State Consumer Disputes Redressal Commission
Ashok Jain S/O Sh. C.P. Jain vs Bhandari Health Care Pvt. Ltd. Through ... on 8 January, 2020
1
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Ashok Jain S/o Shri C.P. Jain, Aged 52 years, R/o C-92, Ramdas Marg,
Tilak Nagar, Jaipur.
- Complainant
Versus
1.Bhandari Health Care Pvt. Ltd, 138A, Vasundhara Colony, Gopalpura Bye Pass, Tonk Road, Jaipur through its Director Dr. K.M. Bhandari.
2. Bhandari Hospital & Research Centre, 138A, Vasundhara Colony, Gopalpura Bye pass, Tonk Road, Jaipur through its Directors Dr. K.M. Bhandari.
3. Dr. K.M. Bhandari, Surgeon, Bhandari Hospital & Research Centre, 138A, Vasundhara Colony, Gopalpura Bye Pass, Tonk Road, Jaipur.
4. Dr. Anshuman, Surgeon, C/o Bhandari Hospital & Research Centre, 138A, Vasundhara Colony, Gopalpura Bye Pass, Tonk Road, Jaipur.
5. Dr. Mohan Saini, Anesthetist C/o Bhandari Hospital & Research Centre, 138A, Vasundhara Colony, Gopalpura Bye Pass, Tonk Road, Jaipur.
6. Dr. K.K. Kushwaha, Cardio Surgeon, C/o Bhandari Hospital & Research Centre, 138A, Vasundhara Colony, Gopalpura Bye Pass, Tonk Road, jaipur.
7. M/s National Insurance Company Pvt. Ltd. registered office at Business Centre Shop No F- Plot No.86, Salasar Enclave, Oppisite Vadic Kanya Mahavidayalay, Raja Park, Jaipur, Rajasthan-302004
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Ltd. & ors. ds fo:) /kkjk 17 miHkksDrk laj{k.k vf/kfu;e esa bl vk;ksx esa fnukad 23-12-2014 dks is'k fd;k x;k gSaA izdj.k ds rF; bl izdkj gS fd ifjoknh dh iq=h lksukyh tSu tks fd 18 o"kZ dh Fkh] PMT ijh{kk dh rS;kjh dj jgh Fkh] isV esa nnZ ds dkj.k HkaMkjh gkWLihVy esa HkrhZ gqbZA vizkFkhZ la- 3 ls 6 }kjk Minor appendix dk operation djuk Fkk ijUrq mldk ifj.kke lksukyh tSu dh e`R;q gksuk fudykA ejht ds ifjtuksa dks crk;k Laparoscopy ds tfj;s operation fd;k tkosxk] operation ds nkSjku ejht dh Right iliac artery dV x;h ftlls Hkkjh ek=k esa [kwu cg x;kA cPph dk B. P- dkQh fxjrk pyk x;k] cPph dks hypoxia gks x;k] dksbZ proper trained staff ugha FkkA gkWLihVy esa [kwu dk bartke ugha Fkk tcfd vkikr fLFkfr esa [kwu dh vko';drk gks] rks bldh O;oLFkk vfuok;Z Hkh gSa ] fo'ks"kK ltZu ugha FkkA gkWLihVy dh ykijokgh ds dkj.k appendix ds operation ds nkSjku vlko/kkuh ls Vascular Artery dV x;hA ifjoknh miHkksDrk gSaA vizkFkhZ la- 3 gkWLihVy dk eSustesaV djrk gSa] vizkFkhZ la- 3 ls 6 dh ykijokgh ds fy, ftEEksnkj gSaA fnukad 14-03-2014 dks ifjoknh dh cPph ds isV esa nnZ gqvk] HkaMkjh gkWLihVy esa Mk- ds ,e HkaMkjh dks fn[kk;k x;k] mls lksuksxzkQh dh lykg nh x;h] lksuksxzkQh VsLV ds ckn dgk x;k fd colitis gSa] 7 fnu dh nokbZ nh x;hA 3 fnukad 15-03-2014 dks ejht ds isV esa T;knk nnZ gqvk] Mk- ds ,e HkaMkjh dks fn[kk;k x;k] Mk- ds ,e HkaMkjh us HkrhZ djkus dh lykg nh rFkk dgk fd Appendix Pain gSa] nokbZ;kW nh] ifjoknh us iSlks dk Hkqxrku fd;kA fnukad 16-03-2014 dks lqcg lksukyh ds [kwu dh tkap dh x;h tks lHkh lgh Fkh] nksigj esa lksuksxzkQh dh x;h ijUrq dksbZ diagnose ugha gqvk] gkWLihVy ds Mk;jsDVj }kjk ;g dgk x;k fd lgh fLFkfr operation theatre esa ys tkus ds ckn clear gksxh] ifjoknh us operation dh C.D. cukus dk dgk ijUrq badkj dj fn;k] ejht dks operation theatre esa f'kQV fd;k x;k] fdlh izdkj ds diagnose ds ckjs esa ugha crk;k x;kA vizkFkhZ la- 3 ls 5 us operation fd;k rFkk ,d ?kaVs ckn [kwu ykus dk dgk] 6 ;wfuV [kwu dh ekax dh x;h] gkWLihVy esa CyM cSad ugha Fkk] ml le; ejht dh fLFkfr ugha crk;h x;h] ejht dks 4- 45 ih-,e- ij operation theatre es fy;k x;k] 5-52 ih-,e- ij Anaesthesia fn;k x;k rFkk vizkFkhZ la- 3 ls 5 dh ykijokgh ls Right iliac artery dV x;h] ftlls Hkkjh ek=k esa [kwu cg x;k] mlds ckn vizk FkhZ la- 3 ls 5 us Open laparotomy djus dh lwpuk nh x;h] gkWLihVy esa CyM dk bartke ugha Fkk] 6-30 ih-,e- ij [kwu dk bartke djus dk dgk x;k] ejht ds ifjtu 6-40 ih- ,e- CyM cSad igqWps rc rd ejht 'kkWd o dksek esa vk pqdh Fkh] ifjoknh okil 7-00 cts gkWLihVy [kwu ysdj igqWps] bl nkSjku vizkFkhZ la- 6 Hkh operation esa Hkkx ys fy;k] cPph dh lgh fLFkfr ugha crk;h x;h] 7-15 ls 8-22 rd operation pyk] 8-23 ij cPph dks operation theatre ls ckgj yk;k x;k] cPph Ventilator ij Fkh] fpfdRldks us crk;k fd Artery iapj gks x;h Fkh ftls fjis;j dj fn;k x;k gSa] cPph dks ICU eas j[kk x;k] dqN le; i'pkr ifjtuksa dks ckgj ls ns[kus dh btktr nh x;h rks ns[kk fd cPph ds dksbZ Movement ugha Fkk] vizkFkhZ la- 3 us crk;k cPph dh fLFkfr Stable gSa tcfd B. P- fujUrj fxj jgk Fkk] 6 ;wfuV [kwu vkSj ykus dk dgk x;kA fnukad 16-03-2014 dks High risk consent latter lkbZu djus dk dgk ijUrq ifjtuksa us badkj dj fn;kA fnukad 17-03-2014 dks lqcg crk;k fd cPph dh fLFkfr [kjkc gSaA fnukad 23-03-2014 dks ICU eas cPph Ventilator ij Fkh] 11-29 ih-,e- ij mldh e`R;q gks x;h] bldh lwpuk ejht dh ekrk dks nh x;h] ejht dh lgh fLFkfr ifjtuksa dks dHkh ugha crk;h x;h] ejht dh Laparoscopy ltZjh dh 4 x;h] cPph ds dksbZ VsLV ugha fd;s x;s] ;gkW rd dh cYM xqzi dk Hkh VsLV ugha fd;k x;k tc Laparoscopy isV esa Mkyh x;h rks cPph dh Artery iapj gks x;h] ftldh tkudkjh 5-46 ih-,e- ij gqbZ]B. P. cgqr T;knk de gks x;k] cPph gsejst 'kkWd esa vk x;h] Vascular fjis;j vizkFkhZ la- 6 }kjk fd;k x;k] fpfdRldks us dgk fdArtery dh ejEer dj nh x;h gSa ijUrq [kwu uqdlku ds ckjs esa dqN ugha crk;k x;kA fnukad 22-03-2014 dks High risk isij ij lkbZu djus ds fy, dgk x;k] ejht ds ifjtuksa us badkj dj fn;k] ifjoknh dks dgk x;k fd ;fn dkxtkr ij lkbZu ugha djksxs rks dksbZ Hkh fpfdRld vkxs bZykt ugha djsxk] igys dkxtkr ij gLrk{kj djus dh eukgh dk uksV fy[k fn;k x;k Fkk] fnukad 22-03-2014 dks gLrk{kj fd;s ijUrq mu dkxtkr ij fnukad 16-03-2014 vafdr gks x;h] cPph ds hypoxia gks x;k Fkk] cPph dks tc operation theatre esa ys tk;k x;k rks mldh fLFkfr vPNh Fkh] ekewyh appendix ds operation dk ifj.kke cPph dh e`R;q jgk] ;g dHkh ugha crk;k fd cPph dh Artery dSls dVh] cPph ds ifjtuksa dks crk;k x;k fd cPph dk 'ko highly infectious case gks pqdk gSa] iksLVekVZe ugha djkuk pkfg,] operation 15&20 fefuV dk crk;k x;k Fkk] vLirky esa [kwu dk bartke ugha Fkk rFkk uk gh igys djus dk dgk x;k] fpfdRld operation ds lkbZM bQsDV o dkWEiyhds'ku ds fy, rS;kj ugha Fks] operation ds ckn dgk x;k fd cPph vka[ks [kksy jgh gSa rFkk lkal ys jgh gSa tcfd cPph dks ckgj yk;k x;k rc mlds Ambu bag yxk gqvk Fkk rFkk Ventilator ij Fkh] tc cPph dks operation theatre ls ckgj yk;k x;k rks cPph dk B. P- 91&47 Fkk] flVh Ldsu ds vuqlkj cPph ds hypoxia gks x;k Fkk] cPph dks fnukad 15-03-2014 dks HkrhZ djk fn;k Fkk ijUrq 24 ?kaVs ckn vkWijs'ku fd;k x;kA bl operation esa 200&300 ,e ,y [kwu dk uqdlku gksrk gSa ijUrq 6 ;wfuV cYM dh ekax dh x;h] Vascular Artery] Appendix ls 3&4 bap dh nwjh ij Fkh fQj ;g dSls dV x;h]ICU easa cPph ds [kwu p<k;k x;k ijUrq estj QkYV o mldh ejEer ds ckjs esa dqN ugha crk;k x;kA fnukad 16-03-2014 dks operation ds ckn Dr.Shyam Vardani us Right side eas Needle esa Mkyh rks ;g ik;k fd Lungs eas [kwu Hkjk gqvk gSa] cPph dh fLFkfr [kjkc gksrh x;h ijUrq nqckjk operation fFk;sVj esa ugha ys tk;k x;k] fnukad 15-03-2014 ds gkWLihVy fjdkMZ esa ifjorZu fd;k x;k gSa rFkk ;g vafdr fd;k x;k gSa fd ,slk gh nnZ dksVk esa Ms< eghus igys gqvk Fkk tks iw.kZr;k >wBa k gSa] operation ds le; cPph dh fLFkfr cf<;k Fkh] gkWLihVy us xyr fjdkMZ crk;k] consent latter ij QthZ gLrk{kj fd;s x;s] 5 gkWLihVy iz'kklu dks nks izfrosnu fn;s x;s] ftldk tokc fn;k x;k og larks"kizn ugha Fkk fQj nks izfrosnu fn;s x;s ftldk tokc fn;k x;k ijUrq og igys okys tokc dk fjihVs'ku Fkk] ekuuh; eq[;ea=h o esfMdy dkWfUly dks f'kdk;r dh x;hA cPph PMT esa lysDV gqbZ Fkh ijUrq vPNh jSad ds fy, nqckjk rS;kjh dj jgh Fkh] cPph fpfdRld curh rFkk dkQh iSlk dekrhA ifjokn Lohdkj djus dk fuosnu fd;kA ifjoknh us ifjokn ,oa lk{; ds leFkZu esa Loae ifjoknh v'kksd tSu dk 'kiFk i= rFkk nLrkost izn'kZ&01 yxk;r izn'kZ&18 is'k fd;sA vizkFkhZ la- 1 ls 4 ds tokc esa igys Fact fy[ks x;s gS] blds vuqlkj ejht us fnukad 14-03-2014 dks isV nnZ dh f'kdk;r ds fy, fn[kk;k rFkk ;g Hkh crk;k fd ,d&Ms< eghus igys Hkh ,slk gqvk FkkA Clinical examination ls ;g yx jgk Fkk fd ;k rks Appendicitis ;k Colitis gSa] nksuksa ds bZykt vyx&2 gSaA Ultrasonography djk;h rks ,slk gh ifj.kke vk;kA vizkFkhZ la- 3 o Dr. D.S.Pokharna us ns[kk rFkk ejht ds ifjtuksa dks crkdj Conservative treatment dk Iyku fd;k x;k] Symptoms ls ,slk yx jgk Fkk fd Appendicitis gSa rFkk ltZjh gksuh pkfg,A fnukad 15-03-2014 dks ejht dks Pain Abdomen, Nausea & vomiting dh f'kdk;r ds lkFk vk;kA vizkFkhZ la- 3 us tkap dh rFkk ik;k fd Li"V Appendicitis gSaA bldh Fresh Ultrasonography Hkh dh x;h] ejht ds ifjtuksa dks crk fn;k x;k fd vLirky esa HkrhZ gksuk t:jh gS] pre-operative Tkakp djkuh gksxh tks ltZjh ds fy, vko';d gSa] ,d vkWi'ku Laparoscopic & conventional approach Fkk] laHkkfor Difficulties, expected benefits & possible risks, as also the estimated expenses and period of hospitilization dk crk fn;k x;k] ejht HkrhZ gks x;kA fnukad 16-03-2014 dks ejht o ejht ds ifjtuksa dks Laparoscopic appendectomy ds ckjs esa crk fn;k x;k Fkk] appendix ds vkl ikl ds LVªsDpj ds fpidk gqvk Fkk] appendix ds vkl ikl fpids gq, LVªsDpj dks gVkrs oDr vpkud bleeding gqvk] vizkFkhZ la- 3 us Vsx fd;k rFkk izs'kj fn;k rks bleeding 6 :d x;h] Laparoscopic ls vksiu ltZjh dk fu.kZ; fy;k] tkap esa ;g ik;k x;k fd Rt. External iliac artery esa NksVk iapj gks x;k] izs'kj fn;k x;k rFkk Vascular fjis;j djuk FkkA ;|fi vizkFkhZ la- 3 lhfu;j o jsiqVsMsV ltZu gSa rFkk 36 lky dk vuqHko gSa] ij fcuk LokfHkeku ls rFkk better fjis;j o ejht ds fgr esa CTVS lTkZu Dr. Kushwaha dks cqyk;k x;k] bl nkSjku Appendix vyx dj nh x;h rFkk fudky nh x;h] Mk- eksgu tks Anesthetist Fkk] vksijs'ku fFk;sVj ds ckgj vk;k rFkk lthZdy ,DlhMsUV ds ckjs esa crk;k] ejht dh fLFkfr ds ckjs esa Hkh crk;k rFkk ikl ds CyM cSad ls [kwu dk bartke djus dk dgk rFkk fjDohts'ku nh] ;g Hkh crk;k fd Vascular ltZu dks cqyk;k x;k] High risk consent ysus