c kh\u00e1ng sinh <\/em><\/strong>-Kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng sinh th\u01b0\u1eddng quy cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean \u0111\u01a1n thu\u1ea7n.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>V\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam ph\u1ed5i, c\u1ea5y m\u00e1u v\u00e0 c\u1ea5y \u0111\u1eddm t\u00ecm vi khu\u1ea9n v\u00e0 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng kh\u00e1ng sinh th\u00edch h\u1ee3p theo kinh nghi\u1ec7m c\u00f3 t\u00e1c d\u1ee5ng v\u1edbi c\u00e1c t\u00e1c nh\u00e2n vi khu\u1ea9n, n\u1ea5m c\u00f3 th\u1ec3 \u0111\u1ed3ng nhi\u1ec5m g\u00e2y vi\u00eam ph\u1ed5i, (t\u00f9y theo l\u1ee9a tu\u1ed5i, d\u1ecbch t\u1ec5, \u0111\u1ec3 g\u1ee3i \u00fd c\u0103n nguy\u00ean). \u0110i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh th\u00edch h\u1ee3p theo kh\u00e1ng sinh \u0111\u1ed3 khi c\u00f3 k\u1ebft qu\u1ea3 ph\u00e2n l\u1eadp vi khu\u1ea9n. <strong><em>&nbsp;<\/em><\/strong><\/li><li>N\u1ebfu c\u00f3 t\u00ecnh tr\u1ea1ng nhi\u1ec5m tr\u00f9ng huy\u1ebft, c\u1ea7n cho kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng theo kinh nghi\u1ec7m s\u1edbm, trong v ng m\u1ed9t gi\u1edd t\u1eeb khi x\u00e1c \u0111\u1ecbnh nhi\u1ec5m tr\u00f9ng huy\u1ebft. \u0110i\u1ec1u ch\u1ec9nh kh\u00e1ng sinh th\u00edch h\u1ee3p khi c\u00f3 k\u1ebft qu\u1ea3 vi khu\u1ea9n v\u00e0 kh\u00e1ng sinh \u0111\u1ed3.<\/li><li>C\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng th\u1ee9 ph\u00e1t, t\u00f9y theo c\u0103n nguy\u00ean, \u0111\u1eb7c \u0111i\u1ec3m d\u1ecbch t\u1ec5, kh\u00e1ng kh\u00e1ng sinh \u0111\u1ec3 l\u1ef1a ch\u1ecdn kh\u00e1ng sinh th\u00edch h\u1ee3p.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6.6 <em>Thu\u1ed1c kh\u00e1ng vi r\u00fat: <\/em><\/strong>\u0110\u00e3 c\u00f3 nhi\u1ec1u thu\u1ed1c \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m nh\u01b0ng ch\u01b0a c\u00f3 hi\u1ec7u qu\u1ea3 r\u00f5 r\u00e0ng. Khi \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o, B\u1ed9 Y t\u1ebf s\u1ebd cho ph\u00e9p s\u1eed d\u1ee5ng.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"B\u00e0i 5. H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng Remdesivir c\u1ee7a B\u1ed9 y t\u1ebf - BS. Phan Th\u1ecb H\u1ea3i L\u00fd\" width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/qGpIZO1FCrc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6.7 <em>Kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng<\/em><\/strong>: \u0110ang trong qu\u00e1 tr\u00ecnh th\u1eed nghi\u1ec7m, n\u1ebfu c\u00f3 thu\u1ed1c Tocilizumab ho\u1eb7c REGEN-COV 2 (Kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng k\u00e9p g\u1ed3m Casirivimab 600mg v\u00e0 Imdevimab 600 mg) \u0111\u1ec1 ngh\u1ecb b\u00e1o c\u00e1o H\u1ed9i \u0111\u1ed3ng chuy\u00ean m\u00f4n c\u1ee7a B\u1ed9 Y t\u1ebf \u0111\u1ec3 xin \u00fd ki\u1ebfn \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1eUCxzvaLLVzyg-48b6clpMT6aqqGGqkj\/view\" target=\"_blank\"><strong>\u0110\u1ecdc th\u00eam b\u00e0i: Nh\u1eefng \u0111i\u1ec1u m\u00e0 b\u00e1c s\u0129 h\u1ed3i s\u1ee9c n\u00ean bi\u1ebft v\u1ec1 Tocilizumab<\/strong><\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1Nb-34mhJpVlWNuZJfIzYRptr9lSE0Q3u\/view\" target=\"_blank\"><strong>\u0110\u1ecdc th\u00eam b\u00e0i \u0110i\u1ec1u tr\u1ecb b\u1eb1ng dexamethasone v\u00e0 tocilizumab l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 gi\u00e1 tr\u1ecb c\u1ee7a protein ph\u1ea3n \u1ee9ng C v\u00e0 Procalcitonin \u0111\u1ec3 ph\u00e1t hi\u1ec7n nhi\u1ec5m khu\u1ea9n th\u1ee9 