State Consumer Disputes Redressal Commission
Dr. Preeti Sharma W/O Shri Sunil Sharma vs Rajendra Kumar Agarwal on 5 March, 2020
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mifLFkr %& vihykFkhZ dh vkSj ls Jh foTth vxzoky vf/koDrk izR;FkhZ la[;k 1 dh vksj ls Jh ,l0ih0 vxzoky vf/koDRkk izR;FkhZ la[;k 3 dh vksj ls Jh jhrs'k /khaxM+k vf/koDRkk vkns'k fnukad 05 ekpZ] 2020 jkT; vk;ksx jktLFkku t;iqj ¼}kjk Jh dey dqekj ckxM+h] lnL; ¼U;kf;d½ ;g vihy MkWa0 izhfr 'kekZ dh vksj ls jktsUnz dqekj vxzoky ,oa vU; ds fo:) ftyk miHkksDrk fookn izfrrks"k eap] t;iqj r`rh;] t;iqj ds fu.kZ; fnukad 01 vxLr] 2016 ls O;fFkr gksdj is'k dh xbZ gSA izdj.k ds rF; bl izdkj gS fd ifjoknh dh ifRu Jherh vk'kk vxzoky dh cPpsnkuh esa rdyhQ gksus ij fnukad 22-06-05 dks mls foi{khx.k ds vLirky 2 esa HkrhZ djok;k x;kA tgka ij foi{kh laWa[;k 1 }kjk fnukad 24-06-05 dks ifjoknh dh ifRu dk vkWijs'ku fd;kA mlh jkst djhc lka; 4 cts okMZ ds jsthMs.V MkWDVjksa }kjk Jherh vk'kk vxzoky dks pk;&ikuh fiykus dh lykg nh xbZ bl ij mUgsa pk; nh xbZA dqN le; i'pkr ejht dh rch;r [kjkc gksus yxh mls cSpsuh o ?kcjkgV gksus yxhA MkWDVjksa vkSj ulksZa dks ckj&ckj dgus ij Hkh ;g dgrs gq, Vky fn;k fd lkekU; vkWijs'ku gS ,slk gksrk jgrk gSA fnukad 26-06-05 dks lqcg ejht dh rch;r dkQh fcxM++ xbZ CyM izs'kj de gks x;k] ejht rMiM+k jgh Fkh dkQh le; rd ejht dks ugha lEHkkyk x;kA dkQh vuqu; fou; djus ij ofj"B MkWDVj dks cqyk;k x;k ftlus ,Dl&js ns[kus ds ckn dgk fd izFke vkWijs'ku esa deh jg xbZ gS vr% rqjUr nqckjk vkWijs'ku djuk iM+sxkA mlh jkst fnukad 26-06-05 dh 'kke dks MkWDVj jketh ukjk;.k foi{kh lWa[;k 2 }kjk vkWijs'ku fd;k x;kA ifjoknh dh ifRu f}rh; vkWijs'ku ds i'pkr dHkh Hkh gks'k esa ugha vkbZA fnukad 29-06-05 dks mls e`r ?kksf"kr dj fn;k x;k ml le; mldh vk;q ek= 35 o"kZ FkhA izFke vkWijs'ku mis{kkiw.kZ rjhds ls fd;k x;k ftlesa ifjoknh dh ifRu dh cMh vkar dks dkV fn;k x;k vkSj mls 'kjhj esa [kqyk NksM fn;k x;k ftlls lkjs 'kjhj esa vif'k"V inkFkZ Qsy x, rFkk ifjoknh o jksxh ds }kjk ckj&ckj fuosnu djus ij foi{khx.k us dksbZ /;ku ugha fn;k vkSj bZykt esa ?kksj ykijokgh cjrhA nks fnu i'pkr viuh xyrh dks nwj djus gsrq nqckjk vkWijs'ku fd;k x;k ftlesa isV esa ls vif'k"V inkFkZ fudky dj isV esa ckbZ vksj ls ysfVªu dh uyh yxkbZ xbZ mlesa ?kksj ykijokgh cjrh xbZ ftlls ifjoknh dh ifRu rhu fnu rd gks'k esa ugha vkbZA ifjoknh dh ifRu dks fnukad 26-06-05 ls e`R;q rd lh-lh-;w- okMZ esa j[kk x;k rFkk ifjoknh o mlds ifjtuksa dks dHkh okLrfod fLFkfr ls voxr ugha djok;k u gh feyus fn;kA nokb;ksa dh iphZ rd ejht ds vVsUMsUV~l dks ugha nh xbZA ejht dks e`r ?kksf"kr djus ds i'pkr dkmUVj ij lEidZ fd;k rks irk pyk fd 20]000@& :i, MkWDVj izhfr 'kekZ }kjk tek djok, x, Fks rFkk ifjoknh dks crk;k fd cdk;k jkf'k ifjoknh dks tek djokus dh t:jr ugha FkhA ifjoknh dh ifRu ds bZykt ls lEcfU/kr fpfdRlh; nLrkost foi{khx.k ls izkIr djus ij ;g rF; Kkr gqvk fd foi{khx.k }kjk ifjokfn;k ds bZykt esa ?kksj ykijokgh cjrh xbZ tks batsD'ku fn;k tkuk vko';d Fkk og ugha fn;k x;kA fnukad 22-06-05 dks lh-lh-;w- esa HkrhZ gksuk o vkWijs'ku crk;k tcfd ml fnukad dks dksbZ vkWijs'ku ugha gqvkA ejht dk CyM xqzqi , ikWthfVo crk;k x;k 3 tcfd mls , usxsfVo xqzi dk CyM fn;k x;kA vkWijs'ku ds nkSjku ifjokfn;k dh ifRu dh cM+h vkWar dV tkus ij mls [kqyk NksM +fn;k x;k rFkk mldk dksbZ bZykt ugha fd;k x;k tks foi{khx.k }kjk dkfjr xEHkhj