dh dksf'k'k dh rks ejht ds ifjtuksa us dgk fd ge Dr. HkaMkjh ls ckr djsxs] Dr. HkaMkjh vkWijs'ku fFk;sVj ls ckgj vk;s] mUgksua s lkjh fLFkfr crk;h rks ejht ds ifjtuksa us High risk consent nh] 10&15 fefuV ckn Dr. Kushwaha vk x;s] mUgksaus Vascular fjis;j fd;k] iwjh txg dh lQkbZ dh x;h rFkk isV cUn dj fn;k x;k] CyM Transfusion o supportive measures dke esa fy;s x;s] ejht dks ICU eas f'kQV fd;k x;k] ejht LVscy dUMh'ku esa Fkk] bQsfDVo osUVhys'ku dh O;oLFkk dh x;h] ml le; ejht gks'k esa Fkk] vka[ks fgyk jgk Fkk rFkk fyEc esa ewesUV Fkk] ejht ds ifjtu feys] ogha ejht ds ckr dk tokc fn;k] ejht dks ICU-4 esa iwjs /;ku ls j[kk] ofj"B Anesthetist Dr.S.S.Varandhani ls Hkh fopkj fd;k x;k] djhc 3 ?kaVs ckn ejht dh fLFkfr fcxMus yxh rFkk mls bradycardia arrest vk x;k] mls CPR Ykxk;k] ;g ik;k fd ejht ds right side esa air entry gks jgh Fkh] Needle yxk;h x;h rks right pneumothorax gks x;k blfy, chest esa V;wc Mkyh x;h rks dkQh gok ckgj vk;h rFkk Fluid esa [kwu ds /kCcs Hkh FksA fnukad 17-03-2014 dks ejht esa improvements fn[k jgk Fkk ijUrq ejht esa dull o pupilary reaction fn[k jgk Fkk] U;wjks ltZu Mk- nhid oaxuh us tkap dh] mlus CT scan o EEG djus dh lykg nh] tkap ls ;g irk pyk fd Brain hypoxia gks x;k gS] nq%[kn fLFkfr dh lwpuk ejht ds ifjtuksa dks ns nh x;hA fnukad 18-03-2014 dks ejht Comatose esa Fkk rFkk stable vital signs. Fks] mls ICU esa Closely monitored ij j[kk x;kA 7 fnukad 23-03-2014 dks ejht ds ifjtuksa dks ejht dh fLFkfr crk nh x;h rFkk fnu&izfrfnu ds ejht ds bZykt dk crk fn;k x;k] fnukad 23-03-2014 dks gh ejht ds Cardiac arrest vk;k] mldks cpkus dh dksf'k'k dh ijUrq 11-29 ih-,e- ij mldh e`R;q gks x;hA jsLiksMsUVl us ejht ds ifjtuksa dks nq%[k O;Dr fd;k rFkk dgk fd iksLVekVZe fd;k tkuk pkfg, rkfd okLrfod e`R;q dk dkj.k irk yx lds ijUrq ifjtuksa us lgefr ugha nh rFkk mUgsa dgk fd oks vxys fnu ckr djsxs] ejht dk 'ko ekspZjh :e esa j[k fn;k x;kA vxys fnu fQj ckr dh x;h rks ifjtuksa us iksLV ekVZe esa vlgefr O;Dr dhA ;gkW ;g mYYks[k djuk mfpr gksxk fd vizkFkhZx.k us fnukad 18-03-2014 ls 22-03-2014 ds ?kVukdze dk fooj.k vius pkVZ esa ugha fd;k gSaA izkFkfed vkifRr esa ifjokn >waBk o esfMdyh o yhaxyh fizalhiy ds fo:} crk;k gSaA ifjoknh us ;g ugha crk;k gSa fd fdl rjg vizkFkhZx.k us czh p vkWQ M;wVh dh gSaA ifjoknh us rF; fNik;s gSaA ejht ds ,d&Ms< eghus igys blh izdkj dk recurrent pain gqvk Fkk rFkk og dksVk esa HkrhZ jgh Fkh] ijUrq ;g ckr ifjokn esa ugha crk;h x;hA 'ko ijh{k.k djkus ds fy, ejht ds ifjtuksa us lgefr ugha nh Fkh] operation dh C.D. cukus dks ugha dgk x;k Fkk rFkk xksiuh;rk cjrus ds fy, ;g cuk;h Hkh ugha x;hA dqy fcy 2]27]582@&:i;s dk Fkk ijUrq ifjoknh us 32]000@&:i;s lh/ks rFkk 75]000@&:i;s dk esfMdy bU'kksjsUl ds tfj;s pSd fn;s] ckdh Hkqxrku ugha fd;k x;kA Medical Accident ;k Death, Negligence Eksa ugha vkrk] jDr L=ko gksuk Medical Accident Fkk] tks Appendix dks dissection djus ds oDr tks fpids gqvk LFkku Fkk mldks gVkus ds pDdj esa gqvkA ifjtuksa us RMC dks f'kdk;r dh] ifjoknh dks operation note vkfn miyC/k djk fn;s x;s] ifjoknh us eq[;ea=h o LokLF; ea=h dks Hkh f'kdk;r dhA Dy.CMHO Uks tkap dh] mUgksua s dksbZ vlko/kkuh ugha ik;h x;h rFkk Dy.CMHO dks i{kdkj Hkh ugha cuk;k x;kA iSjkokbt tokc esa rF;ksa dks >waBk o vlR; crk;k] operation djuk Lohdkj fd;k x;k] Rt. External iliac artery iapj gksuk crk;k x;k] trocar ls Injury gksuk xyr crk;k o dgk fd ;g Right side esa Mkyh gh ugha x;h Fkh] 8 trocar ls Injury gksuk laHko ugha Fkk] ;g lc Appendix ds vkl ikl fpidh gqbZ txg dks gVkus ds pDdj esa gqvk] LDr L=ko rqjar jksd fy;k x;k] Vascular ltZu us Hkh bZykt fd;kA Laparoscopic esa cgqr xaHkhj fjLd gksrh gS] hypoxia, bleeding ls ugha gqvk] Spontaneous pneumothorax gqvk rFkk lung collaps gks x;s] VªM sa LVkQ ugha gksuk xyr gSa] gkWLihVy NABH, NABL & ISO 9001 % 2008 ls ekU;rk izkIr gSa rFkk mlh ds vuqlkj bUQzkDVpj gS rFkk LVkQ gSa rFkk ogha Standards Follw djrs gSaA [kwu ds fy, LokLF; dY;k.k cYM cSad ls MOU dj j[kk gSa rFkk gkWLihVy ls ek= 1 fdyksehVj nwj gSa] rqjar [kwu dh O;oLFkk gks ldrh gSa] operation ds iwoZ tkap dh x;h rFkk ejht ds ifjtuksa dks crk nh x;h] artery vlko/kkuh ls ugha dVh cfYd iapj gqbZ Fkh tks Appendix ds vkl ikl fpids gq, vaxksa dks gVkus ds nkSjku gqbZ Fkh] dksbZ fpfdRlh; vlko/kkuh ;k MsfQlsUlh ugha jgh] esfMdy izksVksdkWy ds eqrkfcd operation dh C.D.ugha cuk;h tkrh] ifjoknh dks 121 ist dk esfMdy fjdkWMZ miyC/k djk fn;k x;k] ejht dks 4-45 ih ,e ij operation fFk;sVj esa yk;k x;k rFkk 5-12 ih ,e ij Anesthesia fn;k x;k rFkk Appendix dk operation fd;k tk jgk Fkk fd nq?kZVuk gks x;h] ejht ds ifjtuksa dks crk fn;k x;k] operation ds ckn ejht dks ICU eas f'kQV fd;k x;k] operation fFk;sVj ls ICU rd ejht dks Ambu bag yxkdj ys tk;k x;k rFkk ckn esa osUVhysVj yxk fn;k x;k] ml le; ejht vka[ks [kksy jgh Fkh] ul fgyk jgh Fkh rFkk Verbal commands dk mRrj ns jgh Fkh] trocar ls pksV vkuk laHko ugha gSa] bldk Diagram ,usDpj vkj&1 gSa] Artery Injury ,d nq?kZVuk Fkh] ejht ds ifjtuksa dks le;&2 ij ejht dh fLFkfr ds ckjs esa crk fn;k x;k] gkWLihVy iwjh rjg bDohIM gSa] bejtsUlh Hkh gSa] ejht dk iw.kZr;k esfMdy LVs.MMZ ls bZykt fd;k x;k rFkk ifjokn [kkfjt djus dk fuosnu fd;kA vizkFkhZ la- 5 us vius tokc esa vizkFkhZ la- 1 ls 4 ds tokc dh gh iqujko`fRr dh gSaA foi{kh uss tokc ,oa lk{; ds leFkZu esa Mk- ds ,e HkaMkjh] eSusftax Mk;jsDVj HkaMkjh gkWLihVy ,.M fjlpZ lsUVj dk 'kiFk&i= ,oa ,usDpj vkj&01 yxk;r ,usDpj vkj&6 is'k fd;sA 9 cgl vafre vf/koDrk mHk;i{k lquh x;h rFkk i=koyh ,oa izLrqr nLrkostkr dk v|ksiku voyksdu o euu fd;k x;kA ifjoknh vf/koDrk us ifjokn esa crk;s rF;ksa dh gh cgl esa iqujko`fRr djrs gq, fuEu U;kf;d n`"Vkarksa esa izfrikfnr fl}karksa dh vksj /;ku vkdf"kZr fd;k %& 1- III (2012) CPJ 357 (NC) ARVIND PANDEY & ANR. Vs. DR.
SULEKHA SARAN & ORS.
2- (2010)3SCC 480 Kusum Sharma & Ors. Vs. Batra Hospital & Medical Research Centre & Ors.
3- Ekkuuh; jk"Vªh; vk;ksx] ubZ fnYyh }kjk izFke vihy la- 1140@14 Sunil Vs. Om Multispecialty Hospital & Medical Research Centre Pvt. Ltd.
4- Ekkuuh; jk"Vªh; vk;ksx] ubZ fnYyh }kjk fuxjkuh ;kfpdk la- 3219@12 Kushal Jain and Ors. Vs. Jatinder Gupta and Ors. is'k fd;sA vizkFkhZ dh vksj ls tokc ifjokn ds rF;ksa dh iqujko`fRr djrs gq, Medical Litrature dh vksj /;ku fnyk;kA ;g izdj.k fpfdRlh; vlko/kkuh ls e`R;q dk gSA bl laca a/k esa ekuuh; loksZPp U;k;ky; us (2005) 6 Supreme Court Cases 1 JACOB MATHEW Vs STATE OF PUNJAB AND AN OTHER esa fuEu fu/kkZfjr fd;k gS %& 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, 10 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 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.11
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 ekuuh; loksZPp U;k;ky; us fpfdRlh; vlko/kkuh ds lac/a k esa 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 something 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.
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 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.12
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 13 or clinics for extractine uncalled for compensation. Such malicious proceedings deserve to be discarded against the medical practitoners.
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.
Ekkuuh; loksZPp U;k;ky; }kjk fu/kkZfjr fl}kUrksa dh jks'kuh esa ns[kuk gSa fd D;k gkWLihVy us Skill & Care dk bLrseky fd;k gSaA pwfa d ;g gkWLihVy dkWjiksjsV gkWLihVy gSa rFkk lqij Lis'kfyVh gkWLihVy Claim djrk gSa o ISO izek.k i= Hkh gSaA bl fLFkfr esa ;g Skill & Care Hkh Highest yscy esa mi;ksx djuk gksxkA loZizFke ifjoknh ds rF;ksa dks ns[ks rks ifjoknh dh iq=h lksukyh tSu dks tks fd 18 o"kZ dh Fkh] PMT dh rS;kjh dj jgh Fkh] ,d ckj ijh{kk nh ijUrq vPNk Medical College ugha fey jgk Fkk blfy, nqckjk Kota esa rS;kjh dj jgh FkhA lksukyh tSu ds isV esa nnZ Fkk] fnukad 14-03-2014 dks HkaMkjh gkWLihVy esa vizkFkhZ la- 3 dks fn[kk;kA vizkFkhZ la- 3 o Mk- Mh ,l iks[kjuk us ejht dks ns[kkA Acute appendix ds y{k.k Fks] ftldh ltZjh dh tk ldrh gSa rFkk nokbZ;ka fy[k nh x;h] Conservative treatment dk fu.kZ; fy;k x;k rFkk nokbZ;ka nh x;hA ejht ds mu nokbZ;ksa dk dksbZ vlj ugha iMkA fnukad 15-03-2014 dks iqu% vizkFkhZ la- 3 ds ikl vk;k] Sonography dh x;h] Appendix ik;k x;k] Laparoscopic operation dk dgk x;k] gkWLihVy esa HkrhZ gks x;h] fnukad 16- 03-2014 dks 'kke dks operation fFk;sVj ys tk;k x;k] Laparoscopic operation ds fy, isV ds ck;h vksj lqjk[k fd;s x;s rFkk Appendix ds fpids gq, Hkkx dks gVkus dh dksf'k'k dh rks Right iliac artery ifjoknh ds vuqlkj dV x;h] vizkFkhZ ds vuqlkj jsIpj ;k iapj gks x;h] tSlh Hkh fLFkfr gks {kfrxzLr gks x;h] mlesa [kwu cgus yxk] Cardio ltZu Mk- dq'kokg dks cqyk;k x;k ftUgksaus Artery ejEer dh] [kwu jksdk rFkk Open surgery dh x;h] Appendix fudkyh x;h tks [kjkc voLFkk esa FkhA 14 ;gkW ;g mYys[k djuk mfpr gksxk fd mDr Appendix uk rks ejht ds ifjtuksa dks fn[kk;h x;h] uk gh mldh QksVks yh x;h ftlls ;g irk pys fd Appendix fdl fLFkfr esa fudkyh x;h Fkh ijUrq vkWijs'ku uksV ls ,slk izrhr gksrk gSa fd og [kjkc fLFkfr esa fudky nh x;hA ifjoknh ds vuqlkj mlesa [kwu cgus ls ejht ds hypoxia gks x;k tcfd vizkFkhZ ds vuqlkj hypoxia fnukad 17-03-2014 dks gqvk FkkA tSlh Hkh fLFkfr gks ejht ds hypoxia gqvk FkkA vizkFkhZ ds vuqlkj operation ds 3 ?kaVs ds ckn pneumothorax ;kfu QsQMs collaps gks x;s Fks] ejht dh fLFkfr fdzfVdy cuh jgh] fofHkUu fpfdRldks us Hkh ns[kk] fnukad 23-03-2014 dks 11-29 ih ,e ij ejht dh e`R;q gs x;h] blls iwoZ ml fnu nks ckj Cardiac arrest vk;k rFkk ,d ckj Cardiac arrest fnukad 16-03-2014 dks Hkh vk;kA bl izdkj ifjoknh i{k izkFkfed :i ls viuk izdj.k lkfcr djus esa lQy jgk gSaA 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 %&
(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 15 show that there was no negligence involved in the treatment -
Reasons for, given - Torts - Medical negligence--Burden of proof.