ph\u00e1t \u1edf b\u1ec7nh nh\u00e2n COVID-19<\/strong><\/a><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"> &#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212; <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6.8 <em>Ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng v\u00e0 ch\u0103m s\u00f3c dinh d\u01b0\u1ee1ng<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p s\u1edbm, ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng \u0111\u1ea7y \u0111\u1ee7 Calo v\u00e0 c\u00e1c vitamin thi\u1ebft y\u1ebfu cho c\u00e1c ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u0110\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng n\u01b0\u1edbc, \u0111i\u1ec7n gi\u1ea3i<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>6.9. Ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed c\u00e1c bi\u1ec3u hi\u1ec7n th\u1ea7n kinh v\u00e0 t\u00e2m th\u1ea7n.<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>\u0110\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb m\u00ea s\u1ea3ng, \u0111\u1eb7c bi\u1ec7t nh\u1eefng b\u1ec7nh nh\u00e2n n\u1eb7ng: \u00e1p d\u1ee5ng c\u00e1c thang \u0111i\u1ec3m \u0111\u00e1nh gi\u00e1 s\u1ea3ng, x\u00e1c \u0111\u1ecbnh v\u00e0 x\u1eed l\u00fd nguy\u00ean nh\u00e2n v\u00e0 c\u00f3 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb s\u1ea3ng th\u00edch h\u1ee3p.<\/li><li>\u0110\u00e1nh gi\u00e1 c\u00e1c d\u1ea5u hi\u1ec7u lo \u00e2u v\u00e0 tr\u1ea7m c\u1ea3m; \u00e1p d\u1ee5ng c\u00e1c bi\u1ec7n ph\u00e1p h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd x\u00e3 h\u1ed9i v\u00e0 c\u00e1c can thi\u1ec7p th\u00edch h\u1ee3p<\/li><li>Ph\u00e1t hi\u1ec7n v\u00e0 x\u1eed tr\u00ed c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7.<\/li><li>H\u1ed7 tr\u1ee3 s\u1ee9c kh\u1ecfe t\u00e2m th\u1ea7n v\u00e0 h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd x\u00e3 h\u1ed9i c\u01a1 b\u1ea3n cho t\u1ea5t c\u1ea3 nh\u1eefng ng\u01b0\u1eddi nghi ng\u1edd ho\u1eb7c x\u00e1c nh\u1eadn m\u1eafc COVID-19.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">7. <strong>D\u1ef1 ph\u00f2ng bi\u1ebfn ch\u1ee9ng&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">V\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng \u0111i\u1ec1u tr\u1ecb t\u1ea1i c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c, c\u1ea7n d\u1ef1 ph ng c\u00e1c bi\u1ebfn ch\u1ee9ng hay g\u1eb7p sau:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>7.1 <em>Nhi\u1ec5m tr\u00f9ng t\u1ea1i b\u1ec7nh vi\u1ec7n<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">7.1.1. <em>D\u1ef1 ph\u00f2ng vi\u00eam ph\u1ed5i th\u1edf m\u00e1y<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u00c1p d\u1ee5ng v\u00e0 tu\u00e2n th\u1ee7 g\u00f3i d\u1ef1 ph\u00f2ng vi\u00eam ph\u1ed5i li\u00ean quan t\u1edbi th\u1edf m\u00e1y:&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>N\u00ean \u0111\u1eb7t \u1ed1ng NKQ \u0111\u01b0\u1eddng mi\u1ec7ng.<\/li><li>\u0110\u1eb7t ng\u01b0\u1eddi b\u1ec7nh n\u1eb1m t\u01b0 th\u1ebf \u0111\u1ea7u cao 30-45 \u0111\u1ed9.<\/li><li>V\u1ec7 sinh r\u0103ng mi\u1ec7ng.<\/li><li>S\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng h\u00fat k\u00edn, \u0111\u1ecbnh k\u1ef3 l\u00e0m tho\u00e1t n\u01b0\u1edbc \u0111\u1ecdng trong d\u00e2y m\u00e1y th\u1edf.<\/li><li>S\u1eed d\u1ee5ng b\u1ed9 d\u00e2y m\u00e1y th\u1edf m\u1edbi cho m\u1ed7i b\u1ec7nh nh\u00e2n; ch\u1ec9 thay d\u00e2y m\u00e1y th\u1edf khi b\u1ea9n ho\u1eb7c h\u01b0 h\u1ecfng trong khi ng\u01b0\u1eddi b\u1ec7nh \u0111ang th\u1edf m\u00e1y.