State Consumer Disputes Redressal Commission
Shraddhanjali Maniya & Ors. vs Jawaharlal Nehru Hospital & Research ... on 12 May, 2016
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miHkksDrk fookn Áfrrks"k.k vk;ksx] i.Mjh] jk;iqj ifjokn Øekad% CC/14/39 lafLFkr fnukad% 17.12.2014 1- J)katyh ekf.k;k] /k-i- Lo- lqjsUnz dqekj ekf.k;k] mez&29 o"kZ] fuoklh& DokVj ua-
&3 ch] lM+d&18 lsDVj&1 fHkykbZ] ftyk&nqxZ ¼N-x-½ 2- fV~oady ekf.k;k] vk- Lo- lqjsUnz dqekj ekf.k;k] mez&3 o"kZ] }kjk&oyh&J)katyh ekf.k;k /k-i- Lo- lqjsUnz dqekj ekf.k;k] fuoklh&DokVj ua-&3 ch] lM+d&18 lsDVj&1 fHkykbZ] ftyk&nqxZ ¼N-x-½ 3- eku'oh ekf.k;k] vk- Lo- lqjsUnz dqekj ekf.k;k] mez&7 ekg] }kjk&oyh&J)katyh ekf.k;k /k-i- Lo- lqjsUnz dqekj ekf.k;k] fuoklh&DokVj ua-&3 ch] lM+d&18 lsDVj&1 fHkykbZ] ftyk&nqxZ ¼N-x-½ -----ifjoknhx.k fo:) 1- tokgj yky usg: fpfdRlky;
,oa vuqla/kku dsUnz fHkykbZ }kjk& Mk;jsDVj@izHkkjh% tokgj yky usg:
fpfdRlky; ,oa vuqla/kku dsUnz fHkykbZ lsDVj&9] fHkykbZ] ftyk&nqxZ ¼N-x-½ 2- MkW- ,-ds-xxZ tokgjyky usg: fpfdRlky;
,oa vuqla/kku dsUnz fHkykbZ lsDVj&9] fHkykbZ] ftyk&nqxZ ¼N-x-½ 3- fHkykbZ bLikr la;a= }kjk&eq[; dk;Zikyd vf/kdkjh // 2 // bLikr Hkou] fHkykbZ bLikr la;a=] ftyk&nqxZ ¼N-x-½ -----fo:) i{kdkjx.k le{k% ekuuh; U;k;ewfrZ Jh vkj-,l-'kekZ] v/;{k ekuuh; lqJh ghuk BDdj] lnL;k ekuuh; Jh ujsUnz xqIrk] lnL;
ekuuh; Jh Mh-ds-iksn~nkj] lnL;
i{kdkjksa ds vf/koDrk ifjoknh dh vksj ls Jh vuqjkx Bkdj] vf/koDrkA vukosnd dza-2 lfgr 'ks"k }kjk Jh vkj-ds-Hkkoukuh] vf/koDrkA vkns'k fnukad% 12@05@2016 }kjk% ekuuh; lqJh ghuk BDdj] lnL;k jkT; miHkksDrk fookn izfrrks"k.k vk;ksx ds le{k ifjoknhx.k }kjk ifjokn i= varxZr /kkjk&17 miHkksDrk laj{k.k vf/kfu;e izLrqr dj vukosndx.k ds fo:) fpfdRlh; mis{kk dk vkjksi yxkrs gq, muls ;g vuqrks"k fnyk;s tkus dh izkFkZuk dh xbZ gS fd e`rd Lo- lqjsUnz dqekj ekf.k;k ds }kjk izkIr dh tk ldus okyh Hkkoh vk; 20]25]000@&:-
]¼chl yk[k iPphl gtkj :i;s½ laHkkfor vk; esa o`f) 90]000@&:-]¼uCcs gtkj :i;s½ ekufld larki 'kkjhfjd d"V o vkfFkZd gkfu gsrq 2]00]000@&:-¼nks yk[k :i;s½] {kfriwfrZ] okn O;; ,oa vf/koDrk 'kqYd 20]000@&:-¼chl gtkj :i;s½ fnyk;h tkosA 2- izdj.k esa Lohd`r rF; ;g gS fd e`rd Lo- lqjsUnz dqekj ekf.k;k mipkj gsrq vukosnd dza-1 fpfdRlh; laLFkku esa laidZ dj vukosnd dza-2 dk;Zjr fpfdRld MkW- ,-ds- xxZ ls mipkj izkIr fd;k FkkA izLrqr ifjokn dk la{ksi lkj bl izdkj gS fd ifjokfnuh dza-1 ds ifr Jh lqjsUnz dqekj ekf.k;k fHkykbZ bLikr la;a= vukosnd dza-3 esa dk;Zjr Fkk ,oa mlds xys esa nnZ dh f'kdk;r FkhA vukosnd dza-1 laLFkku esa mipkj gsrq laidZ fd;s tkus ij fpfdRldksa }kjk HkrhZ gksus dh lykg nh xbZA vr% // 3 // ejht us fnukad 15-05-2014 ds nksigj 2 cts vukosnd dza-1 ds laLFkku okMZ dza-1 esa mipkj gsrq HkrhZ gqvkA tgka mldh lkekU; tkap dh xbZ] ftlds vuqlkj mldh fLFkfr lkekU; ikbZ xbZ o ejht ds nkfgus Vkafly esa il Hkjus dh leL;k crkbZ xbZ Fkh] mlh frfFk dks ejht dks ,UVhck;ksfVd nokbZ;ka nh xbZ Fkh o ejht dks iqu% 6 cts tkap dh xbZ] rc mldh fLFkfr lkekU; ikbZ xbZ o iwoZ fyf[kr nokbZ;ksa dks ysrs jgus dh lykg Hkh nh xbZ FkhA nwljs fnu fnukad 16-05-2014 dks ejht dh iqu% tkap dh xbZ o mldh fLFkfr igys ls csgrj gksuk mYysf[kr fd;k x;k o iwoZ esa fy[kh xbZ nokbZ;ksa ds lkFk dqN vfrfjDr nokbZ;ka dk uke tksM+dj lsou gsrq funsZ'k fn;s x;s FksA fnukad 17-05-2014 dh lqcg 8%30 cts fpfdRld vkj-vkj-ckjys tks fd okMZ esa ejhtksa dk tkap ijh{k.k djus vk;s FksA ejht dh tkap dj mldh fLFkfr lkekU; ,oa fLFkj gksus dk mYys[k fd;k Fkk o ejht dks O.P.D. tkus dh lykg nh FkhA mlds i'pkr~ mlh fnukad dh lqcg 10 cts ejht okMZ ls vks-ih-Mh- rd pyrs gq, lkekU; fLFkfr esa x;k tgka vukosnd dza-2 fpfdRld }kjk ejht dh leLr tkap fjiksVZ ns[kh xbZA lqcg 10%15 cts vukosnd dza-2 us fcuk fdlh rS;kjh fcuk fdlh thou j{kd e'khu ;k nokbZ;ksa ds ejht ds Vkafly esa tek il dks fudkyk bl izfdz;k ds nkSjku vukosnd dza-2 }kjk Vkafly ls fudyus okys il dks ejht ds 'okl uyh esa tkus ls jksdus ds fy;s dksbZ lko/kkuh ugha cjrh xbZA ejht dh 'okl lwpk: :i ls pyrh jg]s bl laca/k esa dksbZ Hkh lko/kkuh ugha cjrh xbZ o Vkafly esa Hkjs gq, il dks fudky fn;k x;k] ftlds dkj.k il ejht dh 'okl uyh esa pyk x;k o ejht 'okl u ys ikus ds dkj.k mldh fLFkfr xaHkhj gks xbZ o ejht csgks'k gks x;kA ejht dh 'okl can gksus ds dkj.k rqjar gh osafVys'ku ij j[kk x;kA tgka mldh fLFkfr vkSj [kjkc gks xbZ o dqN le; i'pkr~ mls e`r ?kksf"kr dj fn;kA Lo- lqjsUnz dqekj ekf.k;k dks ek= xys esa nnZ dh f'kdk;r Fkh o fnukad 15-05-2014 ls e`R;q fnukad 17-05-2014 rd O.P.D. esa tkus ds iwoZ rd og lkekU; fLFkfr esa Fkk] // 4 // 'okl ysus o [kkuk [kkus esa fdlh izdkj dh dksbZ rdyhQ ugha FkhA xys esa nnZ ds vfrfjDr mls dksbZ vkSj leL;k ugha FkhA ijarq fQj Hkh ejht ;k mlds ifjtu dks lwfpr fd;k fcuk ;k le>k;s fcuk O.P.D. esa gh vkWijs'ku dj fn;k x;kA tcfd vkijs'ku ds iwoZ mldh xaHkhjrk ds laca/k esa mlds ifjtuks o mldks tkudkjh nsus gsrq o vkijs'ku ds iwoZ vuqefr ysus gsrq fpfdRld nkf;Ro/khu FkkA ejht dk LokLF; fcYdqy lkekU; fLFkfr esa Fkk o thou e`R;q laca/kh dksbZ fodV fLFkfr ugha Fkh] ijarq fQj Hkh O.P.D. esa cqykdj mldk vkWijs'ku dj fn;k x;k] tcfd mldh vko';drk ugha FkhA fpfdRld }kjk ejht dk vkWijs'ku] vkWijs'ku fFk;sVj esa Hkh fd;k tk ldrk gS tgkW thou j{kd midj.k o leLr lqfo/kk,a miyC/k gksrh gSA ijarq mldk vkijs'ku O.P.D. esa fd;k x;k tks ek= fpfdRlh; ijke'kZ gsrq gksrk gSA blds vfrfjDr vkijs'ku ds iwoZ fpfdRld }kjk lkekU; lko/kkfu;ka ugha cjrh xbZA ;fn ejht ds xys esa tek Vkafly ls il dks fudkyk tk jgk gS rks mldh 'okl uyh esa tkus dh iw.kZ laHkkouk jgrh gS] ijarq il dks 'okl uyh esa tkus ls jksdus gsrq dksbZ izca/k ugha fd;k x;kA vukosnd dza-1 fpfdRlky; laLFkk }kjk ejht dh e`R;q gks tkus ls Lo;a dh xyrh dks Nqikus ds fy;s bZykt laca/kh nLrkost esa Qsj cny fd;k gSA vukosnd dza-1 fpfdRlky; }kjk ^^islsaV izksxzsl uksV ,.M MkWDVlZ baLVªD'ku 'khV dza-19** esa ejht dh e`R;q ds i'pkr~ rS;kj fd;s x;s gSaA vukosndx.kksa dk mDr d`R; fpfdRlh; mis{kk dh Js.kh esa vkrk gS] ftlds ifj.kkeLo:i ejht dh e`R;q gks xbZ o ifjoknhx.k dk thou va/kdkj e; gks x;kA vR;f/kd vkfFkZd ekufld o 'kkjhfjd ijs'kkfu;ksa dk lkeuk djuk iM+kA ifjokn vk;ksx ds le{k ifjlhek vof/k ds Hkhrj izLrqr fd;k x;k gSA ejht ifjokj dk ,d ek= vk; vtZu djus okyk lnL; Fkk ifjoknh dza- 2 o 3 vkthou fir` lq[k ls oafpr gks x;s] thou ;kiu laca/kh leL;k mRiUu gks xbZ o Hkfo"; va/kdkj e; gks x;kA e`R;q