Ekkuuh; loksZPp U;k;ky; }kjk fu/kkZfjr fl}karksa dh jks'kuh esa ns[ks rks eq[; Hkkj fd dksbZ fpfdRlh; ykijokgh ugha dh x;h iw.kZ Skill & Care ls bZykt fd;k x;k] vizkFkhZ i{k }kjk lkfcr djuk gSA Ekjht dks fnukad 14-03-2014 dks fn[kk;k x;k] Sonography djk;h x;h rFkk nokbZ;ak nh x;h] fnukad 15-03-2014 dks iqu% fn[kk;k x;k] Appendix ik;k x;k] Operation ds fy, HkrhZ fd;k x;k] gkWLihVy ds HkrhZ ls ysdj ejht ds tkus rd gkWLihVy dh fuEu Dutty Fkh %& Medical negligence & Compensation 4th edition page 214-215 ds vuqlkj The patient has recovered from that particular illness, for which the treatment was initiated;
Patient fails to reattend for further treatment; Patient abandons the treatment;
Patient or the treating doctor dies; in case of treatment in a hospital, the duty of care will still exist in spite of death of the treating doctor; and Patient is referred elsewhere for further treatment. It may be noted that in cases of referral, the duty to care of the referring doctor continues till the time the patient departs for going to the doctor/hospital to whom the patient has been referred. It is the duty of the referring doctor to ensure that:
Proper referral note is given;
Proper guidance regarding transportation, care to be taken in transit, etc. is provided;
In an emergency case, requiring critical care, ambulance service, preferably equipped with ICU facilities, if 16 available, is advised.
All life-saving drugs are give before departure; and The center where the referral is being made is informed in advance. 16 Patients who register with doctors/hospital and patients who enter the accident and emergency ward of a hospital, are allowed a duty of care, because they eithe have a legal right to be treated or have actually been treated; in short, their treatment has been undertaken. The word 'treatment' includes diagnosis and any suggested course of action which ought to be followed, whether the patient has been seen or has not been seen by the doctor; for example, the doctor in the casualty department of a bust hospital who instructs a nurse via telephone of the treatment which the patient is to undergo or, in the case of what has been referred to as telemedicine, where the patient is treated at a long distance using modern technological methods of communication. It may be noted that telemedicine is now being resorted to in India as well.
ejht fnukad 15-03-2014 dks HkrhZ gks x;k] ml fnu Operation ugha fd;k x;k] ;|fi Sonography djkdj Laparoscopic operation dk fu.kZ; ys fy;k x;k FkkA fnukad 16-03-2014 dks 'kke dks Operation fd;k x;kA vizkFkhZx.k i{k dk dguk gSa fd ,slk gh isV nnZ ejht ds ,d&Ms< eghus igys dksVk esa gqvk Fkk rFkk dksVk gkWLihVy esa HkrhZ jgh FkhA ;|fi ifjoknh i{k us blls badkj fd;k gSa rFkk bldk dksbZ fjdkMZ Hkh is'k ugha fd;k gSa ijUrq vizkFkhZ i{k dh ckr eku yh tkos rks ejht ds ;g nwljk Appendix Attack Fkk rFkk ejht dk Appendix xaHkhj fLFkfr esa Fkk tks ;k rks QV pqdk Fkk ;k QVus dh fLFkfr esa Fkk ;k Operation ds nkSjku cLV gks x;k] tSlh Hkh fLFkfr gks] bl ifjfLFkfr esa Laparoscopic operation dk fu.kZ; ysuk xyr FkkA 'kq:okr esa gh open ltZjh dk fu.kZ; fy;k tkuk pkfg, Fkk rFkk rqajr Operation dj nsuk pkfg, D;ksfd Appendix QVus dh fLFkfr esa 'kjhj esa tgj QSyus dk [krjk jgrk gSa ijUrq ,slk ugha fd;k x;k rFkk Laparoscopic ls Operation fd;k x;kA vizkFkhZ ds nLrkost ,usDpj vkj&1 ds vuqlkj ejht ds isV esa 3 Nsn fd;s x;s tks eq[; :i ls isV ds chp es]a nkfguh rjQ fd;s x;sA Appendix cka;h vksj FkkA ekuo 17 'kjhj jpuk ,oa fdz;k foKku lw{etho foKku ds ist 13 esa isV dks ukS Hkkxks esa ckaVk x;k gSa tks ist 14 ds vuqlkj fuEu izdkj gSa %& S.NO. Region Organs Situated In.
1 nk;ha v/ki'kqdh; izn's k ;d`r (Liver) firk'k; (Gallbladder)] Right Hypochondriac Region nk;ka o`Dd (Rt. Kidnery)] NksVh vkar (Small Intestine) 2 vf/ktBj izn's k vek'k; (Stomach) ;d`r(Liver)vXuk'k;
Epigastric Region (Pancreas)] fM;ksfMue(Duodenum)] Iyhgk(Spleen)] vf/ko`Dd xzfUFk (Adrenal Gland) 3 Ckk;kW v/k%i'kqZdh; izns'k Iyhgk(Spleen)]dksyu(Colon)]ck;kW Left Hypochondriac Region o`Dd(Left kidney)] vXU;k'k;
(Pancreas) 4 nk;ka dfV izn's k firk'k; (Gall Bladder)] Right Lumbar Region ;d`r(Liver)]nka;k dksyu(Rt. Colon) 5 ukfHk izn's k ukfHk(Umbilicus)] tstque(Jejunum)] Umbliical Region bfy;e(Ileum)] fM;ksfMue(Duodenum) 6 Ckk;kW dfV izn's k vojksgh dksyu(Descending Colon)] Left Lumbar Region cka;kW o`Dd(Left Kidney) 7 nk;ka Jksf.kQyd izn's k ,isfUMDl(Appendix)] flde(Caecum) Right Iliac Region 8 v/kkstBj izn's k flxeksbM dksyu(Sigmoid Colon)] eknk Hypo Gastric Region tuu vax(Female Reproducive Organ)] ew=k'k; (Urinary Bladder) 9 ck;ka Jksf.kQyd izns'k vojksgh dksyu(Descending Colon)] Left Iliac Region flxeksbM dksyu(Sigmoid Colon) blls ;g izrhr gksrk gSa fd ;g lqjk[k Umbilical region, Hypochondriac Region, Left Lumbar Region o Left Iliac Region ds chp esa fd;k x;k FkkA vizkFkhZ us tks ,usDpj vkj&8 is'k fd;k gSa] mlds vuqlkj Right Iliac Region ds mij n'kkZ;k x;k gSaA Appendix uhps n'kkZ;k x;k gSa] chp esa dbZ vkSj phtsa gSaA ;|fi ;g mij of.kZr Hkkx ds vuqlkj lgh ugha gSa] mlds vuqlkj Appendix] Iliac artery ds gh Region esa gSa] bldk eryc vkl ikl esa gS ijUrq vizkFkhZ }kjk izLrqr ,usDpj vkj&8 dks ns[ks rks bu nksuksa ds chp nwjh gSa rFkk chp esa vU; Organs Hkh gSaA ejht dk Operation Laparoscopic ds tfj;s 'kq: fd;k x;k rks vpkud [kwu cgus yxkA bl ij Open ltZjh dk 18 fu.kZ; fy;k x;kA vizkFkhZ la- 3 ds ckjs esa crk;k x;k fd og l{ke ltZu Fkk] mlds ckotwn Vascular ltZu dks cqyk;k x;k] tks fd dkfMZ;ks ltZu Fkk] mlls Artery dh ejEer djk;h x;h] bl nkSjku izS'kj nsdj blood jksdus dh Hkh dksf'k'k dh x;h] Mk- dq'kokg 10&15 fefuV esa vk x;s Fks mUgksus Artery repair dj nh Fkh] ejht dks ICU esa f'kQV dj fn;k x;k Fkk rFkk vizkFkhZ ds vuqlkj 3 ?kaVs ckn ejht ds pneumothorax gks x;k Fkk tcfd ifjoknh ds vuqlkj mlh le; hypoxia gks x;k Fkk tcfd vizkFkhZ ds vuqlkj hypoxia fnukad 17-03-2014 dks gqvkA cgl ds le; U;k;ky; esa mifLFkr Mk- HkaMkjh ls iwNk x;k fd fdrus ml okyk [kwu p<k;k x;k ijUrq mUgksaus tokc ugha fn;k] pqi jgsA dksbZ O;fDr blood donate djrk gSa rks ,d unit esa 450&500 ml blood fy;k tkrk gSaA vPNs blood Bank esa bls rhu Hkkxksa esa foHkDr dj fn;k tkrk gSa] ,d RBC tks 250&300 ml gksrk gSa] nwljk Fresh frozen plazma tks 150&200 ml gksrk gSa] rhljk RDF tks 50&60 ml gksrk gSaA ;s dze'k% gkseksXykschu de gksus] Bleeding gksus o Plate Lets de gksus ij vyx vyx yxk;k tkrk gSaA pwfa d ejht ds gkseksXykschu de gks x;k Fkk] Bleeding Hkh gqbZ Fkh o Plate Lets Hkh de FksA ,slh fLFkfr esa ;g ekuk tkosxk fd lEiw.kZ CyM 450&500 ml ;wfuV okyk CyM p<k;k x;kA ckWMh esa CYkM 5 yhVj gksrk gSa rFkk vkSlr 475 x 6 &2850 ml p<k;k x;k tks 'kjhj dh [kwu dh ek=k ls vk/ks ls T;knk ,d lkFk p<k;k x;k] mlds ckn Hkh nks&nks ckj 4&4 ;wfuV CyM p<k; x;k tks bl ckr dh vksj bafxr djrk gSA fd tks ejht ds [kqn dk tks CyM Fkk og rks iw.kZ :i ls lekIr gh gks x;kA Blood dh gkWLihVy esa O;oLFkk u djus rFkk Operation ls iwoZ bUrtke u djus ds lac/a k esa III (2012) CPJ 357 (NC) ARVIND PANDEY & ANR. Vs. DR. SULEKHA SARAN & ORS. esa ekuuh; jk"Vªh; vk;ksx us fuEu fu/kkZfjr fd;k gS %&
(ii) Consumer Protection Act, 1986- Sections 2 (1) (g), 14 (1)
(d), 21 (a) (i) -Medical Negligence -Delivery of child -Failure on part of doctor to make provision for blood and other essesntial 19 medical facilities -Death of patient--Shock and mental agony - Compensation claimed - Treating doctor must have informed complainant about likely repercussions of incompatibility of apposite Rh factors - Perusal of medical records before undertaking the LSCS does not indicate that adequate information or advisory necessary to be given to a prospective mother had been rendered - Doctors and hospitals have faild to anticipate/ foresee the contingency/complication that was so obvious to arise in this case, which they had diagnosed to be of 'High risk Category' - They had failed in affanging blood or keeping an ambulance ready for shifting of the patient - Post partum haemorrhage was not being controlled before attempting any hysterectomy - Complainant has lost his 30 Years old wife and has been burdened with care of bringing up infant son left by her - Lump sum compensation of Rs. 5,00,000 awarded.