<\/li><li>Thay b\u00ecnh l\u00e0m \u1ea5m\/\u1ea9m khi b\u1ecb h\u1ecfng, b\u1ea9n, ho\u1eb7c sau m\u1ed7i 5-7 ng\u00e0y.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">7.1.2. <em>D\u1ef1 ph\u00f2ng nhi\u1ec5m tr\u00f9ng m\u00e1u li\u00ean quan t\u1edbi \u0111\u01b0\u1eddng truy\u1ec1n trung t\u00e2m.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">S\u1eed d\u1ee5ng b\u1ea3ng ki\u1ec3m \u0111\u1ec3 theo d\u00f5i \u00e1p d\u1ee5ng c\u00e1c g\u00f3i d\u1ef1 ph\u00f2ng khi \u0111\u1eb7t \u0111\u01b0\u1eddng truy\u1ec1n v\u00e0 ch\u0103m s\u00f3c \u0111\u01b0\u1eddng truy\u1ec1n trung t\u00e2m. R\u00fat \u0111\u01b0\u1eddng truy\u1ec1n trung t\u00e2m khi kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>7.2 <em>Lo\u00e9t do t\u1ef3 \u0111\u00e8: <\/em><\/strong>Xoay tr\u1edf ng\u01b0\u1eddi b\u1ec7nh th\u01b0\u1eddng xuy\u00ean<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>7.3 <em>Vi\u00eam lo\u00e9t d\u1ea1 d\u00e0y do stress v\u00e0 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cho \u0103n qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a s\u1edbm (trong v ng 24-48 gi\u1edd sau nh\u1eadp vi\u1ec7n)- D\u00f9ng thu\u1ed1c kh\u00e1ng H<sub>2<\/sub> ho\u1eb7c \u1ee9c ch\u1ebf b\u01a1m proton cho nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 nguy c\u01a1 xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a nh\u01b0 th\u1edf m\u00e1y \u2265 48 gi\u1edd, r\u1ed1i lo\u1ea1n \u0111\u00f4ng m\u00e1u, \u0111i\u1ec1u tr\u1ecb thay th\u1ebf th\u1eadn, c\u00f3 b\u1ec7nh gan, nhi\u1ec1u b\u1ec7nh n\u1ec1n k\u00e8m theo, v\u00e0 suy ch\u1ee9c n\u0103ng \u0111a c\u01a1 quan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>7.4. Y\u1ebfu c\u01a1 li\u00ean quan t\u1edbi \u0111i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Khi c\u00f3 th\u1ec3, t\u00edch c\u1ef1c cho v\u1eadn \u0111\u1ed9ng s\u1edbm trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>8. M\u1ed9t s\u1ed1 qu\u1ea7n th\u1ec3 \u0111\u1eb7c bi\u1ec7t<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>8.1 <em>Ph\u1ee5 n\u1eef mang thai<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Khi nghi ng\u1edd ho\u1eb7c kh\u1eb3ng \u0111\u1ecbnh nhi\u1ec5m SARS-CoV-2 c\u1ea7n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb theo c\u00e1c bi\u1ec7n ph\u00e1p nh\u01b0 tr\u00ean, tuy nhi\u00ean c\u1ea7n ch\u00fa \u00fd t\u1edbi nh\u1eefng thay \u0111\u1ed5i sinh l\u00fd khi mang thai. <strong>&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>8.2 <em>Ng\u01b0\u1eddi cao tu\u1ed5i<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ng\u01b0\u1eddi cao tu\u1ed5i v\u1edbi c\u00e1c b\u1ec7nh l\u00fd n\u1ec1n k\u00e8m theo t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh n\u1eb7ng v\u00e0 t\u1eed vong. Ch\u0103m s\u00f3c v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ea7n ph\u1ed1i h\u1ee3p c\u00e1c chuy\u00ean khoa, c\u1ea7n ch\u00fa \u00fd t\u1edbi nh\u1eefng thay \u0111\u1ed5i sinh l\u00fd \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, c\u0169ng nh\u01b0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u0110\u1ecdc th\u00eam: <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/17CDS6UJGkh8t8y4OAavHWXkIgFo6b8dP\/view?usp=sharing\" data-type=\"URL\" data-id=\"https:\/\/drive.google.com\/file\/d\/17CDS6UJGkh8t8y4OAavHWXkIgFo6b8dP\/view?usp=sharing\" target=\"_blank\">S\u1ef1 k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb COVID-19 v\u00e0 m\u1ed1i li\u00ean quan v\u1edbi t\u1ef7 l\u1ec7 t\u1eed vong trong m\u1ed9t h\u1ec7 th\u1ed1ng ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe \u0111a \u0111i\u1ec3m l\u1edbn<\/a> (<a href=\"https:\/\/drive.google.com\/file\/d\/17CDS6UJGkh8t8y4OAavHWXkIgFo6b8dP\/view?usp=sharing\" data-type=\"URL\" data-id=\"https:\/\/drive.google.com\/file\/d\/17CDS6UJGkh8t8y4OAavHWXkIgFo6b8dP\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">link 2<\/a>)<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>IX. TI\u00caU CHU\u1ea8N XU\u1ea4T VI\u1ec6N<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>1. Ng\u01b0\u1eddi b\u1ec7nh \u0111\u01b0\u1ee3c xu\u1ea5t vi\u1ec7n khi c\u00f3 \u0111\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n sau<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Ti\u00eau chu\u1ea9n xu\u1ea5t vi\u1ec7n c\u0103n c\u1ee9 v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u00e0 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m c\u1ee5 th\u1ec3 nh\u01b0 sau:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">1.1. Xu\u1ea5t vi\u1ec7n v\u00e0o ng\u00e0y th\u1ee9 10 k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m (+) v\u1edbi SARSCoV-2 khi \u0111\u1ea1t c\u00e1c ti\u1ec3u chu\u1ea9n sau:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng trong v ng 10 ng\u00e0y k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m (+) v\u1edbi SARS-CoV-2.<\/li><li>T\u1ed1i thi\u1ec3u l\u1ea5y hai m\u1eabu b\u1ec7nh ph\u1ea9m li\u00ean ti\u1ebfp (<em>c\u00e1ch nhau t\u1ed1i thi\u1ec3u 24 gi\u1edd<\/em>) c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p real-time RT-PCR \u00e2m t\u00ednh v\u1edbi SARS-CoV2 ho\u1eb7c n\u1ed3ng \u0111\u1ed9 vi r\u00fat th\u1ea5p (Ct \u2265 30); th\u1eddi gian t\u1eeb khi l\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m cu\u1ed1i c\u00f9ng t\u1edbi khi ra vi\u1ec7n kh\u00f4ng qu\u00e1 24h.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">1.2. Xu\u1ea5t vi\u1ec7n v\u00e0o ng\u00e0y th\u1ee9 14 k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m (+) v\u1edbi SARSCoV-2 khi \u0111\u1ea1t c\u00e1c ti\u1ec3u chu\u1ea9n sau:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>C\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng trong 10 ng\u00e0y k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m (+) v\u1edbi SARS-CoV-2.<\/li><li>T\u1ed1i thi\u1ec3u l\u1ea5y hai m\u1eabu b\u1ec7nh ph\u1ea9m li\u00ean ti\u1ebfp (<em>c\u00e1ch nhau t\u1ed1i thi\u1ec3u 24 gi\u1edd<\/em>) c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p real-time RT-PCR \u00e2m t\u00ednh v\u1edbi SARS-CoV2 ho\u1eb7c n\u1ed3ng \u0111\u1ed9 vi r\u00fat th\u1ea5p (Ct \u2265 30); th\u1eddi gian t\u1eeb khi l\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m cu\u1ed1i c\u00f9ng t\u1edbi khi ra vi\u1ec7n kh\u00f4ng qu\u00e1 24h.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">1.3. Xu\u1ea5t vi\u1ec7n sau ng\u00e0y th\u1ee9 14 k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m (+) v\u1edbi SARSCoV-2 (ng\u00e0y ra vi\u1ec7n \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 sau 3 ng\u00e0y k\u1ec3 t\u1eeb ng\u00e0y kh\u00f4ng c n tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng + \u0111\u1ea3m b\u1ea3o ti\u00eau chu\u1ea9n v\u1ec1 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng sau 10 ng\u00e0y k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m x\u00e9t nghi\u1ec7m (+) v\u1edbi SARS-CoV-2.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">T\u1ed1i thi\u1ec3u l\u1ea5y hai m\u1eabu b\u1ec7nh ph\u1ea9m li\u00ean ti\u1ebfp (<em>c\u00e1ch nhau t\u1ed1i thi\u1ec3u 24 gi\u1edd<\/em>) c\u00f3 k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p real-time RT-PCR \u00e2m t\u00ednh v\u1edbi SARS-CoV2 ho\u1eb7c n\u1ed3ng \u0111\u1ed9 vi r\u00fat th\u1ea5p (Ct \u2265 30); th\u1eddi gian t\u1eeb khi l\u1ea5y m\u1eabu b\u1ec7nh ph\u1ea9m cu\u1ed1i c\u00f9ng t\u1edbi khi ra vi\u1ec7n kh\u00f4ng qu\u00e1 24h.