Giai Phau Cao Dang

7/31/2019 Giai Phau Cao Dang

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PHN I: THC HNH GII PHU

BI 1: GII THIU TNG QUAN BN NGOI

Hnh 1.1: Vng u v c bn ngoi.


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Hnh 1.2 Vng ngc bn ngoi


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Hnh 1.3: Vng lng bn ngoi.


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Hnh 1.4: Vng ngoi chi trn


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Hnh 1.5: Vng ngoi chi di


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BI 2 : MT TAI

Hnh 2.6: B my l


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Hnh 2.7: Nhn cu


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Hnh 2.8: ng nhn cm m thanh.


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Hnh 2.9: Tai ngoi v hm nh


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BI 3: HXNG

Hnh 3.11: S-nhn trc.


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Hnh 3.12: S - nhn bn.


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Hnh 3.13: Ct sng


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Hnh 3.14: Cc t sng ngc.


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Hnh 3.16: Khung xng ngc


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Hnh 3.17: Khung xng ca bng


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Hnh 3.18: Skhc bit gii tnh ca chu hng


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Hnh 3.19: Xng cnh tay v xng vai nhn trc.


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Hnh 3.20 : Xng cnh tay v xng vai nhn sau


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Hnh 3.21: Cc xng ca cng tay.


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Hnh 3.22: Cc xng c tay v bn tay


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Hnh 3.23 :Xng chu


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Hnh 3.24: Xng i


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Hnh 3.26: Cc xng ca bn chn.


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Hnh 4.28: C lng-lp nng


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Hnh 4.29: Thnh ngc trc


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Hnh 4.30: Cc c vai.


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Hnh 4.31: Cc c cng tay-nhn sau


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Hnh 4.32: Cc c cng tay nhn trc.


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Hnh 4.33: Cc c ni ti ca bn tay


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Hnh 4.34: Cc c ca i


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Hnh 4.35: Cc c ca cng chn-nhn sau


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Hnh 4.36: Cc c ca cng chn nhn trc


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BI 5: H TUN HON

Hnh 5.37: Tim


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Hnh 5.38: Tim: Cc mt y v mt honh


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Hnh 5.39: Cc ng mch vnh v cc tnh mch vnh.


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Hnh 5.40: Tm nh, cc tm tht v vch gian tht


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Hnh 5.41: Cc ng mch ca vng ming v vng hu


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6/ ng mch nch v vng ni quanh xng vai

Hnh 5.42: ng mch nch v vng ni quanh xng vai


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Hnh 5.43 : Cc ng mch v thn kinh chi trn


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Hnh 5.44: Cc ng mch ca niu qun v bang quang


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Hnh 5.45: Cc ng mch ca i v gi


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BI 5 : H THN KINH

Hnh 6.46: No nhn bn


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Hnh 6.50: Ty gai v thn kinh gian sn


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BI 7 : H H HP

Hnh 7.51:Thnh ngoi ca mi


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Hnh 7.52: Cc sn thanh qun


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Hnh 7.53: nh khu phi nhn trc


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Hnh 7.54: Phi nhn trong


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Hnh 7.55 Kh qun v ph qun


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Hnh 7.56: Cc thy ph qun phi


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Hnh 8.59: Rng


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Hnh 8.60: Cc tuyn nc bt


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Hnh 8.61: D dy


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Hnh 8.62: Mc ni ln v Tng bng


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Hnh 8.63: Ty


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Hnh 8.64: Cc mt ca gan


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Hnh 9.66 Cc cu trc i th ca thn


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Hnh 9.67: Tng chu hng v y chu n


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Hnh 9.68: Tng chu hng v y chu nam


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Hnh 9.69: Tuyn v


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Hnh 9.70: Tcung


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Hnh 9.71: Tcng v phn ph


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Hnh 9.72: Bu v cc cu trc cha bn trong


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PHN 2: THC HNH SINH L

Bi 10: QUAN ST MU BNH THNG

10.1. Hng cu: hnh a, hai mt lm, khng c nhn, mu hng lt,dy 2m, ng knh

7m.