Ikfjoknh ds vuqlkj ejht dk cgqr NksVk Operation Fkk ijUrq vizkFkhZx.k us blls bUdkj fd;k gSaA vizkFkhZ ds vuqkj ejht ds nwljk Appendix Attact Fkk rFkk Operation ds nkSjku Laparoscopy ls Laparotomy esa Hkh Convert fd;k es x;k fQj Hkh Blood dh Advance O;oLFkk ugha dh x;hA gkWLihVy esas blood Bank ugha FkkA fnukad 17-03-2014 dks hypoxia gqvk rks ;g gkWLihVy dh T;knk xyrh gS D;ksfd fnukad 16-03-2014 dh jkf= rd 6 ;wfuV [kwu p<k fn;k x;k Fkk rFkk ejht Ventilator ij Fkk] mlds ckotwn hypoxia dSls gks x;kA ejht fnukad 15-03-2014 dks HkrhZ gqvk] fnukad 16-03-2014 dks Operation gqvk gSa o fnukad 23-03-2014 dks e`R;q gqbZ gSaA bl nkSjku ejht dh B.P. o SPO2 dh fLFkfr fuEu izdkj jgh %& Date B.P. SPO2 16.03.2014 (8.23 P.M.) 91/47 98% with 100% oxygenation 16.03.2014 (11.06 50/30 Not Recordable P.M.) 20 17.03.2014 (1.16 A.M.) 129/72 100% 17.03.2014 (2.05 A.M.) 142/86 100% 16.03.2014 (9.02 P.M.) 73/35 97% 16.03.2014 (10.00 73/28 100% P.M.) 16.03.2014 (11.06 50/30 Not Recordable P.M.) 16.03.2014 (11.08 60/30 Not Recordable P.M.) 16.03.2014 (11.11 82/31 P.M.) 16.03.2014 (11.35 135/95 Not Recordable P.M.) 16.03.2014 (11.58 72/37 99% P.M.) 17.03.2014 (1.16 A.M.) 129/72 100% 17.03.2014 (2.05 A.M.) 142/86 100% 17.03.2014 (3.38 A.M.) 141/84 98% 17.03.2014 (3.11 A.M.) 133/90 97% 17.03.2014 (4.45 A.M.) 139/96 96% 17.03.2014 (6.00 A.M.) 146/100 97% 17.03.2014 (6.30 P.M.) 159/94 95% 17.03.2014 (6.46 A.M.) 140/70 96% 17.03.2014 (10.30 134/83 100% A.M.) 17.03.2014 (12.30 132/69 99% P.M.) 17.03.2014 (1.16 P.M.) 132/70 99% 17.03.2014 (1.45 P.M.) 138/84 99% 17.03.2014 (3.10 P.M.) 138/84 (Norad 3ml/hr.) 17.03.2014 (4.00 P.M.) 141/83 100% 17.03.2014 (6.10 P.M.) 115/79 94% 17.03.2014 (6.50 P.M.) 135/66 95% 17.03.2014 (9.00 P.M.) 110/70 99% With CMV 18.03.2014 (1.00 A.M.) 120/80 (On Norad @ 98% (On VCM) 4ml/hr.) 18.03.2014 (3.00 A.M.) 180/110 98% 21 18.03.2014 (5.00 A.M.) 100/60 (On Norad @ 98% (On VCM) 4ml/hr.) 18.03.2014 (7.00 A.M.) 110/60 (On Norad.) 98% (On VCM) 18.03.2014 (9.00 A.M.) 116/80 (With Nor adr 96% support) 18.03.2014 (9.00 A.M.) 131/170 99˚ 18.03.2014 (4.00 P.M.) 148/120 With Norad 97% 18.03.2014 (5.00 P.M.) 140/100 98% With FlO2 80% 18.03.2014 (7.10 P.M.) 127/107 98% 18.03.2014 (10.00 122/100 99% P.M.) 18.03.2014 (11.55 132/100 100% P.M.) 19.03.2014 (7.00 A.M.) 143/112 100% 19.03.2014 at 9.00 140/90 97% 19.03.2014 (10.15 140/90 Without 98% A.M.) Vasoperssin support 19.03.2014 (6.00 P.M.) 129/96 99% 19.03.2014 (10.30 110/64 98% On SIMV A.M.) 19.03.2014 (3.00 P.M.) 130/100 99% 19.03.2014 (5.00 P.M.) 130/103 19.03.2014 (8.45 P.M.) 111/88 100% 19.03.2014 (10.00 100/60 100% P.M.) 20.03.2014 At 12 130/80 (as Norad @ 100% Midnight 5ml/hr.) 20.03.2014 3.00 P.M. 114/98 100% 20.03.2014 5.00 P.M. 125/90 100% 20.03.2014 6.00 A.M. 140/92 99% 20.03.2014 7.30 A.M. 147/103 20.03.2014 10.00 A.M. 140/100 98% 20.03.2014 11.15 A.M. 80/45 98-99% 20.03.2014 2.30 P.M. 150/100 89% 20.03.2014 10.00 A.M. 140/100 98% 20.03.2014 2.00 P.M. 168/rs 100% 20.03.2014 2.45 P.M. 190/135 100% 20.03.2014 5.45 P.M. 190/135 100% 22 20.03.2014 8.35 P.M. 120/84 97% 20.03.2014 8.46 P.M. 128/91 90% 20.03.2014 9.20 P.M. B/W 120-80/86-60 100% 20.03.2014 10.30 P.M. 100/60 (Norad) 98% 21.03.2014 At 12 Mid 114/76 100% night 21.03.2014 2.00 A.M. 124/84 (on Norad @ 100% (on VCM) 3ml/hr.) 21.03.2014 4.00 A.M. 100/60 ( ) 100% (on VCM) 21.03.2014 6.00 A.M. 124/84 99% 21.03.2014 7.00 A.M. 120/84 (on Norad ) 99% 21.03.2014 11.30 A.M. 82/59 (on Norad) 95% 21.03.2014 9.00 A.M. 140/110 mmhg 98% 21.03.2014 12.45 P.M. 117/84 (Norad 2 amp 100% 15ml/hr.) 21.03.2014 2.45 P.M. 122/88 100% 21.03.2014 3.05 P.M. 64/45 92% 21.03.2014 3.10 P.M. 178/139 21.03.2014 3.20 P.M. 135/122 94% 21.03.2014 3.30 P.M. 123/83 94% 21.03.2014 3.45 P.M. 108/77 98% 21.03.2014 3.47 P.M. 100/72 21.03.2014 3.50 P.M. 88/56 98% 21.03.2014 4.00 P.M. 142/112 94% 21.03.2014 5.00 P.M. 102/58 mmHg 21.03.2014 6.30 P.M. 170/100 (fluctuating) 92% 21.03.2014 3.05 P.M. 64/45 100% 21.03.2014 7.15 P.M. 116/55 93/m 21.03.2014 8.00 P.M. 142/126 100% 21.03.2014 4.45 P.M. 78/39 91% 21.03.2014 4.50 P.M. 135/92 91% 21.03.2014 5.30 P.M. 171/132 100% 21.03.2014 3.05 P.M. 64/45 92% 21.03.2014 9.30 P.M. 140/113 100% 21.03.2014 11.00 P.M. 168/113 98% 22.03.2014 1.00 A.M. 119/60 100% 22.03.2014 3.00 A.M. 120/72 100% 22.03.2014 5.00 A.M. 126/84 100% 23 22.03.2014 6.00 A.M. 100/60 100% 22.03.2014 10.45 A.M. 128/100 97% 22.03.2014 9.00 A.M. 150/100 95% 22.03.2014 5.45 P.M. 157/86 100% 22.03.2014 7.00PA.M. 116/67 100% 22.03.2014 7.25 A.M. 104/51 NR 22.03.2014 7.30 A.M. 104/51 100% 22.03.2014 4.00 P.M. 146/90 99% 22.03.2014 4.30 P.M. 138/79 100% 22.03.2014 5.00 P.M. 138/104 22.03.2014 8.10 P.M. 60/40 76% 22.03.2014 8.15 P.M. 125/73 100% 22.03.2014 10.00 P.M. 116/70 100% 22.03.2014 At 12 Mid 150/87 100% night 23.03.2014 2.00 A.M. 140/86 100% 23.03.2014 4.00 A.M. 160/100 99% 23.03.2014 6.00 A.M. 142/92 100% 23.03.2014 10.00 P.M. 126/76 96% 23.03.2014 11.30 A.M. 115/60 92% 23.03.2014 12.20 P.M. 126/76 90% 23.03.2014 1.00 P.M. 130/77 90% 23.03.2014 1.30 P.M. 134/72 91% 23.03.2014 2.00 P.M. 145/70 94% 23.03.2014 2.35 P.M. 147/73 92% 23.03.2014 3.30 P.M. 128/78 93% 23.03.2014 4.10 P.M. 92% 23.03.2014 4.20 P.M. 135/76 91% 23.03.2014 4.25 P.M. 135/76 23.03.2014 7.00 P.M. 124/64 94% 23.03.2014 9.15 P.M. 77/32 23.03.2014 10.00 P.M. 108/80 96% 23.03.2014 10.25 P.M. 108/41 Not recordable 23.03.2014 10.35 P.M. 110/75 96% 23.03.2014 10.45 P.M. 90/60 96% 23.03.2014 11.05 P.M. 90/40 Not recordable 24 blls ;g izrhr gksrk gSa fd ejht ds Highpertension ¼High blood pressure½ Hkh gqvk Fkk] Hypotension ¼ Low Blood pressure½ Hkh gqvkA ejht dh fofHkUu tkap djk;h x;h tks T;knkrj [kwu ls lacaf/kr Fkh] mldk fooj.k fuEu izdkj gSa %& 14.03.2014 HAEMATOLOGY ROUTINE Investigation Result Units Reference Interval Methodology Haemogolbin 12.2 gm% ( 11.0-15.0 ) CyanmethHb Cptical detec Total Leucocyte 7700 cell/cu ( 4000 - 10,000 ) Impendence Cell Counter Count Polymorph 59 % ( 42 - 80 ) Lymphocytes 35 % ( 20 - 40 ) Eosinophils 05 % ( 01 - 06 ) Monocytes 01 % ( 0-9) Basophils 0 % ( 0 - 02 ) Red Blood Cells 3.94 Million ( 3.8 - 4.8 )Impendence Cell Counter Platelet Count 2.09 lakhs/c ( 1.5 - 4.5 )Impendence Cell Counter P.C.V. 36.5 % ( 37 - 47 )Impendence Cell Counter M.C.V. 92.6 fl ( 83 - 101)Impendence Cell Counter M.C.H. 31 pg ( 27 - 32)Impendence Cell Counter M.C.H.C. 33 % ( 31.5 - 34.5)Impendence Cell Counter 16.03.2014 Investigation Result Units Reference Interval Methodology Hb 12.2 15.0 TLC 7700 20400 P 59 87 L 35 11 Platelet 1.34 BT/CT 3'10/5' 10 Glucose F 92 224.8 (70 - 99) Urea 14 Creatinine 0.95 SGOT 22 SGPT 14 Alk. Phos. 82 (20 - 140) TBil/D.Bil 0.77 (0.2 - 1.2) Alb 3.9 (3.4 - 5.4) Globulin 2.05 (2.0 - 3.5) Na 141 144.7 Electrolytes K 3.9 3.26 Cl 101 111.1 17.03.2014 Investigation Result Units Reference Interval Methodology Hb 15.0 TLC 20400 P 87 L 11 Platelet 1.34 BT/CT Glucose F 224.8 224.8 (70 - 99) 25 Urea 30.12 Creatinine 1.9 SGOT SGPT Alk. Phos. 82 (20 - 140) TBil/D.Bil 0.77 (0.2 - 1.2) Alb 3.9 (3.4 - 5.4) Globulin 2.05 (2.0 - 3.5) Na 144.7 Electrolytes K 3.26 Cl 111.1 18.03.2014 HAEMATOLOGY ROUTINE Investigation Result Units Reference Interval Methodology Haemogolbin 13.9 gm% ( 11.0-15.0 ) CyanmethHb Cptical detec Total Leucocyte 24900 cell/cu ( 4000 - 10,000 ) Impendence Cell Counter Count Polymorph 85 % ( 42 - 80 ) Lymphocytes 12 % ( 20 - 40 ) Eosinophils 01 % ( 01 - 06 ) Monocytes 02 % ( 0-9) Basophils 0 % ( 0 - 02 ) Red Blood Cells 4.38 Million ( 3.8 - 4.8 )Impendence Cell Counter Platelet Count 1.0 lakhs/c ( 1.5 - 4.5 )Impendence Cell Counter P.C.V. 41.6 % ( 37 - 47 )Impendence Cell Counter M.C.V. 95 fl ( 83 - 101)Impendence Cell Counter M.C.H. 31.7 pg ( 27 - 32)Impendence Cell Counter M.C.H.C. 33 % ( 31.5 - 34.5)Impendence Cell Counter 19.03.2014 Investigation Result Units Reference Interval Methodology Hb 13.2 11.0 - 15.0 TLC 16900 4000 - 10000 P 84 48 - 80 L 13 20 - 40 E 01 0-9 M 02 Platelet 0.80 1.5 - 4.5 PT/INR Urea 34.56 13 - 45 Creatinine 1.07 0.6 - 1.2 SGOT - 05 - 34 SGPT - 0 - 31 Na 161 129 - 141 Electrolytes K 3.2 3.6 - 8.2 Cl 130 97 - 107 20.03.2014 Investigation Result Units Reference Interval Methodology Hb 9.8 11.0 - 15.0 TLC 13000 4000 - 10000 P 81 48 - 80 L 16 20 - 40 E 01 0-9 M 02 Platelet 0.50 1.5 - 4.5 26 PT/INR 23/13 Urea - 13 - 45 Creatinine 0.97 0.6 - 1.2 SGOT - 05 - 34 SGPT - 0 - 31 Na 157 (164) 129 - 141 Electrolytes K 2.54 (3.1) 3.6 - 8.2 Cl 123.2 (124) 97 - 107 21.03.2014 Investigation Result Units Reference Interval Methodology Hb 8.9 11.0 - 15.0 TLC 13000 4000 - 10000 P - 48 - 80 L - 20 - 40 E - 0-9 M -
Platelet 0.58 1.5 - 4.5
PT/INR 1.7
Urea - 13 - 45
Creatinine - 0.6 - 1.2
SGOT - 05 - 34
SGPT - 0 - 31
Na 164 129 - 141
Electrolytes K 3.6 3.6 - 8.2
Cl 130 97 - 107
22.03.2014
Investigation Result Units Reference Interval Methodology
Hb - 11.0 - 15.0
TLC - 4000 - 10000
P - 48 - 80
L - 20 - 40
E - 0-9
M -
Platelet - 1.5 - 4.5
PT/INR 17/13 1.3
Urea - 13 - 45
Creatinine - 0.6 - 1.2
SGOT 255.3 05 - 34
SGPT 341.2 0 - 31
Na 168 129 - 141
Electrolytes K 3.2 (3.6) 3.6 - 8.2
Cl 125 (130) 97 - 107
23.03.2014
Investigation Result Units Reference Interval Methodology
Hb 5.8 11.0 - 15.0
TLC 20600 4000 - 10000
P - 48 - 80
L - 20 - 40
E - 0-9
M -
Platelet - 1.5 - 4.5
PT/INR 1.1 (0.50)
Urea 302.2 13 - 45
Creatinine 4.49 0.6 - 1.2
SGOT - 05 - 34
SGPT - 0 - 31
Na 154 129 - 141
Electrolytes K 4.36 3.6 - 8.2
Cl 113 (118) 97 - 107
27
19.03.2014 FDP - 20 Positive (>10) D. Dimer - 4.4 Positive (20.50)
22.03.2014 CPK - 1198 (26 - 192) B 12 - 345 (200 - 900) S.Osmolality
- 342 (282-295) Urine osmolality - 532(>850)