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>2. Theo d\u00f5i sau xu\u1ea5t vi\u1ec7n<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ng\u01b0\u1eddi b\u1ec7nh c\u1ea7n ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c c\u00e1ch ly ph\u00f9 h\u1ee3p t\u1ea1i nh\u00e0 d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a Y t\u1ebf c\u01a1 s\u1edf v\u00e0 CDC \u0111\u1ecba ph\u01b0\u01a1ng th\u00eam 14 ng\u00e0y v\u00e0 theo d\u00f5i th\u00e2n nhi\u1ec7t t\u1ea1i nh\u00e0 2 l\u1ea7n\/ng\u00e0y, n\u1ebfu th\u00e2n nhi\u1ec7t cao h\u01a1n 38<sup>o<\/sup>C \u1edf hai l\u1ea7n \u0111o li\u00ean ti\u1ebfp ho\u1eb7c c\u00f3 b\u1ea5t k\u1ef3 d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng b\u1ea5t th\u01b0\u1eddng n\u00e0o th\u00ec c\u1ea7n \u0111\u1ebfn ngay c\u01a1 s\u1edf y t\u1ebf \u0111\u1ec3 th\u0103m kh\u00e1m v\u00e0 x\u1eed tr\u00ed k\u1ecbp th\u1eddi.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B\u00e0n giao, v\u1eadn chuy\u1ec3n ng\u01b0\u1eddi b\u1ec7nh sau khi xu\u1ea5t vi\u1ec7n: Th\u1ef1c hi\u1ec7n theo C\u00f4ng v\u0103n s\u1ed1 425\/CV-BC\u0110 ng\u00e0y 19\/01\/2021 c\u1ee7a Ban ch\u1ec9 \u0111\u1ea1o Qu\u1ed1c gia ph ng ch\u1ed1ng d\u1ecbch COVID-19 v\u00e0 c\u00e1c v\u0103n b\u1ea3n thay th\u1ebf kh\u00e1c (n\u1ebfu c\u00f3).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C\u00e1ch t\u00ednh FiO2:<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"599\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/71e8b762-2084-4bdb-9804-4bb8fb90f028-1024x599.jpg\" alt=\"\" class=\"wp-image-777\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/71e8b762-2084-4bdb-9804-4bb8fb90f028-1024x599.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/71e8b762-2084-4bdb-9804-4bb8fb90f028-300x176.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/71e8b762-2084-4bdb-9804-4bb8fb90f028-768x450.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/71e8b762-2084-4bdb-9804-4bb8fb90f028.jpg 1266w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"960\" height=\"389\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169387866_6841620288205850744-1.jpg\" alt=\"\" class=\"wp-image-787\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169387866_6841620288205850744-1.jpg 960w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169387866_6841620288205850744-1-300x122.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169387866_6841620288205850744-1-768x311.jpg 768w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>L\u01b0u \u00fd n\u1ebfu bn th\u1edf s\u00e2u qu\u00e1 ho\u1eb7c th\u1edf nhanh qu\u00e1 th\u00ec FiO2 c\u00f3 th\u1ec3 gi\u1ea3m. (b\u00e0i th\u1ea7y V\u0169 trong trang h\u1ed9i y h\u1ecdc)<\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"960\" height=\"720\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169400695_6841620342012899667.jpg\" alt=\"\" class=\"wp-image-788\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169400695_6841620342012899667.jpg 960w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169400695_6841620342012899667-300x225.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169400695_6841620342012899667-768x576.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169400695_6841620342012899667-800x600.jpg 800w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Mask \u0111\u01a1n gi\u1ea3n l\u01b0u l\u01b0\u1ee3ng \u00edt nh\u1ea5t ph\u1ea3i 5L\/p \u0111\u1ec3 \u0111\u1ea9y kh\u00ed th\u1edf l\u1ea1i ra m\u1edbi \u0111\u1ea1t hi\u1ec7u qu\u1ea3.