ykijokgh gS tks lsoknks"k dh Js.kh esa vkrh gS ftlds fy, foi{khx.k la;qDr% o i`FkDr% mRrjnk;h gSaA foi{kh lWa[;k 1 dh vksj ls tokc esa ;g dFku fd;k x;k gS fd ifjoknh dh ifRu Jherh vk'kk nsoh dks ekgokjh ds nkSjku vR;f/kd jDrL=ko o nnZ dh f'kdk;r Fkh ftlds bZykt ds lEcU/k esa mls fnukad 22-06-05 dks vLirky esa HkrhZ djok;k x;k FkkA Jherh vk'kk nsoh dks vafre fMyhojh 1997 esa gqbZ FkhA o"kZ 1997 essa Tubectomy (Sterilization) mlds }kjk djok;k x;k FkkA vR;f/kd jDrL=ko jgus ds dkj.k nks o"kZ iwoZ mlus Mh ,.M lh djokbZ Fkh rFkk iqu% Qjojh 05 esa Hkh d`".kk gkWfLiVy esa Mh ,.M lh djokbZ FkhA Jherh vk'kk nsoh dh Biopsy gqbZ Fkh ftlesa Proliferative phase with Cystic Glandular Hyperplasia dh iqf"V gqbZ FkhA fnukad 16-02-05 dks lksuksxzkQh esa mlds ysQV vkWojh esa 65 X 47 mm dk Cyst ik;k x;k Fkk rFkk bZ lh th esa Sinus Bradycardia ifjyf{kr gqbZ FkhA Jherh vk'kk nsoh dh lEiw.kZ tkap djus ds i'pkr fnukad 24-06-05 dks foi{kh lWa[;k 1 MkW0 izhfr 'kekZ }kjk MkWDVj xqatu o MkW0 lhek vxzoky] MkW0 'kksHkk ikjk'kj o flLVj 'khuk dh lgk;rk ls Laparoscopic Assisted Vaginal Hysterectomy with Lt. Ovary Cystectomy lEiUu dh xbZ ftldk mYys[k tokc esa fd;k x;k gSA vkWijs'ku ds i'pkr Jherh vk'kk nsoh dks vijkUg 12-45 okMZ esa yk;k x;kA foi{kh lWa[;k 1 us mls fnukad 24-06-05 dh la/;k ij iqu% ns[kk rks fdlh izdkj dh dksbZ f'kdk;r ugha dh xbZ] mls fn, tk jgs VªhVesaV dks tkjh j[kus dh lykg nh xbZA nwljs fnu fnukad 25-06-05 dks izkr% Jherh vk'kk nsoh dh tujy d.Mh'ku Qs;j Fkh iYl jsV 80 izfr feuV o ch-ih- 130@80 FkkA dksbZ Qhoj rFkk bUQsD'ku ugha FkkA fnuakd 25-06-05 dks 'kke dks tc Jherh vk'kk nsoh dh tkap dh xbZ rc Hkh mldh tujy d.Mh'ku Qs;j Fkh] VsEizspj ukWeZy Fkk ysfdu ,CMksesu esa FkksM+k fMLVsu'ku ¼QqykoV½ FkhA mls mfpr VªhVesaV fn;k x;kA fnukad 26-06-05 dks izkr% 12 ls 1 cts ds e/; Jherh vk'kk nsoh dks isV ds fupys fgLls essa nnZ o lkal ysus esa rdyhQ dh f'kdk;r gqbZA M~;wVh MkWDVj }kjk ns[kk x;k o mRrjnkrk foi{kh dks lwfpr fd;k x;kA Jherh vk'kk nsoh ds ,CMksfeuy ,Dtkfeus'ku esa yksvj ,CMksesus lightly tense ik;k x;k o Bowel Sounds 4 Sluggish ik, x,A nnZ fuokj.k gsrq mfpr nok nh xbZA fnukad 26-06-05 dks izkr% 7-30 cts Jherh vk'kk nsoh ds ykWvj ,CMksesu tense ik;k x;k o Bowel Sounds Sluggish ik, x,A mls izkr% 9 cts M~;wVh MkWDVj }kjk ns[kk x;k rFkk mRrjnkrk foi{kh dks lwfpr fd;k x;kA mRrjnkrk foi{kh }kjk mls vijkUg 12 cts ns[kk x;k rFkk eqWag ls dqN ugha nsus dk funsZ'k fn;k o mfpr VªhVesaV fn;k x;k o tkWap djokus ds funsZ'k fn, rFkk dsl dks fQftf'k;u MkWDVj e/kqfydk 'kekZ dks jsQj fd;k x;kA fnukad 26-06-05 dks fnu esa 3 cts foi{kh dks iqu% dsl ds ckjs esa lwfpr fd;k x;k rc ejht dks lh lh ;w esa f'kQ~V fd;k x;kA tkap fjiksVZ ls nksigj 3-30 cts e/kqfydk 'kekZ us ;g ik;k fd Diaphragm ds uhps xSl Fkh tks fd suggestive of perforation FkkA Jherh vk'kk nsoh dh ,Dl&js fjiksVZ o fQftf'k;u MkW0 e/kqfydk 'kekZ ds vkWCtjos'ku dks /;ku esa j[krs gq, ltZu MkW0 jkethukjk;.k dks jSQj fd;k x;k] rnqijkar Jherh vk'kk nsoh ltZu MkW0 jkethukjk;.k dh ns[kHkky esa jghA MkW0 jkethukjk;.k }kjk vk'kk nsoh dk fnukad 26-06-2005 dks vkWijs'ku fd;k x;k ftl nkSjku Laparotomy, Peritoneal Toilet , Repair of Rectum perforation o Sigmoid Colostomy [ surgical creation of an artifical opening between sigmoid and proximal portion of colon] dh xbZA vkWijs'ku djus ds i'pkr Hkh ejht ltZu MkW0 