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- Respondent le{k % ekuuh; Jh dey dqekj ckxMh] lnL; ¼U;kf;d½ ekuuh; lnL; Jherh ehuk esgrk mifLFkr %& ifjoknh dh vksj ls Jh ,l ,l gksjk o lqJh xslw gksjk]+ vf/koDrk foi{kh la- 1 ls 4 dh vksj ls Jh foTth vxzoky] vf/koDrk foi{kh la- 5 dh vksj ls Jh jrus'k ;kno] vf/koDrk foi{kh la- 6 dh vksj ls Jh ih lh tSu] vf/koDrk foi{kh la- 7 dh vksj ls Jhefr xk;=h tks'kh o Jh foey 'kekZ] vf/koDrk fu.kZ; fnukad 08 tuojh] 2020 jkT; vk;ksx jktLFkku t;iqj ¼}kjk Jh dey dqekj ckxM+h] lnL;]U;kf;d½ ;g ifjokn Ashok Jain dh vksj ls Bhandari Health Care Pvt. 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 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 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 pwBa 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] 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 :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 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] 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 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.

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.) 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% 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 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% 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 3.20 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 3.50 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% 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 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 7.00 P.M. 124/64 94% 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 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 Platelet 1.34 BT/CT 3'10/5' 10 Glucose F 92 224.8 (70 - 99) Creatinine 0.95 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 Platelet 1.34 BT/CT Glucose F 224.8 224.8 (70 - 99) 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 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 Platelet 0.50 1.5 - 4.5 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 -

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 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.

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.