<\/p>\n <div style=\"overflow: hidden; height: 1px;\"><a href=\"https:\/\/www.mclinica.com\/kaufen-sie-generisches-levitra\/\">Levitra Generika 20mg<\/a><\/div> \n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"960\" height=\"720\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169410663_6841620383825556906.jpg\" alt=\"\" class=\"wp-image-789\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169410663_6841620383825556906.jpg 960w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169410663_6841620383825556906-300x225.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169410663_6841620383825556906-768x576.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169410663_6841620383825556906-800x600.jpg 800w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">C\u00f3 van 1 chi\u1ec1u (kh\u00f4ng th\u1edf l\u1ea1i) th\u00ec t\u1ed1t h\u01a1n. T\u00fai ph\u1ea3i ph\u1ed3ng.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"877\" height=\"312\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-4.png\" alt=\"\" class=\"wp-image-804\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-4.png 877w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-4-300x107.png 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/image-4-768x273.png 768w\" sizes=\"auto, (max-width: 877px) 100vw, 877px\" \/><figcaption>M\u1eb7t n\u1ea1 Venturi (B\u00e0i th\u1ea7y V\u0169 &#8211; h\u1ed9i y h\u1ecdc)<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"920\" height=\"438\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169421732_6841620430252262879.jpg\" alt=\"\" class=\"wp-image-790\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169421732_6841620430252262879.jpg 920w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169421732_6841620430252262879-300x143.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169421732_6841620430252262879-768x366.jpg 768w\" sizes=\"auto, (max-width: 920px) 100vw, 920px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"960\" height=\"720\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169432168_6841620474021188740.jpg\" alt=\"\" class=\"wp-image-791\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169432168_6841620474021188740.jpg 960w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169432168_6841620474021188740-300x225.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169432168_6841620474021188740-768x576.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/facebook_1631169432168_6841620474021188740-800x600.jpg 800w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"558\" src=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6143079792505891925_121-1-1024x558.jpg\" alt=\"\" class=\"wp-image-795\" srcset=\"https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6143079792505891925_121-1-1024x558.jpg 1024w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6143079792505891925_121-1-300x163.jpg 300w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6143079792505891925_121-1-768x419.jpg 768w, https:\/\/cdha.edu.vn\/cdha\/wp-content\/uploads\/2021\/09\/6143079792505891925_121-1.jpg 1035w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>\u0110I\u1ec0U TR\u1eca B\u1ec6NH N\u1ec0N<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>T\u0102NG HUY\u1ebeT \u00c1P:<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/0B9ygT2i1zbU-Nm5WSTA5N3cycnc\/view\" target=\"_blank\">Ph\u1ed1i h\u1ee3p