jkethukjk;.k dh ns[kHkky esa jghA fnukad 29-06-05 dks mls Cardiac Arrest gqvk rFkk reke iz;klksa ds ckotwn mls cpk;k ugha tk ldk rFkk lka; 6-55 ij mls e`r ?kksf"kr dj fn;kA e`R; q dk dkj.k Multiple Organ Failure o Septicemia vafdr fd;k x;kA ifjokfn;k ds bZykt esa foi{kh laWa[;k 1 }kjk fdlh izdkj dh ykijokgh ugha cjrh xbZ gS iw.kZ lko/kkuh ds lkFk fpfdRlh; ekin.Mksa ds vuq:i mldk le;≤ ij lgh mipkj fd;k x;k gSA bZykt esa dfFkr ykijokgh ls lEcfU/kr rF;ksa dk ifjokn esa xyr mYys[k fd;k x;k gSA fdlh izdkj dh dksbZ ykijokgh vFkok lsoknks"k mRrjnkrk }kjk dkfjr ugha fd;k x;k gSA foi{kh lWa[;k 2 o 3 dh vksj ls tokc esa ;g dFku fd;k x;k gS fd ifjoknh dh ifRu ds bZykt esa fdlh izdkj dh dksbZ ykijokgh ugha cjrh xbZ gSA gkWLihVy ds LVkQ }kjk fdlh izdkj dh lsokvksa esa dksbZ =qfV ugha dh xbZ gSA MkW0 izhfr 'kekZ }kjk fn;k x;k tokc lgh gS mlls fdlh izdkj dh dksbZ usxyhtsUlh foi{khx.k dh gksuk ugha ik;h tkrh gSA foi{kh lWa[;k 1 ds tokc dk leFkZu djrs gq, foi{kh lWa[;k 2 o 3 us mlh vuq:i vius tokc esa dFku fd, 5 gSaA tokc esa ;g mYys[k Hkh fd;k x;k gS fd fnukad 26-06-05 dks crk fn;k x;k Fkk fd ejht dh fLFkfr xEHkhj gS vkSj lSfd.M ltZjh gkbZ fjLdh gSA bl lEcU/k esa ifjoknh i{k dh dUlUV ys yh xbZ FkhA vkWijs'ku o vkWijs'ku ds ckn foi{kh lWa[;k 2 dh vksj ls o gkfLiVy dh vksj ls fdlh Hkh izdkj dh dksbZ ykijokgh ugha cjrh xbZ gSA foi{kh lWa[;k 2 }kjk vfoyEc vkWijs'ku fd;k x;k Fkk ysfdu rc rd is'ksaV dh fLFkfr dkQh xEHkhj gks pqdh Fkh vkSj mls cpk, tkus ds fy, vkWijs'ku fd;k tkuk vko';d FkkA tokc esa ;g Hkh crk;k gS fd ^^,^^ usxsfVo CyM ;k IykTek ^^,^^ is'ksUV dks dzkl eSfpax ds ckn fn;k tk ldrk gSA ejht dks ^^,^^ usxsfVo IykTek VªkUlIykUV fd;k x;k Fkk ,slk djus ls igys dzkl eSp fd;k x;k FkkA foi{kh lWa[;k 2 dh vksj ls ejht ds vkWijs'ku o bZykt esa fdlh izdkj dh dksbZ ykijokgh ugha cjrh xbZ gSA cgl lquh ,oa i=koyh dk voyksdu fd;kA ;g izdj.k fpfdRlh; vlko/kkuh dk gSA ifjoknh dh iRuh ds cPpsnkuh esa rdyhQ gksus rFkk CyhfMax gksus ds dkj.k fnukad 22-06-2005 dks HkrhZ djok;k x;k] fnukad 24-06-2005 dks ejht dk vkWijs'ku fd;k x;kA fnukad 26-06-2005 ls ejht dh rfc;r [kjkc gksus ij mldk nckjk vkWijs'ku djok;k x;kA ejht f}rh; vkWijs'ku ds ckn dHkh gks'k esa ugha vk;hA ejht dk izFke vkWijs'ku MkWa0 izhfr 'kekZ us fd;k Fkk] f}rh; vkWijs'ku MkWa0 jkethukjk;.k us fd;k FkkA fnukad 29-06-2005 dks ejht dh e`R;q gks x;h e`R;q dk dkj.k Septicemia o Multiple Organ Failure FkkA ejht tc HkrhZ gqbZ rc mldh fLFkfr lkekU; FkhA ifjoknh ds vuqlkj izFke vkWijs'ku xyr dj fn;k x;k tks ,d izdkj ls lkekU; vkWijs'ku Fkk ijUrq ;wjsVj ds lkFk vU; vksxZu dkV fn;s ejht ds isV esa xUnxh QSy x;h nqckjk vkWijs'ku fd;k x;k gkWfLiVy esa gh ejht ds Septicemia gks x;k rFkk ejht ds Multiple Organ Failure ls e`R;q gks x;hA bl izdkj ifjoknh ds ftEes tks Hkkj Fkk og ifjoknh us 'kiFk&i= o nLrkost ls buf'k;yh lkfcr dj fn;k gSA vc bldk Hkkj foi{khx.k ij vk tkrk gSA bl laca/k esa ekuuh; loksZPp U;k;ky; us fuEu fu/kkZfjr fd;k gS%& bl laca/k esa II (2009) CPJ 61 SC NIZAM INSTITUTE OF MEDICAL SCIENCES Vs. PRASANTH S. DHANANKA esa ekuuh; loksZPp U;k;ky; us fuEu fu/kkZfjr fd;k gS %& 6
(ii) Medical Negligence--Burden of Proof -- Initial burden to prove medical negligence discharged by complainant - Burden shifts on hospital/attending doctors to satisfy Court that there was no lack of care or deligence.