10.2. Tiu cu: hnh trn hay hnh bu dc, thng c tua nhn, khng co nhn, ng knh 2-

4m. Thng t li thnh tng m.


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10.3. Bch cu: Chia lm 2 nhm: Bch cu n nhn v bch cu a nhn

3.1 Bch huyt bo (lympho bo): Chim 20%, ng knh 7-12m, nhn hnh bu dc, chim

gn ht th tch, t bo c nhim sc cht mu tm sm. T bo cht nhiu, mu xanh dng lt.

3.2 Bch cu n nhn to: Chim 8% ng knh 15-25 m, nhn hnh thn hay hnh mng nga,

c nhim sc cht tha hnh si dy, mu tm. T bo cht cha nhiu mu xanh dng lt.


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3.3 Bch cu a nhn trung tnh: chim 60%-70%. ng knh 12-15 m. Nhn thng c t 2-

4 thy, c nhim sc cht m c mu tm sm. T bo cht mu hng, c nhiu tiu ht nh hp

phm mu trung tnh mu hng.

3.4 Bch cu a nhn toan tnh: Chim 1%. ng knh 10-15 m. Nhn ch c 2 thy, c nhim

sc cht m c mu tm sm. T bo cht cha nhiu tiu ht to, hp phm acid c mu da

cam.


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3.4 Bch cu a nhn kim tnh: Chim 0,5%. ng knh 10-15 m. Nhn hnh qu du (khng

chia thy r rt) c nhim sc cht m c mu tm sm. T bo cht mu xanh lt. C nhiu tiu

ht kch thc to nhkhng u nhau c mu xanh dng m


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BI 11: XC NH NHM MU A, B, O V Rh11.1 i cng

Trn mng hng cu trong mu ni c hai loi khng nguyn l A v B. Trong huyt tng c

hai loi khng thtng ng vi khng nguyn l anti A v anti B. Khi khng nguyn trn mng

hng cu. Th d: A gp anti A hay B gp anti B.

Da vo s c mt ca khng nguyn trn mng hng cu v khng th trong huyt tng c

chia ra lm 4 nhm mu.

Nhm mu Khng nguyn Khng th

A A Anti A

B B AntiB

AB AB Khng c AntiAB

O Khng c khng nguyn AB AntiAB

nh nhm mu ca mt ngi l xc nh khng nguyn trn mng hng cu ca ngi .

xc nh nhm mu hABO, ngi ta thng dung 2 phng php.

Phng php dng huyt thanh mu ca Beth Vincent.

Phng php dng hng cu mu ca Simonin

H Rh (Rhesus) : Mng hng cu c khng nguyn Rh, trong huyt tng khng th Anti D.

Ngi ta qui c: mu ngi no c cha yu t Rh gi l Rh+ cn khng c th gi l Rh-.

11.2 Phng php dng huyt thanh mu

11.2.1 Nguyn tc

Trn mu ngi th vi tng git huyt thanh mu c khng th bit trc, hng cu s b

ngng kt bi khng thtng ng vi khng nguyn trn mng hng cu, t bit c khng

nguyn trn mng hng cu ngi th l g, v nh nhm mu.


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Khi trn nhm mu ngi th vi huyt thanh mu c khng th anti-D, nu hng cu bngng kt

chng t anti-D gn vo hng cu c Rh+, mu ngi c kt lun l Rh+.

