Bao Cao Thuc Tap Benh Vien Da Khoa Tinh Dak Lak

B GIO DC V O TO

Trng Trung Cp Y k Lk

LI NI U

c mt hnh trang bc vo ngh tt, khng ch cn kin thc trong hc tp m cn phi hc hi, tch ly nhiu kinh nghim t nhiu yu t bn ngoi. Bi vy, phi hc i vi hnh.

K thc tp l thi gian sinh vin bt u lm quen vi tc phong lm vic tiu c s y t. i vi dc s trung hc tng lai, y l c hi tt em c th vn dng nhng kin thc c hc trn gh nh trng v kinh nghim trong thc t hon thnh bo co thc tp.

Bi bo co thc tp ca em l cun ti liu thu nh, ghi chp li tt c nhng vn em c hc, thc hin v nhng gt tip thu c trong qu trnh i thc t ti c s.

hon thnh tht tt cc mc tiu nh trng giao, t chuyn i thc t, em hc hi c nhiu kinh nghim t cc y bc s ti bnh vin. l nhng kin thc b ch, l hnh trang vng bc sau ny bc vo ngh sau ny trong cng tc chuyn mn.

Qua y em cng gi li xin chn thnh cm n n cc thy c gio trong trng v cc y bc s ti bnh vin to mi iu kin gip em hc hi nng cao v chuyn mn, kin thc thc t

Bun Ma Thut, ngy 27 thng 1 nm 2014

Sinh vin

ng Th Thu ThoLI CM N

Qua mt nm hc tp ti trng Trung cp y t k Lk, y l khong thi gian khng di nhng em c cc thy c tn tnh dy d, truyn t cho em nhng kin thc qu bu v b ch trong ngnh y dc.

Sau t thc tp thc t 5 tun ti bnh vin a Khoa Tnh k Lk va qua em cng hiu hn cng sc ca cc thy c, nhng k nng kint hc m cc thy c trao i cho chng em l rt ln m chng em khng bao gi qun.

Bi thu hoch ny ch l mt phn kin thc nh b, n cha nh gi ht nhng g m thy c ch dy cho chng em.

Em xin chn thnh cm n.

* Ban gim hiu, phng o to vi qu thy c trong trng du dt chng em t nhng bc i u tin, xy dng cho chng em mt nn kin thc qu bu v b ch trong ngnh y dc.

* Ban gim c bnh vin a Khoa Tnh k Lk, cng ton th cc cn b y, bc s ca bnh vin to iu kin thun li cho em thu nhp s liu ti bnh vin.

Em xin chn thnh cm n!

Bun Ma Thut, ngy 27 thng 1 nm 2014

Hc sinh

ng Th Thu Tho I. Gii thiu i nt v c s thc tp* Lch s hnh thnh v pht trinBnh vin a Khoa Tnh k Lk thuc thnh ph Bun Ma Thut, tnh k Lk, c xy dng gn trung tm tnh k Lk. Bnh vin c din tch ln, nm trn trc ng giao thng thun li nn rt thun tin cho vic khm cha bnh cho nhn dn, vi s dn gn 100.000 ngn dn, l mt thnh ph ng dn c v dn tc thiu s nn lng ngoi ti khm cha bnh rt ng. Chnh v vy m bo thc hin tt ni dung khm cha bnh ti c s l chm sc sc khe cho ngi dn trn a bn, nn bnh vin a Khoa Tnh k Lk xy dng c c s vt cht, khang trang, sch s, y . Gm c cc khoa, phng bnh, khun vin, sn th thao thong mt, rng ri v c i ng y, bc s c tay ngh p ng nhu cu chm sc sc khe ca nhn dn trong thnh ph v mt s ni ln cn.

II. V tr ca khoa dc

- Khoa dc ca bnh vin l mt khoa chuyn mn gip gim c bnh vin qun l ton b cng tc dc v cung cp nhu cu cho cng tc iu tr v nghin cu dc trong bnh vin.- L t chc cao nht m bo mi cng tc chuyn mn v dc, do khoa dc khng ch mang tnh cht ca mt khoa qun l, tham mu v ton b cng tc dc trong ton bnh vin nhm gp phn nng cao hiu qu v m bo an ton trong cng tc khm v cha bnh nht l trong vic s dng thuc.

Khoa dc chu s lnh o ca ban gim c bnh vin.

1. Chc nng ca khoa dc

- Qun l thuc men, ha cht, dng c v cc ch chuyn mn v dc trong bnh vin.

- Trong bnh vin khoa dc c b tr a im thun li trn, c iu kin lm vic, h thng kho, kho iu ch thuc y hc c truyn phng cp pht m bo ch v sinh, sch s, cao ro, thong mt.

- Lp k hoch cung ng v m bo s lng, cht lng thuc khng thng, thuc chuyn khoa, dng c y t ha cht cho iu tr ni tr. Ngoi tr p ng nhu cu hp l.

- Tham gia qun l kinh ph thuc, thc hin tt hiu qu cao, l c s thc hnh ca cc trng trung hc y dc.

- Tham gia nghin cu khoa hc, thng tin v thuc.

2. Nhim v ca khoa hc

- Lp k hoch pht trin cng tc dc v k hoch lp d tr v nhu cu thuc, nghin cu khoa hc v l c s o to cn b cho cc trng.

- Thng xuyn thc hin kim tra, kim sot thuc cht ch, nhm khng ngng nng cao trch nhim, m bo an ton cho ngi dng.

- Bo qun thuc, dng c khoa phng mnh qun l ng thi hng dn phng khc trong bnh vin v bo qun thuc, y dng c.

- Chp hnh cc ch chuyn mn v dc trong khoa phng mnh hng dn v thc hin cc ch chuyn mn cho ngnh.

- Hng dn s dng thuc, thc hin cc ch ca bnh vin, tham d v tham gia kin v dc trong cc bui hp chuyn mn.

- Ch o k thut v nghip v v dc i vi tuyn trc.

- Nghin cu khoa hc v dc theo phng hng ca ngnh v yu cu iu tr.

- Tng hp bo co trnh hot ng thng k, quyt on thuc v mt hm lng dng ng quy nh, ng thi hn v ng quyn hn chuyn mn.- Lp k hoch v cung ng m bo s lng, cht lng thuc thng thng v thuc chuyn khoa, ha cht vt dng y t tiu hao: Bng, bng, cn, gc cho iu tr ni tr, p ng nhu cu iu tr hp l.

- Kim tra theo di, vic x l, s dng thuc an ton, hp l trong ton bnh vin.

- Tham gia qun l kinh ph thuc, thc hin tit kim t hiu qu cao trong phc v ngi bnh.

- L c s thc hnh cc trng cao ng, trung cp y dc.

- Tham gia nghin cu khoa hc thng tin v thuc.

- Khoa dc c b tr thun tin, c iu kin lm vic, cung cp thuc cho cc khoa v bnh nhn.- Qun l quy ch, ch chuyn lp k hoch hng thng thuc. VTTH st vi thc t cho iu tr ni ngoi tr ca bnh vin.

- Cung ng thuc, vt t tiu hao cho ton bnh vin v 22 n v x, phng.

- Cp pht thuc ni, ngoi tr hng ngy cho bnh nhn, hng thng cho x, phng.

- Cp pht, thuc chng trnh cho bnh nhn ngoi tr.

- Giao thuc iu tr ni tr ti tn khoa lm sng.

- Kim k hng thng vo ngy cui thng.

- i chiu xut, nhp, tn bo co, vi phng k ton bnh vin.

- Bo co thuc gy nghin, hng tm thn hng ngy, 6 thng, c nm.

- Qun l thuc hng thn, gy nghin.- Qu trnh cp pht.

* Nhim v khoa dc vi hi ng v iu tr ca bnh vin.

- Xy dng danh mc thuc ph hp vi c th bnh tt v chi ph v thuc, vt t tiu hao ca bnh vin.

- T vn cho gim c v cung ng, s dng thuc an ton, hp l v hiu qu.

- Xy dng danh mc thuc ph hp vi c th bnh tt v hp l vi chi ph.- Theo di phn ng c hi ca thuc v bo co kp thi ln cp trn. - Gim st vic thc hin quy ch s dng thuc v quy ch cng tc kho dc.

- T chc gim st vic thc hin quy ch, chun on, qun l h s bnh nhn, bnh n v k n iu tr ca bc s.

- Bo co giao ban rt kinh nghim trong cng tc qun l v sai st trong dng thuc an ton, hp l, hiu qu v tit kim.

- Theo di ADR thng tin v thuc mi.

- Xy dng mi quan h hp tc cht ch, gia dc s, bc s, y t, trong dc s l ngi am hiu v thuc v tham gia t vn cho bc s iu tr, bc s ch nh y bnh, y t hng dn s dng thuc an ton, hp l, ng y bnh trong qu trnh chm sc bnh nhn.

- Dc s trng khoa v hi ng thuc iu tr hp nh k hng thng mt ln.3. Nguyn tc iu tr v hot ng ca hi ng thuc

- Bnh vin phi c hi ng thuc v iu tr.

- Hi ng thuc v iu tr l t chc t vn cho gim c bnh vin v cc vn lin quan n thuc v iu tr bng thuc ca bnh vin, m bo s dng thuc an ton, hp l v hiu qu, c th ha cc phc iu tr ph hp vi iu kin bnh vin.4. Cng tc cung ng, tip nhn, tn tr, bo qun cp ht thuc, ha cht, trang thit b y t.

- Lp k hoch thuc, ha cht, vt dng y t tiu hao ng thi gian quy nh.

- Khi nhu cu thuc tng t xut th phi lm d tr b sung.

- Bnh vin ch yu mua thuc doanh nghip nh nc, i vi thuc gy nghin, thuc chuyn khoa do cc cng ty dc phm trung ng hoc a phng cung ng theo ng k hoch.

- Mi ngun thuc trong bnh vin mua, vin tr u phi kim nhp.

- Vic mua bn thuc phi thc hin qua th thc u thu, chn thu, ch nh thu cng khai theo quy nh ca Nh nc.

- Kho c thit k theo ng quy nh ca nh nc.

- Vic sp xp trong kho ngn np c gi k, xp theo chng loi d thy, d ly.

- Thuc, ha cht bo qun iu kin thng thng.

+ Phi bo qun theo ng tnh cht, yu cu ring tng loi

+ Trnh m mc cho thuc vin, trnh chy nc cho vin nang, vin bao ng.

+ Thng xuyn theo di cc hin tng bin cht, i mu, vn c, hunh quang i vi thuc tim.

- Dc liu phi c ng gi v c bin php bo qun thch hp vi tng loi

+ ni kh ro thong mt

+ m bo tiu chun cht lng quy nh, c nh k kim tra, c bin php phi sy.

+ Chng h hng, su mt, mc.

+ nh k chuyn, o kho.

- Thuc, ha cht c yu cu bo qun c bit

* Ch cp pht thuc khoa dc

- Phiu lnh thuc nu ghi sai hoc phi thay th thuc phi c bc s iu tr sa li v xc nhn vo phiu sau khi c kin ca dc s khoa dc.

- Thuc gy nghin, thuc c, thuc hng thn phi thc hin cp pht thuc theo quy nh hin hnh.

- Thuc bt, thuc nc phi ng gi liu nh cho tng loi, tng ngi bnh

- khoa dc bnh vin c cc phng cp pht thuc: kho cp pht thuc bo him y t, y dng c v kho cp pht thuc vin ph, ngun thuc cho tr em di 6 tui, hai kho ny c nhim v qun l, d tr, cp pht thuc v cp y c cho ni tr, ngoi tr.

+ Khoa ni nhi nhim

+ Khoa ngoi sn

+ Khoa cp cu

+ Ngun bo him

+ Ngun tr em di 6 tui, vin ph, cp thuc chng trnh

+ thc hin tt cng tc cp pht thuc ngi dc s trc khi pht thuc phi thc hin tt 3 kim tra, 3 i chiu.+ Hng dn bnh nhn cch s dng thuc an ton hp l, ng liu quy nh.