(2004) 8 SCC page 56 SAVITA GARG (SMT) Vs. DIRECTOR, NATIONAL HEART INSTITUTE esa ekuuh; loksZPp U;k;ky; us fuEu fu/kkZfjr fd;k gS %& D. Consumer Protection Act, 1986 - Ss. 22, 18, 12 and 13 -Mecical negligence -- Burden of proof -Held, once aclaim petition is filed and the complainant has successfully discharged the initial burden that the hospital/clinic/doctor was negligent, and that as a result of such negligence the patient died, then in that case the burden lies on the hospital and the doctor concened who treatedthe patient to show that there was no negligence involved in the treatment - Reasons for, given - Torts - Medical negligence--Burden of proof vc foi{khx.k dks lkfcr djuk Fkk fd ejht dk bZykt iw.kZr% Skill & Care ls fd;k x;kA ;g izdj.k fpfdRlh; vlko/kkuh dk gS bl laca/k esa ekuuh; loksZPp U;k;ky; us fuEu fu/kkZfjr fd;k gS %& bl lac/a k esa (2005) 6 Supreme Court Cases 1 JACOB MATHEW Vs STATE OF PUNJAB AND AN OTHER esa ekuuh; loksZPp U;k;ky; us fuEu fu/kkZfjr fd;k gS %& J. Tort -Negligence - Medical Negligence -When actionable - Test for Approach to be taken in dealing with cases of - Rationable for differential treatment of medical profession, discussed in extenso - Duties undertaken by doctors enumerated - Held, in a claim of medical negligence, it is enough for defendant to show that standard of care and skill attained was that of the ordinary competent medical practitioner exercising an ordinary degree of professional skill - Test for medical negligence laid down in Balam case, (1957) 2 All ER 118, 121 D-F [set out in para 19 herein], held, applicable in india -Further explained in detail when deviation from normal 7 medical practice would amount to evidence of medical negligence - various issues clarified as to (1) state of knowledge by which standard of care is to be determined, (2) Standard of care in case of charge of failure (a) to use some particular equipment, or (b) to take some precaution, (3) enquiry to be made when alleged negligence is (a) due to an accident, or (b) due to an error of judgment in choice of a procedure or its execution--Considerations to be kept in mind by any forum trying issue of medical negligence, specified - Medical Practitioners K. Tort -Negligence - Professional negligence--when actionable--Test for--Held, a professional may be held liable for negligence either (1) wnen he was not possessed of the requisite skill which he professed to have possessed, or (2) when he did not exercise, with reasonable competence in the given case, the skill which he did possess--Standard to be applied would be that of an ordinary competent person exercising ordinary skill in that profession--Test for professional negligence laid down in Bolam case, (1957) 2 All ER 118, 121 D-F [set out in para 19 herein], held, applicable in India - Professional negligence distinguished from occupational negligence.
N. Tort -Negligence-Definition and meaning (jurisprudential and forensic), discussed in estenso -Words and phrases The jurisprudential concept of negligence defies any precise definition. In current forensic speech, negligence has three meanings. They are: (i) a state of mind, in which it is apposed to intention; (ii) careless conduct; and (iii) the breach of a duty to take care that is imposed by either common or stature law. All three meanings are aplicable in different circumstances but any one of them does not necessarily exclude the other meanings. (Paras 10 and 11) Negligence is the breach of a duty caused by omission to do domething which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do. Negligence becomes actionable on account of injury resulting from the act or omission 8 amounting to negligence attributable to the person sued. The essential components of negligence, as recognised, are three:
"duty", "breach" and "resulting damage", that is to say:
(1)the existence of a duty to take care, which is owed by the defendant to the complainant;
(2)the failure to attain that standard of care, prescribed by the law, thereby committing a breach of such duty; and (3)Damage, which is both causally connected with such breach and recognised by the law, has been suffered by the complainant.
(4) If the Claimant satisfies the court on the evidence that these three ingredients are made out, the defendant should be held liable in negligence.
2010 (I) RLW 722 (SC) Kusum sharma & ors. Vs. Batra Hospital & Medical Research Centre & ors. esa fpfdRlh; ykijokgh ds laca/k esa ekuuh; loksZPp U;k;ky; us fuEu fn'kk&funsZ'k fn;s gS%& "On scrutiny of the leading cases of medical negligence both in our country and other countries specially the United Kingdom, some basic principles emerge in dealing with the cases of medical negligence. While deciding whether the medical professional is guilty of medical negligence following well known principles must be kept in view:
I. Negligence is the breach of a duty exercised by ommission to do somethingwhich a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.
II. Negligence is an essential ingredient of the offence. The negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgment.
III. The medical professional is ecpected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence 9 judged in the light of the particular circumstances of each case is what the law requires.
IV. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonable competent practitioner in his field.
V. In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other professional doctor.
VI. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but highest chances of failure. Just because a professional looking to the gravity of illness has taken higher element of risk to redeem the patient out of his/her suffering which did not yield the disired result may not amount to negligence.
VII. Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession. VIII. It would not be conducive to the effciency of the medical profession if no doctor could administer medicine without a halter round his neck.
IX. It is our bounden duty and obligation of the civil society to ensure that the medical professionals are not unnecessarily harassed or humiliated so that they can perform their professional duties without fear and apprehension.
X. The medical practitioners at times also have to be saved from such a class of complainants who use criminal process as a tool for pressurising the medical professionals/hospitals, particularly private hospitals or clinics for extractine uncalled for compensation. Such 10 malicious proceedings deserve to be discarded against the medical practitioners.