11.2.2 Dng c - thit b

- 02 lam knh

- 03 a thy tinh hay tm tre

- Bng st trng v kim chch mu

- Bn l huyt thanh mu

Huyt thanh anti A

Huyt thanh anti B

Huyt thanh anti AB

Huyt thanh anti D

11.2.3 Tin hnh:

a/ Chun b lam knh

Lam knh phi kh sch, nh du vo lam knh bng bt xa hay bt long kim trnh nhm ln

huyt thanh

Lam knh 1: Nh git huyt thanh mu ln ba vtr cch u nhau ca lam knh u hai vch nh

(bn tri lam knh) huyt thanh anti A, gia nh huyt thanh anti AB, u ba vch nh (bn phi

lam knh) huyt thanh anti B. ng knh mi git huyt thanh khong 5mm


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b/ St trng chch mu, khng cn b git u.

c/ t 3 git ln lam knh 1, cnh 3 git huyt thanh mu (lu : ng knh mi git bng khong

1/3 ng knh git huyt thanh.)

Trn u mu vi huyt thanh mu, ch dng cc u thy tinh khc nhau trn, khng

huyt thanh ln sang nhau. i 2pht c kt qu.

d/ Kt qu

Nu c hin tng ngng kt, hng cu b t li thnh tng m ( c hnh chum nho) gia huyt

thanh trong sut)

Nu khng c hin tng ngng kt: hng cu phn bu, ha tan vi huyt thanh nh pha long

mu.


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BI 13: O HUYT P NG MCH GIN TIP .KHO ST MT S YU TNH HNG LN HUYTP

13.1 i cng

13.1.1 nh ngha:

Huyt p l lc ca mu tc dng ln mi n v din tch ca thnh mch

13.1.2 n vo

n vo huyt p l mmHg hoc Kpa (Kilopascal) 1 KPa= 7,5 mmHg

13.1.3 Nguyn tc

o huyt p ng mch bng phng php gin tip

- p ng mch c ng knh tng i ln bng mt bng qun cao su. Bm hi vo bng qun.

Khi p sut trong bng qun ln hn huyt p tm thu, ng mch b p, mu khng chy qua c

- Khi p sut bng qun bng v thp hn huyt p tm thu, trong ktm thu ng mch khng b

p cht, mu chy qu ch b p, di vo ct mu ang yn tnh pha di nn gy ra ting ng.

Lc ny c th sc mch trli hoc nghe c ting ng ny. p sut trong bng qun cnggim, mi k tm thu mu chy qua cng nhiu hn cho n khi p sut bng qun bng huyt p

tm trng: Ting ng m i (muffling), ri mt hn. Ting ng nghe c gi l ting

Korotkoff.

Ting Korotkoffc chia thnh 5 giai on:

Giai on 1: Ting xut hin u tin, tng ng vi huyt p tm thu.

Giai on 2: Ting to hn, u n.

Giai on 3: Ting to ln, c l do dng mu chy xoy.

Giai on 4: Ting mi

Giai on 5: Ting mt hn


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13.2 Dng c

- ng nghe

- Huyt p kc kch thc bng qun ph hp vi cnh tay ngi c o

- ng heo tay

- Ging

- Chu ng nc

13.3THC HNH

13.3.1 Xc nh huyt p bnh thng:13.3.1.1 Phng php smch

- Sinh vin ngi, cnh tay dui trn bn, ngang tim. B l cnh tay, qun bng qun va

kht vi cnh tay, bdi bng qun cch np khuu tay 2-3cm, ngang lien sn 4 (v tr ngang

tim)

- Tm mch quay c tay bng 3 ngn tay 2,3,4. ng van. Bm khng kh vo bng qun

cho n khi khng cn thy mch p, bm them 30 mmHg, trn mc mch sau mvan lm

gim p sut t t, khong 2-3 mmHg mi giy

- Huyt p tm thu l tr s lc mch quay xut hin trli. Tip tc gim p sut trong bng

qun cho n khi 0 mmHg

13.3.1.2 Phng php nghe

Bt mch cnh tay. t phn chung hoc mng ca ng nghe ln trn ng mch cnh tay.

Bm kh vo bng qun n tr s cao nht bm ln trc ( o bng phng php smch).