+ Khoa dc chu trch nhim ton b v cht lng thuc do khoa dc cp pht.III. Danh sch thuc ca khoa dc:

A. Thuc d tr bo him:

STTTn ThucBit DcHng SXVTD Tr

I. Nhm thuc khng khun

1Chloramphenicol 250mgung ChlosamphenicoQung Bnhvin

2Chloramphenicol 0,4%Nh mt ChlosamphenicolBidipharl

3Chloram + dexamethosonnh mt: ticolderDanapharl

4Metronida zole 250mgungS. Pharmvin

5Metro + Neomycin + Nystatint m o: Neo penotranTh Nh Kvin

6Clrithromycin 500mgung: Amfarex 500Ampharcovin

7Erythromycin 250mgung: ErythromycinKhapharcovin

8Hoxithromycin 250mgUngTipharcovin

9Spyramycin 1,5tr VIUng DorepcinDomescovin

10Spiramycin 3tr VIUng DorepcinDomescovin

11Spiramycin 750.000VIUng DorepcinDomescovin

12Spiramycin + MetronidazoleUng NaphacogylNam Hvin

13Gprofloxacin 500mgUng Scanex 500Stadavin

14Gprofloxacide 0,3%Nh mt Evrocin 5mlVNl

15Nalidixicacide 500mgUng Nergamdicin 500Khapharcovin

16Oflexcin 200mgUng: Mediflox 200Indiavin

17Sunfamethoxa + trimethoprinUng: Biseptol 480 Ba Lanvin

18Doxycylin 100mgUngStadavin

19Tetracylin 500mgUngMekophavin

20Tetracylin 1%M tra mtQung Bnhtube

21Tinidazol 500mgUngDomescovin

22Amoxycillin 500mgUng: PharmoxTW7vin

23Amoxycillin 250mgungBnh nhvin

24Amoxycillin 250mgUng eumocinEovipharvin

25Amoxyallin + ClavulalamicUng ofmantin 250 + 3125Domescovin

26Amoxycillin + ClvlalamicUng Claminat 500 + 125Imexophamvin

27Ampicillin + SulbactimUng Unasyn 250 + 125vin

28Cefalexin 500mgUng Cefalexin 500Cyprusvin

29Cfalexin 250mgUng Cefalexin 250Bnh nhvin

30Cefalexin 250mgUng EulexcinEuviphargi

31Cefixime 100mgUng Mexim 100TW7vin

32Cefixime 200mgUng forfexim 200Torrenvin

33Cefaclor 250mgUngVNvin

34Cefaclor 500mgUng: MedocloMedovin

35Cefuroxin 250mgUng: Penturox 250Indianvin

36Cefuroxim 500mgUng: Lexibase 500Indianvin

37Cefadroxyl 500mgUng: TorodroxylTorrenvin

38Cefdinir 300mgUng Uphacefdi 300Uphacevin

39Cefdinir 125mgUng Uphacefdi 125Uphacegi

40Cfradin 500mgUng BfrandinBidipharvin

41Phenoxy Methypenicillin Ung: penicillin 400000 VIMekophavin

42Gentamycin 0,3%

Nh mt: Gentamycin 10gBidipharl

43Neomycin + polymicinB +DexaNh mt: MaxitronEuvipharl

44ThramycinNh mt: FyraanBl

45Thramycin + DexamethasNh mt: Eytobra DKoreal

46Chloramphenicol + DexamerhNh mt Sperradex 5mlThy Sl

47Providon + Acidbo + Nacl + KGNh mt: Oculotect 10mlPhpl

IIThuc nhm Virus

48Acyclovir 200mgUng AcylovirDomescovin

49Acyclovir 5%Dng ngoiMedipharcotube

50Lamivudin 100mgUngDomescovin

IIIThuc khng nm vng ngoi

51Clotrimazol + Betamothsol Dng ngoi GentrisonVNtube

52Fluconazol 150mgUng: Flucotedt V Phvin

53Ketoconazole 200mgUngStadavin

54Ketoconazole 2%Dng ngoi: Comzel 5gVNtube

55Nystatin 100.000VItMedipharcovin

56Nystatin 500.000VIUngng Naivin

57Nystatin + Metro + Cloram + DexatDP 3/2vin

58Nystatin + Neomyein + Ployt: FungractIndianvin

59Saliaflic aad + BetamethasonDng ngoi: Keradesim 15gAmpharcotube

60Du m uDng ngoil

IVThuc tr giun, snvin

61Albendazol 200mgUng zentelOPVvin

62MebendazoleUng: Benca 500mgTW7vin

63Pysantel 125mg Ung: pantelIndianvin

VThuc chng ri lon tm thn

64Sulepercl 200mgUngDanapharvin

65Amitriptylin 25mgUngDanapharvin

VIThuc hc mn, thng thn, ni tit t:

66BudesomiclDng ht: Budenase AQAplal

67Beclometason (Dicloproncit)Dng xt: Beclate 0,1%Aplal

68Dexamethason + NeomycinNh mt, mi: polydexon 5mlVidipharl

69Methyl prednisolo 4mgUng: MedisonPymepharevin

70Hydrocortisone 100mgtimc ng

71Hydrocotisone 1%Dng ngoi: Enoti 10gVNng

72ErgometrinTim: Egrometrin 0,2mg/1mlcng

73Estriol 1mgUng: ovestinOrganonvin

74LynestrenolUng: orgametri 5mgOrganonvin

75ProgestersoneUng: Utrogestan 100mgBvin

VIIThuc h ng huyt, huyt thanh v gluco min dch

76Gliclazide 80mgUng: Gliclazic 80Domescovin

77Gliclazid 30mgUng Dcron 30MRDomescovin

78Gliclazid 80 + Metformin 500Ung: Dianm MIndianvin

79Insulin (30/70)Tim Wosulin 4000L/10mlWockhardtng

80Metfomin 500mgUng FinascarBangladesvin

81Proglitazon 15mgUng: DobidiDomescovin

82Huyt thanh khng un vnTim: Sat 5000l/ml-3mlIvaeng

VIIIThuc gin c v tng trng lc c

83Epesison 0,05gUng MacininrIndianvin

84Pipercusium bronmicleTim arduan 4mg/2mlHungng

85Suxamethonium 100mg/2mlTimcng

86Thiccolehicosid 4mgUng ColtramylRusselvin

87Neostigmine bromicleTim Notigmine 0,55cng

IXThuc iu tr mt, tai, mi, hng

88DiceinNh mt: Tetracin 0,5%DP 3/2l

89Acetazolemide 250mgUngPharmedicvin

90Piloceurpin 2%Nh mt: Isopto carpinAlcoll

91Atropin 0,1%Nh mt: Airopin 0,1%Vin mtl

92Natri chloride 0,9%Nh mt, mi Natrol 10mlEuvipharl

93Triopicamid 0,5% 5mlNh mt: Mydrin PNhtl

94Xylometazolin 0,05%Nh mi: XylometazolinDanapharl

95Naphazolin 0,05%Dng ngoi: EuvinexEuvipharl

96Argyrol 3%Nh mtDanapharl

97BetahistinUng: Sese 8mgH Lanvin

XThuc cm mu, thc , gy t, m

98Oxytexcin 50LTim: VinphatoxinVinpharcong

99MysoprostolUng: Alsoben 200mgKoreavin

100Halothanng h hp: 250mlAnh l

101BupsvaceineTim Marcain 0,5% 4mlThy Sng

102Lidocein _ AdrelnalinTim: Medicein 2%Koreang

103Lidocein 10%Kh dung: 10% spayHungaril

104Lidocein 2%Thuc m: Xylocein 2% 30gThy Stube

105Lidocein 2%TimVnh Phcng

106Isoflusaneng h hp Foran 100mlAnhl

107PropofolTim Propofol 20ml/200mgBrdunng

108Ioxitalmetmeglumin + SodiumTim telebrix 35 mg/50mlPhpl

109Thiopental 1gTiml

* QUY TRNH CUNG NG V CP PHT THUC CA KHOA DC

B. Mt s bn lu khi dng thuc cho bnh nhn

* NHNG THC NN GIM, TRNH HOC THN TRNG KHI DNG NGI BNH SUY GIM CHC NNG THN

TN THUCMC SUY THNNHN XT

AcetazolamidNh trnh dng, nhim c aud, chuyn ha

Aud Acetyl SalicylicNng Tranh dng vi nc v natri gin tit sau khi TM nhanh

GentamycinNhDng liu hiu qu thp nht gy tch nc v natri, yhair chc nng thn c th dn n suy chcx nng thn

InsulinT va n nngTrnh Dng

IroniazidNngLiu ti a 200mg/Ngy, bnh thn kinh ngoi vi

Magnesi sulfatVatrnh dng hoc gim liu

Morphin T va n nngGim liu hoc trnh dng c tc dng tng hoc ko di, nhy cm ca no tng

OfloxacinNhDng liu u tien nh bnh thng sau dng liu gim = 1/2

PethilinT va n nngGim liu hoc trnh dng, tc dng cao hoc ko di, tng nhy cm ca no

KalicloridVaTrnh dng hng ngy c nguy c kali huyt cn

PropranololNngBt u vi liu nh c th lm gim lu lng mu trong thn nh hng xu n chc nng thn ngi bnh suy chc nng thn nng

QuininNngTrnh Dng

Streptomycin NhGim Liu

Sulfa methoxazolt trimethoprum NhDng vi1/2 liu thng thng nu thanh thi creatinin l 15 30ml/pht trnh dng nu thanh thi nh hn 15ml/pht

WasfarinNng Gim liu

CalcioninVaGim liu

CefoaximNng Dng vi liu chc nng thn tng nguy c xut huyt ng tiu ha

Amoxicylin Nng Gim liu hay pht ban

Amoxicylin + AcidclauvulanicT va n nngGim Liu

Ampicillin,penzathin, pennicillinNngNg c thn kinh, liu cao, c th gy co git

CarbamazepinNngHng sn xut khuyn co nn thn trng

CloramphenicolNngTrnh dng nu c thuc thay th gim d to huyt theo liu

CloroguineT va n nngGim liu

CimeiclinT nh n vaHn ch liu xung 600/800mg/ngy i khi c nguy c ri lon

Ciprofloxacin ClindamycinvaDng liu thng thng, thi gian na i trong huyt tng thng ko di c th cn gim liu

CodeinT va n nng Gim hoc trnh dng tng liu v ko di tc dng ca thuc, tng nhy cm ca no

DiazepamNngBt u vi liu nh, tng nhy cm ca no

DigoxinNh Gim liu, tng nhim c do nhiu lon cht in phn.

EphedrinNngTrnh dng, ng c h thn kinh trung ng.

ErythromycinNngDng liu ti a 1,5g/ngy, ng c thnh gic

FusoseinidVaC th cn dng liu cao

CeflexinNngLiu ti a 500mg/ngy

ClopromazinNngBt u thp nht

ClosythromycinT va n nngDng vi liu

BiclofencieT va n nngDng vi liu tc dng thp, theo di chc nng thn gi nc v Natri gy hi chc nng thn c th dn n suy thn

FentanylT va n nngGim liu hoc trnh dng, tng nhy cm ca no

IndomethacinNhDng liu thp nht, theo di chc nng thn gi nc v Natri gy hi chc nng thn c th gy n suy thn

PisoixcamT va n nngDng vi liu c tc dng thp nht, theo di chc nng thn.

TetracylinNhTrnh dng tc dng chng ng ha, tng ur trong huyt tng tng tc hi ti chc nng thn

TobramycinNhGim liu

DiltiazemBt u vi liu thp hn

* Nhng loi thuc nn trnh hoc thn trng khi dng cho:TN THUCNHN XT

Acid AcetylsalicylicTrnh dng nguy c chy mu, ng tiu ha.

AmynophylinGim liu

CarbamzpinSuy gim chuyn ha bnh gan ang tin trin

TheophylinGim liu

EtemeTrnh dng

LevonrgestrelTrnh dng ngi bnh gan tin trin nu c lch s bnh nga hoc vim mt trong thi k mang thai.

Silfamethoxzel + TrimeHng sn xut khuyn co nn trnh dng ngi b bnh gan nng

TestostessonTrnh dng th tt hn c kh nng gy c theo liu v gy tch nc

* Cc thuc bi tit qua sa mTN THUCNHN XT

RuS lng ln c th nh hng n tr v gim tiu th sa

Cc loi thuc chng ng muTng nguy c xut huyt do thiu vitamin, warafin an ton nn trnh dng phenidone, hng sn xut dicuomasol gi d phng vitamin K cho tr.

Thuc khng HistaminMt s thuc Histamin vo sa m vi mt s lng ln mc d cha r tc hi nhng cc hng sn xut khuyn co khng nn dng, c thng bo tr b hoa mt, chng mt vi thuc Clemastine

CephalospinC bi xut trong sa m vi nng thp.

ClosmaphenicolsNn dng loi khng sinh khc v c th gy ng c ty xng tr em, nng thuc trong sa m thng khng gy hi chng xanh, xm, Greysyndrome.

GprofloaxcinTrnh dng, nng thuc trong sa m s cao

Thuc trnh thai ungTrnh ung thuc trnh thai trong 6 thng hoc cho n khi cai sa m.

ErythrromycinCh c lng nh trong sa m

ThyprofenLng thuc qu nh khng gy hi nhng mt s nh sn xut khuyn co nn trnh dng.