thu\u1ed1c trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/0B2O1DNO9TW1IdXl4bjBXTlBIelE\" target=\"_blank\">C\u1eadp nh\u1eadt JNC VIII<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/17VgbKxUiKY55mrsdQOmwGK6m8p9-XHB-\/view\" target=\"_blank\">T\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb<\/a><\/li><li><a href=\"https:\/\/drive.google.com\/file\/d\/14onpVG16WuKCPmnyii9Ks5ZvyRlsvtd8\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">T\u0103ng huy\u1ebft \u00e1p v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch<\/a><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>ECG<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/107AdPT2FwsV8V3BwrfvBCgMQhWj4-XCk\/view?usp=sharing\" target=\"_blank\">R\u1ed1i lo\u1ea1n nh\u1ecbp li\u00ean quan \u0111\u1ebfn covid 19<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/0Bxn0W00nFqQjcnVrUThLS0pGMVk\/\" target=\"_blank\">100 ecg c\u1ea5p c\u1ee9u<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/18KU0mjOBdLlqHYHOLq600Fqw1W7R7EeD\/view?usp=sharing\" target=\"_blank\">70 ca l\u00e2m s\u00e0ng v\u00e0 bi\u1ec7n lu\u1eadn ECG<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.facebook.com\/100019519457107\/posts\/824310954896212\/\" target=\"_blank\">H\u1ed9i ch\u1ee9ng wellen<\/a><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>KH\u00cd M\u00c1U \u0110\u1ed8NG M\u1ea0CH<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"https:\/\/drive.google.com\/file\/d\/1Y4ARVRY3l3MEqE6pFtPzRmIXC7O_1HZY\/view?usp=sharing\" target=\"_blank\" rel=\"noreferrer noopener\">Ph\u00e2n t\u00edch KM\u0110M<\/a><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>TR\u1eccN B\u1ed8 VIDEO H\u01af\u1edaNG D\u1eaaN TH\u1ede M\u00c1Y<\/em><\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=7v-a09v5zWc\" target=\"_blank\">Cau tao may tho&nbsp;&nbsp;<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=-XO5Fi_qVnY\" target=\"_blank\">Chuc nang may tho<\/a> 840&nbsp;&nbsp;<\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=E9yy6eFhDyA\" target=\"_blank\">C\u1ea5u t\u1ea1o m\u1ed9t nh\u1ecbp th\u1edf c\u01a1 h\u1ecdc<\/a>&nbsp;&nbsp;<\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=XIxxm8Gc9H4\" target=\"_blank\">Mode tho VCV<\/a>&nbsp;&nbsp;<\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=XzCE3w2rrIQ\" target=\"_blank\">Mode th\u1edf PC v\u00e0 VC+&nbsp;<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=r2HXDXVqcOQ\" target=\"_blank\">Cai dat ban dau benh nhan ARDS&nbsp;<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=V_lgKlq6UsY\" target=\"_blank\">Nguyen tac dieu chinh thong khi<\/a>&nbsp;&nbsp;<\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=ITMxrLCGyGo\" target=\"_blank\">Xu tri gi\u1ea3m oxy mau nang&nbsp;<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=bO2Z2Elbv88\" target=\"_blank\">Xu tri bao dong may tho<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=vMiRZee-qd4\" target=\"_blank\">Thong so theo doi may tho (Phan 1)&nbsp;<\/a><\/li><li><a href=\"https:\/\/www.youtube.com\/watch?v=yU_Qy48XOWU\" target=\"_blank\" rel=\"noreferrer noopener\">Theo doi benh nhan tho may (phan 2)<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.youtube.com\/watch?v=0rK6DY7h-8Q\" target=\"_blank\">Cham soc benh nhan tho may<\/a><\/li><\/ol>\n\n\n\n<p class=\"wp-block-paragraph\"><em>\u0110I\u1ec0U TR\u1eca CHUNG<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1PKILf7YQHOubwtXydDoHYjWPDy3pIPv-\/view?usp=sharing\" target=\"_blank\">Annual Update in Intensive Care and Emergency Medicine 