ds le; e`rd dh vk;q ek= 36 o"kZ Fkh o mldh okf"kZd vk; 1]80]000@&:- Fkh] mldh vk; dk rhu pkSFkkbZ // 5 // fgLlk mldh iRuh o nks larku izkIr djus dk vf/kdkjh gSA vr% 15 o"kZ gsrq mldh e`rd dh rhu pkSFkkbZ vk; 20]25]000@&:- vukosndx.k nsus gsrq nkf;Ro/khu gSA mlh izdkj Hkfo"; esa 90]000@&:- izfro"kZ dh nj ls mldh vk; esa o`f) gks ldrh FkhA mldk Hkh rhu pkSFkkbZ fgLlk 15 o"kZ ds fy;s 10]12]000@&:-] vkfFkZd ekufld 'kkjhfjd d"V gsrq 2]00]000@&:-] okn O;; vf/koDrk 'kqYd 20]000@&:- dk vuqrks"k ifjoknhx.k dks iznku djus gsrq vukosndx.k dks funsZ'k fn;s tkus dh izkFkZuk dh xbZA 3- ifjokn i= ds leFkZu esa ifjokfnuh dza-1 }kjk Lo;a dk 'kiFk i= o lwph vuqlkj lkr nLrkost izLrqr fd;s x;s gSaA 4- leLr vukosndx.k }kjk la;qDr :i ls mRrj izLrqr dj viuh izfrj{kk esa vfHkdFku fd;k gSA vukosndx.k }kjk bl rF; dks Lohdkj fd;k x;k gS fd e`rd dh izkjafHkd tkap djus ds i'pkr~ fnukad 15-05-2014 dks ,aVhck;ksfVd nokbZ;ka nh xbZ Fkh] fnukad 16-05-2014 dks Hkh ejht ds y{k.k oSls gh ik;s x;s FksA vr% iwoZ fy[kh xbZ nokbZ;ksa ds lkFk vfrfjDr vU; nokbZ;ka Hkh fy[kh xbZ FkhA ,oa fnukad 17-05-2014 dks lqcg 8%00 cts okMZ jkmaM ds le; ejht dh tkap dh Fkh] mUgksaus ik;k Fkk fd ejht dh fLFkfr esa lq/kkj ugha Fkk] blfy;s E.N.T. O.P.D. esa ofj"B fpfdRld ls tkap gsrq lykg nh xbZ FkhA bl rF; ls fo'ks"k :i ls badkj fd;k x;k gS fd fnukad 17-05-2014 dks ejht dh fLFkfr lkekU; Fkh] D;ksafd ejht dh izksxzsl fjiksVZ esa lkQ&lkQ fy[kk x;k Fkk fd not improved symptomatiacally A bl rF; ls Hkh badkj fd;k x;k gS fd ejht fnukad 17-05-2014 dks okMZ ls O.P.D. lkekU; fLFkfr esa pyrs gq, x;k FkkA ,oa ejht dk 10%15 cts O.P.D. esa fcuk fdlh iwoZ rS;kjh o thou j{kd e'khuksa ds fcuk ejht ds VkaflYl ls il dks Mªsu fd;k x;k ,oa lko/kkuh u cjrs tkus ds dkj.k il ejht dh 'okl uyh esa pyk x;k Fkk] ftlds dkj.k ejht csgks'k gks x;k Fkk o mldh // 6 // fLFkfr xaHkhj gks xbZ Fkh ,oa vukosndx.k }kjk ;g Li"V fd;k x;k fd ejht dh 'okluyh esa il ugha x;k FkkA ejht dh iksLVekVZe fjiksVZ voyksduh; gS (Annxure D-1) A 'okluyh esa VsªdksLVVkseh V~;wc Mkys tkus ds fy;s tks vksifuax cukbZ xbZ Fkh mlls cgqr FkksM+h ek=k esa tks CyM fudyk Fkk ogh iksLV ekVZe fjiksVZ esa ik;k x;kA vukosndx.k }kjk bl rF; ls Li"V :i ls badkj fd;k x;k gS fd lqjsUnz dqekj ekf.k;k dks xys esa lkekU; f'kdk;r Fkh o blfy;s gh mls gkfLiVy esa HkrhZ fd;k x;k A vfirq ;g vfHkdFku fd;k x;k gS fd ifjokfnuh }kjk gh izLrqr nLrkost ejht ds jftLVsª'ku fMVsy uksV ds dkWye esa izkjafHkd tkap funku esa ;g uksV fy[kk x;k gS fd ejht dks Impending peritonsiller abscess(R) gSA bl rF; ls Hkh fo'ks"k :i ls badkj fd;k x;k gS fd ejht ds ifjtuksa dks lwfpr fd;s fcuk o le>k;s fcuk vkWijs'ku dj fn;k x;k FkkA lkekU; Lohd`fr QkeZ esa ejht ds lkFk vk;s ifjtuksa ls gLrk{kj fy;s x;s Fks ejht dks vkijs'ku fFk;sVj esa ltZjh ds fy;s ys tkus gsrq iqu% fyf[kr Lohd`fr fy;k tkuk vko';d ugha FkkA vukosndx.k }kjk ;g Hkh vfHkdFku fd;k x;k fd E.N.T. O.P.D. esa tks izfdz;k e`rd ds lkFk laiUu dh xbZ FkhA mlds fy;s i`Fkd ls fyf[kr lgefr ugha yh tkrh gS] ekSf[kd lgefr yh tkrh gSA e`rd ls izfdz;k fd;s tkus ds iwoZ izfdz;k ds ckjs esa foLrkj iwoZd le>kdj crkbZ xbZ Fkh mlds le>us ds i'pkr~ gh mldh ekSf[kd lgefr ij gh izfdz;k dh xbZA fnukad 17-05-2014 ds 8%30 cts MkW- ckjys }kjk crk;k x;k Fkk fd ejht dh fLFkfr esa dksbZ lq/kkj ugha gqvk gS blfy;s mls E.N.T. O.P.D. esa tkus ds fy;s funsZ'k fn;s x;s Fks tgka nksckjk tkap ds mijkar ;g ik;k x;k fd Swelling has increased/tonsil pushed medially bl vk/kkj ij gh vukosnd dz-a2 }kjk ;g fu.kZ; fy;k x;k fd ^^VkaflYk esa vksifuax cukdj il fudkyuk vfrvko';d gSA ejht dh lgefr izkIr gksus ds i'pkr~ gh il fudkyus dh izfdz;k izkjaHk dh xbZ Fkh ,oa bl izdkj ls o"kksZ ls VkaflYl ls il fudkyus dh izfdz;k E.N.T. O.P.D. esa gh laiUu // 7 // dh tkrh gSA E.N.T. O.P.D. esa ejht dks cSBkdj fcuk csgks'k fd;s gh ;g izfdz;k dh tkrh gS] ftlls 'okluyh esa il tkus dh laHkkouk u jgsA** vukosndx.k }kjk ;g fof'k"V :i ls dFku fd;k x;k fd tokgj yky usg: fpfdRlk ,oa vuqla/kku dsUnz ] lsDVj&9] fHkykbZ ds E.N.T. O.P.D. esa loZlqfo/kk ;qDr E.N.T. VªhVesaV ;wfuV miyC/k gSA ;g Hkh fo'ks"k dFku gS fd bZ-,u-Vh-] vks-ih-Mh- esa vko';d thou j{kd midj.k ,oa VkfUly ds il dks Msªu djus ds fy;s vkStkj ,oa vkikrdkyhu lqfo/kk,a jgrh gSA fpfdRlh; foKku ds vusd iqLrdksa esa VkfUly ls il fudkyus ds fy;s Peritonsilar Absecesss Drainage Procedure dks ekU;rk nh xbZ gSA bl izdj.k esa Hkh ejht dh fLFkfr dks ns[krs gq, vko';drk vuqlkj gh il fudkyus ds fy;s ;g izfdz;k viukbZ xbZ Fkh ,oa bl izfdz;k gsrq laiw.kZ lko/kkfu;ka cjrh xbZ Fkh ejht dks fcuk csgks'k fd;s cSBkdj VkfUly ls il fudkyk x;k Fkk] D;ksafd ,slh fLFkfr esa tc Vkafly ls il fudysxk rks 'okluyh esa tkus dh laHkkouk ugha jgrh gS Vaccume Sucetion Hkh miyC/k FkkA bl rF; ls fo'ks"k :i ls badkj fd;k gS fd Lo;a dh xyrh dks fNikus ds fy;s vukosndx.k mipkj laca/kh nLrkost esa Qsjcny fd;k gSA ifjokfnuh }kjk nLrkostksa esa mYysf[kr le; dks ysdj tks vkjksi yxk;k x;k gS mlds laca/k esa Li"Vhdj.k fn;k x;k fd iwjs vLirky esa 70&80 ?kfM+;k gS mlesa 10&15 feuV dk QdZ gksuk LokHkkfod gS vr% izksxzsl lhV] O.P.D. ipkZ o vkbZ-lh-;w- uksV esa le; ,d ?kM+h ls ns[kdj ugha fy[kk x;k gSA LFkkuh; iqfyl }kjk fpfdRlh; mis{kk dh tkap djus ds fy;s fnukad 17-05-2014 dks gh ejht ls lacaf/kr lkjs nLrkost vukosnd dza-1 laLFkku ls tIr dj fy;s x;s Fks blfy;s muesa gsjQsj djus dk iz'u gh iSnk ugha gksrk gSA vukosndx.k }kjk e`rd ds lkFk dksbZ Hkh fpfdRlh; mis{kk ;k lsok esa fuEurk ugha dh xbZA u gh muds }kjk fn;s x;s mipkj ds ifj.kkeLo:i mldh e`R;q gqbZ gS vr% ifjoknhx.k dksbZ Hkh izdkj dk vuqrks"k vukosndx.k ls izkIr djus dk vf/kdkjh ugha gSA vukosndx.k // 8 // }kjk okLrfod rF;ksa dks Li"V djrs gq, fo'ks"k dFku fd;s gSa fd ifjoknhx.k }kjk rF;ksa dks rksM+ejksM+dj Hkzked vk/kkj ij ifjokn izLrqr fd;k x;k gS tks fd fujLr fd;s tkus ;ksX; gSA ejht dk bZykt fpfdRldksa }kjk fpfdRlk foKku dh iqLrdks esa crkbZ xbZ i)fr ls gh fd;k FkkA okLrfodrk rks ;g gS fd dqN ejhtksa dk Larynx more sensitive jgrk gS tks vpkud ekalisf'k;ska esa ladqpu vkus ls can gks tkrk gSA fpfdRlk foKku dh iqLrdks ds vuqlkj il fudkyus dh izfdz;k ejht dks fcuk csgks'k fd;s fcuk ysVk;s cSBkdj dh tkrh gSA rkfd il fudkyrs le; ykj vkfn [kkalh ds lkFk ckgj vk tk;s] ijarq bl izdj.k esa ejht dk Larynx Sensitive Fkk vr% vpkud can gks x;kA ftlds dkj.k