22.03.2014 MRI - Hypoxic Ischemic Injury ejht ds ifjtuksa dks ejht dh fLFkfr ds ckjs esa dc&2 crk;k x;k] ;g fuEu izdkj gS %& 16-03-2014 08-23 P. M. 11-05 P. M. 11-11 P. M. 17-03-2014 02-05 A. M. 03-38 A. M. 03-11 A. M. 10-30 A. M. 20-03-2014 03-00 A. M. 21-03-2014 07-00 A. M. 11-30 A. M. 22-03-2014 11-10 A. M. 02-30 P. M. 23-03-2014 08-10 P. M. 08-40 P. M. 11-45 P. M. Expired 11-29 P. M. bl izdkj fnukad 18-03-2014 o 19-03-2014 dks ejht ds ifjtuksa dks dqN crk;k gh ugha x;kA vkbZ lh ;w esa HkrhZ gksus okys ejht ds fj'rsnkj }kjk Hkjk tkus okyk QkeZ Name lksukyh tSu Regd. No.157314@111974 gesa gekjs ejht Jh@Jhefr@dqekjh Miss. Sonali Jain ds ckjs esa bykt dj jgs fpfdRld Dr. K.M.B }kjk ejht dh chekjh ds ckjs esa vPNh rjg ls le>k fn;k x;k gSaA ejht dh fLFkfr xaHkhj gSA ge py 28 jgs bZykt ls larq"B gSa vkSj gekjs ejht ds vkbZ-lh-;w- esa HkrhZ j[kus o mlesa gksus okys leLr [kpsZ ogu djus dks rS;kj gS & fnukad Ekjht ds lkFk laca/k gLrk{kj MkDVj ds gLrk{kj 16-3-14 Father gLrk{kj gS gLrk{kj gSa 17-3-14 Father gLrk{kj gS gLrk{kj gSa 18-3-14 Father gLrk{kj gS gLrk{kj gSa 19-3-14 Father gLrk{kj gS gLrk{kj gSa 20-3-14 Ekjht ds fdlh gLrk{kj gS gLrk{kj gSa fj'rsnkj ds gLrk{kj gSa 21-3-14 Ekjht ds fdlh fj'rsnkj gLrk{kj gS gLrk{kj gSa ds gLrk{kj gSa vizkFkhZ dh vksj ls vkbZ lh ;w ds nLrkost is'k gq, gSa ftlesa ejht dh fLFkfr ds ckjs esa crkus dk crk;k x;k gSa] blesa fnukad 16-03-2014 o 17-03-2014 dks rks ejht ds firk ds Li"V gLrk{kj gSa] vkxs dh tks Hkh rkjh[ks crk;h x;h gSa] mlesa fdl ds gLrk{kj gSa] ;g Li"V ugha gSa rFkk fnukad 22-03-2014 o 23-03- 2014 esa fdlh ds gLrk{kj ugha gSaA ejht dks fnukad 17-03-2014 dks Mk- nhid oxkuh tks U;wjks ltZu Fkk] fnukad 22-03-2014 dks Mk- vfer ukgVk tks fd ENT dk Fkk] fnukad 23-03-2014 dks gh lwjt xksnkjk tks usQzksyksth dk Fkk] mls fn[kk;k x;kA blds vykok fnukad 17-03-2014 dks 10 ih-,e- ij C/D/W Dr. Shashikant Jain for opinion (Neurosurgeon), fnukad 18-03-14 dks 11.15 A.M ij C/D/W Dr. Ravinder singh (Neuro physician), fnukad 20-03-2014 dks 6-15 ih-,e- ij C/D/W Dr. Sanjeev sexena and Dr. Deepak vangani, fnukad 23-03-2014 dks 02-35 ih-,e- ij Nephrology fo'ks"kK dks fn[kk;k x;k gSaA Mk- jktkjke U;wjks fQftf'k;u dks fn[kkus dh ejht ds ifjtuksa us ekax dh Fkh ijUrq og Refues dj nh x;h] fnukad 22-03-2014 dks Mk- v'kksd iuxf<;k dks fn[kk;k x;k] ;|fi ns'k&fons'k ds ekus gq, U;wjks fQftf'k;u gS rFkk dbZ jk"Vªh; o varj jk"Vªh; iqjLdkj izkIr O;fDrRo gSa ijUrq mUgksaus D;k Mk;XuksfLVd fd;k rFkk D;k jk; nh] bldk dksbZ fooj.k esfMdy fjdkMZ esa ugha gSaA vizkFkhZ ds vuqlkj ejht dk QsQMk [kjkc gks x;k Fkk ijUrq Lung Specilist dks 29 ugha fn[kk;k x;kA ejht ds 'kq: esa Heart Attact vk;k Fkk rFkk fnukad 23-03-2014 dks Hkh Heat Attact vk;k Fkk ijUrq Cardiologist dks ugha cqyk;k x;kA ejht ds Sugar fnukad 19-03-2014 dks c<uk 'kq: gks x;k Fkk ijUrq Endorrcinologist dks ugha fn[kk;k x;kA ejht dh Laparoscopic djus dh rks lgefr Loae ejht ls yh x;h Fkh ijUrq Open ltZjh dh lgefr fdlh ls ugha yh x;hA tgkW High risk consent dk vizkFkhZ crk jgk gSaA ;|fi ifjoknh ds vuqlkj bl ij fnukad 22-03-2014 dks gLrk{kj djk;s x;s Fks ijUrq ;g eku Hkh ys fd fnukad 16-03-2014 dks gLrk{kj djk;s x;s Fks rks High risk consent fuEu izdkj gSa %& gkbZ fjLd dUlsUV uke % Miss Sonali fyax F vk;q 18 Yrs vkbZ ih Mh ua- 1119514 jftLVªs'ku ua- 157314 okMZ ua- ICU cSM ua- 4 eq>@ s gesa gekjs ejht ds ckjs esa fpfdRld Dr. KMB/AS/RK us vPNh rjg le>k fn;k gSa] ejht dh fLFkfr vPNh ugha gSaA eq>s ;g Hkyh&Hkkar crk fn;k x;k gSa fd vkWijs'ku@mipkj@fof/k esa] vuns[ks gkykr gks ldrs gSa] ftlesa vkWijs'ku] mipkj vFkok nwljh fof/k ls tks Hkh vko';d gks] mldks djuk iM ldrk gSaA blfy, eS@ge fpfdRld vkSj muds lgk;d dks vf/kdkj nsrs@nsrk@nsrh gwW] bl rjg dh vkWijs'ku@mipkj@fof/k viuk ldrs gSa tks vko';d yxrh gks vkSj ijkef'kZr gksA vkWijs'ku dk izdkj vkSj m}s';@fof/k vkSj bl mipkj ds lEHkkfor fodYi ,ao [krjs] my>uks@ a tfVyrkvksa ds ckjs esa eq>s Hkyh&HkkWfr ls voxr djk fn;k x;k gSA eSa@ge viuh bPNk ls fQj Hkh ;gh bykt tkjh j[kuk pkgsx a s vkSj bldh ftEesnkjh esjh@gekjh Loa; dh gksxh] Hk.Mkjh vLirky ,oa izca/ku dh dksbZ ftEesnkjh ugha gksxhA 30 blls ;g izrhr gksrk gSa fd ;gkW rd Laparoscopic Operation gksus] Open ltZjh gksus] Iliac artery {kfrxzLr gksus] [kwu cgus] {kfrxzLr Artery dh ejEer djus] Appendix fudkyus ds ckn ICU esa yh x;h Fkh] blls iwoZ dksbZ lgefr ugha yh x;h tcfd ejht dks fnukad 16-03-2014 dks gh Operation ds nkSjku gh gkyr xaHkhj gks x;h FkhA vizkFkhZ ds vuqlkj tc mls ICU esa f'kQV fd;k x;k rks og vka[ks [kksy jgh Fkh] gks'k esa Fkh o fyEc fgyk jgh Fkh] 'okl ys jgh Fkh] ejht ds ifjtuksa dks feyk;k x;k rFkk fLFkfr ls voxr djk;k x;k tcfd ifjoknh ds vuqlkj tc ejht dks ckgj ls fn[kk;k x;k rks ejht csgks'k Fkh] tSlh Hkh fLFkfr gks ejht dh fLFkfr xaHkhj Fkh] ejht dk Operation fd;k x;k Fkk] Operation note fuEu izdkj gSa %& After aseptic P&D pneumo peritoneum created using verres needle. Abdominal cavity visualized. The Appendix was badly inflammed, retocaecal in position and adherent to caecum and posterior abdominal wall and surrounded by Pus flakes.
Suction irrigation of pus flakes done. Mobilization of caecum with Adhesiolysis done. Gradual Separation of appendix from Caecum and posterior abdominal wall done. While separating we saw gush of blood from posterior abdominal wall which was not possible to control laparoscopically, hence on table decision for appendicular artery ligated. Appendix ligated at base and separated.
Post OP Notes On Removing the packing and further exploration we saw a small puncture below the originatal of external and Internal iliac artery, on external iliac artery. Packing done. Cardiothoracic Surgeon called. Mobilization of vessel proximally upto common Iliac and distally to external iliac done. Bull dog clamps applied on common iliac, External and internal iliac vessel. The puncture in the vessel repaired by 6-0 prolene. Hemostasis checked. Wound closed in layers after thorough 31 washing. Lavage and putting abdominal drain. Intra operatively patient was given blood transfusion, inotropic supports and Plasma Expanders in OT. Pt then shifted to ICU.
Operation ds nkSjku o ICU esa f'kQV gksus rd 5-12- ih ,e ls 8-21 ih ,e rd tks ?kVukdze ?kVk og fuEu izdkj gSa %& 5:12 PM 8:21 PM Venti Mask Induction: Poor oxygenation with bain circuit for 2 min. IV Propolol 100 mg with Inj Rocueurium 40 mg given Controlled ventilation with mask BAG.
Direct Laryngoscopy done ETT 7.5 CUEF placed At fixed at 21 cm LEVEL CUEF inflated.
Bilateral air entry equal on Auscliltation Mech ventilation with TV 450 cc RR 16/ min N2O: O2 60:40 sevoflurance IMAC Laparoscopic ports placed uneventfully. Sudden drop in BP at 5:46 pm as some vascular Injury at external iliac level so plan of surgery Changed to Laprotomy and vascular repair done.
BP was persistently on lower side (hemmragic Blood - 1 Unit Shock ?). 18 G canula placed on Rt. Arm hestril 500 ml Infused rapidly. Inj. Nor adrenaline infusion Started 5ml/hr. 5:49 PM BP = 73/45 mm hg So an emergency Rt. Subclavion Central line placed with seldinger technique aseptic precaution. 500ee Free flow of blood achieved.
Sample taken for blood grouping and arrangement. B/L equal air entry on ascularation.
BP: 78/36 Inj. Hestril 500ml IV blous infused Inj. Heparin 5000 IV infused after Vascular Rapair (as advised by Cardiothorasic Surgery) Inj. R.L. infused 1 liter One unit blood transfused.
At end of surgery Pt. shifted to ICU with ETT in situ For further management of condition with 100% Oxygen With Ambu bag with 5 liter/min 02 flow.
32fnukad 16-03-2014 dks ejht ds ,d ;wfuV [kwu Operation fFk;sVj esa gh ns fn;k x;k] 5 ;wfuV [kwu ICU esa Operation ds rqjar ckn fn;k x;kA fnukad 20-03-2014 dks 4 ;wfuV [kwu fn;k x;k] fnukad 20-03- 2014 dks 4 ;wfuV [kwu fn;k x;k] fnukad 17-03-2014 ls 22-03-2014 rd ejht dh fLFkfr xaHkhj cuh jgh] mldk B.P. mij uhps gksrk jgk] SPO2 Hkh mij&uhps gksrk jgkA fnukad 23-03-2014 dks B.P. cgqr de gks x;k Fkk rFkk SPO2 Hkh cgqr de gks x;k Fkk] 9-40 ih ,e ij mls Heart Attact vk;k] rks mls Inj. Atropin 0.6 mg fn;k x;k rFkk chest Compression fd;k x;kA ;g fLFkfr 10 cts o 10-19 ls 10-25 ih-,e- rd cuh jgh] 11-15 ih ,e ij fQj Cardiac Attact vk;k] Atropin dk Inj.fn;k x;k] chest Compression fd;k x;k ijUrq var esa 11-29 ih ,e ij ejht dh e`R;q gks x;hA ejht ds ifjtuksa dks voxr djk fn;k x;kA vizkFkhZ ds vuqlkj ejht dks iksLVekVZe djkus dk dgk x;k ijUrq ifjtuksa us dg fn;k fd Body ekspZjh esa j[k ys lqcg fu.kZ; djsxsA lqcg tc 'ko ysus vk;s rc 'ko ijh{k.k ls badkj dj fn;kA ;|fi vizkFkhZ ds vuqlkj 'ko ijh{k.k ls fyf[kr esa ifjoknh i{k us badkj fd;k gSa ijUrq ,slk dksbZ nLrkost i=koyh ij miyC/k ugha gSa ijUrq tc ;g Lohd`r fLFkfr Fkh fd ejht ds hypoxia gqvk Fkk tks pkgs 16 dks gqvk ;k 17 dks gqvk] mlh ls ejht dh e`R;q gqbZA ejht dk tks e`R;q ds dkj.k ckcr lfVZfQfdV tkjh fd;k x;k gSa] mlesa lkjh fLFkfr LIk"V gks tkrh gSA ejht dk Cause of death Cardio respiratory Attact crk;k gSA Cardio dk eryc heart, respiratory arrest dks Oxford Medical Dictionary Sixth Edition ds ist 654 ij fuEu izdkj crk;k x;k gSa %& respiratory arrest cessation of breathing, which - without treatment - will very quickly be followed by *cardiac arrest. It may result from airway obstruction, brain or spinal injury, overdose of certain medications (e.g. opioids), disease of the muscles and/or nerves necessary for breathing, or severe lung disease or injury. Treatment must be prompt and include clearance of any blockage in the air-way and ventilatory support, for example by *mouth-to- mouth resuscitaion.
33nwljk dkj.k Septicaemia, ftldk ILLUDTRATED MEDICAL DICTIONARY 3RD EDITION ds ist 504 ij fuEu izdkj crk;k x;k gSa %& Septicaemia A potentially life-threatening condition in which there is rapid multiplication of bacteria and in which bacterial toxins are present in the blood. See also bacteraemia.
Septicaemia usually arises through escape of bacteria from a focus of infection, such as an abscess, and is more likely to occur in people with an immunodeficiency disorder, cancer, or diabetes mellitus: in those who take immunosuppressant drugs: and in drug addicts who inject.
Symptoms include a fever, chills, rapid breathing, headache, and clouding of consciousness. There may be multiple organ failure and the sufferer may go into life-threatening septic shock.
Glucose and/or saline are given by intravenous infusion and antibiotics by injection or infusion. Surgery may be necessary to remove the original infection. If treatment is given before septic shock develops. The outlook is good.
blds lkFk pyaemia ftldk Oxford Medical Dectionary ist 634 ij fuEu vFkZ gSa %& 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.
sapraemia ftldk Oxford Medical Dectionary ist 674 ij fuEu vFkZ gSa %& 34 sapraemia n. blood poisoning by toxins of saprophytic bacteria (bacteria living on dead or decaying matter). Compare PYAEMIA, SEP-TICAEMIA, TOXAEMIA.