XI. The medical professionals are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals.
ekuuh; loksZPp U;k;ky; }kjk izfrikfnr fl)kUrksa dks ns[krs gq, ;g ns[kuk gS fd foi{khx.k us iw.kZ Skill & Care ls bZykt fd;k ;k ugha \ foi{khx.k larksdck nqyZHkth eseksfj;y gkWfLiVy izkbZoV gkWfLiVy gS rFkk nksuksa fpfdRld fo'ks"kK gSA bl fLFkfr esa foi{khx.k dk ;g drZO; gks tkrk gS fd High Skill & care ls ejht dk bZykt djsa ejht ds cPpsnkuh esa rdyhQ FkhA ejht dks vihykFkhZ dks fn[kk;k x;k rFkk vihykFkhZ dh lykg ij 22-06- 2005 dks HkrhZ fd;k x;k] fnukad 24-06-2005 dks vkWijs'ku fd;k x;k blls iwoZ VsLV djok;s x;s ejht ds ECG djus ds ckn Sinus bradycardia vk;k Fkk tks ân; ls lacfa /kr gSA Sinus bradycardia ds ckjs esa Davidson's Principles and Practice of Medicine iqLrd ds ist la[;k 469 ij fuEu crk;k x;k gS%& This may occur in healthy people at rest and is a common finding in athletes. Some pathological causes are listed in Box 16.19 If sinus bradycardia is asymptomatic then no treatment is required. Symptomatic sinus bradycardia may occur acutely during an Ml and can be treated with intravenous atropine (0.6-1.2 mg). Patients with recurrent or persistent symptomatic sinus bradycardia should be considered for pacemaker implantation.
bl izdkj ls ;g ân; ls lacfa /kr nks"k gSA bl lac/a k esa MkWa0 v'kksd tSu ân; jksx fo'ks"kK dks fn[kk;k x;k ijUrq MkWa0 v'kksd tSu us D;k lykg nh rFkk dksulh nokbZ nh] ,MOkkbZt nh ;g rF; fjdkMZ ij ugha gS] ijUrq ,sls ekeys esa lk/kkj.kr;k Atropine nok nh tkrh gSA 11 ejht dk vihykFkhZ dks vkWijs'ku djuk Fkk ejht dh lgefr yh x;h gS mlesa ejht dk Hysterectomy djus dh lgefr yh x;hA ejht dh fdl izdkj Hysterectomy dh x;h ;g dUlsaV ysVj ls Li"V ugha gSA Hysterectomy ds laca/k esa Stedman's Medical Dictionary ds ist 940 ij fuEu izdkj crk;k x;k gS%& Hysterectomy Removal of the uterus, unless otherwise specified, usually denotes complete removal of the uterus (corpus and cervix) (hystero + G. ektome, excision) abdominal h . removal of the uterus through an incision in the abdominal wall SYN abdominohysterectomy.
Abdominovaginal h. a combined vaginal and abdominal surgical dissection that allows partial or complete removal of vagina, vulva, rectum and perineum (abdominoperineal approach) as well as pelvic organs; usually done in cases of advanced pelvic cancer.
Cesarean h. cesarean section followed by h.SYM porro h.
laparoscopic assisted vaginal h. vaginal h. in which the ovarian pedicle, broad ligament and uterosacral ligaments are surgically served using laparoscopic instruments and the procedure completed through a colpotomy done in the typical fashion.
Modified radical h. an extended h. in which a portion of the upper vagina is removed, the utreters are exposed and pulled back laterally without dissection from the ureteral bed SYN Telinde operation.
Porro h. SYN cesarean h.
radical h. complete removal of the uterus, upper vagina and parametrium subtotal h. SYN supracervical h.
supracervical h. removal of the fundus of the uterus, leaving the cervix in situ. SYN subtotal h.
vaginal h. removal of the uterus through the vagina without incising the wall of the abdomen.SYN colpohysterectomy, vaginohysterectomy.12
ejht dk vkWijs'ku vihykFkhZ }kjk fd;k x;k vkWijs'ku uksV bl izdkj gS%& Patient placed in lithotomy position. Part cleaned and draped. Crevix [neck of uterus; the lower and narrow end of uterus, between the isthmus and the ostium uteri] held with volsellum and uterine manipulator inserted. 3 ports made in the abdominal wall. One major & two small. Laparoscope introduced --- interior seen. Uterus normal in shape. Rt. side adenexa normal. 5 X 6 Cm. large cyst present on left side adhered to the omentum and lateral wall. Flimsy adhesions also present to the anterior abdominal wall. Adhesiolysis [separation of adhesions] done. Ist right side and then left side. Round ligament, Fallopian Tube and Ovarian Ligament clamped and ligated with a portion of Broad Ligament. Cyst ruptured and contents aspirated. Then Hysterectomy proceeded through vaginal route. Bladder pushed up. Anterior and Posterior pouch opened in usual way. Macken Rodt's [tissues that connect uterus with side wall], Uterine Artery and portion of Broad Ligament clamped, cut and ligated. Uterus with Cervix taken out. Stitch taken to support the Bladder. Vaginal Vault closed. Foley's catheterization done [Catheter is put in Bladder]. Clean urine drained. Vaginal packing done. Patient stood procedure well. Specimen sent for Histo-Pathological Examination [HPE}.
bl vkWijs'ku ds ckn ejht 2 fnu Bhd jgh mlds ckn mldh gkyr [kjkc gksrh x;h] ejht dks MkWa0 jkethukjk;.k ds ikl f'k¶V fd;k x;k rFkk MkWa0 jkethukjk;.k us ejht dk vkWijs'ku djus dk fu.kZ; fy;k ejht dk tks vkWijs'ku gksuk Fkk og Laparotomy gS ftldk Black's Medical Dictionary ds ist 348 ij fuEu vFkZ gS%& Laparotomy A general term applied to any operation in which the abdominal cavity is opened. A laparatomy may be exploratory to establish a diagnosis or as a preliminary to major surgery. Viewing of the peritoneal cavity through an endoscope is called a laparoscopy or peritoneoscopy.
vkWijs'ku ds le; gh ejht ds lsfIVd 'kksd o pyaemia Fkk ftlds ckjs esa fuEu fLFkfr gS%& loZizFke lsIVhflfe;k o lsfIll ds ckjs esa fopkj fd;k tk jgk gSA Stedman's Medical Dictionary 28th Edition ds ist uacj 1750 ij crk;k x;k gS %& 13 Septicemia- Systemic disease caused by the spread of microorganisms and their toxins through circulating blood, formerly called 'blood poisoning' See also pyemia, becateremia. See page C 5 SYN septic fever, septic intoxication (G. sepsis puttefaction +haima, blood) acute fulminating menigococcal s- SYN waterhouse- Friderichsen syndrome anthrax s- SYN anthracemia cryptogenic s - a form of s. in which no primary focus of infection can be found metastasizing s- sepsis with entry of mnocroorganisms into the bloodstream leading to abscess formation at a distance from the original site of infection morphine injector's s- obsolete term for bloodstream infection in someone who self injects narcotics, usually intrvenously due to bacterial contamination of equipment used. Seen more often with heroin and other narcotics other than morphine.