Lyrangospasm gks x;k tks fdlh ds lkFk dHkh Hkh gks ldrk gSA tSls ejht dks Lyrangospasm gqvk fpfdRldks dh Vhe }kjk E.N.T. O.P.D. esa gh Intubation dh izfdz;k izkjaHk dj nh xbZ] ijarq ejht ds Larynx dh ekalisf'k;ksa esa bruh T;knk fldqM+u Fkh (spasm) dh 'okluyh esa baMksVsªfD;y V~;wc ugha xbZ rc rRdky 3&4 feuV ds vanj ejht dks E.N.T. O.P.D. ls vkbZ-lh-;w- ys tk;k x;kA MkWDVjks }kjk 'okluyh dk Åijh fgLlk [kksydj izfdz;k viukrs gq, cgqr gh de le; esa V~;wc Mkyk x;k vkSj V~;wc dks rRdky osfUVysVj ls dusDV dj fn;k x;kA mijksDr izfdz;k esfMdy lkbZUl esa fu/kkZfjr i)fr ls fd;k x;k gSA ejht dh lkekU; fLFkfr cgqr [kjkc Fkh vkSj gkVZchV de gks jgh gS rFkk ;g ik;k x;k fd ch-ih- Blood pressure not recordable blfy, rRdky lh-ih-vkj- Cardiopulmonary resuscitation izfdz;k viuk;h xbZ vkSj ,Vªksfiau o ,Mªhuyhu dk bUtsD'ku rRdky ejht dks fu/kkZfjr ek=k esa yxk;k x;k o psLV dEizslu yxkrkj tkjh j[kk x;k rFkk 'okluyh esa VsªdksLVVkseh V~;wc Mkyh x;hA MkWDVjksa ds bl lkr vkB feuV ds vFkd iz;kl ds dkj.k ejht dh 'okal o gkVZchV okil vk xbZ rFkk mldk B.P.-180/100 M.M. HG rFkk PR 130/MIN vk x;kA 10%30 ls ysdj yxHkx 01%20 rd ejht lqjsUnz ekf.k;k dks fu/kkZfjr ek=k esa tks // 9 // nokbZ;ka nh xbZ rFkk bZ-,u-Vh- fMikVZesaV ds MkW- vkj-vkj-ckjys }kjk vU; MkWDVjksa dh Vhe ds lkFk 01%20 P.M. dks ejht dks ns[kk x;k vkSj ik;k x;k dh og Unconscios gS] 01%30 P.M. iqu% ofj"B MkWDVjksa }kjk ejht dks ns[kk x;k dh Pink Frothy secretion tracheotomy tube ls fudy jgk gSA Lyrangospasm gksus ij rFkk pulmonary edema gksus ij ,slk dHkh&dHkh gks ldrk gSA esfMdy fyVjspj es bldk jsQjsUl fn;k x;k gS tks e`rd ds dsl 'khV ds ist ua-&1 ds vfUre fu"d"kZ esa e`R;q dk dkj.k pulmonary edema after peritonsilar abscess fn;k x;k gSA izLrqr layXud D-11 & D-12 ds vuqlkj peritonsillar Abscess ?kkrd@e`R;q dkjd gks ldrk gS ,oa ;g Hkh fy[kk gS fd bl izdkj ds dsl esa e`R;q nj 11 ls 40 izfr'kr gks ldrh gSA fd Negetive pressure pulmonary edema Immediatialy after pharyngeal Surgery gksus ds ckn vf/kdrj ;qok O;fDr;ksa esa e`R;q gksuk laHkkfor gks ldrk gSA rRdky ejht ds ifjtuksa dks ;g tkudkjh nh fd ejht dh gkyr vR;f/kd xaHkhj gSA MkWDVjksa }kjk vU; tks fo'ks"k vko';d mipkj miyC/k gS og rRdky fn;k x;k rFkk 01%40pm esa ik;k x;k dh ejht ds Lungs esa ikuh Hkj x;k gS vkSj vHkh Hkh Frothy secretion gks jgk gSA fnukad 17-05-2014 dks 02%05 P.M. ejht dks vpkud Cardiac arrest gqvk vr% mls yxkrkj eSdsfudy osUVhysVj liksVZ fn;k x;k] ekWfuVj ls ch-ih- ukik tkrk jgk o thou j{kd nokbZ;ka Hkh nh xbZA fd blds ckn 02%25 feuV ij ejht dks iqu% Cardiac arrest gqvk ftlds dkj.k mls CPR fn;k x;k o Nkrh esa elkt dj thou j{kd nokbZ;ka ,Mªkfyu o ,Vªksfiu nh x;hA MkWDVjksa ds bl yEcs vFkd iz;kl o lkjs cpko rduhd viukus ds ckotqn Hkh ejht dks ugha cpk;k tk ldk vkSj mls 03%45 P.M. Dead ?kksf"kr dj fn;k x;kA MkWDVjksa dh Vhe us vius drZO;ksa dk ikyu fd;k ejht ds bZykt esa dksbZ ykijokgh ugha cjrh xbZ gSA ifjoknh }kjk vLirky o fpfdRldksa ds fo:) fcuk fdlh vk/kkj fpfdRlh; mis{kk dk vkjksi // 10 // yxkdj vk/kkjghu ifjokn izLrqr fd;k x;k gS ftl ij 5]000@&:- ifjO;; yxkdj ifjokn fujLr fd;s tkus dh izkFkZuk dh xbZA 5- vukosndx.k }kjk vius mRrj ds leFkZu esa lwph vuqlkj 12 nLrkost o MkW- misUnz tSu] MkW- ,-ds-xxZ dk 'kiFk i= Hkh izLrqr fd;k x;k gSA 6- izdj.k ds U;k;ksfpr fujkdj.k gsrq gekjs le{k fuEufyf[kr iz'u fopkj.kh; gS%& 1- e`rd Lo- lqjsUnz dqekj ekf.k;k ds mipkj esa fpfdRldksa }kjk fpfdRlh; mis{kk dh xbZ] ftlds ifj.kkeLo:i Lo- lqjsUnz dqekj ekf.k;k dh e`R;q gqbZ\ 2- ifjoknhx.k] vukosndx.k ls izkfFkZr vuqrks"k izkIr djus ds vf/kdkjh gSa\ 7- vk;ksx ds le{k ifjoknh dh vksj ls Jh vuqjkx Bkdj vf/koDrk ,oa vukosndx.k dh vksj ls Jh vkj-ds-Hkkoukuh] vf/koDrk }kjk vafre rdZ izLrqr fd;s x;sA mHk;i{kdkjksa }kjk vfHkys[k esa fyf[kr rdZ Hkh izLrqr fd;k x;kA gekjs }kjk vfHkys[k esa layXu nLrkostks dk ifj'khyu fd;k x;kA 8- ifjoknh ds fo}ku vf/koDrk Jh vuqjkx Bkdj }kjk eq[;r% ;g rdZ fd;k x;k gS fd e`rd lqjsUnz dqekj ekf.k;k fnukad 15-05-2014 dks nksigj 2 cts xys esa nnZ dh lkekU; f'kdk;r ysdj mipkj gsrq vukosnd dza-1 dh laLFkku esa x;k FkkA fpfdRldksa ds funsZ'k ij gh mls HkrhZ fd;k x;k Fkk] mldh fLFkfr lkekU; FkhA fnukad 16-05-2014 ds fnu Hkh mldh fLFkfr Bhd Fkh nokbZ;ksa dk fu;fer lsou fd;k tk jgk FkkA fnukad 17-05-2014 dks okMZ foftV ij vk;s MkW vkj-vkj-ckjys }kjk e`rd dks E.N.T. O.P.D. tkus dh lykg nh rFkk fnukad 17-05-2014 dks 10am cts Lo;a pydj ejht vks-ih-Mh- x;k Fkk tgka vukosnd dza-2 // 11 // fpfdRld }kjk VkfUly esa ls il fudkyus ds fy;s ejht dks mis{kkiw.kZ rjhds ls phjk yxk;k x;kA ftlds ifj.kkeLo:i VkfUly ls eokn il fudyk tks ejht ds 'okluyh esa pyk x;k o ejht ds 'okluyh vo:) gks xbZA dqN le; i'pkr~ ejht dk vdkfLed fu/ku gks x;kA bl izdkj vukosnd fpfdRld }kjk mis{kk o ykijokgh iwoZd ejht ds il fudkyus gsrq O.P.D. es gh phjk yx;k x;k o bl izfdz;k ds iwoZ ejht ls ;k mlds ifjtuksa ls dksbZ Hkh lgefr ugha yh xbZ vkSj u gh blds ckjs esa tkudkjh nh xbZ vkSj u gh bl izfdz;k ds tksf[ke ds ckjs esa le>k;k x;kA ftlds dkj.k ejht o mlds ifjtu mldh xaHkhjrk o e`R;q dh laHkkouk ls vufHkK FksA fo}ku vf/koDRkk }kjk ;g Hkh rdZ fd;k x;k fd tc e`rd il fudkyus dh izfdz;k ds mijkar csgks'k gks x;k rks fpfdRldksa us mlds i'pkr~ mls cpkus ds fy;s gh dksbZ fo'ks"k iz;kl ugha fd;s x;sA D;ksafd O.P.D. esa ejht ds fy;s dksbZ thou j{kd nok lqfo/kk ;k midj.k ;a= miyC/k ugha gksrs gSaA vukosnd fpfdRld }kjk vius izfrj{kk esa tks vfHkdFku fd;s gSaS og muds }kjk izLrqr nLrkostksa ls izekf.kr ugha gksrs gSA vukosnd dza-2 dks iz'ukoyh ds ek/;e ls iwNs x;s iz'uksa dk Hkh mRrj vukosnd dza-2 }kjk Li"V o lgh <ax ls ugha fn;k x;k gSA ftlls Li"V izekf.kr gksrk gS fd vukosndx.k }kjk fpfdRlh; mis{kk o lsok esa fuEurk dh xbZA ifjokfnuh dza-1 dks ;g Kkr gh ugha gks ldk fd mldk ifr tks fd lkekU; fLFkfr esa Fkk vpkud I.C.U. esa D;ksa HkrhZ fd;k x;k o vpkud mldh e`R;q fdl dkj.k ls gqbZ e`rd vius ifjokj dk ,d ek= dekÅ lnL; Fkk] ftldh vlkef;d e`R;q ds mijkar mlds nks cPps vkthou fir` lq[k ls oafpr gks x;sA vlkef;d e`R;q mijkar iwjs ifjokj dks vkfFkZd ekufld larki lgu djuk iM+k tks fd ,d viw.kZ {kfr gSA vr% ifjoknhx.k vukosndx.k ls ifjokn i= esa mYysf[kr {kfriwfrZ izkIr djus dh vf/kdkjh gSA // 12 // ifjokfnuh ds vf/koDrk }kjk fuEu U;k;n`"Vkar ij fo'okl fd;k x;k%& A.S.Mittal Vs. State of Uttar Pradesh, LAWS(SC)-1989-5-11.