2021<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1HsazMhpv9D2cDyEGw5dCdZT2vVd8716j\/view?usp=sharing\" target=\"_blank\">ICU protocol<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1Ahr_gJKmgRHSbjBx2rBVFL80krUa0xZj\/view?usp=sharing\" target=\"_blank\">D\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch &#8211; t\u00ednh ch\u1ea5t v\u00e0 ch\u1ec9 \u0111\u1ecbnh<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.facebook.com\/groups\/607354566521188\/permalink\/934192867170688\/\" target=\"_blank\">C\u00e1c b\u00e0i gi\u1ea3ng v\u1ec1 HSCC<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1tdK_C59LdifFWo9nIljpFmbNb3ReiAAR\/view\" target=\"_blank\">C\u00e1c th\u1ee7 thu\u1eadt quan tr\u1ecdng trong HSCC<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/0Bw0Y1kRVykxmcklNTGhseDBSbHc\/\" target=\"_blank\">\u0110i\u1ec1u tr\u1ecb h\u1ecdc n\u1ed9i khoa<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1jhJAyW6cTat1qS-1Z97P9TiU7lyQVWJT\" target=\"_blank\">V\u1eadn m\u1ea1ch v\u00e0 c\u01b0\u1eddng tim<\/a> &#8211; c\u1ef1c hay<\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/0BwS43h9KWTgqZ1IybDlFaWZWakU\/\" target=\"_blank\">H\u1ed3i s\u1ee9c ch\u1ea5n th\u01b0\u01a1ng<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1M5hJBu990_2JqBDcKWVU_3gqKWtD2RLt\" target=\"_blank\">C\u00e1c dung d\u1ecbch d\u00f9ng b\u00f9 \u0111\u1eafp th\u1ec3 t\u00edch l\u01b0u h\u00e0nh trong s\u1ed1c gi\u1ea3m th\u1ec3 t\u00edch<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/docs.google.com\/document\/d\/1CFIf1inUayaOzxFkb_9NHHL3PQIzq5EJ\/edit?usp=sharing&amp;ouid=101622462074885606361&amp;rtpof=true&amp;sd=true\" target=\"_blank\">X\u1eed tr\u00ed nh\u1ecbp nhanh tr\u00ean th\u1ea5t \u1edf ng\u01b0\u1eddi l\u1edbn<\/a><\/li><li><a rel=\"noreferrer noopener\" href=\"https:\/\/drive.google.com\/file\/d\/1Ki4AuiZ8GfyUFIjIe0UhLds6SzwT7w4S\/view?usp=sharing\" target=\"_blank\">H\u1ea1 Na m\u00e1u<\/a><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>H\u1ed2I SINH TIM PH\u1ed4I<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a rel=\"noreferrer noopener\" href=\"https:\/\/www.facebook.com\/100045982173323\/posts\/413109273565142\/\" target=\"_blank\">Ng\u01b0ng tim ng\u01b0ng th\u1edf<\/a><\/li><li><a href=\"https:\/\/drive.google.com\/file\/d\/11JQns-MS0wUhr4S_E7eAqyLiX_YXN6-i\/\" target=\"_blank\" rel=\"noreferrer noopener\">C\u00e1c thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb ng\u01b0ng tim<\/a><\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>B\u00c0I THAM KH\u1ea2O Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb Covid-19 &#8211; B\u1ed9 Y T\u1ebf 14-07-2021 S\u1ed5 tay \u0111i\u1ec1u tr\u1ecb h\u1ed3i s\u1ee9c covid \u0110\u1ed3ng thu\u1eadn<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-759","post","type-post","status-publish","format-standard","hentry","category-khong-phan-loai"],"_links":{"self":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/759","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/comments?post=759"}],"version-history":[{"count":33,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/759\/revisions"}],"predecessor-version":[{"id":952,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/posts\/759\/revisions\/952"}],"wp:attachment":[{"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/media?parent=759"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/categories?post=759"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cdha.edu.vn\/cdha\/wp-json\/wp\/v2\/tags?post=759"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}