Mvan, gim p sut t t (2-3 mmHg)/ 1 giy cho n khi nghe ting ng u tin, l

huyt p tm thu. Tip tc gim p sut trong bng qun ting ng gim cng mt hn. Tr s


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tng ng vi lc ting ng mt hn l huyt p tm trng. Trong trng hp ting ng gim

hn trc khi mt th phi ghi r tr s huyt p lc ting ngg gim v mt hn.

V d: 120/80-70 mmHg

13.3.1.3 Kt quo huyt p

So snh huyt p tm thu, c c bng hai phng php ( huyt p tm thu o c bng

phng php nghe ln hn huyt p tm thu o c bng phng php bt mch t 2-5 mmHg)

13.3.2 Tng quan gia huyt p tm thu v huyt p tm trng

Huyt p tm trng = HATT/2*10mmHg

Tri s huyt p bnh thng ngi ln 140/90 mmHg

13.3.3 Mt s nguyn nhn lm sai lch huyt p.

- Huyt p k: kim chkhng ng s 0 mmHg. Nu dng huyt p kng h phi kim tra i

chiu vi huyt p thy ngn 6 thng mt ln.

- Kch thch bng qun phi ph hp: chiu rng ti hi bng 40% chu vi cnh tay, chiu di bng

80% chu vi cnh tay hay khong hai phn 3 chiu di cnh tay.

- o huyt p nhiu ln cng mt cnh tay lm tr mu trong tnh mch cng tay.

- Khng nghe r, khng nhn r, nhn nh sai ting ng. Xhi qu nhanh khng c kp.

- Bnh nhn khng tun th nhng iu sau

Khng ung c ph trc 01 gi.

Khng ht thuc trc 15 pht.

Khng dng thuc kch thch giao cm ( nh mi), v ph giao cm (nh mt lm gin ng t)Th gin

Khng mt m


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13.3.4 Kho st cc yu tnh hng

13.3.4.1 nh hng ca trng lc

o huyt p cc t th khc nhau:

-T thc th:

+ Nm , tay ngang tim

+ ng dy t ngt, tay ngang tim (o tc khc)

- T th cnh tay:

+ Ngi, tay ngang tim

+ Ngi, tay gi cao khi i

+ Ngi, nghing ngi sang mt bn tay cng di tim cng tt.

-Ghi v gii thch kt qu.

Huyt p Nm Ngi ng

Tm thu mmHg

Tm trng mmHg

Huyt pCnh tay ngang

timCnh tay gi cao Cnh tay h thp

Tm thu mmHg

Tm trng mmHg


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Huyt p Trc khikch thch au

0 pht 2 pht 4 pht 6 pht 8 pht

HA tm thu mmHg

HA tm trng mmHg

Nhp mch

+ Phn ng km: Huyt p tm thu v Huyt p tm trng tng < 22mmHg

+ Phn ng mnh: Huyt p tm thu v huyt p tm trng tng > 22mmHg


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TI LIU THAM KHO

[1] Khoa Dc- Trng H Nguyn Tt Thnh, Bi ging l thuyt Y Hc C S1, 2012, luhnh ni b.

[2] Khoa Dc- Trng H Nguyn Tt Thnh, Bi ging l thuyt Y Hc C S2, 2012, lu

hnh ni b.

[3] GS Nguyn Quang Quyn, Gin Yu Gii Phu Ngi, 2012, NXB Y Hc.

[4] GS. Phm nh Lu. Sinh L Y Khoa tp 1&2, 2009 B Mn Sinh L Hc, H Y DcTp. HCM. NXB Y Hc.

[5] FRANHK H. NETTER.MD, Alatas Gii Phu Ngi, 2010, NXB Y Hc

[6] B Mn Sinh L, Gio Trnh Thc Hnh Sinh L, 2011, i Hc Y Dc TP. H ChMinh

[7] TS. Nguyn Xun Cng, Gii Phu Sinh L Ngi, 2009. NXB Gio Dc Vit Nam

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