9- vukosndx.k ds fo}ku vf/koDrk }kjk eq[;r% ;g rdZ fd;k x;k gS fd e`rd lqjsUnz ekf.k;k fnukad 14-05-2014 dks E.N.T. foHkkx eas HkrhZ gqvk Fkk rc mldh tkap mijkar gh fpfdRldksa }kjk mlds nkfgus VkfUly esa il gksus dh tkudkjh nh Fkh o ,aVhck;ksfVd Hkh fy[kh FkhA fnukad 16-05-2014 dks vU; vfrfjDr nokbZ;ka Hkh ysus gsrq funsZ'k fn;s FksA mlds i'pkr~ fnukad 17-05-2014 dh lqcg fLFkfr esa lq/kkj u gksus ij bZ-,u-Vh- vks-ih-Mh- tkus dks dgk x;k FkkA e`rd ds Vkafly esa lwtu c<+ xbZ Fkh blfy;s Vkafly ls il fudkyus dk fu.kZ; fy;k x;kA Vkafly ls il fudkyus dh izfdz;k fpfdRlk foKku dh iqLrdksa esa fofgr
i)fr ds vuqlkj gh fd;k x;k FkkA bl izfdz;k ds nkSjku ejht dh 'okluyh esa il ugha x;k Fkk] vfirq mldh ekal isf'k;ka laosnu'khy gksus ds dkj.k ladqfpr gks xbZ Fkh o rqjar csgks'k gks x;k Fkk ejht dks xaHkhj fLFkfr ls Bhd djus gsrq rqjar vkbZ-lh-;w- ys tk;k x;k] o ejht dks cpkus ds fy;s leLr ;Fkksfpr iz;kl fd;s x;s ijarq nqHkkZZX;o'k ejht dks Negetive pressure pulmonary edema Immediatialy after pharyngeal Surgery gks x;k Fkk o mlds i'pkr~ 02% 05 feuV ij Cardiac arrest gqvk o iqu% 2%25 feuV ij Cardiac arrest gqvkA varr% 03%45 lqjsUnz ekf.k;k dh e`R;q gks xbZA leLr vukosnd fpfdRld }kjk fpfdRlk foKku esa ekud
i)fr ds vuqlkj gh mldk mipkj fd;k Fkk o mlds thou dks cpkus ds laiw.kZ Hkjld iz;kl fd;s FksA fpfdRldks }kjk mlds mipkj esa mis{kk ;k lsok esa fuEurk ugha dh xbZ FkhA ifjokn i= esa ;g Hkh vkjksi yxk;k x;k gS fd mipkj laca/kh nLrkostks esa Qsjcny fd;k x;k Fkk tcfd okLrfodrk ;g gS fd ejht dh e`R;q ds ckn iqfyl }kjk leLr nLrkost tIr dj fy;s x;s Fks vr% mlesa Qsjcny djuk laHko gh ugha FkkA ejht ds mipkj ds iwoZ mlds ifjtuksa ls fyf[kr esa lgefr yh xbZ // 13 // FkhA vr% izR;sd fnu izR;ds mipkj ds iwoZ i`Fkd&i`Fkd lgefr ysuk vko';d ugha FkkA lqjsUnz ekf.k;k dks Vkafly ls il fudkyus ds iwoZ vks-
ih-Mh- esa gh laiw.kZ tkudkjh fooj.k ls nh xbZ Fkh o mlus le>dj lgefr iznku dh xbZ Fkh mlds i'pkr~ gh izfdz;k izkjaHk dh xbZ FkhA ifjoknhx.k vukosndx.k ls fdlh Hkh izdkj dk vuqrks"k izkIr djus dk vf/kdkjh ugha gS feF;k vk/kkj ij ifjokn izLrqr fd;s x;s gSA 10- vfHkys[k esa ifjokfnuh }kjk izLrqr nLrkostksa dk ifj'khyu fd;k x;kA tokgjyky usg: fpfdRlky; ,oa vuqla/kku dsUnz fHkykbZ }kjk ejht ds iath;u fooj.k dh izfr fnukad 15-05-2014 ds vuqlkj lqjsUnz ekf.k;k tc gkfLiVy esa mipkj gsrq HkrhZ gqvk Fkk mlds d"V dk funku Impending peritonsiller abscess(R) mYysf[kr gSA mDr nLrkost ds i`"B Hkkx ij lkekU; Lohd`fr esa fj'rsnkj ds gLrk{kj ftldk uke ih-tkslsQ ,oa fj'rk&^^fe=** mYysf[kr gS vFkkZr~ e`rd dh iRuh ;k mlds vU; fdlh ifjtu dh mifLFkfr esa mlds fe= }kjk gh lkekU; Lohd`fr esa fnukad 15-05-2014 dks gLrk{kj fd;s Fks%& tokgj yky usg: fpfdRlky; ,oa vuqla/kku dsUnz] fHkykbZ lkekU; Lohd`fr@General Consent ^^tokgj yky usg: fpfdRlky; ,oa vuqla/kku dsUnz] fHkykbZ esa HkrhZ ds fy, eSa Lo;a dh ethZ ls ;g lgefr nsrk@nsrh gwa& &vLirky] vLirky ds fpfdRldksa] uflaZx] iSjkesfMdy ,oa lQkbZ djus okys LVkQ dks mfpr ns[kHkky djus ds fy, ,oa lHkh vko';d funku] jsfM;ksykWth fpfdRldh; fdz;k;sa djus ds fy,] ftlesa lfEefyr gS jDr fudky dj tkWp djuk ,oa vU; dksbZ tkWp tks MkWDVj t:jh le>sA &t:jr iM+us ij vko';d nok,Wa] vkS"kf/k] vUr% f'kjk nzO; mi'kked] HkkSfrd izfrcU/k vkfn nsus ds fy,A &mipkj ds nkSjku fudys Årdksa ,oa vU; foHkDr 'kkjhfjd Hkkxksa dks vLirky izca/ku }kjk mfpr fuiVkjs ds fy,A &esfMdy] oSKkfud ,oa 'kS{kf.kd dk;Z gsrq esjs mipkj ds izdk'ku ds fy,] c'krsZ dksbZ fp= vFkok o.kZukRed ikB~; lkexzh ls esjh igpku u gksrh gksA &esjs mipkj ds nkSjku fdlh Hkh le; vU; fdlh vLirky esa LFkkukarj.k ds fy,] tc esjs fpfdRld esjs LokLF; ykHk ds fy, mfpr ,oa t:jh le>sA eSa ,rn~}kjk vLirky] blds fpfdRld] vusLFksfVLV] uflZax LVkQ] iSFksykWftLV] jsfM;ksykWftLV ,oa vU; lHkh deZpkjh tks esjs mipkj esa lgHkkxh gksaxs mu lcdks // 14 // vLirky esa mipkj ds nkSjku gksus okys fdlh Hkh izdkj ds vizR;kf'kr ;k izfrdwy ifj.kke ds nkf;Ro ls eqDr djrk@djrh gwWaA eSa vkxs ;g Hkh lwfpr djrk@djrh gWaw fd eSaus vius iwoZ jksx] ,ythZ] nokbZ ls gksusokyh izfrfdz;k,Wa] 'kY;fd;k ,oa vU; t:jh tkudkjh ls MkWDVj dks voxr djk fn;k gSA mipkj ds fy, leqfpr tkudkjh u nsus ds dkj.k gksus okys fdlh Hkh ifj.kke ds fy, eSa fpfdRld ;k vLirky dks ftEesnkj ugha BgjkÅaxk@BgjkÅaxhA eSa vLirky ds dk;ns ,oa fu;eksa dks iw.kZr% le> pqdk@pqdh gwa vkSj mudk ikyu djus dh lgefr nsrk@nsrh gwaA Åij nh xbZ lwpuk,a eq>s esjh le>us okyh Hkk"kk esa Li"V dj nh xbZ gS vkSj eSa mUgsa vPNh rjg ls le> x;k@x;h gwa vkSj eSa Lo;a dh ethZuqlkj ,oa lko/kku eu%fLFkfr ls ;g lgefr i=d ij gLrk{kj djrk@djrh gwWaA** Patient Progress Note & Doctor's Instructions dk voyksdu fd;k x;k fnukad 16-05-2014 dh lqcg 8 cts o 'kke 7 cts e`rd dh tkap dh xbZ Fkh o fnukad 17-05-2014 dh lqcg lk<s+ 8 cts MkW- ckjys }kjk tkap mijkar not improved symptomatically congestion on Ap deceased ,oa fnukad 17-05-2014 dh 10%00 cts ^^procedure risk explain to patient"
mYysf[kr gSA o fnukad 17-05-2014 dh 11%30 cts ;g uksV fy[kk x;k gS %& "R/t is case of ® peritonsillon abscess with lorynsgeal oedema, gone into sudden shock in OPD. Intubation tried in OPD & ICU but could not be attained because glottic can not be visualised"
blds i'pkr~ e`rd dks fn;s tkus okys leLr mipkjks dk fooj.k gS pwafd ;g leLr nLrkost ifjokfnuh }kjk gh izLrqr fd;s x;s gSaA vr% ifjokfnuh dk ;g rdZ Lohdkj ;ksX; ugha gS fd mDr nLrkost esa vukosnd fpfdRld }kjk Qsjcny fd;k x;k gS leLr nLrkost lkekU; vuqdze esa cuk;s x;s izrhr gksrs gSaA 11- ifjokfnuh }kjk vukosnd ij ;g vkjksi yxk;k x;k gS fd peritonsillar abscess dk mipkj nks fnu djus ds mijkar fLFkfr esa lq/kkj gqvk Fkk ijarq fQj Hkh O.P.D. esa iwoZ lgefr fy;s fcuk ejht ds Vkafly ls il fudkyus dh izfdz;k laiUu dh xbZ] tcfd mDr izfdz;k vkijs'ku fFk;sVj esa dh tkuh pkfg, Fkh tgka thou j{kd midj.k ;a= lqfo/kk,a miyC/k gksrh gS o bl laca/k esa ejht o mlds ifjtuksa dks laiw.kZ // 15 // tkudkjh o izfdz;k lacaf/kr tksf[ke le>kuk Fkk tks fd vukosnd fpfdRld dk nkf;Ro Fkk ijarq fpfdRld }kjk ,slk ugha fd;k x;k ejht o mlds ifjtu izfdz;k ds tksf[ke ls vufHkK FksA vc gesa ;g tkap djuh gS fd fdlh ejht ds Vkafly esa il Hkj tkus ls fpfdRld }kjk dc ;g mipkj iznku fd;k tkrk gSA ifjokfnuh }kjk Emedicinhealth website ls Peritonsillar Abscess ds laca/k esa mipkj fooj.k izLrqr fd;k x;k tks fuEukuqlkj gS%& Emedicinhealth experts for everyday emergencies Peritonsillar Abscess(cont.) medical Treatment IN THIS ARTICLE The doctor's primary concern will be your Peritonsillar Abscess breathing and airway. If your life is in Overview danger because your throat is blocked, the Peritonsillar Abscess Causes first step may be to insert a needle in the Peritonsillar Abscess pus pocket and drain away enough fluid Symptoms so you can breathe comfortably.