IsonizidTheo di tr phng c ng c thuc nguy c trn l thuyt v co git v bnh thn kinh khuyn dng Pysidoxin d phng cho c m v con

MorphinLiu iu tr khng c nh hng n tr, vi nhng b m ph thuc xy ra triu chng cai thuc ph n cho con b khng phi l bin php tt nht iu tr ph thuc con nn ngng li.

NicolinTrnh dng, c trong sa m

NorflexainCha c thng tin, khuyn co nn trnh dng.

ParacetunolLng thuc vo sa m qu nh, khng gy hi

PenicillinTheo di lng thuc trong sa

TheophylinThng bo c gy kch thch cho tr, dng ch phm phng thch gy c kim sot, c th an ton.

Thuc Steriod chuyn ha (Anabohic Steroid 1.2.3)Gy nam ha cho thai nhi n

Thuc gy m ti chVi liu lng c ch h hp s sinh, gim trng lng v nhp tim chm sau khi nghn c, hoc ngoi mng cung, Methacmoglebin huyt s sinh vi thuc prilocin v procain

Thuc ng mu Heparin (1.2.3)C thng bo v chng long xng sau khi dng ko di.

Thuc Chen betaC th gy c ch pht trin ca thai nhi trong t cung, gy gim glucose huyt v nhp tim chm, nguy c cai hn th hin tng huyt p trm.

TetracylinTrnh dng v gy vng men rng tr

Thuc gy m chungGy c ch h hp s sinh

* Cc thuc nn trnh s dng hoc thn trng khi s dng trong thi k mang thai:+ Giai on: 1:3 thng u

+ Giai on: 2:3 thng tip theo

+ Giai on: 3:3 thng cui

Thuc Nhn xt

Cc thuc c ch men chuyn ng AngiotesinTrnh s dng nh hng ti thai nhi, huyt p v chc nng thn ca tr s sinh, cng c th gy khuyt tt s v gy chong t dch i, c ng c thng qua nghin cu trn ng vt

AlbandazolCc nh sn xut c gy qui thai trn ng vt

Ru (1,2)Nu dng hng ngfy c th gy qui thai (hi chng ru trong thai nhi) v c th gy chm pht trin nu thnh thong ung v ung t c th an ton, c th xut hin hi chng cai thuc nhng tr c m nghin ru.

Thuc nhm Aminoglycosid (2,3)Gy tn hi thn kinh thnh gic hoc thn kinh tin nh, nguy c cao nht vi thuc Streptomycin c nguy c rt nh vi thuc gentamyan v tobramyin, nhng nn trnh dng ngoi tr trng hp cn thit (nu dng phi theo di nng thuc trong khi nghin cu trn ng vt)

Nicotin (1,2,3)Trnh dng

OmeprazolNh sn xut khuyn co ng c

Gim u Opi (3)c ch h hp sinh gy t, iu dng dng cc thuc tr s sinh, cc b m ph thuc thuc gy d dy v vim phi do ht kh dch cho b m trong khi chuyn d sinh.

ParasetmolCha bit tc hi

PenicillinCha bit tc hi

CephalosprinCha bit tc hi

CimetidinNn trnh s dng ngoi tr tht cn thit

ClayrthromycinCha bit tc hi, tuy nhin nn trnh dng tr khi li ch cao hn nguy c.

CorticosteroidCh dng khi li ch cao hn nguy c.

Thuc li tiu (1)Khng dng trong khi iu tr tng huyt p trong thai k, nn trnh dng Actnzolamio v toracemid thuc Thiazid c th gy gim tiu cc s sinh.

MebenelazolKhuyn co ng c qua nghin cu trn ng vt.

Vitamin a(1)Qu liu gy qui thai

IV. Mi quan h Y Bc s, dc s v y t trong s dng thuc an ton cho ngi bnh

V. Mt s n thuc1. n 1:

H tn bnh nhn: T Th Thy LanNm sinh: 2007Chun on: Hi chng ly- Klion (Metronicdazol) 0,25g x 7 vin

- Ung:

- Amoxcillin 0,25g x 10 gi

- Ung:

- L Bio 1g x 10 gi

- Ung:

- Hupacol (paracetunol) 150mg x 10 gi

- Ung:

- Bameplex 100ml x 1 chai

- Ung: Sng 1 tha c ph Chiu 1 tha c ph.

2. n 2:

H tn bnh nhn: V Xun CngNm sinh: 1936Chun on: Cao huyt p- Trofurid (Furosemid) 40mg x 10 vin

- Ung: sng 1 vin Chiu 1 vin

- Catoril 25mg x 10 vin

- Ung: Sng 1 vin Chiu 1 vin

- Magie B6 x 20 vin


3. n 3:

H tn bnh nhn: Nguyn Minh TnNm sinh: 1994 Chun on: Hi chng d dy- Amoxcillin 500mg x 10 vin


- Klion (Metronidazol) 250mg x 10 vin

- Ung: sng 1 vin Chiu 1 vin

- Omeprazol 20mg x 5 vin

- Ung: Sng 1 vin

- Grangel x 10 gi

- Ung: Sng 1 gi chiu 1 gi

4. n 4:

H tn bnh nhn: Trng Quc MinhNm sinh: 1980Chun on: Chm bi nhim- Cefalexin 500mg x 20 vin


- Clophenisamin 4mg x 10 vin


- Serazyl 10mg x 10 vin


- Bar x 10 vin


- Hankocin x 10 vin


5. n 5:

H tn bnh nhn: Bi Vn QuNm sinh: 1954 Chun on: Vim khp bn ngn 1 tay/vim d dy

- Pemicillin 1.000.000VI x 18 vin

- Ung:

- Pesnisolon 5mg x 16 vin

- Ung:

- Meloxicam (Melotop) 7,5mg x 15 vin

- Ung:

- Omeprazol 20mg x 10 vin

- Ung:

- Gromgel x 10 gi

6. n 6:H tn bnh nhn: Phan ng HngNm sinh: 2005Chun on: Vim h hp trn- Cefuroxim 125mg x 10 gi

- Ung: Sng 1 gi Chiu 1 gi

- Presnisolon 5mg x 10 vin


- Mitux (Acetylsystein) 200mg x 5 gi

- Ung: Sng gi Chiu gi

- Hapacol (paracetamol) 125mg x 10 gi

- Ung: Sng 1 gi Chiu 1 gi

7. n 7

H tn bnh nhn: Nguyn Th VnNm sinh: 1966Chun on: Vim mi d ng- Bar x 60 vin


- Cetirizin 10mg x 10 vin


- Hankocin x 30 vin

- Ung:

- Ginrokin x 30 vin

- Ung:

8. n 8

H tn bnh nhn: Nguyn Vn SnNm sinh: 1986Chun on: Vim i trng- Amoxcillin 500mg x 20 vin

- Ung:

- Klion (Metronidazol) 200mg x 20 vin

- Ung:

- L-Bio x 10 gi

- Ung:

- Buscopan 10mg x 10 vin

- Ung:

9. n 9

H tn bnh nhn: Nguyn Th Thanh TNm sinh: 2007Chun on: Vim phi- Ibamentin x 10 gi

- Ung:

- Preolnisolin 5mg x 10 vin

- Ung:

- Bameplex 100ml x 1 chai

- Ung: Sng 1 tha c ph Chiu 1 tha c ph

- Porox 10 vin

- t hu mn

10. n 10

H tn bnh nhn: Nguyn Th Hng

Nm sinh: 1960Chun on: Thiu nng tun hon no

- Piracetum 0,4mg x 20 vin

- Ung:

- Deupmin 25mg x 10 vin

- Ung:

- Ginsokin x 10 vin

- Ung:

- Diclofenac 50mg x 10 vin

- Ung:

VI. Mt s thuc bn hng dn s dng

1. Serrazyme 10mg (Sessstiopeptidase)

Ch nh: Chng vim sau chn thng v phu thut.

- Gim vim trong nhng bnh l sau: Vim xoang, sng huyt phi, vim mng quang, vim mo tinh hon, p xe chn rng, vim nha chu.

- Khc m kh trong nhng bnh l sau: Vim ph qun, hen ph qun lao phi.- Khc m kh sau gy m.

- Chng ch nh: bt thng v chc nng ng mu

- Suy gan, thn nng.

Liu dng: 10mg x 3 ln/ ngy, ung sau mi ba n.

2. Glumeform 500mg (Metformin hydroclorid) Ch nh: iu tr bnh i tho ng tup 2 (khng ph thuc Insullin), c bit ngi bo ph sau khi p dng ch n king khng hiu qu.

Chng ch nh:

- Mn cm vi cc thnh phn ca thuc.

- Ngi bnh c trng thi d ha cp tnh, nhim khun nng, nhim khun huyt, chn thng, suy thn bnh gan nng, bnh tim mch nng, bnh h hp nng vi gim oxygen gan huyt, ngi nghin ru, thiu dinh dng, ngi c thai cho con b, nhim axit chuyn ha cp tnh hoc mn tnh.- Liu dng: Ty theo mi bnh nhn da trn hiu qu v s dung np nhng khng vt qu 2 vin/ ngy

- Ung 1 vin x 2 3 ln/ ngy, ung trong cc ba n.

3. Gliclarid:

Ch nh:

- iu tr i tho ng tup 2.

Chng ch nh:

- Qu mn cm vi bt k thnh phn no ca thuc.

- i tho ng ph thuc Insulin.

- Hn m hay tin hn m do i tho ng.

- Suy gan, thn nng.

- C tin s d ng vi Sulfonamid v cc Sulfonylure khc.

- C thai v cho con b.

Liu dng:

- Dng ng ng.

- Ty theo lng ng huyt ca ngi bnh i tho ng s c ch dn thch hp. Tuy nhin c th dng liu nh sau:

+ Liu thng thng: 1 vin/ ngy.

+ C th bt u liu - 1 vin/ ngy sau tng liu.

+ Trong a s trng hp: Ung liu duy nht 2 vin vo bui sng.

+ Trong trng hp iu tr cha hiu qu c th tng dn ln liu ti a l 4 vin/ ngy, chia lm 2 ln.

+ Trong qu trnh iu tr c th thay i liu hoc l ngng thuc ty theo liu lng ng huyt ca ngi bnhh.

+ Ung vo ba n sng.

4. Captyril 25mg

Ch nh:

- Cc th can huyt p.

- Suy tim khng p ng hoc khng th ch ng c bng cc liu php thng thng vi thuc li tiu hoc digitalis.

Chng ch nh:- Liu s ph mch, mn cm vi thuc, sau nhi mu c tim (nu huyt ng khng n).- Hp ng mch thn 2 bn hoc hp ng mch thn thn c nht.

- Hp ng mch ch hoc hp van 2 l, bnh c tim tc nghn nng.

Liu dng:

- Cao huyt p: liu khi u 25mg x 2 3 ln/ ngy, trng hp nng c th tng ti 50mg x 3 ln/ ngy, liu thng thng khng qu 150mg/ ngy.

- Suy tim, huyt: nn dng km theo thuc li tiu theo ch dn ca thy thuc.

- Ung 1 gi trc khi n.

5. Vastec 20mg (Trimetazidin dihydroclosid)

Ch nh:

- iu tr d phng cn au tht ngc.

- iu tr h tr cc triu chng: chng mt, tai, gim th lc v ri lon th trng do nguyn nhn h mch.

Chng ch nh

- Trong trng hp qu mn cm hoc khng dung np vi trimetazidin.

- Thn trng vi ngi c thai cho con b.Liu dng:

Ung vo u cc ba n.

- Ung mi ln 1 vin x 2 3 ln/ ngy hoc theo ch dn ca thy thuc.

6. Dolocep (ofloxacin)

Ch nh:

- Tr nhim khun nng do vi khun gram m, t cu khun lu cu khun.- Tr cc nhim khun ng h hp, ti mi hng mn tnh nhim khun huyt, niu, thn, tuyn tin lit, ph khen xng, khp, gan, mt.

- Nhim khun da, m mm

Chng ch nh:

- D ng vi thuc hoc qu mn cm vi Guinolon.

- Tr em di 15 tui.

- C thai, cho con b.

- Ngi ng kinh thiu men G6PD.

Liu dng:

- Ngi ln ung 1 vin/ ln, ngy 2 ln.

- Ngi gi, ngi suy gan thn 1 vin/ ngy, ung cch 2 ngy.

- Bnh nng c th dng 4 vin/ ngy.

- Ung gia ba n sng v chiu vi nhiu nc.

7. Amoxicillin 500mg

Ch nh:

- Ngi bnh c tin s vi bt k Penecillin no.

Liu dng:

- Ngi ln ung 1 2 vin/ ln, ngy 3 ln.