TOXAEMIA. ftldk Oxford Medical Dectionary ist 673 ij fuEu vFkZ gSa %& toxaemia n blood poisoning that is caused by toxins formed by bacteria growing in a local site of infection. It produces generalized symptoms, including fever, diarrhoea, and vomiting. Compare PYAEMIA, SAPRAEMIA, SEPTICAEMIA.
Accute Rental Failure dk eryc fdMuh gSa] ;kfu fdMuh Qsy gks x;hA fQj hypotension crk;k x;k gSa] ftldk Black's Medical Dictionary 40th edition Page 305 ij fuEu vFkZ gSa %& HYPOTENSION Low blood pressure (see HYPERTENSION for raised blood pressure). Some healthy individuals with a normal cardiovascular system have a permanently low arterial blood pressure for their age. What blood- pressure reading constitutes hypotension is arguable, but a healthy young person with figures below 100mm Hg systolic and 65 mm Hg diastolic could be described as hypotensive. for a healthy 60 year-old, comparative figures might be 120/80. The most common type of hypotension is called postural, with symptoms occurring when a person suddenly stands up, particularly after a period of rest or a hot bath. It results from the muscular tone of blood vessels becoming relaxed and being unable to respond quickly enough to the changing posture, the consequence being a temporary short-age of arterial blood to the brain and organs in the chest. Symptoms of dizziness, occasionally fainting, and nausea occur. Older people are especially vulnerable and may fall as a result of the sudden hypotension. Some drugs -anti-hypertensives and antidepressant once- cause hypotension. People with DIABETES MELLITUS occasionally devlop hypotension because of nerve damage that 35 affects the reflex impulses that control blood pressure. Any severe injury or burn that results in serious loss of blood or body fluid will cause hypotension and SHOCK. Myocardial infarction (see HEART DISEASES) or failure of the ADRENAL GLANDS can cause hypotension and shock. A severe emotional event that causes shock may also result in hypotension and fainting.
Hypotension in healthy people does not require treatment, though affected individuals should be advised not to stand up suddenly or get out of a bath quickly. Someone who faints as a result of a hypotensive incident should be laid down for a few minutes to allow the circulation to return to normal. Hypotension resulting from burns, blood loss, heart attack or adrenal failure requires medical attention for the causative condition.
blds lkFk Hypoxia crk;k x;k gSa] tks Ross & Wilson ANATOMY AND PHYSIOLOGY in Health and Illness Thirteenth Edition Page 194 ij fuEu izdkj gS %& Cerebral hypoxia Hypoxia may be due to disturbances in the autoregulation of blood supply to the brain or conditions affecting cerebral blood vessels.
When the mean blood pressure falls below about 60 mmhg,the autoregulating mechanisms that control the blood flow to the brain by adjusting the diameter of the arterioles fail. The consequent rapid decrease in the cerebral blood supply leads to hypoxia and lack of glucose. If severe hypoxia is sustained for more than a few minutes, there is irreversible brain damage. Neurones are affected first, then the neuroglical cells and later the meninges and blood vessels. Conditions in which auoregulation breaks down include. Cardiorespiratory arrest sudden severe hypotension carbon monoxide poisoning hypercapnia (excess bolld carbon dioside) 36 drug overdosage with, for example, opioid analgesics or hyponotics.
Conditions affecting cerebral blood vessels that may lead to cerebral hypoxia include:
Occlusion of a cerebral artery by, for example, a rapidly expanding intracranial lesion, atheroma, thrombosis or embolism (ch. 5) arterial stenosis that occurs in arteritis, e.g. polyarteritis nodosa, syplhilis, diabetes mellitus, or degenerative changes in older adults.
If the individual servives the initial episode of ischaemia, then infarction, necrosis and loss of function of the affected area of brain may occur.
STEDMAN'S MEDICAL DICTIONARY 28Th Edition ds ist 98 esa fuEu crk;k x;k gSa %& an-ox-i-a (an -ok'se-a). Avoid the careless substitution of the word for hypoxia or hypoxemia. Absence or almost complete absence of oxgen from inspired gases, arterial blood, or tissues, [G. an- priv. + oxygen] anemic a., a term formerly considered synonymous with anemic hpoxia, but now reserved for extremely severe cases in which oxygen and functional erythrocyte volume are alomost completely lacking.
anoxic a., ., a term formerly considered synonymous with hypoxic hypoxia, but now reserved for extremely severe cases in which oxygen is alomost completely lacking.
diffusion a., diffusion hypoxia severe enough to result in the absence of oxygen in alveolar gas.
histotoxic a., poisoning of the respiratory enzyme systems of the tissues, as in the inhibition of cytochome oxidase by cyanides; because of the inability of tissue cells to use oxygen, its tension in artrial and capillary blood is usually greater than normal.
37a. neonatorum, any a. observed in newborn infants. oxygen affinity a., a due to inability of hemoglobin to release oxygen.
stagnant a., stagnant hypoxia severe enough to result in the absence of oxygen in tissues.
Cause of death esa Hypovolaemia Shock crk;k x;k gS] ILLUDTRATED MEDICAL DICTIONARY 3RD EDITION ist 297 ij fuEu izdkj gS %& Hypovolaemia An abnormally low volume of blood in the circulation, usually following blood loss due to injury, internal bleeding, or surgery. It may also be due to loss of fluid from diarrhoea and vomiting. Untreated, it can lead to shock.
rFkk Shock dk vFkZ Oxford Medical Dectionary ds ist 690 ij fuEu gSa %& shock n. the condition associated with circulatory collapse, when the arteri8al blood pressure is too low to maintain an adequate supply of blood to the tissues. The patient has a cold sweaty pallid skin, a weak rapid pulse, irregular breathin, dry mouth, dilated pupils, a decreased level of consciousness, and a reduced flow of urine.
Shock may be due to a decrease in the volume of blood (hypovolaemic shock), as occurs after internal or external *haemorrhage, burns, dehydration, or severe vomiting or diarrhoea. It may be caused by reduced activity of the heart (cardiogenic shock), as in coronary thrombosis, myocardial infarction, or pulmonary embolism. It may also be due to widespread dilation of the blood vessels so that there is insufficient blood to fill them. This may be caused by severe *sepsis (septic, bacteraemic, or toxic shock), with a resultant systemic inflammatory response associated 38 with *disseminated intravascular coagulation and multiple organ failure. It may also be caused by a severe allergic reaction (anaphylactic shock: see ANAPHYLAXIS), overdosage with such drugs as opioids or barbiturates, or the emotinal shock due to a personal tragedy or disaster (neurogenic shock). Sometimes shock may result from a combination of any of these causes, as in *peritonitis. The treatment of shock is determined by the cause.
Ekjht ds fnukad 14-03-2014 dks Colitis dh laHkkouk Hkh ekuh x;h Fkh ftldk ILLUSTRATED MEDICAL DICTIONARY 3RD EDITION ds ist ij fuEu vFkZ gSa %& Colitis Inflammation of the colon causing diarrhoea, usually with blood and mucus. Other symptoms may include abdominal pain and fever. Colitis may be due to infection by various types of microorganism, such as Campylobacter and Shigella bacteria, viruses, or amoebae. A form of colitis may be provoked by antibiotic drugs destroying bacteria that normally live in the intestine and allowing CLOSTRIDIUM DIFFICILE, a bacterim that causes irritation, to pro-liferate. Colitis is a feature of ulcerative colitis and Crohn's disease.
Investigations into colits may include examining a feacal sample, sigmoidoscopy or colonoscopy, biopsy of inflamed areas or ulcers, and a barium enema [see barium X=ray examinations]. If the cause is an infection, antibiotics may be needed. Crohn's disease and ulcerative colitis are treated with coriticosteroid and immunosuppressant drugs, and a special diet.
ejht ds Laparoscopy Appendicitis gksuk Fkh] Laparoscopy dk GRAY'S ANATOMY FOR STUDENTS FIRST SOUTH ASIA EDITION Page 304 esa crk;k x;k gSa] tks fuEu gSa %& laparoscopic surgery 39 Laparoscopic surgery, also known as minimally invasive or keyhole surgery, is performed by operation through a series of small incisions no more than 1 to 2 cm in length. As the incisions are much smaller than those used in traditional abdominal surgery, patients experience less postoperative pain and have shorter recovery times. There is also a favorable cosmetic outcome with smaller scars. Several surgical procedures such as appendicetomy, cholecystectomy, and hernia repair, as well as numerous orthopedic, urological, and gynecological procedures, aare now commonly performed laparoscopically.
During the operation, a camera known as a laparoscope is used to transmit live, magnified images of the surgical field to a monitor viewed by the surgeon. The camera is in serted into the abdominal cavity through a small incision, called a port-site, usually at the umbilicus. In order to create enough space to operate, the abdominal wall is elevated by inflating the cavity with gas, typically carbon dioxide. Other long, thin surgical instruments are then introuduced through additional port-sites, which can be used by the surgeon to operate. The placement of these port-sites is carefully planned to allow optimal access to the surgical field.
Laparoscopic surgery has been further enhanced with the use of surgical robots. Using these systems the surgeon moves the surgical instruments indirectly by controlling robotic arms, which are inserted into the operating field through small incisions. Robot- assisted surgery is now routinely used worldwide and has helped overcome some of the limitations of laparoscopy by enhancing the surgeon's dexterity. The robotic system is precise, provides the surgeon with a 3D view of the surgical field, and allows improved degree of rotation and manipulation of the surgical instruments. Several procedures such as prostatectomy and cholecystectomy can now be performed with this method.
40Laparoendoscopic single-site surgery, also known as single-port laparoscopy, is the most recent advance in lapar4oscopic surgery. This method uses a single incision, usually umbilical, to introduce a port with several operating channels and can be performed with or without robotic assistance. Benefits include less postoperative pain, a faster recovery time, and an even better cosmetic result than traditional laparoscopic surgery.
MINIMALLY INVASIVE SURGERY dk vFkZ Oxford Medical Dectionary ds ist 480 esa crk;k x;k gSa]tks fuEu izdkj gSa %& minimally invasive surgery minimalaccess surgery surgical intervention involving the least possible physical trauma to the patient, particularly surgery perfomed using an operatnig laparoscope or other endoscope [see LAPAROSCOPY] passed through tiny incisions; it is known popularly as keyhole surgery. Several types of abdominal surgery, including gall bladder removal [see CHOLE-CYSTECTOMY] and extracorporeal shock-wave lithotipsy for stones in the urinary or bile drainage system, are commonly perfromed in this way. Such methods are usually more comfortable and allow the patient to resume normal activity much sooner than would be possible after more conventional procedures. See also INTERVENTIONAL RADIOLOGY.
Appendicitis dk Ross & Wilson ANATOMY AND PHYSIOLOGY in Health and Illness Thirteenth Edition Page 354 esa crk;k x;k gSa] tks fuEu izdkj gSa %& Appendicitis The lumen of the appendix is very narrow and there is little room for swelling when it becomes inflamed.The initial cause of inflammation is not always clear. Microbial infection is commonly superimposed on obstruction by, for example, hard faecal matter (faecoliths), kinking or a foreign body. Inflammatory exudate, with fibrin and phagocytes, causes swelling and 41 unceration of the mucous membrane lining. In the initial stages the pain of appendicitis is usually located in the central area of the abdomen. After a few hours the pain typically shifts and becomes localised to the region above the appendix (the right iliac fossa). In mild cases the inflammation subsides and healing takes place, In more severe cases, microbial growth progresses, leading to suppuration, abscess formation and further congestion. The rising pressure inside the appendix occludes local veins first and then the arteries, causing ischaemia, which may be followed by gangrene and perforation.
Complications of appendicitis Peritonitis The peritoneum becomes acutely inflamed, the blood vessels dilatye and excess serous fluid is secreted. Pertonitis occurs as a complicaton of appendicitis when:
microbes spread through the wall of the appendix and infect the peritoneum an appendix abscess (Fig. 12.49) perforates and pusenters the peritoneal cavity Figure 12.49 Abscess formation. This is a complication of appendicitis.
the appendix becomes gangernous and perforates, discharging its contents into the peritoneal cavity.
Abscess formation The most common types are:
subphrenic abscess, between the liver and diaphragm, from which infection may spread upwards to the pleura, pericardium and mediastinal structures pelvic abscess, from which infection may spread to adjacent structures (Fig. 12.49).42
Adhesions When healing takes place, bands of fibrous scar tissue (adhesions) form and later shrinkage may cause:
stricture or obstruction of the bowel limitation of the movement of a loop of bowel, which may twist around the adhesion, causing a type of bowel obstruction called a volvulus (p. 359).
Ekjht ds ckn esa Laparotomy gqbZ] ftldk vFkZ Black's Medical Dictionary 40th edition Page 305 esa crk;k x;k gSa]tks fuEu gSa %& 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.
Ekjht dh iliac artery {kfrxzLr gks x;h Fkh] bldk vFkZ Oxford Medical Dectionary ds ist 379 esa crk;k x;k gSa] tks fuEu gSa %& iliac arteries the arteries that supply most of the blood to the lower limbs and pelvic region. The right and left common iliac arteries form the terminal branches of the abdominal aorta. Each branches into the external iliac artery and the smaller internal iliac artery.
vizkFkhZ ds vuqlkj ejht ds pneumothorax o Lung Collaps gqvk Fkk] ftldk Oxford Medical Dectionary ds ist 597 ij fuEu vFkZ gSa %& pneumothorax n. air in the *pleural cavity. Any breach of the lung surface or chest wall allows air to enter the pleural cavity, causing the lung to collapse. The leak can occur without apparent cause, in otherwise healthy people (spontaneous pneumothorax), 43 or result from injuries to the chest (traumatic pneumothorax). In tension pneumothorax a breach in the lung surface acts as a valve, admitting air into the pleural cavity when the patient breathes in but preventing its escape when he breathes out. This air must be let out by surgical incision.
A former treatment for pulmonary tuberculosis - artificial pneumothorax - was the deliberate injection of air into the pleural cavity to collapse the lung and allow the tuberculous areas to heal.
Col-lapse STEDMAN'S MEDICAL DICTIONARY 28Th Edition ds ist 137 esa crk;k x;k gSa] tks fuEu gSa %& Col-lapse (kol-laps) 1. A Condition of extreme prostration, similar or identical to hypovelemic shock and due to the same causes. 2. A state of profound physical depression. 3. A falling together of the walls of a structure. 4. The failure of a physiologic system. 5. The falling away of an organ from its surrounding structure, e.g. collapse of teh lung. [ L. col- labor, pp. - lapsus, to fall together] absorption c., pulmonary c. due to rapid complete obstruction of a large bronchus.