If your life is not in immediate danger, When to Seek Medical Care the doctor will make every effort to keep Exams and Tests the procedure as painless as possible. you Peritonsillar Abscess will receive a local anesthetic (like at the Treatment dentist) injected into the skin over the abscess and, if necessary, pain medicine and sedation Medical Treatment through an IV inserted in your arm. The Follow-up doctor will use suction to help you avoid Prevention swallowing pus and blood. Outlook The doctor has several options for Multimedia treating you:
o Needle aspiration involves slowly Peritonsillar Abscess Topic putting a needle into the abscess and Guide withdrawing the pus into a syringe.
o Incision and drainage involves using a scalpel to make a small cut in the abscess to pus can drain.
o Acute tonsillectomy (having a surgeon remove your tonsils) may be needed if, for some reason, you cannot tolerate a drainage procedure, or if you have a history of frequent tonsillitis. You will receive an antibiotic. The first dose may be given through an IV. Penicillin is the best drug for this type of infection, but if you are allergic, tell the doctor so another can be used (other choices may be erythromycin or clindamycin).
If you are healthy and the abscess drains well, you can go home. If you are very ill, cannot swallow, or have complicating medical problems(such as diabetes), you may be admitted to the hospital. Young children, who often // 16 // need general anesthesia for drainage, frequently require a hospital stay for observation.
mDr ys[k esa ;g mYys[k ugha gS fd il fudkyus dh izfdz;k dgka laiUu dh tkuh gS O.P.D. ;k O.T. esaA ,sUlfFkfl;k fn;s tkus ds laca/k esa ;g mYys[k gS fd tc il flfjat ds ek/;e ls fudkyk tkrk gS rc yxk;k tkrk gS] ijarq izLrqr izdj.k esa e`rd ds xys ls il flfjat ds ek/;e ls ugha fudkyk x;k FkkA 12- vukosndx.k }kjk vfHkys[k esa izLrqr 'ko ijh{k.k izfrosnu fnukad 18-05-2014 dh izfr dk ifj'khyu fd;k x;kA ftlds vuqlkj e`R;q dk dkj.k fuEukuqlkj gS%& "The cause of death is Asphyxia due to Pulmanry Edema & Laryngial edema, The time sinc that can not be assertain because.........." vukosnd dza-1 }kjk iznRr e`R;q izek.k i= esa Hkh e`R;q dk dkj.k Laryngial edema pulmanry edema mYysf[kr gSA vukosndx.k }kjk Peritonsillar Abscess ds mipkj o mlds y{k.k o il fudkyus dh izfdz;k ds laca/k esa baVjusV esa miyC/k tkudkjh dh izfr izLrqr dh gSA tks fd fuEukuqlkj gS%& Medscape website Peritonsillar Abscess in Emergency Medicine Updated: Apr 28, 2014 Practice Essentials Peritonsillar abscesses (PTAs) are common infections of the head and neck region, accounting for approximately 30% of soft tissue head and neck abscesses. With an incidence of about 1 in 10,000, PTA is the most common deep space infection of the head and neck that presents to the emergency department.
Signs and symptoms Symptoms of PTA usually begin 3-5 days before evaluation and may include the following:
Fever, Malaise, Headache, Neck pain, Throat pain (more severe on the affected side, occasionally referred to the other ear), Dysphagia, Change in voice, Otalgia, odynophagia.
1. Needle aspiration // 17 // The main advantages of needle aspiration are case of the procedure, decreased pain for the patient, and cost-effectiveness.
The patient should be sitting upright.
Lidocaine with epinephrine should be used to anesthetize the area.
2. Abscess incision and drainage The Patient should be sitting upright with a pan availabel to spit out any blood or pus.
A tongue depressor is used to retract the tongue. To prevent the risk of aspiration, allow the patient to hold the Yankauer catheter tip and to suction the pus.
bl izdkj Vkafly ls il fudkyus dh nks rduhd izpfyr gS ,d flfjat ds ek/;e ls ftlesa ejht dks nnZ de gks tkrk gS ,oa nwljh rduhd ;g Fkh] ftlesa xys esa NksVk lk fNnz dj il ckgj fudkyk tkrk gSA mijksDr nksuksa rduhd esa ejht dks lh/ks cSBdj gh il fudkyus dh izfdz;k laiUu dh tkrh gSA ifjoknh ds vf/koDrk }kjk dh xbZ vkifRr fd ejht dks Anesthesia ugha yxk;k x;k Fkk ,oa ;g izfdz;k O.P.D. esa cSBkdkj dh xbZ] tcfd vkijs'ku fFk;sVj esa dh tkuh Fkh Lohdk;Z ugha gSA Scott-Brown's Diseases of the Ear, Nose and Throat ds iqLrd ls Vkafly ls il fudkyus dh i)fr ds v/;k; dh izfr izLrqr dh ftlds vuqlkj xys esa Nsn dj lqjf{kr rjhds ls ejht ds Vkafly ls il fdl izdkj fudkyk tk; fuEukuqlkj mYysf[kr gS%& "Incision When pus is present or believed to be present and accessible for drainage into the pharynx, the safest course to pursue is to make an incision, without general anaesthetic, through the anterior pillar of the fauces. The pain of the quinsy is already intense and pain does not summate so that a sharp stab through the mucosa and muscle is not as brutal as it may seem. The patient sits holding a basin under his chin and his mouth open as far as possible. The most prominent part of the swelling is selected (if this is not obvious a site of selection is chosen half-way between the base or the uvula and the upper third molar tooth) and a pledget of wool moistened with ten per cent cocaine gently applied to the area. While the patient closes his mouth and waits for a few moments the surgeon selects a // 18 // sharp scalpel (e.g. size 15 Bard-Parker) and leaving 6mm of the tip only uncovered protects the rest of the blade with adhesive tape. He then takes a tongur depressor, instructs the patient to open his mouth,depresser the tongue and, without more ado, stabs the knife into the chosen site. He then thrusts a pair of sinus forceps through the incision, opens them widely, closes them, withdraws them and tells the patient to spit the pus into the basin. When pus is found the relief is so immediate that any distress occasioned by the operation is soon forgotten.
There is a tendency for quinsy to recur in the same patient. In view of the disagreeable nature of the condition and the risk of possible serious complications it is wise peranently to prevent further attacks by removing the tonsils. An internal tonsillectomy is therefore advised and usually performed 6-8 weeks after the resolution of the quinsy"
bl lkfgR; ds vuqlkj xys esa fNnz djds il fudkyus dh rduhd esa fcuk Anesthesia yxk;s il fudkyuk lqjf{kr gksrk gS ,oa ejht ds izfdz;k ds laca/k esa vlger gksus dh fLFkfr esa ;k xaHkhj tfVyrkvksa dh laHkkouk gksus ij vafre fodYi ds :i esa tonsillectomy dh lykg nh xbZ gSA vukosnd fpfdRld }kjk izLrqr nksuksa lkfgR; ds vuqlkj mijksDr nksuksa rduhd ls il fudkyus dh izfdz;k O.P.D. esa gh dh tkrh gS ,oa ,sUlfFkf'k;k fdl ejht dks yxk;k tkosa fpfdRld ds foosd ij vk/kkfjr fu.kZ; gksrk gSA izdj.k esa ;g /kkfjr ugha fd;k tk ldrk fd ,sUlfFkf'k;k u yxkus dh otg ls e`rd Jh lqjsUnz ekf.k;k dh fLFkfr ?kkrd o xaHkhj gks xbZ FkhA vukosnd }kjk ys[kd Jeffrey D Suh, dh iqLrd ls Peritonsillar Abscess Drainage Procedures dh ekud i)fr dks Li"V djus gsrq v/;k; dh izfr izLrqr dh gS] ftlesa Vkafly ls il fudkyus dh fuEufyf[kr nks i)fr gS ftldks ejht dks cSBkdj laiUu fd;k tkrk gS o fpfdRld dks izfdz;k djus ds iwoZ D;k rS;kjh djuh pkfg, o ejht dks izfdz;k gsrq lg;ksx djs blds fy;s mls dSls izsfjr djuk pkfg,%& Positioning The patient should be sitting upright in one of the following locations:
o At the edge of a gurney o In an ENT examination chair // 19 // Technique Preparation Explain the procedure, benefits, risks, and complications to the patient and/or the patient's representative and obtain a signed informed consent.
Ask the patient and/or the patient's representative if they would like others to be present for the procedure.
o Ensure that adequate lighting is available.
o Ask the patient to assume the preferred upright seated position. An oral suction system should be available to prevent aspiration of abscess contents into the patient's airway. Turn the suction system on and test for adequate suction strength.
fpfdRld dks pkfg, fd og izfdz;k izkjaHk djus ds iwoZ ejht dks izfdz;k dk ifjp; ns o D;ksa vko';d gS mlds ykHk ds laca/k esa tkudkjh ns rkfd og iwjh izfdz;k esa laiw.kZ lg;ksx iznku djsa blds vfrfjDr fpfdRld dks izfdz;k ls lacaf/kr tksf[ke o tfVyrkvksa ds ckjs es Hkh Li"V djs o mlls gLrk{kj ds lkFk izfdz;k gsrq lgefr izkIr djsasA bl iqLrd esa Hkh il fudkyus dh ;gh nks rduhd crkbZ xbZ gSA Incision and drainage technique o With a guarded scalpel (Only part of the blade is exposed, to prevent a deep incision from being made), make a small incision above the tonsil, in the soft palate. Medial and superior incisions are safer from the standpoint of potential injury to the carotid artery. Incision of PTA.
o Using a curved Kelly clamp, enter the incision and perform gentle blunt dissection inferiorly, posteriorly, and slightly laterally. Gentle dissection in the area of fluctuance is usually sufficient to enter the abscess cavity. Once the abscess cavity is found, continue gentle dissection with the curved kelly clamp to break up any loculations. Blunt dissection with curved Kelly clamp.
// 20 // Needle aspiration technique Insert an 18-ga needle on a 10-ml syeringe into the area of suspected PTA.