- Tr em 20 40 mg/kg th trng/ ngy, chia 3 ln.

- Bnh lu: ung liu duy nht 3g cng vi 1g probenecid.

8. Buscopan.

Ch nh:

- iu tr au bng co tht trong hi chng kch thch rut.

Chng ch nh:

- Mn cm vi hot cht thuc hoc cc thnh phn khc ca thuc, hp c hc ng tiu ha, to tit trng, b tiu do chn p di bng quang, glaucom gi hp, nhp tim nhanh v chng nhc c nng.

Liu dng:

- Ngi ln v tr em tui n trng 1 2 vin nen bao ng, 3 ln/ ngy.- Liu n: 10 20 mg, liu hng ngy ti a 60mg hyoscime N Butylbromid).

- Vin nn bao ng nn c nut nguyn vin nhiu nc.

9 Hapacol 500mg (paracetamol)

Ch nh:

- iu tr cc triu chng au nhc v st trong cc trng hp.

+ Cm lnh, cm cm, au u, au c xng, bong gn, au khp, au lng, au rng, au bng kinh, au do chn thng, au thn kinh.

+ Nhim khun ng h hp trn: au tai, au hng, vim mi xoang do nhim khun, hay thi tit.

+ Sau phu thut nha khoa, nh rng, ct abiclan.

Chng ch nh

- Qu mn cm vi paracetamol, ngi bnh thiu mu, c bnh tim, phi, thn.

- Cc trng hp: Thiu ht glucose 6 Phosphat dehydrogenase, suy chc nng gan.

Liu dng- Ngi ln, tr em > 12 tui: ung 1 vin/ ln, au nhiu ngi ln c th ung 2 vin/ ln, khong cch gia hai ln ung phi hn 4 gi v khng ung qu 8 vin/ ngy.

- Trng hp bnhnhn suy thn nng ( thanh thi creatinin < 10ml/ pht) khong cch gia cc liu ung phi t nht 8 gi, hoc theo ch dn ca bc s.

10 Baromezole 20mg (pmeprazole)

Ch nh:

- iu tr ngn hn lot d dy t trng.

- Cc triu chng tro ngc thc qun, tro ngc nng v lot d dy kh tr.

- iu tr kt hp vi khng sinh n vi lot t trng ti pht do nhim vi khun Hpylori.

- Phng nga ti pht vim thc qun tro ngc.Chng ch nh

- Mn cm vi omeprazole, lot d dy c th km theo u c tnh.

Liu dng:

- Lot d dy 1 vin/ ngy x 4 tun.

- iu tr ngn hn lot t trng 1 vin/ ngy x 2 tun.

- Bnh l tro ngc d dy thc qun: 1 vin/ ngy x 2 4 tun.

- Thi gian iu tr c th thay i ty theo tnh trng ca bnh nhn ung vi hn 1 ly nc.

11. Pms Probio

Ch nh:

- B sung vi khun c ch rut, gip tiu ha thc n, h tr s tiu ha lactose (c nhiu trong sa).

- Cn bng h vi sinh ng rut b ph v do, ru, stress, nhim trng, s dng khng sinh hoc thuc ha tr liu.

- S ln men bt thng rut, ri lon tiu ha.

- Vim rut cp tnh hay mn tnh: tiu chy, to bn.

Chng ch nh:

Mn cm vi cc thnh phn ca thuc

Liu dng:

Ngi ln v tr em: 1 2 gi mi ngy, pha trong sa, nc sp hoc ng

12. Hot huyt dng no Nam dc

Ch nh:

Phng v iu tr cc trng hp:

- Suy gim tr nh, thiu nng tun hon no, hi chng ri lon tin nh

- Suy tun ton no vi cc biu hin: au u, mt ng, chng mt hay mt thng bng.

- Gim chc nng no b: gim tr nh, suy nhc thn kinh, nhn no

- Ngi lm vic tr c cng thng b au u, hoa mt, chng mt, mt mi.

- Chng run git ca bnh nhn Paskinson

Chng ch nh:

Ngi ln v tr em > 12 tui, ngy ung 2 3 ln, mi ln 1 vin, ung sau ba n13. Vitamin PP 500mg

Ch nh:

Cc bnh v da do nhy cm vi nh sng

- iu tr cc trng hp thiu nicotiamid

Chng ch nh:

- Qu mn cm vi nicotiamid

- Bnh gan nng, lot d dy tin trin

- Xut huyt ng mch, h huyt p nng

Liu dng:

Ung 1 3 vin ngy chia lm 3 ln

VII. TI CC PHNG BNH CA BNH VIN

S mi quan h gia khoa dc vi cc khoa phng khc

1. Gim c bnh vin

- L ngi trc tip lnh o cc hot ng ca khoa dc v ng li, chnh sch, ch trng.

- Khoa dc tham mu cho Ban Gim c v cng tc dc, qun l vic s dng thuc, ha cht, y c, hng dn gim st kim tra s dng thuc an ton, hp l.

* i vi khoa cn lm sng:

- Cung cp trang thit b my mc, ha cht cho khoa, gip cho vic chn on t hiu qu.

- Lp k hoch danh mc thuc hng nm

* i vi khoa lm sng:

- L mt khoa phng chuyn mn tham mu cho y bc s iu tr thc hin cc quy ch v dc.

- Cung cp thuc, theo di qun l s dng thuc an ton, hp l, hiu qu.

* Phng k hoch tng hp dng c y t:

- Dng c y t:

+ L ni qun l chuyn mn y, ln k hoch thc hin cung ng thuc, dng c y t trong bnh vin.+ Sau khi nm bt tnh hnh, s dng thuc phn nh ln y, phi hp tham mu ln Ban Gim c kp thi.

+ Kim tra vic thc hin quy ch chuyn mn ti khoa phng.

+ Phng dng c y t ln k hoch kim tra vic cung ng thuc ha cht, dng c y t v kim tra vic thc hin.

- Phng k hoch tng hp.

+ Nhu cu v kinh ph mua thuc, ha cht, dng c y t quan trng l i chiu s dng thuc.

+ Phng k hoch tng hp cung cp kinh ph mua thuc, ha cht dng c y t, vt liu y t v thanh quyt ton ph cp.

5. i vi phng t chc, hnh chnh, qun tr. xut kin, kin ngh tu sa kho, c s vt cht, phn b, rn luyn v bi dng cn b, nng cao trnh , thchin cc quy ch, chnh sch cho cn b.

1. Khoa ni nhim

- Khoa ni l khoa lm sng, thc hin cc phng php, khng phu thut cha bnh. Trong cha bnh kt hp lm sng, cc xt nghim cn lm sng v kt hp chuyn khoa.

* T thuc trc ca khoa

STTTN THUC, HM LNGVTLNGGhi ch

1Diazepam 5mgVin10

2Ampicillin 1gL10

3Atropun 0,25mgng10

4Cefotaxime 1gL10

5Calcichlorua 5mlng5

6Gentunycin 80mgng5

7Paracetamol + Diclophenacng5

8Primral 10mgng5

9Frurocemid 20mgng5

10Hyoscin 20mgng5

11Insulin 400VIng1

12Nc ctng10

13Glucoza 5%Chai5

14Glucoza 10%Chai5

15RingerlactatChai5

16Nacl 0,9%Chai5

*Thuc st rt

17AstecanVin20

18Cloroquin 250mgVin20

19Frimaquin 13,2mgVin

*Vt t tiu hao

20Dy oxy 2 nhnhDy2

21ng ht mDy2

22SondenelatonCi2

23Sonde poleyCi2

24Dy truyn dchDy5

* Mt s bnh n ti khoa ni nhim

* Bnh n 01:

- H tn ngi bnh: Trn Vn Tng, tui 1984, Nam/n: Nam- a ch: Thn 9, P.Tn An, TP.BMT, k Lk.

- L do vo vin: St- Chun on: Vim amydan cp- Nhp vin: 01/04/2012* iu tr

Ngy, giDin Bin BnhY Lnh

15h30

01/04/2012- Bnh pht 3 ngy nay vi st nng, c lnh run khng thnh cn, km au hng.

- Cha iu tr g khi nhp vin.- Lc vo:

+ T: 39OC

+ M: 100 nhp

+ HA: 120/70

- Bnh nhn tnh to, st cao, khng nn i.

- i tiu tin bnh thng, nhp tim u.

- Phi khng nghe sau, bng mm.

- Gan lch khng ln, c m.

- Amyden sng to, .

- XN mu: BC: 10.900/mmg

N: 67%; CRN: dng tnh.

- Kt lun: Vim Amydan cp- Claminat 625mg x 3v ung 15h30 21h30 2h

- Alpha trimotrypsin 4,2mg x 4v ung 16h-21h.

- Paracetamol 0,5g x 3v ung 15h30 21h 4h.

- Sumiton x 2v ung 16h 21h.

- Dung dch ORS 100mlm ung ri rc.

- Cho tht

2/04/2012- Claminat 625mg x 3v ung 8h-16h-20h.- Alphachymotrypsin 4,2mg x 4v ung 8h-16h.

- Paracetamol 0,5g x 4v ung 8h khi st cch 6h.

- Sumiton x 2v ung 8h 16h.

- Dung dch ORS x 1000ml.

- Ung ri rc.

- Cho, sa, chm sc cp 3.

03/04/2012- Bnh nhn st, n ung c.

- M: 90ln/ pht

- To: 37oC

- HA: 100/60mmHg

- Tim: T172 u.

- Phi khng nghe, bng mm, gan lch.

- Bnh nhn tnh to khi tip xc.

- Dch mang no (-)

04/04/2012- Bnh nhn st, n ung c.

- M: 90 ln/ pht

- To: 37oC

- HA: 100/60 mmHg

- Tim: T172 u.

- Phi khng nghe ral, bng mm, gan lch.- Bnh nhn tnh to khi tip xc.

- Dch mng no (-)- Claminat 625mg x 3 v ung 9h-16h-22h.- Alphachymotrypsim 4,2mg x 4v ung 9h-12h.

- Paracetamol 0,5g x 3v ung lc ti 1 v.

- Suniton x 2v ung 9h 16h.

05/04/2012- Bnh nCho xut vin

* Phn tch pht iu tr:

- Claminat: khng sinh iu tr vim amydan.

- Alpha trymotrypsin: iu tr cc trng hp ph n

- Paracetamol: gim au

- Suniton: b sung vitamin

- Dung dch ORS: b nc

* Bnh n 02:

H tn ngi bnh : TRN KIM NGA Tui: 1956Nam/N: N

a ch

: Phng Khnh Xun, BMT, k LkL do vo vin

: au bng i ngoi nhiuChun on

: Nhim khun rutNhp vin

: 02/04/2013* iu tr:

NGY/GIDIN BIN BNHY LNH

15h

02/04/2013Bnh nhn tnh, khng st, mt

M: 72 ln/ pht

To: 37oC

NT: 20 ln/ pht

H/A: 100/60 mmHg

- Tim: u, r, phi khng ral

- Bng: mm, khng phn ng

- au rm ran ton bng

- Gan, l lch khng ln

- i cu lng ton nc, khng nn, tiu t ch

Chun on: Tiu chy cp

Xt nghim: mu, phn

- Siu m bngRingerlactat x 500ml

NaCl 0,9% x 500ml

Truyn TM: 40 git/pht

GT: 15 gi

- Amoxicilin 500mg x 4v, ung 15h 22h

- LbiO 1g x 2 gi, ung 15h 22h

- ORS 1000ml ung dn

- Hankocin x 1v, ung 15h

- Papaverin 40mg x 2v, ung 15h

- Negram 0,5g x 4v, ung 15h 22h

- Cho CSC3

03/04/2013- Bnh nhn tnh, khng st, cn i lng phn nc

- au qun bng tng cn

- Bng mm, sinh tn n, tim u, phi m th.- Ringerlactat x 500ml

NaCl 0,9% x 500ml


GT: 9 gi



- ORS 1000ml ung dn

- Hankocin x 2v, ung 9h 16h


- Cho : chm sc cp 3

04/04/2013Bnh nhn tnh, khng st, cn i lng phn nc.

- au qun bng tng cn.

- Bng mm, sinh tn n, tim u, phi m th.- Ringerlactat x 500ml

NaCl 0,9% x 500ml


GT: 9 gi



- ORS 1000ml ung dn



- Cho : chm sc cp 3

05/04/2013- Ringerlactat x 500ml

NaCl 0,9% x 500ml


GT: 9 gi



- ORS 1000ml ung dn



- Cho : chm sc cp 3

06/04/2013Bnh nhn tnh, khng st, tim u, r, phi khng ral.