Plague s- infection with the plague organism. Yersinia pestis, with bloodstream infection puerperal s- a severe bloodstream infection resulting from an obstetric delivery or procedure typhoid s- typhoid during the phase when the organism can be cultured from the blood SYN typhosepsis Sepsis ds Salient Features Standard Treatment Guidelines A Manual for Medical therapautics ds ist uacj 119 ij crk;k x;k gS %& SALIENT FEATURES Sepsis is life threatening organ dysfunction caused by a dysregulated host response to infection.
Infection: A suspected or proven infection caused by any pathogen or a clinical syndrome associated with a high probabiity of infection. Evidence of infection includes positive findings on clinical examination, imaging or laboratory tests (e.g. leucocytes in a normally sterile body fluid, perforated viscus, chest radiograph consistent with penumonia, petechial or purpuric rash or purpura fulminans) or a positive culture, tissue stain or polymerase chain reaction test.
Sepsis- Organ dysfunction can be identified as an increase in the Sequential Organ Failure Assessment (SOFA) score >2 points consequent to the infection. The baseline SOFA 14 score can be assumed to be zero in patients not known to have preexisting organ dysfunction. A SOFA score > 2 is associated with an in hospital mortality greater than 10%. In out of hospital, emergency department or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical or spesis if they have atleast 2 of the following clinical criteria:
alteration in mental status, systolic blood pressure < 100 mmHg, or respiratory rate > 22/min. Neither bedside quick Sequential Organ Failure Assessment (qSOFA) nor SOFA is intended to be a stand-alone definition or sepsis. It is crucial, however that failure to meet 2 or more qSOFA of SOFA criteria should not lead to a deferral of investigation or treatment of infection or to a delay in any other aspect of care deemed necessary. The new definition abandoned useof host inflammatory response syndrome criteria (SIRS) in identification of sepsis and eliminated the term severe sepsis.
Septic shock is a subset of sepsis in which particularly profound circulatory,cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a persisting hypotension requiring vasopressors to maintain MAP > 65 mmHg and having a serum lactate level > 2 mmol/L (18 mg/dl) despite adequate volume resuscitation. Sepsis with cardiovascular dysfunction persisting after atleast 40 ml/kg of fluid resuscitation in 1 hour.
Refractory septic shock- Fluid refractory septic shock- Shock persisting after > 60 ml/kg of fluid resuscitation. Catecholamine-resistant septic shock - Shock persists despite treatment with catecholamines (i.e. dopamine or adrenaline (epinephrine) infusion or both or noradrenaline (norepinephrine) infusion).
The initial clinical presentation of sepsis in children may be non-specific (especially in younger age groups.) lsfIVflfe;k ds lkFk tks 'kCn tqM+s gS mlesa Toxaemia ftldk Black's Medical Dictionary Edited by Gordon Macpherson MB,BS ds ist uacj 629 ij crk;k x;k gS %& TOXAEMIA- A term applied to forms of blood poisoning due to the absorption of bacterial products (Toxins) formed at some local site of infection such as ABSCESSES. In other cases the tocaemia is due to defective action of some excretory organ such as the KIDNEY. As regards treatment the most important consideration is to remove the source of infection.15
Toxaemia of PREGNANCY is a term sometimes used to describe the two complications of pregnancy known as pre- eclampsia and ECLAMPSIA.
blds lkFk tks 'kCn tqM+s gS mlesa Sepraemia ftldk Oxford Concise Colour Medical Dictionary ds ist uacj 674 ij crk;k x;k gS %& Sapraemia - blood poisoning by toxins of saprophytic bacteria (bacteria living on dead or decaying matter). Compate PYAEMIA, SEPTICAEMIA, TOXAEMIA.
blds lkFk tks 'kCn tqM+s gS mlesa pyaemia ftldk Oxford Concise Colour Medical Dictionary ds ist uacj 634 ij crk;k x;k gS %& pyaemia n. blood poisoning by pus-forming bacteria released from an abscess. The wide-spread formation of abscesses may develop, with fatal results. Compare SAPRAEMIA, SEPTICAEMIA, TOXAEMIA.
lsfIVflfe;k ds ifj.kkeLo:i ejht lsfIVd 'kksd esa vk tkrk gS ftlls mldh e`R;q gks ldrh gSA Septic Shock ds ckjs esa Black's Medical Dictionary Edited by Gordon Macpherson MB,BS ds ist uacj 557 ij crk;k x;k gS %& Septic Shock- A dangerous disorder characterized by a severe fall in blood pressure and damage to the body tissues as a result of SEPTICAEMIA. The toxins from the septicaemia cause widespread damage to tissue, provoke clotting in small blood vessels and seriously disturb the circulation. The kidneys, lungs and heart are particularly affected. The condition occurs most commonly in people who already have a chronic disease such as cancer, cirrhosis of the liver or diabetes mellitus. Septic shock may also develop in patients with immunodeficiency illnesses such as AIDS. The symptoms are those of septicaemia coupled with those of shock, cold, cyanotic limbs, fast thready pulse and a lowered blood pressure. Septic shock requires urgent treatment with antibiotics, intravenous fluids and oxygen.
lsfIVflfe;k dk eq[; dkj.k csfDVfj;k gksrk gS ftlls cpus dh vko';drk gksrh gSA blds ckjs esa Illustrated Medical Dictionary ds ist uacj 63 ij crk;k x;k gS %& Bactereria- Single-celled microorganisms that are invisible to the naked eye. The singular form of the term is bacertium. Abundant in the air, soil, and water, most bacteria 16 are harmless to humans. Some bacteria such as those that live in the intestine are beneficial and help to break down food for digestion. Bacteria that cause disease are known as pathogens and are classified by shape into three main groups: cocci (spherical) ; bacilli (rod shaped) and spirochaetes or spirilla (spiral shaped). Many bacteria have whiplike threads called flagella, which enable them to move in fluids and pili which anchor them to other cells.