Aspirate with the syringe while inserting it. If no abscess is found, slowly withdraw the needle and reinsert.
vukosnd }kjk izLrqr fpfdRlk lkfgR; esa Vkafly ls il fudkyus dh nksuksa i)fr esa ls dkSu lh i)fr lqjf{kr o Js"B gS o fpfdRld dks dc fdl i)fr dks izkFkfedrk nsuh pkfg, bl laca/k esa iqLrd es fuEukuqlkj mYys[k gS%& "Controversy remains over the necessity of incision and drainage versus needle aspiration alone. However, most otolaryngologists consider incision and drainage to be the gold standard for treatment. An otolaryngologist should usually be consulted to perform this procedure unless the treating physician has the appropriate experience and training. A review of the incision and drainage technique for peritonsillar abscess is beyond the scope of this article."
mDr nksuksa rduhd eas ;k Incision rduhd esa D;k&D;k tksf[ke gks ldrs gSa o mlds ckn bl rduhd ls il fudkyus ds ckn fdu tfVyrkvksa dk lkeuk djuk iM+ ldrk gSA izLrqr izdj.k esa Laryngospasm -"Spasm of laryngeal muscles" vFkkZr~ ekalisf'k;ksa dk ladqpu gqvk ,oa mlds i'pkr~ Laryngeal edema dh fLFkfr fufeZr gqbZA vukosnd }kjk Negative Pressure Pulmonary Edema after Laryngospam:A dks Li"V djus gsrq iqLrd ls ,d izdj.k dk fooj.k dh izfr izLrqr dh gS%& Introduction Laryngospasm, a brief closure of the vocal cords is not an uncommon perioperative occurrence. If recognized and managed appropriately, the effects are transient and reversible. However, in rare cases where recognition and management are delayed, the consequences are // 21 // associated with a high morbidity including desaturation, awareness, negative pressure pulmonary edema, and mortality." vukosnd }kjk NPPE dks izLrqr djus gsrq ,d vU; izdj.k dk Hkh fooj.k izLrqr fd;k gS%& ACase of Negative Pressure Pulmonary Edema Immediately after Pharyngeal Surgery "Pulmonary edema following acute upper airway obstruction is called negative pressure pulmonary edema (NPPE). The predominant mechanism is increased negative intrathoratic Pressure, although hypoxia, cardiac and neurologic factors may contribute. We encountered a case of pulmonary edema after pharyngeal surgery. A 50-year-old male with peritonsillar abscess underwent incision and drainage under general anesthesia, After extubation of the tracheal tube following successful surgical procedure, upper airway obstruction due to larynospasm and/or edema of the pharynx ensued. the patient developed respiratory distress with vigorous inspiratory efforts. After reestablishment of the airway, pink frothy sputum flowed from his mouth and nose.....The onset of NPPE is usually rapid, and without prompt recognition and intervenition, the outcome can be fatal. NPPE appears more frequently in healthy male patients, particularly patients reveiving head and neck surgery with or without concurrent airway obstruction."
vukosnd }kjk izLrqr mDr nksuksa izdj.k ls ;g Li"V gksrk gS fd NPPE xys o flj dh 'kY;fdz;k ds nkSjku ekalis'kh ls vk;s ladqpu ds dkj.k 'okl vo:) gks tkus ds mijkar gksrk gSA izLrqr izdj.k esa Hkh Vkafly ls il fudkyus dh izfdz;k esa Laryngospasm ds dkj.k Laryngeal edema o NPPE dh fLFkfr fufeZr gqbZA o ejht O.P.D. esa gh csgks'k gks x;k patient progress note fnukad 17-05-2014 Time 11%30 AM "Pt is a case of R peritonsillar abscess With laryngeal oedema gone into // 22 // Sudden shock in OPD Intubation tried in OPD and ICU But could not be attained Because glottis can not be Visualized.
Emergency cricithyrodotomy done IN icu & Pt shifted on ventilator"
,oa blh nLrkost esa 11%30AM cts fyf[kr esa e`rd ds ifjpkjd dks lwfpr fd;k x;k Fkk o mipkj gsrq lgefr yh xbZ FkhA blh nLrkost esa rdjhcu 1%30PM cts ejht dh vR;ar xaHkhj gkyr ds ckjs esa lwfpr fd;k x;k FkkA nLrkost ds vuqlkj e`rd dh thou j{kk gsrq leLr iz;kl fd;s x;sA rdjhcu 2%05PM ij ejht dks g`n;k?kkr gqvk o 2%25PM ij iqu% g`n;k?kkr gqvk o 3%00PM cts vafre g`n;k?kkr gqvk mlds i'pkr~ 3%45 ij ejht dks e`r ?kksf"kr fd;k x;kA vukosnd }kjk izLrqr fooj.k esa NPPE ds laca/k eas fu"d"kZ fn;k x;k gS fd %& CONCLUSION "With prompt diagnosis and therapeutic action, NPPE resolves generally within 24h. However, when recognition is delayed, patients with NPPE have mortality rates ranging from 11% to 40% [46] Therefore, early revognition of NPPE is crucial to decrease morbidity in these patients. A high index of suspicion for NPPE must be maintained for the patient who experiences postextubation laryngospasm."
ekalis'kh ladqpu laryngospasm ds dkj.k NPPE dh fLFkfr fufeZr gksus ij ejhtksa dh ekjd nj 11 ls 40 izfr'kr gS vr% izLrqr izdj.k esa bZykt djus okys fpfdRld dks ;g vPNs ls Kkr Fkk fd Jh lqjsUnz ekf.k;k mlds Vkafly ls il fudkyus ds fy;s fNnz djus dh rduhd esa vfrlaHkkfor tksf[ke o tfVyrk laryngospasm dh Fkh ftlds i'pkr~ NPPE dh fLFkfr fufeZr gksus ds i'pkr~ ejht dh tku dks [krjk gqvk o Hkjld iz;klksa ds i'pkr~ Hkh mldh e`R;q dks fuokfjr ugha fd;k tk // 23 // ldkA vukosnd }kjk viuh izfrj{kk esa ;g vfHkdFku fd;k x;k gS fd ejht dks HkrhZ djrs le; mlls lgefr yh xbZ Fkh ,oa fyf[kr lgefr dh izfr Hkh ifjoknh }kjk vfHkys[k esa izLrqr dh xbZ gSA mDr lkekU; Lohd`fr esa mipkj gsrq HkrhZ gksus ds fy;s tkap 'kY;fdz;k ,usLFksf'k;k ,oa leLr izfd;kvksa nok dh izfrfdz;kvksa ,oa funku ds laca/k esa lgefr nsdj izfrdwy vizR;kf'kr o izfrdwy ifj.kke ds nkf;Ro ls fpfdRldksa dks eqDr djus dh Lohd`fr gSA vukosnd }kjk izLrqr nLrkost ds vuqlkj fnukad 17-05-2014 dh lqcg tc ejht dh fLFkfr esa lq/kkj ugha gqvk o mldh vkokt 1day patient is having complain of change in voice(hot potato voice) ftldk mYys[k islsaV izksxzsl uksV esa mYys[k fd;k x;k gS] f'kdk;r gksus ij E.N.T. O.P.D. esa MkW- xxZ vukosnd dz-a 1 }kjk 10%00 cts Vkafly ls il fudkyus ds iwoZ Patient Progress Note esa fuEukuqlkj mYys[k fd;k gS%& Patient Progress Note & Doctor's instructions 17/05/14 8.30am case seen by Dr RR Barle Conscious, oriented Afebrile Vitals stable PR 80/min BP 120/80 mmhg RBS 150 mg/dl Not improved symptomatically Oral cavity congestion on AP decreased 17/5/14 10 am X ST done (neg) Procedure/risk explained to patient 17/5/14 ENT 10.15 AM swelling has increased Rt tonsil pushed medially IDL oedema rt valeculla Has increased glottis space Is adequate JD LN enlarged tender Early stridor Drainage of abscess paratonsillar rt done SD/ Pus drained Inj effcorling 100 mg stat Shift to ICU mDr nLrkost esa ek= ;g mYys[k fd;k x;k gS fd ^^ejht dks izfdz;k o mlds tksf[ke ds laca/k esa Li"V fd;k x;k** ek= bl 'kCn in // 24 // ls ;g mi/kkfjr ugha fd;k tk ldrk gS fd ejht dks oSdfYid izfdz;k ,oa dh tkus okyh izfdz;k ds leLr pj.k laHkkfor tksf[ke i'pkr~orhZ tfVyrk ;k laryngospasm tks fd okLro esa ejht ds lkFk gqvk ds laca/k esa Hkh tkudkjh le>k;h xbZ Fkh tksf[ke ds laca/k esa ltx fd;k x;k FkkA vukosnd }kjk gh izLrqr nLrkost - ys[kd Jeffrey D Suh, dh iqLrd dh izfr esa Li"V :i ls mYysf[kr gsS fd ejht o mlds ifjpkjd dks izfdz;k ds ykHk tksf[ke tfVyrk dks le>kdj o gLrk{kfjr lgefr izkIr djsA Technique Preparation Explain the procedure, benefits, risks, and complications to the patient and/or the patient's representative and obtain a signed informed consent.
gLrk{kfjr lgefr ls ;g izekf.kr gksrk gS fd izfdz;k ds ykHk izfdz;k ds leLr pj.k dks ejht le> pqdk gS o izfdz;k esa gksus okyh tksf[ke o tfVyrk,a ftl ij fu;a=.k ugha gS mudh xaHkhjrk dks Hkh le>dj izfdz;k esa lg;ksx djus dh lgefr iznku dh gSA izLrqr izdj.k esa ejht dks bl tksf[ke ;k tfVyrk ds ckjs esa tkudkjh u gksus ij fd ^^ek= il fudkyus dh izfdz;k esa mldh e`R;q dk Hkh tksf[ke gks ldrk gSA** lgefr iznku dh xbZ FkhA D;ksafd fpfdRld ds le{k ejht ds lkFk dh xbZ Incision rduhd ds vykok nwljs fodYi Hkh miyC/k Fks tks fd vukosnd }kjk izLrqr nLrkost esa gh mYysf[kr gS fd ejht ;fn bl rduhd dks djkus esa vlger gks ;k izfdz;k esa djus esa T;knk tksf[ke gks rc tonsillectomy fd;k tk ldrk FkkA ijarq izLrqr izdj.k esa fodYi dh tkudkjh Hkh ejht dks ugha nh xbZ Fkh pawfd izfdz;k ds tksf[ke ls og vufHkK Fkk blfy;s fuf'par gksdj mlus ekSf[kd lgefr ns nh gksxh rHkh izfdz;k laiUu djuk laHko gks ldkA mipkj djus okys fpfdRld ij lcls igys nkf;Ro gksrk gS fd mipkj izfdz;k dk vius foosd ls fu.kZ;
// 25 // ys fd izfdz;k dk ykHk ;k ifj.kke bruk egRoiw.kZ gS ;k vko';d gS fd ejht dh e`R;q dk tksf[ke mBk;k tk ldsaA vukosnd }kjk vius mRrj dh dafMdk 4-II esa fuEukuqlkj vfHkdFku fd;k gS%& ^^4-II ---- bZ-,u-Vh vks-ih-Mh- esa nqckjk tkWp mijkUr ;g ik;k x;k Swelling has increased/tonsil pushed medially bl vk/kkj ij ;g fu.kZ;
fy;k x;k fd VkfUly esa vksifuax cukdj il fudkyuk vfrvko';d gS vr% MkDVjksa }kjk ejht dks izfdz;k ds ckjs foLrkjiwoZd le>k;k x;k o rqjUr il dks fudkyus dh izfdz;k izkjaHk dh xbZA** vukosnd fpfdRld MkW- ,-ds-xxZ }kjk vius 'kiFk i= dh dafMdk& 1 esa fuEukuqlkj dFku fd;k gS%& ^^----- fd fnukad 17-05-2014 dks lqcg 10%15 cts esjs }kjk ejht lqjsUnz ekf.k;k ds xys ds vUnj ds VkfUly dks [kqn ns[kk x;k rFkk esfMdy lkabZl esa izsldzkbCM i)fr ij tkWpk x;k ftlesa esjs }kjk ik;k x;k fd Vkafly dh lwtu c<+ xbZ Fkh (Swelling has increased, tonsil pushed medially) ,oa yxkrkj il fudyuk izkjaHk gks jgk gS ftls geus rqjUr fudkyus dh izfdz;k izkjaHk dh xbZA fd il fudkyus dh izfdz;k dksbZ estj vkijs'ku ugha gS rFkk bls fcBkdj ges'kk bZ-,u-Vh- vks-ih-Mh- esa fd;k tkrk gS ,oa esfMdy dkWystksa esa Hkh bZ-,u-Vh- vks-ih-Mh- esa gh fd;k tkrk gSA** vukosnd fpfdRld }kjk vfHkdFku o vius 'kiFk i= esa Hkh Li"V :i ls vfHkdFku ugha fd;k gS fd Vkafly ls il fudkyus dh izfdz;k ds iwoZ lqjsUnz ekf.k;k dks izfdz;k ds tksf[ke vFkkZr~ D;k&D;k laHkkfor {kfr ihM+k gks ldrh gS o tfVyrkvksa ds laca/k esa foLrkj ls le>k;k x;k FkkA ifjoknh }kjk vukosnd fpfdRld MkW- ,-ds-xxZ ls iz'ukoyh ds ek/;e ls iz'u iwNs x;s Fks ftlesa ^^lgefr** ds laca/k esa iz'u dzekad 3]14]15]16 ftldk mRrj vukosnd fpfdRld }kjk 'kiFk i= esa iznku fd;k gS tks fd fuEukuqlkj gS%& // 26 // ^^3- fnukad 15-05-2014 ls fnukad 17-05-2014 ds vks-ih-Mh- tkus ds iwoZ rd Lo- lqjsUnz dqekj ekf.k;k ds le{k isjhVkWfUlyj ,Clsl dh leL;k ds dkj.k thou&e`R;q (Life Treatening) dh fLFkfr gksus laca/kh uksV ;k fVIIk.kh ejht lq/kkj ,oa mipkj i=d esa mYysf[kr ugha gSA lgh gS ;k xyr\ Ans. Wrong.