- Bng mm, cu st 2 ln/ ngy, cn au lm rm bng.- Ringerlactat x 500ml

NaCl 0,9% x 500ml


GT: 9 gi



- ORS 1000ml ung dn



- Cho : chm sc cp 3

07/04/2013Bnh nhn tnh, khng st, tim u, r, bng mm, cu c

08/04/2013Bnh n nh

Chun on ra vin: Tiu chy cpCho ra vin

* Phn tch pht iu tr

- Ringerlactat: cung cp nc v cht in gii cho c th

- Amoxicilin: iu tr nhim khun ng tit niu

- Hankocin: tng cng sinh lc c th do mt mi

- LbiO: Men tiu ha, iu tr chng ri lon tiu ha nh tiu chy, to bn

- Negram: iu tr nhim khun tiu ha

- Papaverin: iu tr chng co tht c trn ng tiu ha

* Bnh n s 03:

H tn ngi bnh: TRN THANH PHNG Tui: 1957 Nam/N: Nama ch: khi 19, phng Ha Khnh, TP.BMT, k LkL do vo vin: StChun on: St siu viNhp vin ngy: 29/04/2013* iu tr:


8h

29/04/2013

9h

12h

19h

2hBnh nhn tnh to, tip xc tt, khng sng hch ngoi vi, khng ho

To: 37oC

HA: 130/80 mmHg

NT: 20 ln/ pht

Spo2: 95%

Tim nhp r

Kt lun: st cha r nguyn nhn

Bnh nhn st 38oC

Bnh nhn au nhiu

Hng lng (T) c mt vt ct y vy mu en, khng sng hch.

Ht dung dch Ringerlactat

Bnh nhn st 38,5oCDung dch Ringerlactat x 1000ml

Truyn tnh mch xxx git/pht, ung tch cc.

- Cm - cho

TD: NT, HA, SPO2 2h/ln; nc tiu 24h.

Paracetamol 500mg x 1,5v ung lc 9h.

Diclomine x 1 ng

Tim bp

Dung dch Ringerlactat x 500ml

Truyn TM x 5 git/pht

Viramol x 450mg x 1 ng tim bp lc 12h.

30/04/2013

6h30

7h40

14h

17hBnh nhn st 38oC, au u nhiu

- Bnh nhan tnh to, da nim mc hng, ph n

To: 38,5oC

HA: 130/90 mmHg

NT: 23 ln/ pht

SPO2: 94%

Nhp tim r

Phi khng nghe ral

- Bng mm khng au, gan, lch khng ln

Tiu tin bnh thng

- C vt so vng lng bn (T) =, nghi st m.


Bnh nhn tnh to, au u vng thi dng

M: 71 ln/pht

To: 38,5oC

NT: 20 ln/ pht

SPO2: 96%

Nhp tim r, phi khng nghe ral


Bnh nhn tnh to

M: 71 ln/pht

To: 38,5oC

NT: 20 ln/ pht

SPO2: 96%

Nhp tim r, phi khng nghe ralParacetamol 0,5g x 1,5v ung lc 6h30.

Dung dch RingerLactat

Truyn tnh mch xxx git/pht

Doxycylin: 100mg x 3v, ung chia 3 ln.

Paracetamol 0,5g x 1,5v ung lc st cao >= 38,5oC

Dung dch ORS x 1000ml ung dn

Cho, chm sc cp 3

Theo di: M, To, HA, NT

SPO2 2h/ln

Nc tiu 24h

Thm thuc

Flunarizon 5mg x 2v, ung lc 16h30

Thm thuc :

Paracetamol 0,5g x 1,5v, ung lc 17h30

31/04/2013Bnh nCho ra vin


- Ringerlactat: cung cp nc v cht in gii cho c th

- Dung dch ORS: b mt lng nc cn thit cho c th

- Paracetamol: gim au, h st

- Viramol: iu tr cc cn au va v nh, cc cn st

- Diclomine: gim au, h st

- Doxycylin: khng sinh iu tr nhim khun

- Flunarizin: iu tr chng au u, chng mt

* Bnh n s 04:

H tn ngi bnh: L TH VN Tui: 1937 Nam/N: Na ch: s nh 97 Trn Hng o, phng T An, TP.BMT, k Lk

L do vo vin: Kh thChun on: t cp tng huyt pNhp vin ngy: 02/05/2013* iu tr:


15h

02/05/2013

16h30Bnh nhn c tin s PD iu tr lin tc ngoi tr.

Bnh nhn ln cn kh th t ngy hm qua, s dng thuc khng nn vo vin.

- Ti khoa, bnh nhn tnh to, ni thnh cu ngn; kh th cp 2,3; khng v m hi, co ko hn c nh

M: 100 ln/pht

HA: 170/70 mmHg

To: 37,5oC

NT: 28 ln/ pht

Tim nhp khng r, phi gim thng kh, c t ral m, ral rt hai bn.

Bng mm, gan, lch khng ln

Kt lun: t cp co PD mc TB-THA

Kt qu xt nghim:

BC: 12700/mm3N: 84%

CRD: Dng tnh

Ure: 38

Creatinin: 118

Ghure:120

AST: 293,6 mg/de

ACT: 24 u/l

Na+: 137

K+: mEg/l

Cl-: 110

Kt lun: t cp do PD mc trung bnh bi nhim THA

H K+ muNm u cao 30oTh oxy 30 ln/pht qua smd mi

Berodual x 3ml

Natriclorua 9o/oo x 2ml x 2 ln th kh dung lin tc.

Dung dch Natriclorua 9o/oo x 500ml

Truyn tnh mch xx git/pht

Hydrocostison 100mg x 1 l tim TM lc 15h30

Amlodipin 5mg x 1v, ung lc 15h30

Acetylsystein 0,2g x 4v, ung chia 2 ln 15h30 22h30.

- Cm, cho, CSC 3

Theo di M, HA, To, NT

SPO2 2 ln/h

nc tiu 24h

Thm thuc

Cefotaxim 1g x 4 l

tim TM lc 16h30 3h30

Gentamycin 80mg x 2 ng

tim TM lc 16h30

Kaleorid 10% x 2 ng ha vo dung dch

Natriclorua 9o/oo ang truyn

truyn xx git/pht

Berodual x 3ml

Natriclorua x 1ml 9o/oo x 4 ln th kh dung.

19h 23h 3h 7h

03/05/2013Bnh nhn tnh to, theo di ti khoa khng ln cn kh th

M: 81 ln/pht

To: 37oC

HA: 130/80 mmHg

NT: 20 ln/ pht

SPO2: 96%

Chuyn khoa ni iu tr tip

Kt lun: Co PD trung bnh, THA/ h K+ mu

04/05/2013Bnh nhn tnh to, da, nim mc hng

Cn kh th II

To: 37oC

M: 80 ln/pht

HA: 130/80 mmHg

NT: 22 ln/ pht

Khng ph

TMC: -45oTiu nhiu

Tim p u

Phi ral ngy, m, ri rc 2 phi

Bng mm

Gan, lch khng ln

Kt lun: t cp co PD mc trung bnh/THA.Nm u cao

Berodual x 6ml

Natriclorua 9o/oo x 3ml, th kh dung 10h 20h 4h

Cefotaxim 4 l, tim TM lc 10h 12h.


tim bp lc 10h

Acetylsystein 0,2g x 3v, ung 10h 20h 4h

Cetizidin 10mg x 4v ung 8h

Amlodipin x 1v, ung lc 10h

Suniton x 2v, ung 18h 20h

Salbutamol 2mg x 2v, ung 10h 20h

Cm nht

05/05/2013Bnh tm nCho ra vin

* Phn tch pht iu tr

- Berodual: phng nga, iu tr kh th

- Natriclorua: b sung Natriclorid v nc

- Hydrocortison: chng vim

- Amlodipin: iu tr tng huyt p, d phng cn au tht ngc

- Acetylcystein: tiu nhy trong cc bnh vim ph qun

- Cefotaxim: iu tr nhim khun nng

- Gentamycin: khng sinh iu tr t nhim khun

- Kaleorid: b sung Kali, ch nh tng Kali mu

- Suniton: b sung vitamin

- Salbutamol: c tc dng lm gim ph qun gip thng thong ng th

* Bnh n s 05:

H tn ngi bnh: NGUYN TH HNG Tui: 1937 Nam/N: Na ch: phng Tn Li, TP.BMT, k LkL do vo vin: Hp mn v, suy kit, lot d dy, i tho ng tup IIChun on: t cp tng huyt pNhp vin ngy: 02/06/2013* iu tr:


02/06/2013

Bnh nhn vo khng st, ngi mt mi, rt hu mn, th trng gy, tiu t ch.

HA: 100/60 mmHg

Mch: 86 ln/pht

Nhit : 37oC

Nhp tim u, r, khng nghe ral

Bng mm, tiu bnh thngRinger lactate 500ml x 1 chai

Natriclorua 9o/oo x 2 chai

Amoxicilin 0,5g x 4v

Clanftheomycin 0,5g x 2v

Omeprazole 20mg x 2v

Diamicron 30mg x 2v

Ginrokin 40mg x 2v

- Cho, sa, CSC 3, ch tiu ng.

03/06/2013Bnh nhn mt, khng st, nhp tim u, r, bng mm, gan lch khng ln.

HA: 100/70 mmHg

Mch: 85 ln/pht

Nhit : 37,5oC

Ringer lactate 500ml x 1 chai





Diamicron 30mg x 2v

Ginrokin 40mg x 2v

Cho, sa, chm sc cp 3

Ch tiu ng

04/06/2013Bnh nhn mt, khng st, nhp tim u, r, bng mm, gan lch khng ln.

HA: 100/70 mmHg

Mch: 85 ln/pht

Nhit : 37,5oC

Ringer lactate 500ml x 1 chai





Diamicron 30mg x 2v

Ginrokin 40mg x 2v

Cho, sa, chm sc cp 3

Ch tiu ng

05/06/2013Sinh tn n nh

Tim: u, r

Phi khng nghe rale

Khng nn, bng mm

Ngi nh bnh nhn xin ra vinCho ra vin


- Ringer lactate : dng b nc v cht in gii cho c th, gip c th hp thu nhanh.

- Natriclorua : cung cp b sung nc, cht in gii

- Amoxicilin : l khng sinh dng trong cc trng hp nhim khun ng h hp trn, nhim khun ng tit niu, nhim khun da, nhim khun ng mt.

- Clanftheomycin : l khng sinh dng trong cc trng hp nhim khun ng h hp, m mm, nhim trng da, vim lot d dy t trng do nhim H.pylori.

- Omeprazole : iu tr lot d dy t trng tin trin, vim thc qun do hi lu d dy thc qun.

- Diamicron : iu tr i tho ng

- Ginrokin : l thuc b, iu tr gim tr nh, tai, chng mt

2. Khoa Sn:

- Khoa Sn l ni thc hin cc nhim v sanh thng, sanh kh phu thut, m ly thai, m ly thai vt m c, khng au.

- iu tr cc bnh ph khoa

- Xt nghim sng lc trc khi sinh v cc d tt bm sinh thai nhi

* T thuc trc ti khoa

STTTN THUCVTP. SANHPK SNGHI CH

1Morphin 10mg/1mlng1Thuc gy nghin

2Dolargan 100mg/2mlng5Thuc gy nghin

3Diazepam 10mg/2mlng5Thuc hng thn

4Diazepam 5mgvin5Thuc hng thn

5Alphatrimotripsin 5mgvin100

6Adrenalin 1mg/1mlng5

7Ampixilin 1gl15

8Atropin 0,25mg/1mlng5

9Doxycillin 100mgvin10

10Drotaverin 40mgng10(no spa)

Biseptol 48mg

11Sunfamethoxa+trimethoprinvin10

12Canciclorua 0,5g/5mlng5

13Cefalexim 500mgvin200

14Cefotuxim 1gl50

15Clopheniramin 4mgvin10

16Cefadovin50

17Methyldopa 250mgvin10

18Furrosemide 20mgng2

19Gentamycin 80mg/2mlng100

20Lidocain 2%ng50

21Magnesium 15%ng10

22Methyl Frgometrin 0,2mgng10

23Metronidazole 250mgvin10

24Nc ct 5mlng50

25Naloxon 0,4mg/1mlng1

26Nifedipin 10mgvin51

27Oxytocin 5UI/1mlng150

28Hyorin 20mgng20

29Hydrocorthyson 100mgng52

30Paracetamol+Diclofenacng10

31Paracetamol 500mgvin60

32Primperan 10mg/2mlng10

33Transamine 250mg/5mlng10

34Acetylcystein 200mgvin10

35Simethyson 250mgvin20

36St Furmarat+Flic+B12+Cvin20

37Vitamin A,E,B1,B2,B6,PP,acidvin100

38Vitamin K1 10mg/1mlng20

*Dch truyn

39Gelatin 500mlchai2

40Glucoza 5%, 500mlchai20

41Glucoza 10%, 500mlchai4

42Ringerlactat 500mlchai50

43NaCl 0,9%, 500mlchai8

44Nabicarbonat 1,4%chai1

45Metronidazole 100mlchai6

* MT S BNH N TI KHOA SN:

* Bnh n s 01:

- H v tn: NGUYN TH NHUNG- Sinh nm: 1987

Gii tnh: N- a ch: Nguyn Vn C, TP.BMT, k Lk- Ngy vo vin: 10/09/2013- L do vo vin: c thai + ra nc m o- Chun on: thai con so 37 tun ngi u chuyn d* iu tr:


9h

10/09/2013

11h

21hSn ph mang thai ln u, qu trnh mang thai khe, nay thy ra nc m o, vo vin.