Aerobic bacteria require oxygen to grow and multiply in the body these are most commonly found on the skin or in the respiratory system. Anaerobic bacteria thrive where there is no oxygen deep within tissue or wounds. They reproduce by simple division which can take place every 20 minutes. Some bacteria also produce spores that can survive high temperatures, dry conditions and lack of nourishment and some produce poisons (either endotoxis or exotoxins) that are harmful to human cells.
The body's immune system attacks invading bacteria but in some cases treatment with antibiotic drugs is necessary and will speed recovery. Superficial inflammation and infected wounds may be treated with antiseptics. Immunity to invading bacterial diseases such as some types of meningitis can be acquired by active immunization (See also infecious disease) blds vykok vkWijs'ku ds le; esa ejht ds Peritonitis Fkk Stedman's Medical Dictionary ds ist 1465 ij fuEu izdkj crk;k x;k gS%& per-i-to-ni-tis Inflammation of the peritoneum adhesive p. a form of p. in which a fibrinous exudate occurs matting together the intestine and various other organs. Benign paroxysmal p. SYN familial paroxysmal polyserostitis bile p. inflammation of the peritoneum caused by the escape of bile into the free peritoneal cavity chemical p. due to the escape of bile contents of the gastrointestinal tract or pancreatic juice into the peritoneal cavity; the contents of the fluid cause chemical injury, shock and peritoneal exudation before any associated infection has occurred.
Chyle p. due to free chyle in the peritoneal cavity circumscribed p. syn localized p.17
p.deformans a chronic p. in which thickening of the membrane and contracting adhesions shortens the mesentery and causes kinking and retration of the intestines.
Diaphragmatic p. affecting mainly the peritoneal surface of the diaphragm diffuse p. syn general p.
p.encaposulans a localized fibrous or adhesive p. remaining after a generalized p. has nearly disappeared it is marked by pain, constipation and a palpable tumor.
Fibrocaseous p. characterized by caseation and fibrosis usually caused by the tubercle bacillus.
Gas p. inflammation of the peritoneum accompanied by an intraperitoneal accumulation of gas.
General p. throughout the peritoneal cavity syn diffuse p.
localized p. p.confined to a demarcated region of the peritoneal cavity syn circumscribed p.
meconium p. caused by intestinal perforation in the fetus or newborn; associated with congenital obstruction or due to cystic fibrosis.
Pelvic p. generalized inflammation of the peritoneum surrounding the uterus and uterine tubes syn pelvioperitonitis, pelviperitonitis.
bu nksuksa ifjfLFkfr;ksa esa gh ejht dk vkWijs'ku djuk vR;f/kd gkbZ fjLd Fkk blds ckotwn ejht dk vkWijs'ku fd;k x;k] fuf'pr :i ls ejht dh fLFkfr xaHkhj gksxh rFkk ejht dk vkWijs'ku djuk vko';d gksxk rc gh vkWijs'ku fd;k x;k ejht dh HkrhZ ls ysdj e`R;q rd fofHkUu tkWap fjiksVksZ dk voyksdu djsa rks ejht tc HkrhZ gqbZ Fkh rFkk igys vkWijs'ku gqvk Fkk rc mldh fLFkfr lkekU; Fkh ijUrq ckn esa WBC RBC fgeksXyksfcu o IysVysV~l dh fLFkfr fcxM+rh x;h] IysVysV~l bruk de Fkk dh ejht Hk;adj baQDs 'ku dh fLFkfr esa Fkk f}rh; vkWijs'ku esa ejht ds Laparotomy, Peritoneal Toilet, Repair of Rectum Perforation o Sigmoid Colostomy dk vkWijs'ku fd;k x;kA Laparotomy dk fpfdRlh; vFkZ Åij crk;k tk pqdk gS] Peritoneal dk vFkZ Åij crk;k tk pqdk gS] rhljk Rectum Perforation dh ejEer gSA Rectum dk vFkZ Black's Medical Dictionary ds ist uacj 531 ij crk;k x;k gS %& 18 Rectum The last part of the large intestine. It pursues a more or less straight course downwards through the cavity of the pelvis, lying against the sacrum at the back of this cavity. This section of the intestine is about 23 cm (9 inches) long. Its first part is freely movable and corresponds to the upper pieces of the sacrum, the second part corresponds to the lower two pieces of the sacrum and the coccyx, whilst the third part known also as the anal canal is about 25 mm (1 inch) long, runs downwards and backwards and is kept rightly closed by the internal and external sphincter muscles which surround it. The opening to the exterior is known as the anus. The structure of the rectum is similar to that of the rest of the intestine.