On that day after the rounds at about 10 am, it is written clearly xylocaine sensitivity test(XST) done and procedure/risk explained.
14- fnukad 17-05-2014 dks lqcg 10%15 cts vks-ih-Mh- esa isjhVkWfUlyj Msªu djus ds iwoZ ejht Lo- lqjsUnz dqekj ekf.k;k dks bykt dh xaHkhjrk rFkk e`R;q dh Hkh laHkkouk laca/kh rF; ekSf[kd :i ls crk;s tkus dh fVIi.kh ejht lq/kkj ,oa mipkj i=d esa mYysf[kr ugh gSA lgh gS ;k xyr\ Ans. Wrong Clearly mentioned procedure/risk explained to patient.
15- vks-ih-Mh- esa isjhVkWfUlyj Msªu djus ds iwoZ ejht Lo- lqjsUnz dqekj ekf.k;k dks bykt dh xaHkhjrk rFkk e`R;q dh Hkh laHkkouk gksuk crykrs gq, isjhVkWfUlyj Msªu djus dh fyf[kr lgefr ugha yh xbZA lgh gS ;k xyr\ Ans. As a protocol for OPD procedure written consent is not taken but procedure/risk was explained to patient.
16- Lo- lqjsUnz dqekj ekf.k;k dk vks-ih-Mh- esa isjhVkWfUlyj Msªu djus dh tkudkjh mlds ifjtuksa dks fn;s tkus laca/kh rF; ekSf[kd :i ls crk;s tkus dh fVIi.kh ejht lq/kkj ,oa mipkj i=d esa mYysf[kr ugha gSA lgh gS ;k xyr\ Ans. Applicable to only childrens/unconscious patients."
vukosnd MkW- xxZ }kjk iz'u dza- 3 dk mRrj Hkzked fn;k gS tcfd iz'u esa muls Li"V :i ls iwNk x;k gS fd isfjVkfUly vkSj ,Clsl dh leL;k esa thou dk tksf[ke Fkk izksxzsl 'khV esa mYysf[kr ugha gSA ijarq vukosnd fpfdRld }kjk mRrj fn;k x;k fd izksfltj djus ds iwoZ ejht dks izksfltj o tksf[ke ds laca/k esa le>k;k x;k Fkk o mldh laosnu'khyrk dh tkap dh xbZ Fkh mldh fjiksVZ izksxzsl 'khV esa gSA iz'u dza- 14 esa Li"V :i ls iwNk x;k gS fd ^^il fudkyus dh izfdz;k esa e`R;q // 27 // dh Hkh laHkkouk ;k tksf[ke gS ,slk ejht dks ekSf[kd :i ls crk;k x;k Fkk ;g mYys[k Hkh 'khV esa ugha gS** ftldss mRrj esa O;Dr fd;k x;k fd ^^izksxzsl 'khV esa Li"V :i ls risk explained fy[kk gS** ijarq bl mRrj ek= ;g mi/kkfjr ugha fd;k tk ldrk fd ejht dks ;g Hkh crk;k x;k Fkk fd ^^izfdz;k ds fdl 'kkjhfjd {kfr d"V ihM+k ;k thou dk tksf[ke laHko gS ;k laryngospasm dh vfrlaHkkouk gS ftldk ifj.kke NPPE gks ldrk gS o e`R;q laHkkoh gSA** ;fn ejht ;k mlds ifjpkjd dks bl tksf[ke ¼laryngospasm½ ds laca/k esa crk;k x;k gksrk rks vo'; gh og lgefr ugha nsrs ;k fdlh nwljs fodYi dk pquko djrsA izksxzsl 'khV esa risk explained ds i'pkr~ ;g Hkh mYys[k ugha gS fd ^^ekSf[kd :i ls ejht }kjk tksf[ke dks le>dj izfdz;k izkjaHk djus dh lgefr nh xbZ FkhA** vukosnd }kjk iz'u dza- 15 o 16 ds mRrj esa Li"V :i ls Lohdkj fd;k gS fd ejht ls O.P.D. esa izfdz;k izkjaHk djus ds iwoZ fyf[kr esa lgefr ugha yh xbZ Fkh ,oa ifjpkjd dks Hkh ugha crk;k x;k Fkk D;ksafd ejht ltx Fkk o o;Ld FkkA vukosnd }kjk izLrqr lkfgR; ds vuqlkj gh laryngospasm ekal is'kh dk ladqpu gS o laosnu'khy ekalisf'k;ksa esa ladqpu gks tkus ij 'okl vo:) gks tkrk gS tks fd ukd o flj dh 'kY;fØ;k ds nkSjku gksus dh laHkkouk gksrh gS tks fd fdlh ds fu;a=.k eas ugha gS ;|fi bl izdj.k esa vukosnd fpfdRld }kjk izksfltj izfØ;k izkjaHk djus ds iwoZ laosnu'khyrk dh tkap Hkh dh xbZ Fkh] ijarq fQj Hkh e`rd dks laryngospasm gqvk] ftlls Li"V gksrk gS fd laryngospasm ,d lkekU; o vfrlaHkkfor tksf[ke gS tks fd fpfdRld ds fu;a=.k esa Hkh ugh gksrk gS vr% izfdz;k ds iwoZ laryngospasm ds laca/k esa tks fd lkekU;r% ,d lkekU; lh 'kkjhfjd ?kVuk gS ijarq 'kY;fdz;k ;k ,slh izfdz;k ds nkSjku ;g 'kkjhfjd ?kVuk e`R;q rqY; tksf[ke dk ifj.kke ns ldrh gSA vr% gekjs erkuqlkj ek= nks 'kCn izksxzsl 'khV esa fpfdRld }kjk mYysf[kr djus ls o izfdz;k ls lacaf/kr izR;sd laHkkfor tksf[ke dks ejht dks crkus ds nkf;Ro dk yksi djus ds dkj.k ;g /kkfjr ugha fd;k // 28 // tk ldrk fd fpfdRld us viuk drZO; ikyu fd;k FkkA D;ksafd vukosnd fpfdRld }kjk crk;s x;s tksf[ke o fodYi dks le>us ds i'pkr~ ejht ;k mlds ifjpkjd }kjk nh xbZ izfdz;k gsrq lgefr gh ekU; gksrh gSA izfdz;k ls lacaf/kr tksf[ke laHkkfor ifj.kke o tfVyrkvksa ls vufHkK j[kdj ejht ls ;fn lgefr yh tkrh gS rks ,slh lgefr 'kwU; gS fuFkZjd gS o ,slh fLFkfr esa foijhr ifj.kke gsrq fpfdRld iw.kZ :i ls nkf;Ro/khu gSA fpfdRld dk ;g foosdkf/kdkj gksrk gS fd os ejht ds fgr esa vius foosd lss mipkj izfdz;k dk pquko dj mipkj djsa ijarq fpfdRld dk ;g Hkh drZO; gS fd izfdz;k ls lacaf/kr ^^tksf[ke** izfdz;k ds ^^ykHk** ls xq:rj u gksA vukosnd }kjk izLrqr nLrkost ds vuqlkj gh izfdz;k izkjaHk djus ds iwoZ gLrk{kfjr lgefr ysuk vko';d gSA vukosnd }kjk izLrqr lkfgR; ds vuqlkj gh ;fn dksbZ ejht bl izfdz;k gsrq vlger gksrk gS In view of the disagreeable nature of the condition and the risk of possible serious complications it is wise peranently to prevent further attacks by removing the tonsils. -
bl izdkj ;fn ejht dks il fudkyus dh izfdz;k esa e`R;q tksf[ke dks crk;k gksrk vo'; gh og vU; fodYi dk pquko djrk ftlds laca/k esa vukosnd us vius mRrj esa vfHkdFku fd;k gS fd ^^flfjat ds ek/;e ls Vkafly ls il fudkyus dh izfdz;k esa iw.kZ :i ls il ugha fudyrk vr% fNnz dj il fudkyus dh izfdz;k viukbZ xbZ FkhA** ijarq ejht dh izksxsl 'khV] vfHkdFku] 'kiFk i=] iz'ukoyh ds mRrj esa Hkh vukosnd }kjk dgh bl rF; dk mYys[k ugha fd;k x;k gS fd f}rh; fodYi ;k Incision rduhd esa e`R;q dh tksf[ke ;k larygospasm dh tksf[ke esa ifjoknh dks O;kid :i ls lwfpr fd;k x;k FkkA 13- vfHkys[k esa vukosnd }kjk izdj.k esa e`rd dks fn;s x;s mipkj ds laca/k esa fpfdRlh; mis{kk dh tkap djkus esfMdy cksMZ ds }kjk fn;k // 29 // x;k vfHker dh izfr vk;ksx ds le{k izLrqr dh xbZ gS tks fuEukuqlkj gS%& dk;kZy; foHkkxk/;{k] ukd]dku]xyk jksx foHkkx ia-t-us-Le`fr fpfdRlk egkfo|ky;] jk;iqj¼N-x-½ izfr] la;qDr lapkyd ,oa v/kh{kd MkW- Hkhejko vEcsMdj Le`fr fpfdRlky;