Circulatory C., failure of the circulation, either cardiac or peripheral. C. of dental arch, movement of teeth of fill a space that would normally be filled by another, missing tooth, creating a malpositioning of adjacent and opposing teeth.
Massive C., relatively complete atelectasis of an entire lung or of a lobe, may be acute or chronic.
Pressure C., Plumonary C. due to external compression of the lung as by a pleural effusion or pneumothorax.
Pulmonary C., secondary atelectasis due to bronchial obstruction, pleural effusion or pneumothorax, cardiac hypertrophy, or enelargement of other structures adjacent to the lungs. Often used in the sens of massiv c.
Ekjht ds lcls igys Brachycardia vk;k Fkk] ftldk vFkZ STEDMAN'S MEDICAL DICTIONARY 28Th Edition ds ist 249 ij fuEu crk;k x;k gSa %& 44 bra-dy-car-di-a [brad'e-kar'de-a]. Slowness of the heartbeat, usually defineed [by convention] as a rate under 50 beats/minute. SYN brachycardia, bradyrhythmia. [brady-+G. kardia, heart] Ek`R;q izek.k i= ds ifjis{; esa ejht dh e`R;q ns[ks rks ejht ds Cardiac problem Hkh gqbZ Fkh tks igys fnu 16-03-2014 dks gqbZ Fkh rFkk 23-03-2014 dks Hkh gqvk FkkA septicimia ;|fi esfMdy fjdkMZ esa bldk dgha ftdz ugha gSa ijUrq ;g ,d izdkj dk bUQsD'ku o CyM iksbZtfuax gSA ;g ejht dks gkWLihVy esa gh gqvk gSaA vizkFkhZ i{k dk bl laca/k esa dksbZ LkQkbZ ugha gSaA Accute Renal Faliure gqvk] ejht ds 19-03-2014 ls sugar c<us yxh Fkh rFkk ;g 380 mg rd c<h gS] dzsVhu Hkh c<h gS] B.P. Hkh Low gks x;k Fkk] tks bl ckr dh vksj bafxr djrk gSa fd fdMuh Hkh Qsy gks x;h FkhA Hypoxia gqvk Fkk] tks ifjoknh ds vuqlkj fnukad 16-03-2014 dks gqvk Fkk] vizkFkhZ ds vuqlkj fnukad 17-03-2014 dks gqvk Fkk] tSlh Hkh fLFkfr gks Hypoxia gqvk Fkk] Hypoxia brain Eksa gqvk gSa tks fuf'pr :i ls [kwu dh deh ds dkj.kk rFkk vkWDlhtu dh deh ds dkj.k gqvk gSaA fnukad 17-03-2014 dks gqvk rks ;g vkSj xaHkhj fLFkfr gS D;ksfd fnukad 16-03-2014 dh jkf= dks 6 ;wfuV blood ns fn;k x;k Fkk rFkk ejht osUVhysVj ij Fkh] mlds ckotwn Hypoxia gqvk ;kfu ejht ds bruk [kwu cg pqdk Fkk rFkk Oxigen bruh de gks xbZ fd bruk [kwu p<kus o osUVhysVj ij j[kus ds ckotwn Hypoxia gks x;kA tgkW rd Pneumothorax dk iz'u gSa] ;|fi bldk esfMdy fjdkMZ esa dksbZ ftdz ugha gSa ijUrq tc vizkFkhZ lung collaps gksus dh ckr Lohdkj djrk gSa rks fuf'pr :i ls Operation ds ckn ;g gks x;k FkkA ejht fnukad 15-03-2014 dks tc HkrhZ gqvk rc isV nnZ ds vykok mldh fLFkfr lkekU; Fkh ijUrq Operation ds ckn mldh fLFkfr Critical curh x;hA t;iqj esa HkaMkjh gkWLihVy ls vPNs gkWLihVy miyC/k gSaA ;gkW rd fd ,l ,e ,l vLirky tks mRrj Hkkjr dk cMk gkWLihVy ekuk tkrk gSa rFkk fnYyh 300 fdyksehVj nwj gSa] tgkW dkQh ek=k esa lqij Lis'kfyLV gkWLihVy gSa rFkk xqMxkao esa izfl} esnkark gkWLihVy gSa ftldk uke iwjs ns'k eas gSa ogWk Refer ugha fd;k x;k tcfd ejht dks cpkus ds fy, gj rjg dh 45 dksf'k'k dh tkuh pkfg,A blls ;g izrhr gksrk gSa fd ejht dks gkWLihVy okys viuh detksjh fNikus ds fy, nwljs gkWLihVy ugha Hkstk x;kA ejht ds ifjtuksa dks nwljs gkWLihVy esa ys tkus dk dgk x;k gks \ ,slk dksbZ rF; esfMdy fjdkWMZ esa ugha gSa] bldk eryc ejht dks Advance Centre esa Hkstus dksf'k'k gh ugha dh x;hA bl laca/k esa II (2015) CPJ 578 (NC) VIJAY HEALTH CENTRE V/S CHANDRA DAS & ORS. rFkk CHANDRA DAS V/S CHENNAI WILLINGDON CORPORATE FOUNDATION & ORS. esa ekuuh; jk"Vªh; vk;ksx us fu/kkZfjr fd;k gS fd %& Consumer Protection Act, 1986 - Sections 2(1)(g), 14(1)(d), 21(a)(ii) - Medical Negligence - Laparoscopic Adhesiolysis - Surgery conducted - Severe infection - 30 Lack of care - Delay in referral
- Mental agony and physical pain - Deficiency in service - State Commission allowed complaint - Hence appeal - OP 4 delayed to performed resection anastomosis after one or two surgical interventions - There was also delay in referring patient - OP 2 and OP 4 doctors failed in their duty of care - OP 3 - Hospital has not maintained any medical records about treatment given by OP 4 - Hospitals Ops 1 and 3 also vicariously liable - Ops 1 to 4 directed to pay compensation @ Rs. 6,00,000 jointly and severally to complainant - Litigation cost @ Rs. 20,000 paid.
fDyfud] uflZx gkse] vLirkyksa ds uohuhdj.k o iathdj.k ds fy, fDyfudy ,LVCyh'kesUV¼jftLVªs'ku ,.M jsxqys'ku½ ,DV 2010 ¼2010 dk½ dsUnzh; vf/kfu;e la[;k 23 cus gq, gS rFkk bldh /kkjk 54 ds rgt jktLFkku fDyfudy ,LVhCyh'kesVa jftLVªs'ku ,oa jsxqys'ku :y 2013 cus gq, gSa tks 05 twu 2013 dks ykxw gks pqds gSaA bl vf/kfu;e ds rgr cus fu;e] mifu;e]ldqZyj vkns'k ds rgr izR;sd fDyfud] uflZx gkse]gkWLihVy dk iathdj.k vfuok;Z gSa rFkk fdl ysoy ds gkWfLiVy dk iathdj.k gksxk rFkk ftl rjhds ls vizkFkhZ vius vkidks mPp Js.kh dk gkWLihVy crkrk gSa] ml yscy dk gh iathdj.k gksxk] mlds ckotwn gkWLihVy esa Blood bank ugha gSA vizkFkhZ us vius tokc esa ;g dgk gSa 46 fd LokLF; dY;k.k cYM cSad ls MOU dj j[kk gSaA ;g Blood bank HakMkjh gkWLihVy ls 1 fdyksehVj nwj iMrk gSa rFkk ;g gkWLihVy xksikyiqjk eksM ij gSa tks Hkkjh HkhM&HkkM okyk {ks= gSaA vxj 1 fdyksehVj ls Hkh Blood yk;s rks nsjh yxuk LkaHko gSaA vizkFkhZ Blood bank ls MOU djuk crkrk gSa] mDr MOU is'k ugha fd;k x;k gSa] bldk eryc flQZ eseksjs.Me vkWQ v.MjLVsfMax Fkk] uk fd Blood bank ls vuqca/k FkkA ejht dh Laparoscopic ls Operation fd;s tkus dk fu.kZ; gqvkA ;|fi ;g fu.kZ; lgh ugha Fkk ijUrq ckn esa Open ltZjh dh x;h] bldh laHkkouk Hkh Fkh ijUrq Blood dk igys bartke ugha fd;k x;k tcfd lk/kkj.kr;k Open ltZjh ds ekeys esa Blood dk igys bartke jgrk gSA ejht dk fnukad 14-03-2014 dks ULTRA SOUND gqvk Fkk ftldh fjiksVZ fuEu izdkj gSa %& FINDINGS ARE SUGGESTIVE OF NORMAL LOWER ABDOMEN PROBE TENDERNESS IS PRESENT IN R.I.F ? CAUSE ? COLITIS.
ADVICE - PLEASE CO-RELATIVE CLINICALLY blls ;g izrhr gksrk gSa fd ejht ds flQZ isV esa TENDERNESS FkhA ejht dk fnukad 16-03-2014 dks X- RAY gqvk Fkk ftldh fjiksVZ fuEu izdkj gSa %& X- RAY CHEST P.A. VIEW Both the lung field are clear.
Bronchovascular markings are normal.
Both the C.P. angles are clear.
Cardiac size is within normal limits.
Both teh domes of diaphragm are normal.
CONCLUSION: XRAY CHEST NORMAL.47
blls ;g izrhr gksrk gS fd ejht dk heart o lung lkekU; FksA fnukad 16-03-2014 dks ejht dh lksuksxzkQh gqbZ] mlesa Hkh isV esa TENDERNESS o Fluid Fkk] ckdh lkekU; FksA fnukad 17-03-2014 dks ejht dh Ultra sound gqvk ftlds Others esa fuEu izdkj vafdr fd;k x;k gSa %& Gas is present in subcutenous tissue in right side chest region so chest tube & other details could not be seen. 'ks"k lHkh vax Notmal Size Eksa crk;s x;s gSaA fnukad 17-03-2014 dks ejht dk Chest X- RAY djk;k x;k Fkk] tks fuEu izdkj gSa %& . Hetrogenous opacities seen in right mid. & lower zone in parahillar region . Chest tube seen in situ.
. Both the C.P. angles are clear.
. Cardiac size is within normal limits.
. Both the domes of diaphragm are normal.
. Subcutaneous emphysema seen in right chest wall.
blls ;g izrhr gksrk gSa fd ejht ds gn~; o QsQMks esa nks"k mRiUu gks x;k FkkA fnukad 17-03-2014 dks gh iqu% ejht dk X- RAY djk;k x;k Fkk] ftldh fjiksVZ fuEu izdkj gSa %& . Homogenous opacities seen in right upper, mid. & lower lung zone in parahillar region . Both the C.P. angles are clear.
. Cardiac size is within normal limits.
. Both the domes of diaphragm are normal.
. Chest tube seen in right side, tip seen near the heart. . There is subcutaneous emphysema seen in right chest wall.48
blls Hkh ;gha izrhr gksrk gSa fd ejht ds nks"k mRiUu gks x;k FkkA fnukad 17-03-2014 dks gh CT SCAN BRAIN djk;k x;k Fkk] ftldh fjiksVZ fuEu izdkj gSa %& Hyperdensity seen along falx cerebri. Ventricles & Basal and sylvian cisterns are appear effaced.
There is no shift of the midline structures. Convexity sulci appear effaced. Cerebellum and brainstem are unremarkable. IMPRESSION: DIFFUSE EDEMA IN BRAIN WITH ?
MINIMAL SUBARECHNOID HAEMORHAGE
ALONG FALX CEREBRI.
Findings: The study reveals pronounced gray-white matter differentiation of the cerebral & cerebellar hemispheres and gyral swelling as well as cortical & deep gray matter hyperintensity on T2 and FLAIR images with effaced cortical sulci, CSF spaces and ventricular system in both supratentorial and infratentorial region. DW images also shows diffuse uniform cortical, basal ganglia and middle cerebellar hyperintensity with accentuation of the gray-white matter imerface with hypointensity on ADC images in left middle cerebellar peduncle and bilateral cerebellar tonsils.
blls ;g izrhr gksrk gSa fd BRAIN esa nks"k T;knk gks x;k FkkA bldh Findings fuEu izdkj gSa %& Findings:
The study reveals pronounced gray-white matter differentiation of the cerebral & cerebellar hemispheres and gyral swelling as well as cortical & deep gray matter hyperintensity on T2 and FLAIR images with effaced cortical sulci, CSF spaces and ventricular system in both supratentorial and infratentorial region. DW images also shows diffuse uniform cortical, basal ganglia and middle cerebellar hyperintensity with accentuation of the gray-49
white matter imerface with hypointensity on ADC images in left middle cerebellar peduncle and bilateral cerebellar tonsils.
Mass effect over brain stem also seen with distoration. There is evidence of herniation of cerebellar tonsils about 30 mm below foramen magnum level with compression over cervicomedullary juction.
Hyperintensity seen withn proximal cervical cord at C2 to C4 level cord centrally and anteriorly with owl eye appearance--likely infarct.
Significant hypointensity is seen in subarachnoid spaces with both supratentiorial and infra-tentorial region on SW images probably due to apparent prominence of vessels. Possibility of subarachnoid hemorrhage is less likely, however CT scan correlation may be more informative.
No midline shift is seen.
Corpus Callosum is normal.
Sella and parasellar regions do not reveal any significant abnormality.
Vertebrae are normal in signal intensity and height. Intervertebral discs are normal in signal intensity and height. Note is made of scalp swelling in bilateral pariental region and posterior paraspinal back muscles and trapezius hyperintensity in cervical region. Secretions are seen in bilateral mastoid air cells with mild pansinusitis.
blls Hkh ;gha izrhr gksrk gSa fd ejht ds vkWijs'ku ls iwoZ tks tkap djk;h x;h mlesa isV esa TENDERNESS ds vykok lHkh lkekU; Fks] ckn esa /khjs&2 vlkekU; gksrs x;sA ejht dh 'kq: esa gh Open Surgery dj nh tkuh pkfg, Fkh] tks ugha dh x;hA ejht dk bZykt ftl izdkj fd;k tkuk pkfg,] bldk 50 Master Doctor gksrk gSa ijUrq bldk vFkZ ;g ugha fd Doctor unreasonable Decision ys] bl lac/a k esa (2019) 7 Supreme Court Cases 401 ARUN KUMAR MANGLIK V/S CHIRAYU HEALTH AND MEDICARE PRIVATE LIMITED AND ANOTHER ds iSjk 45 esa ekuuh; loksZPp U;k;ky; us izfrikfnr fd;k gS fd %& In the practice of medicine, there could be varying approaches to treatment. There can be a genuine difference of opinion. However, while adopting a course of treatment, the medical professional must ensure that it is not unreasonable. The threshold to prove unreasonableness is set with due regard to the risks associated with medical treatment and the conditions under which medical professionals function. This is to avoid a situation where doctors resort to "defensive medicine" to avoid claims of negligence, often to the detriment of the patient. Hence, in a specific case where unreasonableness in professional conduct has been proven with regard to the circumstances of that case, a professional cannot escape liability for medical evidence merely by relying on a body of professional opinion.