Perforation dk vFkZ Black's Medical Dictionary ds ist uacj 476 ij crk;k x;k gS %& Perforation The perforation of one of the hollow organs of the abdomen or major blood vessels may occur spontaneously in the case of an ulcer or an advanced tumour or may be secondary to trauma such as a knife wound or penetrating injury from a traffic or industrial accident. Wharever the cause perforation is a surgical emergency. The intestinal contents which contain large numbers of bacteria,pass freely out into the abdominal cavity and cause a severe chemical or bacteral petitonitis. This is usually accompanied by severe abdominal pain, collapse or even death. There may also be evidence of free fluid or gas within the abdominal cavity. Surgical intervention to repair the leak and wash out the contamination is often necessary. Perforation or rupture of major blood vessels whether from disease or injury is an acute emergency for which urgent surgical repair is usually necessary. Perforation of hollow structures elsewhere than in the abdomen-for example the heart or oesophagus - may be caused by congenital weaknesses, disease or injury. Treatment is usually surgical but depends on the cause.
vkxs Colostomy dh x;h Sigmoid Colon ds ckjs esa Illustrated Medical Dictionary ds ist uacj 510 ij crk;k x;k gS %& Sigmoid colon The S-shaped part of the colon in the lower abdomen, extending from the brim of the pelvis usually down to the third segment of the sacrum. It is connected to the descending colon above and the rectum below.
rFkk Colostomy dk vFkZ dze'k% Black's Medical Dictionary ds ist uacj 131 o Illustrated Medical Dictionary ds ist uacj 138 ij fuEu crk;k x;k gS%& 19 Colostomy The operation for the establishment of an artificial opening into the colon. This acts as an artificial anus.
The operation is carried out when there is an obstruction in the colon or rectum that cannot be overcome or in cases, such as cancer of the rectum in which the rectum and part of the colon have to be removed. Such a colostomy opening can be trained to function in such a way that the patient can carry on a normal life, eating a more or less normal diet. Anyone wishing help or advice in the practical Colostomy An operation in which part of the colon is brought through an incision in the abdominal wall and formed into a stoma, an artificial opening through which faeces are discharged into a bag attached to the skin. A temporary colostomy may be performed at the same time as a colectomy to allow the colon to heal without faeces passing through it. The colostomy is closed when the rejoined colon has healed. A permanent colostomy is needed if the rectum or anus has been removed.
bl izdkj ejht ds isV [kksydj mlds ÍVh ds LFkku esa Hkh vkWijs'ku gqvk vU; Hkh vkWijs'ku gq, rFkk ÍVh fudkyus dk jkLrk cnyk x;k Rectum Perforation dh ejEer dh x;h tks fuf'pr :i ls Msest gksxk rHkh mldh ejEer dh x;hA bl izdkj ejht dk yEck vkWijs'ku fd;k x;k mlds i'pkr~ ejht dHkh gks'k esa ugha vk;k osUVhysVj ij Hkh jgh rFkk vUrr% 29-06-2005 dks mldh e`R;q gks x;h ejht 22-06-2005 dks HkrhZ gqbZ Fkh ml le; mlds ;wVjl ds vykok fdlh Hkh izdkj dh rdyhQ ugha Fkh ;wVjl ds vkWijs'ku ds ckn nwljs vksxZu ls NsM+NkM+ gks x;h ejht ds isV esa xUnxh Hkj x;h] ftls vkWijs'ku djds fudkyk x;k Msest vksxZu dh ejEer dh x;h ;gkWa rd fd ÍVh fudkyus dk LFkku Hkh ifjofrZr fd;k x;k ;g lc bl ckr dh vksj bafxr djrk gS fd ejht dk iww.kZ Skill & care ls bZykt ugha fd;k x;kA ejht ds gkWfLiVy esa HkrhZ ds nkSjku gh lsfIVflfe;k gqvk Fkk ftldk fooj.k Åij fn;k tk pqdk gS] ejht ds lsfIVflfe;k gqvk tks Hkkjh baQsD'ku o csfDVfj;k dk ifj.kke gS tks gkWfLiVy esa gh gqvk gSA vxj ejht dh izksij Care gksrh rks ,sls ugha gksrkA bl fLFkfr esa foi{khx.k fpfdRlh; vlko/kkuh ds nks"kh gS foi{khx.k esa ls ,d MkWa0 izhfr 'kekZ us vihy dh gSA larksdck nqyZHkth eseksfj;y gkWfLiVy us vihy ugha dh gS tc fd ejht ds Sinus bradycardia gksus ds ckotwn foi{kh la[;k 1 us vkWijs'ku fd;k rFkk mDr vkWijs'ku ls gh ejht ds nwljs vksxZu dV x;s ;k 20 Msest gks x;s ftlds ifj.kkeLo:i nwljk cM+k vkWijs'ku djuk iM+kA bl izdj.k esa eq[; xyrh vihykFkhZ dh gSA bldh vihy lkjghu gSA fo)ku ftyk eap us foi{kh la[;k 1 o 3 dks tks nks"kh ekuk gS blesa fdlh izdkj dh =qfV ugha gS u gh bl izdj.k esa DokaVe ij fopkj djus dh vko';drk gSA D;ksa fd ejht dh 35 lky dh mez Fkh rFkk fpfdRlh; ykijokgh ds ifj.kkeLo:i ejht dh e`R;q gks x;hA tks 10]00]000@&:- ¼ nl yk[k :- ½ o 12 izfr'kr okf"kZd C;kt dh {kfriwfrZ fnyk;h gS og yksvj lkbZM esa gS rFkk ifjoknh i{k us {kfriwfrZ jkf'k c<+kus dh dksbZ vihy ugha dh gSA bl fLFkfr esa vihykFkhZ dh vihy bl funsZ'k ds lkFk [kkfjt dh tkrh gS fd vihykFkhZ] vihy vkns'k rd {kfriwfrZ dh ewy jkf'k o C;kt dh jkf'k tksM+dj tks jkf'k curh gS mls ,d ekg esa ifjoknh@izR;FkhZ dks vnk djsa] ,d ekg esa vnk u djus ij vihy vkns'k dh fnukad ls {kfriwfrZ dh ewy jkf'k o C;kt dh jkf'k tksM+dj tks lEiw.kZ jkf'k curh gS ml ij 12 izfr'kr okf"kZd dh nj ls C;kt vnk djuk gksxkA ¼ehuk esgrk½ ¼dey dqekj ckxMh½ lnL; lnL; ¼U;kf;d½ @ikBd@