|
d}n]
tL tLg lbgdf h] b]v]F
cfdL{sf] s]6f]n]] df]6/ xfFs]sf] tfn b]Vb}
d}n] o'j/fhnfO{ 7"n} clgi6 eP5 eGg] cg'ej ul/;s]sf]
lyPF . c:ktfnsf] 9f]s}b]lv ;}lgs sd{rf/Lx¿sf]
efubf}8 b]lvGYof] . k|:6 lyof], dnfO{ oxfF
Nofpg]x¿ ;Lw} dfly o'j/fh ePsf 7fpFdf n}hfg rfxGy],
t/ aLr}df c¿n] tfg]/ …6«df xnÚ lt/ nu] .
sf]xL …otf 8fS6/;fÚaÚ eGb}lyP t sf]xL …dfly
8fS6/;fÚaÚ eGb}lyP . Tolta]nf;Dd d}n] o'j/fhnfO{
uf]nLsf] rf]6k6s nfu]sf] 5 eGg] s'/f dfq yfxf kfPsf]
lyPF . dnfO{ xnlt/ 8f]¥ofpFb} ;a}eGbf klxn]
b]a|]lt/ Ps la/fdL ePkl§ nluof] . la/fdLsf]
cg'xf/ k"/} km'Ë p8]sf], sdLh, ;'?jfn / clncln
km'n]sf] skfn /utkR5] ePsf] / 3fF6Ldf ;fOafafsf]
ns]6 ‰'l08Psf] lyof] . la/fdLnfO{ Po/ Aofusf]
d2tn] ;f; km]g{ ;3fpg vf]lhFb}lyof] . d}n] yfxf
kfOg la/fdL sf] lyof], t/ lghL{j 5 eGg] s'/fsf] e]p
6f9}af6 kfO;s]sf] lyPF . d}n] cfFvf x]/]F, gf8L
5fd] / eg]F, ælalt;s] .Æ
To;kl5
8fS6/ vu]Gb| >]i7n] æaaf{b} eof], sf]xL afFsL
5}gg\, ;a}sf] ;+xf/ ePsf] 5Æ eGb} dnfO{ xnsf] kNnf]
5]plt/ n}hfg'eof] . ToxfF ;]tf] tGgfn] 9flsPsf]
Pp6f zj lyof] . pxfFn] tGgf x6fpg'eof] /
eGg'eof], æ>L % a8fdxf/fgL ;/sf/ ÛÆ a8fdxf/fgLsf]
6fpsf]sf] dflyNnf] efu Ift–ljIft ePsf] lyof] .
d}n] s'g} k|ltlqmof hgfpg gkfpFb} pxfFn] dnfO{
e'O{+df ePsf] csf]{ :6«]r/lt/ 8f]¥ofpg'eof] / tGgf
x6fpFb} eGg'eof], æclw/fhs'df/ lg/fhg ;/sf/ Û /,
otf clw/fhs'df/L zf/bf ÛÆ
dnfO{
olQ g} sfkmL e};s]sf] lyof] . 8fS6/ >]i7n]
km]l/ csf]{ :6«]r/ ePlt/ n}hfg'eof], hxfF Pshgf la/fdLnfO{
k'ghL{jg lbg]
k|of; ul/Fb}lyof], / eGg'eof], æclw/fhs'df/L >'lt .Æ
hLljt Pshgf t b]v]F, t/ la/fdLsf] cj:yf Psbd gfh's
lyof], d'6' d'lZsnn] rln/x]sf] lyof], gf8L rn]sf]
lyPg, ‰§ x]bf{ s'g} aflx/L rf]6k6s b]lvFb}gYof],
To;}n] d}n] eG7fg]F cfGtl/s /Qm;|fj jf kmf]S;f]sf]
aflx/L / leqL kqaLr xfjf el/P/ kmf]S;f]n] sfd gu/]sf]
cj:yf (pneumothorax) x'g;S5 . clw/fhs'df/Lsf]
6fpsf]df rf]6 lyPg / c¿ 8fS6/x¿n] x]l//fv]sf lyP,