(2019) 6 Supreme Court Cases 512 NAND KISHORE PRASAD V/S MOHIB HAMIDI AND OTHERS esa ekuuh; loksZPp U;k;ky; us izfrikfnr fd;k gS fd %& Consumer Protection - Services- Medical practitioners/ services - Varying approaches to treatment available - Choice amongst - Medical negligence - Test for
- Unreasonableness of decision as to course of treatment adopted, as the criterion - In present case, since decision to operating patient concerned was unreasonable, finding of negligence against Operating Surgeon affirmed 51
- Held, while adopting a course of treatment, the medical professional must ensure that it is not unreasonable
- The threshold to prove unreasonableness is set with due regard to the risks associated with medical treatment and the conditions under which medical professionals function - This is to avoid a situation where doctors resort to "defensive medicine" to avoid claims of negligence, often to the detriment of the patient - Hence, in a specific case where unreasonableness in professional conduct has been proven with regard to the circumstances of that case, a professional cannot escape liability for medical evidence merely by relying on a body of professional opinion B. Consumer Protection - Services - Medical practitioners/services - Medical negligence - Decision to perform surgery - If unreasonable, thus amounting to medical negligence - Determination of - Surgery if was of immediate necessity to save life of patient who had critical platelet count
- Held, at admission, recorded history of patient was to complain about pain in abdomen, fever and hemorrhage in both eyes for five days - No evidence of critical condition of patient to be operated upon even with low platelet count - Surgery to remove roundworms not proved to be of immediate necessity to save life of patient who had critical platelet count - In absence of any evidence that surgery was only option even with low blood platelets, finding of negligence of Operating Surgeon cannot be ignored - Thus, it is a case if unreasonable decision of Operating Surgeon to operate and not a case of "bit negligent" so as to absolve surgeon from allegation of medical negligence- Consequently, finding of NCDRC to that extent set aside.
52gkWLihVy esa lksukyh dh e`R;q ds dkj.kksa dh tkap ds fy, desVh dk xBu fd;k] ftldh fjiksVZ Annaxure-R 6 fuEu izdkj gSa %& Report of the committee in respect of the death of Miss. Sonali Jain admitted on 15.03.2014 with Reg No. 157314 IPD No. 1119514 . The committee has gone through the relevant case file in respect of the deceased about the management of the patient Miss. Sonali Jain and probable cause of death.
. Case record was reviewed and discussed by committee members. It was noted, that all the standard protocols, precautions, measures such as Physician and Anaesthetist check up, obtaining consent of patient and relatives were followed.
. The patient was managed in ICU, post operatively. Necessary investigations like X-Ray, CT scan, MRI, ABG, Blood test and relevant special investigations were done.
. Constant monitoring of the patient was done with, time to time consultation with the concened specialist like Intensivist, Neurosurgeon, Neurologist, Vascular Surgeon, Physician and Anaesthetist and others.
.Throughout the hospitalization patient attendants and parents were counseled and explained about the operation difficulties and seriousness of case.
It has been seen by the committee that all out efforts were made to save the ife of the patient by the treating team.
In the opinion of the committee members the probable cause of the death is Hypoxia.
53 The exact cause of death could not have been ascertained because of the refusal for Post Mortem by the relatives of the deceased.
S. Name of the member Designaion Signature No.
1. Brig.[Dr.] B.R. jain [Retd] [Addl Chairman Director Admin]
2. Dr. Ashish Bhartiya [Physician] Member
3. Dr. Srikant Bulakh [Senior Surgeon] Member
4. Dr. S. N. Mathur [Surgeon] Member
5. Dr. Neeraj Garg [Anaesthetist] Member Dy.C.M.H.O. Uks viuh Report Annaxure-R 1 fnukad 06-06-2014 dks nh gSa tks fuEu izdkj gSa %& fo"k; %& HkaMkjh vLIkrky]t;iqj esa vfu;ferrkvksa ,oa vlko/kkuh ds lac/a k esa f'kdk;r dh tkapA lanHkZ %& vfrfjDr funs'kd¼fp0iz0½ fpfdRlk ,oa LokLF; lsok;sa jkt0 t;iqj ds i= dzekad fnukad 29-04-2014 ,oa eq[; fpfdRlk ,oa LokLF; vf/kdkjh]t;iqj izFke ds i= dzekad lkekU;@2014@628 fnukad 06-05-2014 ds dze esAa mijksDr lanfHkZr i= esa fo"k; esa fuosnu gSa fd v'kksd tSu] lh& 92 jkenkl ekxZ] fryd uxj] t;iqj ds i= fnukad 31-03-2014 tks fd ekuuh; eq[;ea=h egksn;] jktLFkku ljdkj t;iqj dks lEcksf/kr gSa] dk voyksdu mijkar ,oa fnukad 30-05-2014 dks O;fDrxr :i ls lquokbZ djus ,oa fyf[kr vfHkdFku ,oa HkaMkjh vLirky ds fjdkMZ ds voyksdu mijkar lqJh lksukyh tSu iq=h Jh v'kksd tSu dk ysizksLdksih ls visfUMDl dk vkWijs'ku fnukad 16-03-2014 dks HkaMkjh vLirky esa fd;k x;k FkkA vkWijs'ku ,oa visfUMDl ds vkWijs'ku ds iwoZ e`rdk ds firk@fj'rsnkjksa ls lgefr yh tkuk izrhr gksrk gSaA vkWijs'ku ds nkSjku dfBukbZ;ksa rFkk lhfj;lusl ds ckjs esa vLirky }kjk e`rd ds firk Jh 54 v'kksd tSu dks lwfpr fd;k tkuk rFkk gkbZ fjDl dlsUV Hkh yh tkuk izrhr gksrk gSaA vLirky }kjk izLrqr fjdkWMZ ds vk/kkj ij vkWijs'ku fo"k; fo'ks"kKksa¼Lis'kfyLV½ }kjk funku] mipkj] ,oa vkWijs'ku fd;k tkuk izrhr gksrk gSaA ejht dh e`R;q ds mijkar HkaMkjh vLirky }kjk xfBr desVh us ejht dh laHkkfor e`R;q dk dkj.k \ Hypoxia crk;k x;k gSaA ejht dh e`R;q dk okLrfod dkj.k tkuus gsrq vLirky }kjk e`rd dk iksLVekVZe ds fy, ejht ds ifjtuksa dks lq>ko fn;k x;k ysfdu mUgksua s iksLVekVZe ugha djus gsrq fyf[kr esa vLirky dks euk dj fn;kA vr% HkaMkjh vLirky }kjk izLrqr fjdkWMZ ,oa f'kdk;rdrkZ }kjk izLrqr fjdkWMZ ds vk/kkj ij ejht dh e`R;q dk laHkkfor dkj.k \ Hypoxia gks ldrk gSaA ;fn ejht dk iksLVekVZe djok;k tkrk rks e`R;q dk okLrfod dkj.k dk irk yxk;k tk ldrk FkkA ejht dk funku] mipkj ,oa vkWijs'ku fo"k; fo'ks"kKksa }kjk fd;k tkuk gh izrhr gksrk gSaA fjiksVZ voyksdukFkZ ,oa vko';d dk;Zokgh gsrq izLrqr gSA bu Reports esa ifjtuksa }kjk Post Mortam ls badkj djus dk dkj.k exact Cause of the death crkus esa vleFkZrk tkfgj dh gSaA 'ko ijh{k.k djus ds lac/a k esa ifjtuksa dh badkjh dk dksbZ Record is'k ugha gqvk gSa ijUrq ;g eku Hkh fy;k tkos fd ifjtuksa us bl ijh{k.k ls euk fd;k Fkk] rks Hkh e`R;q izek.k i= ls lkjh fLFkfr Li"V gks tkrh gSaA bl fLFkfr esa 'ko ijh{k.k lkjghu gksrk gSaA mijksDr foospuk ds vk/kkj ij vizkFkhZ la- 1 ls 3 dh Hka;dj fpfdRlh; ykijokgh gSaA vizkFkhZ la- 1 ls 3 us uk rks bZykt ds fy, Skill dk mi;ksx fd;k rFkk uk gh Care dh x;h] ejht dh fLFkfr fcxMrh x;hA ifjoknh ds vuqlkj vizkFkhZx.k dk ;g d`R; Medical Negligence dh Js.kh esa vkrk gSa tcfd vizkFkhZ ds vuqlkj Medical Accident FkkA ;fn vizkFkhZ dh ckr dks Lohdkj fd;k tkos rks bls Medical Accident 55 eku Hkh fy;k tkos rks Accident dh ifjHkk"kk C.P. Act esa ugha nh x;h gSa bls I.P.C.dh /kkjk 304&, ds ifjis{; esa ns[kk tkos rks Accident dk eryc Race Ok Negligent Act dk ifj.kke gksrk gSaA bl izdkj Accident esa Negligence ds lkFk&2 Race Hkh vk tkrk gSa tks vizkFkhZx.k la- 1 ls 3 ds fo:} tkrk gSaA bl izdj.k esa dqekjh lksukyh tSu ftlesa mez 18 o"kZ Fkh mlus PMT dh ijh{kk nh Fkh ijUrq Entrance Test esa mldh jsad tks Fkh og uhps Fkh blfy, vPNk esMhdy dkWyst ugha fey jgk FkkA vPNs esMhdy dkWyst gsrq oks nqckjk Entrance Test dh rS;kjh dksVk esa dj jgh Fkh mlds Appendicitis dk nnZ crk;k tkrk gS ftldh Laproscopy ls vkWijs'ku djuk Fkk ejht dks fnukad 14-03-2014 dks fn[kk;k x;k lksuksxzkQh gqbZ ijUrq ;g Li"V ugha gqvk fd Appendicitis gS] ml le; Appendicitis vkSj Colitis nksuksa dh laHkkouk, FkhA nksuksa ds bZykt vyx&vyx gS blfy, MkWa0 iksdj.kk ls Consult djds 7 fnu dh nokbZ;kW nh ijUrq mldk dksbZ vlj ugha gqvkA fnukad 15-03-2014 dks iqu% mls foi{kh gkWfLiVy esa yk;k x;k rFkk foi{kh la[;k 3 us tkWap dh lksuksxzkQh djok;h ;g Li"V ugha gks ldk fd ejht ds isV esa Appendicitis gS] ek= lansg O;Dr djrs gq, Appendicitis dh Laproscopy ls vkWijs'ku djus dk fu.kZ; fy;k x;kA izh&vkWijs'ku VsLV djok;s x;s cPph ds isV nnZ ds vykok iw.kZr% lkekU; FkhA fnukad 16-03-2014 dks mldk vkWijs'ku 'kq: gqvk tks Laproscopy ls gqvk Fkk] bl nkSjku Right iliac artery {kfrxzLr gks x;h [kwu cgus yxk iliac artery dh ejEer ds fy, MkWa0 dq'kokgk dks cqyok;k x;k mlus ejEer dh] Appendicitis MkWa0 Hk.Mkjh us fudkyh Appendicitis fdl fLFkfr esa Fkh ejht ds ifjtuksa dks ugha fn[kk;k x;k u gh mldh QksVks yh x;hA ejht ds gkVZ&vVsd vk;k CPR fn;k x;k 6 cksry [kwu eaxk;k x;k tks vLirky esa miyC/k ugha Fkk rFkk u gh igys O;oLFkk djus dks dgk x;k Laproscopy vkWijs'ku djus dk fu.kZ; gh xyr Fkk D;ksa fd lksuksxzkQh esa gh ;g Li"V ugha gks ik;k Fkk fd Appendicitis gS ;k ugha \ ek= lansg Fkk bl fLFkfr esa vksiu ltZjh gksuh pkfg, ijUrq ugha dh x;hA ejht dh fLFkfr 7 fnu rd xaHkhj cuh jghA ejht ds vR;f/kd [kwu cgk 14 ;wfuV [kwu p<+k 3 ckj gkVZ vVSd vk;k] lsIVhflfe;k gks x;k] Hypoxia gks x;k ;g xaHkhjre fpfdRlh; ykijokgh dk izdj.k gSA 56 I (2017) CPJ 1 (SC) SHEELA HIRBA NAIK GAUNEKAR Vs. APOLLO HOSPITALS LTD. esa ekuuh; loksZPp U;k;ky; us fuEu fu/kkZfjr fd;k gS%& Consumenr Protection Act, 1986 - Sections 2 (1)(g), 14 (1)(d), 23 - Medical Negligence - Angioplasty procedure - Patient died of a Heart Attack - Improper Post -operative care - deficiency in service - Evidence on record proves negligence on part of hospital in not taking proper post-operative care of deceased - Legal and substantive evidence on record - Total compensation @ Rs. 50,00,000/- awarded - Doctor who performed surgery also liable to pay Rs. 10,00,000 out of total Rs. 50,00,000/- along with the Apollo Hospital.
ekuuh; loksZPp U;k;ky; ds bl fu.kZ; ds vuqlkj ifjoknh dks 50]00]000@&:- ¼ v{kjs ipkl yk[k :- ½ fn;s x;s FksA bl izdj.k dh fLFkfr Hkh blls de ugha gSA fLFkfr esa foi{kh la[;k 1 yxk;r 3 ls ifjoknh dks yele 50]00]000@&:- ¼ v{kjs ipkl yk[k :- ½ ifjokn nk;j djus dh fnukad 23-12-2014 ls 9 izfr'kr okf"kZd dh nj ls C;kt lfgr vnk;xh rd vkns'k dh rkjh[k ls nks ekg esa fnyok;k tkuk U;k;ksfpr gSA vkns'k vr% foIk{kh la- 1 yxk;r 3 ifjoknh dks yele 50]00]000@&:-
¼ v{kjs ipkl yk[k :- ½ ifjokn nk;j djus dh fnukad 23-12-2014 ls 9 izfr'kr okf"kZd dh nj ls C;kt lfgr vnk;xh rd vnk djsA vkns'k dh ikyuk nks ekg esa dh tkosA foi{kh la- 4 yxk;r 7 ds fo:} ifjoknh dk ifjokn [kkfjt fd;k tkrk gSaA ¼ ehuk esgrk ½ ¼ dey dqekj ckxMh ½ lnL; lnL; ¼U;kf;d½ @izlkn@