- Sn ph tnh, nim mc da hng, khng ph.

Mch: 90 ln/pht

Nhit : 37oC

Huyt p: 170/80 mmHg

- Tim phi bnh thng

- Khm sn: t cung hnh trng, t th trung gian c t cung t lt ngn tay, u cao, i v t nhin gi th 5.

- Cc c quan khc cha pht hin bnh l.

- Bnh nhn tnh khng st

- Tim thai: 145 ln/pht

BC/VB: 26/84cm

Tim thai 140 ln/phtTheo di st du hiu chuyn d

Nghe tim thai bng my dopler

Xt nghim huyt , TS-TC, HbsAg, 10 thng s nc tiu

- Cm

- Cefotaxime 1g x 1l

Glucoza 5% 500ml x 1 chai

Oxytocin 5UI x 1 ng

Calciclorid 0,5g x 1 ng

Buscoban 20mg x 2 ng

- Theo di st du hiu chuyn d, CSC 1.

Glucoza 5% 500ml x 1 chai


Theo di st du hiu chuyn d

11/09/2013Sn ph au dn, c cm gic mt rn, khm trong c t cung m trn, u lt thp, hng dn sn ph rn, sau 5 sinh thng 1 b trai, appar 7/10, x tr tch cc giai on 3, kim tra tng sinh mn ct may.

Chun on: mt thai t nhinOxytoxin 5UI x 4 ng


Cefotuxime 1g x 3 l

Vitamin A x 1v

Theo di chm sc hu sn 6 gi sau

12/09/2013Sn ph tnh, khng st

Sn ph tnh, khng st, t cung go hi hi tt, sn dch ra tGentamycin 80mg x 2 ng

Cefotaxime 1g x 3 l

Oxytoxin 5UI x 2 ng

St folic x 1v

Cm, chm sc cp 3


Cefotaxime 1g x 2 l

St folic x 1v

lm thuc m

Cm, CSC 3

13/09/2013T cung go hi tt, sn dch ra t, n ng ttAvacan 1g x 2v

St folic x 1v

lm thuc m, CSC 3


St folic x 1v

lm thuc m, CSC 3


St folic x 1v

lm thuc m, CSC 3


St folic x 1v

lm thuc m, CSC 3



- Cefotaxime: l khng sinh cha nhim khun ng niu, sinh dc phng nhim khun khi phu thut.

- Glucoza: b sung lng ng cho c th

- Oxytocin: c tc dng thc

- Gentamycin: cha nhim khun

- St folic: tng nhu cu to mu, b sung st cho c th

- Avacan: iu tr nhim trng da, m mm, ng tiu di

- Buscopan: iu tr co tht ng tiu ha hoc niu sinh dc

- Calci clorid: b sung mt lng calci cho sn ph

* Bnh n s 02:

- H v tn: NGUYN TH MAI- Sinh nm: 1992

Gii tnh: N- a ch: phng Tn Tin, TP.BMT, k Lk- Ngy vo vin: 02/10/2013- L do vo vin: c thai au bng + ra nhy m o- Chun on: thai con so 37 tun ngi u chuyn d* iu tr:


5h30

02/10/2013

6h45

Sn ph sinh con so, qu trnh mang thai khe, au bng + ra nc m o, xin vo vin.

- Tim thai: 140 ln/ pht

- Go 30 2

- GC: 09cm

- u cao

- Sn ph au dn, c t cung m trn, sau 15 sinh thng 1 b trai p ga 8/10, cn nng 2,9 kg, b khc ngay, x tr tch cc giai on IIICalciclorid 0,5g x 1 ng


Oxytocin 5UI x 2 ng

Lidocain 2% x 4 ng

Cefotacin 1g x 2 l


Vitamin A 200000 UI x 1v

03/10/2013Sn ph tnh, t cung co tt, sn dch ra vaGentamycin 80mg x 2 ng

Cefotaxime 1g x 2 l

Oxytocin 5UI x 2 ng

Mgie B6 x 2v

lm thuc m, cm, CSC 3

04/10/2013Bnh nhn tnh, khng stGentamycin 80mg x 2 ng

Cefotaxime 1g x 2 l

Mgie B6 x 2v

lm thuc m, cm, CSC 3



- Buscopan: chng co tht ng niu, sinh dc

- Oxytocin: thuc tc dng thc , lm cho qu trnh din ra nhanh

- Lidocaine: tc dng gy t

- Cefotaxime: l khng sinh cha nhim khun ng niu, sinh dc, phng nhim khun khi phu thut.

* Bnh n s 03:

- H v tn: NGUYN BCH NGC

Tui: 1990

Nam/N: N- a ch: Nguyn Th nh, phng Khnh Xun, TP.BMT, k Lk- Chun on vo vin: sy thai- Ngy vo vin: 09/11/2013* iu tr:


8h

09/11/2013

Bnh nhn sau sy thai vo khoa tnh to

M: 80 ln/pht

To: 37oC

HA: 120/80 mmHg

Khng ph c nn i, TV, CTC h c mu, thn t cung ln hn bnh thng.

Thai 8 tun syRingerlactat x 500ml

Glucoz 5% x 500ml

TTM 40 git/pht

GT 8h

GH: 16h


TB: 9h

16h

Cefotaxim 1g x 2 ng

TB: 9h

16h

Oxytocin 5UI x 2 ng

TB: 9h

Varocomin x 2v

ung 9h

16h

Cm, CSC2

10/11/2013Tnh, ht au bng

Sn dch ra t

Sinh tn n nhRingerlactat x 500ml

Glucose 5% x 500ml

TTM 30 git/pht

GT 9h


TB: 9h

Cefotaxim 1g x 2 ng

TMC: 9h

16h

Varocomin x 2 vin

TMC: 9h

16h

Cm, CSC2

11/11/2013Ngi bnh tnh, khng st, than mt, t cung go tt, sn dch ra vaGentamycin 80mg x 2 ng

TB: 8h

Cefotaxim 1g x 2 ng

TMC: 8h

16h

Varocomin x 2 vin

ung: 8h

16h

Cm, CSC3

12/11/2013Ngi bnh tnh, khng st, cn mt, t cung go tt, sn dch ra vaGentamycin 80mg x 2 ng

TB: 8h

Cefotaxim 1g x 2 ng

TMC: 8h

16h

Varocomin x 2 vin

ung: 8h

16h

Cm, CSC3

13/11/2013Gia nh xin chuyn tuyn trn iu trGentamycin 80mg x 2 ng

TB: 8h

Cefotaxim 1g x 2 ng

TMC: 8h

16h

Varocomin x 2 vin

ung: 8h

16h

Cm, CSC3


- Gentamycin: iu tr nhim khun

- Cefotaxim: iu tr nhim khun ng tit niu sinh dc, phng nhim khun do phu thut.

- Varocomin: thuc b, c tc dng bi b sc khe

* Bnh n s 04:

- H v tn: TRN H VY

Tui: 1982

Nam/N: N- a ch: X Ha Thng, TP.BMT, k Lk- L do vo vin: au bng- Chun on: thai ln 5; 38 tun chuyn d* iu tr:


9h

02/11/2013

15h

16hQu trnh mang thai khe, nay thy au bng vo vin, sn ph vo vin tnh to, da, nim mc hng.

M: 80 ln/pht

To: 37oC

HA: 120/80 mmHg

Tim, phi bnh thng

Khm sn: t cung hnh trng

BCTC/VB: 29/90cm

Ngi u, th tri

Tim thai: 140 ln/pht

C t cung h, c nhy mu hng theo gng, u cao, cc c quan khc cha pht hin g l.


G: 40 3

CTC: 80cm, mp dy, i v t nhin mu trng c.

u: cht

Sn ph au d di, c cm gic mun rn, khm li c t cung m trn, u rt thp.

Hng dn sn ph rn sau 5 sinh thng 1 b gi, p ga 8/10. Cn nng: 2,8kg, x tr tch cc giai on 3.Theo di st cc du hiu chuyn d, nghe tim thai bng my doppher, xt nghim huyt , TS-TC, test HIV, test HBSAg, 1 thng s nc tiu, siu m thai, ECG.

Cm, chm sc cp 3

Buscopan 20mg x 2 ng

Sonde nc tiu + tht tho

Ringerlactat x 1 chai

CSC 2

Oxytocin 5% UI x 2 ng

Lidocaine 2% x 4 ng


Cefoxime 0,5g x 4v

Vitamin K1 10mg x 1/10 ng

Vim gan siu vi B x 1 liu

Theo di, chm sc hu sn trong 6 gi sau .

03/11/2013Sn ph tnh, khng st, t cung go hi tt, sn dch ra t, b khe, b ttCefoxime 80mg x 2 ng

Cefoxime 0,5g x 4v


St folic x 1v

lm thuc m, rn b

Cm, CSC 3

04/11/2013Sn ph tnh, khng st, t cung go hi tt, sn dch ra t, b khe, b ttCefoxime 80mg x 2 ng

Cefoxime 0,5g x 4v


St folic x 1v

lm thuc m, rn b

Cm, CSC 3



- Buscopan: chng co tht ng niu sinh dc

- Ringerlactat: b nc v in gii cho c th

- Lidocaine: tc dng gy t

- St folic: tng nhu cu to mu, b sung st cho c th

- Gentacymin: iu tr nhim khun

- Cefalexine: iu tr nhim khun

- Vitamin K1: iu tr chy mu trc khi sinh, d phng thiu vitamin K1 cho tr s sinh.

* Bnh n s 05

- H v tn: L TH THU THYTui: 1985

Nam/N: N

- a ch: X Ha Thun, TP.BMT, k Lk- L do vo vin: au bng tng cn- Chun on: thai con so, 34 tun da sanh non- Ngy vo vin: 14/11/2013* iu tr:


14/11/2013

Thai ph c thai ln u, khong 34 tun, ngy nay au bng lm rm, au tng dn xin vo vin, bnh nhn vo vin tnh to.

M: 80 ln/pht

To: 37oC

HA: 120/80 mmHg

Tim, phi bnh thng

Cc c quan khc cha pht hin g l.

Khm sn:

BCTC/VB: 24/84cm


C t cung h, c nhy mu hng theo gng, u cao, cc c quan khc cha pht hin g l.


Cn go: 20 4

m h, m o bnh thngPapaverin 40mg x 1 ng

Papaverin 4mg x 2v

Ngh ngi tuyt i, chm sc cp 3

Xt nghim huyt , TS-TC, nghe tim thai bng my.

15/11/2013Bnh nhn tnh, tip xc tt


C t cung ng kn,khng c mu theo gng, cn au bng t, khng ra dch bt thng.Papaverin 40mg x 1 ng

Vitamin E 400 x 2v

Salbutamol 1mg x 1v

Ngh ngi tuyt i, CSC 3

Xt nghim nc tiu ECG

16/11/2013Bnh nhn tnh, khng st, khng au bng, khng ra dch bt thng.Papaverin 40mg x 1 ng

Vitamin E 400 x 2v

Vitamin C 0,5g x 2v

Ngh ngi tuyt i, cm, CSC 3

17/11/2013Bnh nhn tm nCho ra vin


- Papaverin: chng co tht c trn ng tiu ha, ng niu, ng mt, au bng do ng rut.

- Vitamin E

- Salbutamol: c tc dng gim c t cung run

- Vitamin C: tng sc khng cho c th, cung cp vitamin C cho c th

3. Khoa Ngoi Tng Hp

- Tip nhn cc bnh l ngoi khoa v: tiu ha, gan mt, tit niu, cc loi u bu,

- M cp cu v m phin i vi cc bnh l ngoi khoa.