jk;iqj¼N-x-½ fo"k;%& Fkkuk fHkykbZ uxj exZ dzekad 34@14 /kkjk 174 tk-QkS- esa lsDVj 9 ch-,l-lh- vLirky ds MkWDVj ds }kjk bZykt ds le; e`rd lqjsUnz ekfu;k dh e`R;q gksus ls bZykt esa ykijokgh cjrus dh tkudkjh ckcr~A lanHkZ& vkidk i= dza- MkW-Hkh-v-fp-@2015@752] jk;iqj fnukad 09-01-2015 egksn;] mijksDr lanfHkZr i= }kjk fo"k;kafdr izdj.k ij vfHker pkgk x;k gSA fcanqokj vfHker fuEukuqlkj gS%& 1- fopkjk/khu izdj.k ij vks-ih-Mh- esa fpfdRld }kjk ejht ds Vkafly esa fpjk yxk;k tk ldrk gSA 2- Vkafly dh chekjh lkekU;r;k xaHkhj ugha gksrh gSA 3- miyC/k vfHkys[k ds voyksdu ls e`rd ds xys dh chekjh ds bZykt esa ykijokgh gksuk izrhr ugha gksrk gSA mijksDrkuqlkj vfHker vko';d dk;Zokgh gsrq izsf"kr gSA l/kU;okn foHkkxk/;{k ukd]dku]xyk foHkkx fpfdRlk egkfo|ky;] jk;iqjA gekjs erkuqlkj Hkh fpfdRld }kjk fpfdRlk foKku dh ekud izfdz;k ds vuqlkj gh mipkj o izfdz;k laiUu dh xbZ FkhA ijarq mipkj izkjaHk djus ds iwoZ fpfdRlh; drZO; ds vfrfjDr mldk fof/kd drZO; Hkh Fkk fd mDr mipkj izfdz;k ls lacaf/kr leLr tksf[ke tfVyrk tSls dh Laryngospasm ds dkj.k thou ladV gks ldrk gS o bl izfdz;k ds vU; fodYi ds ckjs esa tkudkjh nsus ds mijkar ejht ls yh xbZ izfdz;k gsrq lgefr gh ekU; Fkh] ysrk tks fd fpfdRld }kjk ugha yh xbZA ;|fi fpfdRld us fpfdRlk foKku ds vuqlkj gh izfdz;k laikfnr dh // 30 // gks ijarq Laryngospasm tks fd ,slh 'kY;fdz;kvksa esa lkekU;r% gksrk gS vfu;af=r vizR;kf'kr tfVyrk FkhA blfy, fpfdRld ds fy;s vkSj Hkh vko';d Fkk fd os bl laca/k esa tkudkjh ejht dks ns mlds i'pkr~ lgefr izkIr djs o izfØ;k laiUu djsaA ejht }kjk vLirky esa HkrhZ gksus ds le; iznku dh xbZ fyf[kr lgefr lkekU; izd`fr dh gS izfdz;k ds laca/k esa fof'k"V lgefr fy;k tkuk vko';d Fkk D;ksafd bl izfdz;k esa LokLF; ykHk ls T;knk thou dk tksf[ke Fkk ijarq vukosnd fpfdRld us vius yacs lsok dky ds vuqHko ds vk/kkj ij fyf[kr lgefr fy;s fcuk gh izfdz;k laikfnr dj nh o tfVy fLFkfr fufeZr gks xbZA fpfdRld }kjk ejht dh fLFkfr xaHkhj gks tkus ds i'pkr~ fnukad 17-05-2014 dks 11%30 cts ^^ejht dh fLFkfr xaHkhj gksus** dh tkudkjh nsrs gq, bZykt dh vuqefr i`Fkd o fof'k"V :i ls izksxszl 'khV esa yh xbZ Fkh tcfd vukosnd ds dFkukuqlkj lkekU; Lohd`fr ysus ds mijkar i`Fkd ls izfrfnu lgefr ysuk vko';d ugha Fkk] tks fd fuEukuqlkj gS%& ^^17@5@14 11%30am eq>s crk;k x;k gS fd esjs ejht dh gkyr [kjkc gSA vkSj mlds tku dks [krjk gks ldrk gSA ;g lc tkurs gq, esa mldk bykt djokus dh vuqerh nsrk@nsrh gwWA** bl izdkj il fudkyus dh izfdz;k izkjaHk djus ds iwoZ gh i`Fkd ls gLrk{kfjr o fyf[kr lgefr yh tkuh Fkh ;k fQj ekSf[kd :i ls le>k;s x;s tksf[ke dk fooj.k izksxszl 'khV esa Lo;a fy[kuk Fkk o bl rF; dks Hkh Li"V djuk Fkk fd izfdz;k ls lacaf/kr tksf[ke tfVyrkvksa dks le>dj ejht us ekSf[kd lgefr iznku dh Fkh mYys[k djuk FkkA bl izdkj tksf[ke dks le>s fcuk izfdz;k dks laiUu djus gsrq nh xbZ ejht dh lgefr fof/kd :i ls ekU; ugha gSA ,oa fpfdRld ftls o"kksZ lsok dk vuqHko izkIr gks dq'ky o ;ksX; gks] ijarq fQj Hkh mls laiUu djus okyh mipkj izfdz;k dk fu.kZ; ysrs le; bl fo"k; ij vo'; fopkj djuk pkfg, fd ^^1- D;k izfdz;k dk ykHk ;k ifj.kke bruk // 31 // vko';d gS fd ejht dh e`R;q dk tksf[ke fy;k tk ldsA** 2- blds lkFk gh izfdz;k esa vfrlaHkkfor vizR;kf'kr tfVyrkvksa dk fuokfjr djuk fu;a=.k esa u gks] rc ,slh izfdz;kvksa esa vkSj vf/kd ltx gksdj ejht dks ,slh tfVyrkvksa ds laca/k esa lwfpr dj le>kdj o bl laca/k esa vk'oLr gksdj fd ejht le>dj LosPNk ls lgefr ns jgk gS fyf[kr lgefr ysuh pkfg, tks fd bl izdj.k esa ugha yh xbZA fpfdRld us iw.kZ vkRefo'okl ds lkFk izfdz;k laikfnr dh o nqHkkZX;o'k ejht dh fLFkfr xaHkhj gqbZ o mldk fu/ku gks x;kA gekjs erkuqlkj vukosnd fpfdRld ,-ds-xxZ }kjk vius fofgr drZO;ksa dk ikyu ugha fd;k x;k tks fd lsok esa fuEurk dh Js.kh esa vkrk gSA gekjs }kjk fopkj.kh; iz'uksa ds laca/k esa fu"d"kZ fn;k tkrk gS fd vukosnd fpfdRld }kjk mipkj ds iwoZ izfØ;k ls lacaf/kr tkudkjh tksf[ke o tfVyrkvksa ds laca/k esa foxrokj tkudkjh e`rd dks ugha nh Fkh u gh e`rd bu tfVyrkvksa ls fHkK Fkk vufHkKrk dh fLFkfr esa e`rd }kjk ekSf[kd lgefr ns nh xbZ fpfdRld oSdfYid izfdz;k dh tkudkjh nsus gsrq Hkh ckf/kr Fkk] ijarq vukosnd fpfdRld }kjk ,slk u dj drZO; ikyu dh mis{kk dh xbZ gS tks fd lsok esa fuEurk dh Js.kh esa vkrk gSA vr% ifj.kkeLo:i ejht dh e`R;q gks xbZA vukosnd dza-1 o 2 ifjoknhx.k dks vuqrks"k iznku djus gsrq nkf;Ro/khu gS vukosnd dza-3 dks mUeksfpr fd;k tkrk gSA 14- ifjoknhx.k }kjk e`rd lqjsUnz ekf.k;k dh vk; dk izek.k i= izLrqr fd;k gS ftlds vuqlkj e`rd dks 15]000@&:- ekfld ldy osru izkIr gksrk FkkA ifjokfnuh }kjk vfHkdFku fd;k x;k gS fd Lo- lqjsUnz dqekj dh e`R;q ds le; mez 36 o"kZ Fkh o mldh okf"kZd vk; 1]80]000@&:- Fkh e`rd dh iRuh ifjoknh dza-1 o nks vo;Ld iq=h;ka ifjoknh dza-2 o 3 ifjokj esa 'ks"k gS tks fd iw.kZ :i ls e`rd dh vk; ij vkfJr FksA ifjokfnuh }kjk mDr osru dk 3@4 va'k 15 o"kZ gsrq 20]25]000@&:- vuqrks"k fnyk;s tkus dh izkFkZuk dh gSA ifjokfnuh }kjk // 32 // e`rd dh Hkfo"; esa laHkkfor okf"kZd vk; dk Hkh 3@4 va'k 15 o"kZ gsrq 10]12]500@&:- dk vuqrks"k fnyk;s tkus dh izkFkZuk dh gSA ;g vuqrks"k Hkkoh vk; ls lacaf/kr gS] tks fd Lohdkj ;ksX; ugha gSA ekufld o 'kkjhfjd] vkfFkZd d"V gsrq 2]00]000@&:- {kfriwfrZ dk vuqrks"k fnyk;s tkus dh ekax dh xbZ gSA gekjs erkuqlkj ifjoknhx.k vkfFkZd ekufld 'kkjhfjd d"V gsrq ldy {kfriwfrZ 15]00]000@&:- iznku fd;k tkuk U;k;ksfpr gksxkA ifjoknhx.k }kjk okn O;; 20]000@&:- dk vuqrks"k fnyk;s tkus dh izkFkZuk dh gS tks fd gesa vR;f/kd izrhr gksrk gS vr% okn O;; 5]000@&:- fnyk;k tkuk U;k;ksfpr gksxkA 15- mijksDrkuqlkj izdj.k ds rF;ksa ij fopkj&foe'kZ djus ds mijkar o nLrkostksa ds ifj'khyu i'pkr~ ge bl fu"d"kZ ij igqaprs gSa fd ifjoknhx.k }kjk izLrqr ifjokn vkaf'kd :i ls Lohdkj fd;s tkus ;ksX; gSA vr% vkaf'kd :i ls Lohdkj dh tkrh gSA vukosnd dza-3 dks mUeksfpr fd;k tkrk gS o vukosnd dza-1 o 2 dks funsZf'kr fd;k tkrk gS fd bl vkns'k fnukad ls 45 fnu dh vof/k ds Hkhrj ifjoknhx.k dks fuEukuqlkj vuqrks"k iznku djsa%& 1- vukosnd dza-1 o 2 la;qDr% o i`Fkdr% vkfFkZd ekufld 'kkjhfjd {kfriwfrZ gsrq ifjoknhx.k dks 15]00]000@&:-¼ianzg yk[k :i;s½ iznku djsaxs ,oa fu;r vof/k ds Hkhrj Hkqxrku djus esa pwd djus dh fLFkfr esa mDr jkf'k ij 9 % okf"kZd dh nj ls C;kt jde vkns'k fnukad ls Hkqxrku fnukad rd dk iznku djus gsrq nkf;Ro/khu Hkh jgsaxsA 2- vukosnd dza-1 o 2 okn O;; gsrq ifjoknhx.k dks 5]000@&:-
¼ikap gtkj :i;s½ Hkqxrku djsaxsA ¼U;k;ewfrZ vkj-,l- 'kekkZ½ ¼fguk BDdj½ ¼Mh-ds-iksn~nkj½ ¼ujsUnz xqIrk½ v/;{k lnL;k lnL; lnL;
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