* T thuc trc ngoi khoa

STTTN THUCVTNGOIPK GHI CH

1Dolargan 100mgng1Thuc gy nghin

2Morphin 10mgng1Thuc gy nghin

3Seduxen 5mgvin10Thuc hng thn

4Ephedrin 10mgng5Thuc hng thn

5Adrenalin 1mgng5

6Acetyleystein 200mgvin20

7Alphachymotripsin 500 UIng5

8Alphachymotripsin 5mgvin100

9Amlodipin 5mgvin5

10Amoxcillin 500mgvin20

11Ampicillin 1gl10

12Biseptol 480mgvin20

13Triobexvin5

14Cefadroxil 500mgvin10

15Cefotaxime 1gl50

16Chlopheniramin 4mgvin10

17Ciprofloxacin 500mgvin20

18Amoxcillin+Acidclauvulamidvin20500mg+125mg

19Amoxcillin+Acidclauvulamidgi10250mg+625mg

20Cefuroxim 600mgvin20

21Diaphylin 4,5%ng2

22Dlosmin+Hosperidinvin20

23Hydrocortison 100mgng55

24Gentamycin 80mg/1mlng40

25Lidocain 2%ng3070

26M: Tetracylin 1%tube2

27Nc ct 5mlng50

28Nifedipino 10mg (Adalat)vin2

29Ofloxacin 200mgvin10

30Oxy gil55

31Hyoscin 20mgng5

32Methylprednisolon 5mgvin30

33Primperan 10mg/2mlng5

34Paracetamol+Dclofenacng10

35Paracetamol 500mgvin50

36Paracetamol 250mggi10

37Tenidazol 500mgvin20

* Dch truyn:

38Glucoza 5% 500mlchai153



41Lactat zinger 500mlchai153

42NaCl 0,9% 500mlchai55

* MT S BNH N KHOA NGOI TNG HP

* Bnh n s 01:

- H v tn bnh nhn: NGUYN VN TNGTui: 45 Nam/N: Nam- a ch: Krng Pk, k Lk- L do vo vin: au bng

- Chun on vo vin: si bng quang- Ngy nhp vin: 20/1/2013* iu tr:


20/01/2013- Bnh nhn khai bnh khi pht lu, au tc vng bng di km theo tiu kh, bnh cng nng nn xin nhp vin.

- Bnh nhn vo vin tnh, da nim mc hng, hch ngoi v kh sng.

M: 80 ln/pht

To: 37oC

HA: 120/80 mmHg

Tim, nhp th r

Phi khng nghe ral

Bng mm, gan lch khng ln, s bng au tc vng bng di, tiu kh.Claminat 625mg x 1v ung 20h

Alphachymotripsin 4,2mg x 2v, ung 20h

Paracetamol 0,5g x 1v, ung 20h

Triobex x 1v, ung 20h

Ung nhiu nc, cm, cho

21/01/2013Bnh nhn tnh to, sinh liu n, n au tc h v, tiu but rtClaminat 625mg x 2v, ung 9h 16h

Alphachymotripsin 4,2mg x 6v, ung 9h 16h.

Paracetamol 0,5g x 2v, ung 9h 16h

Triobex x 2v, ung 9h 16h

Ung nhiu nc, cm, cho

22/01/2013Bnh , gimTip tc iu tr


- Claminat: iu tr nhim khun ng tit niu

- Alphachymotripsin: chng vim, ph n,

- Triobex: thuc b

* Bnh n s 02:

- H v tn bnh nhn: L NGC LANTui: 62 Nam/N: N- a ch: phng Tn An, TP.BMT, k Lk- L do vo vin: U ngn III tay (P)

- Chun on: U b ngn tay III tay (P)- Ngy nhp vin: 27/03/2013* iu tr:


27/03/2013Bnh nhn c m ct cung b ngn III tay (P), cch y khong 2 nm. Nay khi u sng to nn nhp vin.

- Hin ti bnh nhn tnh to, da nim mc hng, sinh liu n, khi u mt lng ngn III tay (p) c kch thc 1,5 x 1,5 c 1cm. gii hn r, khng au, i ng n mm.

- Tim, phi bnh thng.

Kt lun: Ung b ngn III tay (p), t pht.

iu tr: M ct, ung bPenturex x 250mg x 4 v

Pparacetamol 0,5g x 2v

Alphaohymotripism x 4v

Triobex x 2v

Ung chia 2 ln

Lidocein 2% x2 ng

Tim gi ngn tay

M ct ung ba ngn III tay (p)

28/03/2013Bnh nhn tnh to, vt m khng cn au t, sinh liu n- Pentrirox 250mg x 4v

- Paracetimol 0,5g x2v

- Alphachy motripsin x4v

- Triobex x2, ung chia 2 ln

- Pentirox 250mg x 2v

- Paracetamol 0,5g x 2v

- Alphachymotrpim x 4v

- Tiobex x 2 v, ung chia 2 ln

01/04/2013, gimRa vin

* Phn tch pht iu tr

Pentrirox: Chng vim

Paracetimol: Gim au

Alphachymotripsin: Chng vim, ph n sau chn thng.

Triobex: iu tr v d phng triu chng thiu vitamin b.

lidecain: Thuc tim gy t trong phu thut.

* Bnh n s: 03

H v tn bnh nhn: HLen BYa, Tui: 24, Nam/n: Nama ch: C Kuin, TP.BMT, k Lk.L do vo vin: au bngChun on: TD thot i bn (P)Ngy vo vin: 10/04/2013* iu tr

Ngy, giDin bin bnhY lnh

3hBnh nhn khai au bng lc 12h ngy 9/04/2013, au ngy cng tng nn xin nhp vin.

M: 10 ln/ pht

To: 38oC

HA: 120/70mmHg

Khm: Bnh nhn au bng h v (P).

MC-Burney(-) Blumbesg (-)Cefofaxim 1g x 1lo TB.

Gentamycin 80mg x 1 ng TB.

Dclophenac 85g x 1 ng.

Prednisolen 4mg x 5v ng.

8h- Tinh hon sng au

- Bnh nhn tnh to, sinh liu n, tinh hon sng to.

- Tiu tin khng but rt, i tin c- Cefotaxim 1g x 1 l

- TB 9h-16h

- Gentumycin 80mg x 2 l

- TB: 9h

- Diclofhenac 80mg x 2 ng

- TB 1 ng khi au

- Prednisolon 4mg x 2v

- Ung tra sau ba n

- Triobex x 2v

- Ung 9h-16h

11/04/2013- Bnh nhn tnh to, sinh liu n

- Cn au tc vng bng

- Tinh hon cn sng- Cefotuxim 1g x 2 l

- TB: 9h-16h

- Gentamycin 80mg x 2 ng

- TB: 9h

- Diclophenac 8mg x 2 ng

- TB: 1 ng khi au.

- Precl nisolon 4mg x 6v

- Sng ung 4v, tra 2v.

- Triobex x 2v

- Ung: 9h 16h

12/04/203, gimRa vin

* Phn tch pht iu tr

Cefotuxim: iu tr nhim khun nng.

Gentamycin: iu tr nhim khun ng tit niu.

Diclophenac: Thuc iu tr vim khp, gim au, h st.

Preclnisolon: iu tr ri lon ni tit, bnh l thp khp.

Triobex: D phng v iu tr cc bnh v thiu vitamin b.

* Bnh n s: 04

H v tn bnh nhn: Nguyn Th Ngc, tui: 25, Nam/n: Na ch: Tn lp, TP.BMT, k LkL do vo vin: u c tay (I) vo ngy th 20 ca bnh.Chun on: u bao hot dch mu c tay (I).Ngy vo vin: 10/04/2013* iu tr


10/05/2013- Bnh nhn khai, bnh khi pht lu vi khi u vng c tay (I) nh cha iu tr g, nhp vin, iu tr bnh nhn vo khoa tinh to tip xc tt.

- M: 80 ln/ pht

- To: 38oC

- HA: 110/60mmHg

- NT: 20 ln/ pht

- Khm: Khi u vng c tay (I)

- n khng au, gii hn r, khng di ng.

- Kt lun: U bao hot dch c tay (I).- Claminat 625g x 2v

- Ung: 9h30 16h 30

- Alphachymotripsin x 4v

- Paracetimon 0,5g x 2v

- Triobex x2v

- Ung 9h30-10h30

11/05/2013- Hi chun li hon thng nht.

- Chun on: u bao hot dch c tay tri (I)- Gentamycin 80mg x 1 ng

- TB: 10h

- Claminat 625mg x 2v

- Ung 2 ln

- Paracetimol 0,5 x 6v

- Alphachymotripson x 6 v

- Triobex x 3v

- Chia 3 ln ung

- Cm, cho

12/05/2013, gimCho ra vin

*Phn tch pht iu tr:

Claminat: iu tr nhim khun m mm, vt thng.

Alphachymotripsin: Chng ph n, sng sau phu thut.

Paracetimol: Gim au

Triobex: Thuc b

Gentamycin: iu tr nhim khun

* Bnh n s 05

H v tn bnh nhn: Nguyn Vn Nam, tui: 1945, Nam/N: Nama ch: Tn li, TP.BMT, k Lk

L do vo vin: D tt i (P)Ngy vo vin: 22/06/2013* iu tr


22/06/2013- Bnh nhn vo khoa tnh, tip xc tt.

- M: 85 ln/ pht

- To: 37oC

- HA: 130/90mmHg

- NT: 20 ln/ pht

- Tim u phi khng nghe ral bng mm, gan lch khng ln.

- Vng i (P) c khi g ln, s thy d vt.

- Xt nghim huyt p, nhit , TS-TC, chp x quang tim phi.

- Ch m

8h- Bnh nhn tnh, khng st- Magie B6 x 02v

22/06/2013- D vt vng i g ln da, du hiu sinh tn n nh- Cm, CSC 3

8hM ly d vt

23/06/2013Bnh nhn tnh, khng st thy cng i (P) di dch s thy d vt qua daGii thch, cam oan

- Natriclosia 0,9% x 800ml

- Cefotaxime 1g x 1 l

-Gentamycin 80mg x 2 ng

- Tm nhn, CSC 3

9h30

23/06/2013Sau m bnh n, chuyn hi sc sau m, iu tr tip- Alpha Chymobripsin 500 01x 2 l

- Diclofenac 85 mg x 3 ng

- Cm, CSC 3

24/06/2013Bnh tnh khng st, vt thng r dch, thm bng au- Cefotaxmie 1g x l

- Gentamyin 80mg x 2 ng

- Alpha-Chymotripsin 500 01x 2 l

- Hapacol 0,5g x 2v

- Magie B6 x 1v

- Tha bng

- Cm, CSC 3

25/06/2013- Bnh tnh, khng st, vt m kh, au t.

- Du hiu sinh tn n- Cofotaxime 1g x 2 l

- Gentamyin 80mg x 2 ng

- Alphatrymotripsin 500 01 x 2 l

- Hapacol 0,5g x 2v

- Magie b6 x 2 v Thay bng

- Cm, csc 3

26/06/2013- Bnh n nh- Cho xut vin

* Phn tch pht iu tr

- Natriclorua: b sung nc v cht in, gii cho cho c th.

- Cefotaxime: l khng sinh cefalosposin th h 3, c tc dng chng vim m t bo.

- Gentamyci: L khng sinh tr nhim vng da, xng khp.

- Diclofenac: iu tr ngn hn nhng trng hp vim au cp tnh do chn thng hoc phu thut.

- Alphachymotrpin: iu tr cc trng hp ph n do chn thng.

- Hapacol: c tc dng gim au, h st.

- Magie B6: Thuc b.

4. KHOA NHI

- Tip nhn tt c bnh l ni nhi t s sinh n 15 tui gm c bnh l v h hp tim mch, thn kinh, ng c, ngt nc

* T thuc trc ti khoa

STTTN THUCVTLngGHI CH

1Alphachymotripsin 5mgVin20

2Acetylaystein 200mgVin 10

3Alimemazin 5mgVin 10

4Ampcillin 1gl5

5 Amoxcillin 250mgvin20

6Amox 500 + AcidclauxulamidVin 10

7Amox 250 + AcidclauxulamidVin10

8Besodaan 20mlVin20

9Cefuroxuim 250mgL10

10Chiophesamin 4mgVin20

11Nc ct 5mlng2

12Hydrocostison 100mgng5

13ORSGi20

14Gentamycin 80mgng10

15Penicillin 1.000.000 VIL5

16Prednisolon 5mgVin20

17Paracetamol 500mgVin20

18Paracetamol 150mgGi20

19Paracetamol 80mgGi20

20Paracetamol 100mgVin20

21Salbutamol 20mgvin20

22Simethicone 15mll5

23Loratidime 10mgvin20

24Lactobacilus+Acidophilusgi20

25Glucoz 5% 500mlchai5

26Lactat ringer 500mlchai5

27NaCl 0,9% 500mlchai5

28Artesunat 50mgvin10

29Primaqui 13,2gvin10

30Chloroqui 250mgvin10

31Artecanvin10

* VT LIU TIU HAO

32Bm tim 5mlci20

33Bm tim 10mlci5

34Dy truyn dchci5

35Dy oxyte

36Cun cathete TEci5

37Sonde hu mn

* MT S BNH N TI KHOA NHI

* Bnh n s 01:

- H v tn bnh nhn: TRN VN HONG Tui: 48 thng Nam/N: Nam- a ch: khi 3, phng Tn Li, TP.BMT, k Lk

- L do vo vin: Nn i, i cu phn lng

- Chun on: vim rut- Ngy nhp vin: 08/04/2013* iu tr:


8h30

08/04/2013Bnh 3 ngy, tr st, nn i, i cu phn lng ton nc >10 ln/ngy. ung thuc khng nn vo vin.

Tr vo khoa trong tnh trng tnh

M: 130 ln/pht

To: 39oC

NT: 30 ln/pht

P: 13kg

Mt trng nh, mi kh, capper

Bng chng nh, tim nhp u, phi khng ral.

Kt lun: vim rut c mt nc nh(1) Ringer lactat x 500ml truyn TM 20 git/pht

ORS x 100ml ung dn

Paracetamol 150mg x 3 gi, ung 1 gi khi st cch 4h

L-BiO x 2 gi, ung 9h 16h

Metoclopramid 10mg x 1/4 ng, TB: 9h

- Sa, cho

Xt nghim mu, siu m bng

(2) Negram x 1v, ung 10h

L-BiO 1g x 2 gi, ung 10h

Dung dch ORS ung ri rc trong ngy

Cp IV:(1) Negram 0,5g x 2v

(2) L-BiO x 4 gi

(3) ORS x 2 gi



- Ringer lactat: b nc v cht in gii cho c th

- ORS: b nc


- L-BiO: men tiu ha

- Metoclopromid: iu tr ri lon nhu ng d dy, rut, bun nn

- Negram: iu tr tiu chy

* Bnh n s 02:

- H v tn bnh nhn: NGUYN VN BA Tui: 4 Nam/N: Nam- a ch: Ea Kao, TP.BMT, k Lk- L do vo vin: Nn i, i cu phn lng

- Chun on: vim d dy rut- Ngy nhp vin: 10/09/2013* iu tr:


10/09/2013Bnh 2 ngy, tr st, nn i, i cu phn lng ton nc >10 ln/ngy, phn tanh, ung thuc nhng khng nn xin nhp vin.

M: 130 ln/pht

To: 39oC

NT: 30,8 ln/pht

P: 12kg

Mt trng nh, mi kh,

Bng chng, phi khng nghe ral.

Kt lun: vim d dy rut c mt nc nh(1) Ringer lactat x 500ml truyn

ORS x 100ml ung u

Paracetamol 150mg x 3 gi, ung 1 gi khi st cch 4h

L-BiO x 2 gi, ung 9h 16h

Metoclopramid 10mg x 1/4 ng, TB: 9h

Tr vn mt, mt trng nh, i lng

Negramdicin 50g x 1v

Doperadol x 1v

11/09/2013Bnh gimRa vin


- Ringer lactat: b nc v cht in gii cho c th

- ORS: b nc


- L-BiO: men tiu ha

- Metoclopromid: iu tr ri lon nhu ng d dy, rut, bun nn

- Negramdicin: iu tr nhim trung ng tiu ha, tiu chy do nhim trng

* Bnh n s 03:

- H v tn bnh nhn: HQUYN BYA Tui: 15 thng Nam/N: N- a ch: Ea Tu, TP.BMT, k Lk- L do vo vin: Ho, kh kh - Chun on: vim phi- Ngy nhp vin: 14/02/2013* iu tr:


14/02/2013Tr tnh, sinh liu n, phi ral t

Tim u

Gan lch khng s c

Berudual x 2ml+Natri clorua 9% x 2ml

Cefotaxim 2mg x 1v, ung 9h-16h

Tocemux 2g x 1 gi, ung 9h-16h

Salbutamol 2mg x 1v, ung 9h-16h

Gentamycin 80mg x 2/3 ng, ung 9h

Prednisolon 5mg x 2v, ung 9h 14h sau n

15/02/2013Tr tnhBerudual x 2ml+Natri clorua 9% x 2ml

Cefotaxim 2mg x 1v, ung 9h-16h

Tocemux 2g x 1 gi, ung 9h-16h

Salbutamol 2mg x 1v, ung 9h-16h

Gentamycin 80mg x 2/3 ng, ung 9h

Prednisolon 5mg x 2v, ung 9h 16h sau n

20h30

16/02/2013

2hTr l , mi kh, mt hng, sinh liu n

Tr nn, tiu chy

Phi ral, mt nc TB

Tr tnh, hi l , mi kh, sinh liu n, phi ral.Paracetamol 150mg x 3 gi, ung khi st

Natriclorua 0,9% x 500mg

Truyn TM xxx git/pht

Actapuligot x 1/2 gi, ung 20h40

Xt nghim li GTM, OGD

Th oxy 15 pht

Actapuligit x 1/2 gi, ung 23h

Kaliorid 0,5g x 1/2 vin

17/02/2013Bnh nhi n


- Berodual: phng nga, iu tr trong kh kh bnh phi, hen ph qun

- Natriclorua: b sung nc, cht in gii cho c th

- Cefotaxim: iu tr nhim khun

- Gentamycin: iu tr nhim khun

- Salbutamol: iu tr bnh v ng h hp nh vim ph qun

- Tocemux: iu tr bnh l h hp, c m, lm sch thng quy trong ph qun

- Prednisolon: chng vim, iu tr ri lon ni tit

- Actapuligit: iu tr tiu chy

* Bnh n s 04:

- H v tn bnh nhn: V INH LAN Tui: 10 thng Nam/N: N- a ch: Ea Kao, TP.BMT, k Lk

- L do vo vin: st- Chun on: vim mi hng cp- Ngy nhp vin: 10/08/2013* iu tr:


10/08/2013Bnh khi pht ngy 2 ln vi st cao, km au bng, gia nh lo lng cho vo vin.

Tr tnh

M: 130 ln/pht

To: 37oC - 38oCNT: 30 ln/pht

P: 17kgGentamycin 80mg x 1 ng IM

Cefalexin 1mg x 2v

Cefixim x 6v

Alphanea x 6v

Tocemux 2g x 6 gi

11/08/2013Bnh khiRa vin

* Phn tch pht iu tr

- Gentamycin: iu tr nhim khun nng

- Cefalexim: nhim khun h hp, tai, mi, hng

- Cefixim: iu tr vim phi cp mn tnh

- Tocemux: h hp c m

* Bnh n s 05:

- H v tn bnh nhn: V NG TM Tui: 5 Nam/N: Nam- a ch: Krong Ana, k Lk

- L do vo vin: st cao, au bng- Chun on: vim mi hng

- Ngy nhp vin: 18/09/2013* iu tr:


18/09/2013Bnh khi st ngy hm qua, st cao, gy au bng, gia nh lo lng cho nhp vin.

Tr tnh

M: 130 ln/pht

To: 37oC - 38oCNT: 30 ln/pht

P: 17kgGentamycin 80mg x 1 ng IM

Cefalexin 1mg x 2v

Cefixim x 6v

Alphanea x 6v

Tocemux 2g x 6 gi

19/09/2013Bnh gim, Ra vin

* Phn tch pht iu tr

- Gentamycin: iu tr nhim khun nng

- Cefalexim: nhim khun h hp, tai, mi, hng,

- Cefixim: iu tr vim phi cp mn tnh

- Alphanea:

- Tocemux: iu tr bnh l h hp c m

NHN XT CHUNG V TNH HNH S DNG THUC

TI BNH VIN A KHOA TNH K LK

- Thuc s dng ph hp vi chn on bnh

- Trong thi gian thc tp ti cc khoa trong bnh vin, khng thy c hin tng tng tc thuc v phn ng c hi ADR ca thuc v trc khi dng thuc cho bnh nhn, cc bc s nghin cu rt k khng xy ra cc tng tc c th gy nguy him cho bnh nhn.

- Qua thi gian thc tp ti bnh vin A KHOA TNH K LK t ngy 17/12/2013 n ngy 17/01/2014, c s hng dn nhit tnh ca cc bc s, y t, em hc hi v rt ra c nhiu kin thc b ch gip cho em trong cng tc sau ny nh:

+ nng cao kin thc chuyn mn v hng dn s dng thuc an ton, hp l, th em phi rn luyn kin thc c bn v s dng thuc v phng nga nhng phn ng c hi (ADR) do thuc gy ra, trnh lm dng thuc trong iu tr, trnh s dng thuc ba bi, c bit hiu bit hn v bin php phng nga.

+ S dng t thuc nu c th

+ Ch s dng thuc khi nm r tc dng dc l

+ Khng thay i thuc nu khng cn thit, khi quyt nh dng thuc no th phi nm chc v hiu r v thuc .

+ Nm vng v tng tc thuc trong iu tr

+ Ch cc loi thuc khi s dng d xy ra tng tc

+ phng tng tc thuc vi mt s thc n, ung nh: ru, bia, ha cht, ch, sa, ung c ga,

+ Cng tc theo di ADR l cn thit mi ni, mi c s iu tr.

+ Trin khai rng ti mi c s iu tr nhm thc y s quan tm v nng cao kin thc cho cn b y t v phn ng c hi ca thuc, qua gip cn b y t c t liu tuyn truyn trong cng ng, trnh lm dng thuc.

LI KT

Trong qu trnh v thc tp ti Bnh vin A KHOA TNH K LK, em hiu hn v trch nhim, nhim v ca mt dc s trung hc ang hc, s kt hp gia l thuyt v thc hnh l mt phng php rt hay gip cho hc sinh c nhn nhn v va chm thc t tip xc vi cc cn bnh, hc hi hng iu tr ca cc bc s, ca cc c ch v anh ch trong ngnh.

Em xin chn thnh cm n Trng khoa Dc, Ni, Nhi, Truyn nhim, Ngoi, cng tt c cn b nhn vin ca khoa nhit tnh gip v to iu kin cho em hon thnh tt t thc tp ny.

Em xin cm n cc thy, cc c Trng trung cp Y Dc L Hu Trc to iu kin cho chng em c thc t ti c s pht huy vn kin thc t cc thy c truyn dy vo thc t. Em ha s c gng thc tp tt xng ng vi cng sc ca cc thy c truyn dy.

Em xin chn thnh cm n, v knh chc cc thy, c, cc y, bc s ca Bnh vin A KHOA TNH K LK li chc sc khe v cng tc tt.

CNG HA X HI CH NGHA VIT NAM

c lp T Do Hnh Phc

---o0o---

N XIN XC NHN

Knh gi: Ban Gim c Bnh vin a Khoa Tnh k Lk

Em tn l ng Th Thu Tho l sinh vin trng Trung cp Y Dc L Hu Trc

Trong thng va qua, t ngy 17/12/2013 n ngy 17/01/2014 chng em thc tp ti nm khoa ca bnh vin a khoa tnh k Lk l: Khoa Dc - Khoa Ngoi Khoa ph sn - Khoa ni tim mch - Khoa nhi Khoa truyn nhim.

Nay em lm n ny knh mong Ban gim c bnh vin a khoa tnh k Lk xc nhn cho chng em l hon thnh vic thc tp ti bnh vin a khoa tnh k Lk.

Chng em xin chn thnh cm n.Xc nhn ca bnh vin

BMT, ngy 17 thng 1 nm 2014

Trng nhm

ng Th Thu Tho

Kim k

Qun l ti khoa

Kim nhp

Vn chuyn

Mua

D tr

K n

Cp Pht Thuc

Theo di thuc

Dc lm sng

C khng iu tr thuc sai, thuc di liu, thuc qu liu, phn ng tng tc thuc, khng phc tng ch nh khng hiu qu

T vn theo di ADR ang gi s dng thuc theo di thuc iu tr, phng phi thuc v tng

Gii quyt

Ngn nga

Hiu qu ca thuc tt nht v khng c hi hoc t c hi, cc phn ng c hi

Cht lng cuc sng bnh nhn rt tt

Cc vn lin quan ti thuc

Nhn

bit

Lp s sch

Thng k

Kho BHYT

Kho vin ph

Khoa lm sng

Khoa cn lm sng

Khoa ngoi sn

Khoa cp cu lin chuyn khoa

Khoa ni nhi nhim ng y

Cp pht

Kim tra

BAN GIM C BNH VIN

KHOA DC CN LM SNG

PHNG T CHC HNH CHNH QUN TR

PHNG K HOCH TNG HP VT T THIT B Y T

KHOA LM SNG

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