To;}n] 8fS6/ >]i7n] dnfO{ xtf/–xtf/ ;fOafafsf]
ns]6 nufPsf] pxL d}n] leq k:g] lalQs} b]v]sf] la/fdLlt/
n}hfg'eof] / eGg'eof], æ>L % dxf/fhflw/fh ;/sf/
ÛÆ
d]/f]
nflu ;a}eGbf ef/L If0f ToxL lyof] . d ‰;Ë
ePFM ;Dk"0f{ /fhkl/jf/sf] cGTo Û olta]nf;Dd
klg dnfO{ s] ePsf] xf] eg]/ s;}n] eg]sf] lyPg, t/
d}n] of] ;a} uf]nLsf] rf]6k6sn] xf] eGg] a'l‰;s]sf]
lyPF . d s] cg'dfg nufpg yfn]F eg]F, of] h;n]
u/]sf] eP klg k"/} /fhkl/jf/nfO{ l;Wofpg
vf]h]sf] /x]5 . d]/f] lbdfudf ljleGg ;Defjgfsf
s'/f v]Ng yfn]M ;]gfn] xf] < ls dfcf]jfbLn] <
t/ d}n] s;}nfO{ ;f]lwgF, /fhfk|lt cfˆgf] clGtd ;Ddfg
k|s6 u/]F / aflx/ lg:s]F . dnfO{ tLg jif{cl3
sf7df8f}Fdf cGt/f{li6«o Go"/f];lh{sn ;Dd]ng
x'Fbf /fhf;Fu e]6]sf] ‰‰Nsf] cfof]M pxfF clt eb|
xf]OaS;GYof] / b]zsf] nflu cToGt lrGtf ul/aS;GYof] .
>L % sf] lgwg ePsf] s'/f :jLsf/ ug{ lgs} sl7g
lyof] . d]/f] nflu d}n] cfˆg} dftflktfnfO{
u'dfP h:t} 7"nf] Iflt lyof] Tof] .
To;kl5
d dflyNnf] tnflt/ nfu]F . ;}lgs :jf:YosdL{x¿n]
la/fdLx¿nfO{ cj:yf cg';f/ k|fyldstf lbP/ /fv]sf lyP .
ck/];g ubf{ nufpg] xl/of] n'uf km]/]/ d ck/];g lyP6/df
k;]F . af6f]df rf/hgf c¿ 3fOt] la/fdLx¿ lyP
h;nfO{ d}n] Tolta]nf lrlggF . o'j/fhsf]
6fpsf]sf] b'j}tkm{ b'O{j6f 3fp lyP, h;af6 /ut /
lubLsf 6'qmfx¿ aflx/ lg:s]sf] b]lvGYof] . o'j/fhnfO{
…cG8/j]o/Ú afx]s ;a} sk8f km'sfn]/ ;'tfOPsf] lyof]] .
z/L/df c¿ 3fprf]6x¿ lyPgg\ . 5ftLdf ;f; km]g{
;lhnf] kfg]{ 6\o"a xfNg] / ;nfOg kfgL lbg] sfd
e};s]sf] lyof] / of] ;a} a8f] s'zntfk"j{s ul/Psf]
lyof] . dlg6/df /Qmrfk / d'6'sf] rfn 7Ls}
b]lvGYof]– clwstd !!) / Go"gtd &) jf *) .
cfFvfsf gfgL km}ln;s]sf / crn lyP, t/ xftv'§f eg]
rn]sf lyP . o;sf] cy{, dl:tis c‰} dl/;s]sf] (brain
dead) lyPg . o'j/fh ;f; km]g{ k|of; ul/aS;Fb}
lyof] eg] :jf:YosdL{x¿ /a/ Aofuaf6 xfjf lbP/ ;f;
km]g{ ;lhnf] kfl/lbFb} lyP . Tolta]nfsf] d]/f]
d"NofÍgdf o'j/fhsf] a]xf];Lsf] cj:yf …Unf:uf]
sf]df :sf]/Ú df $ lyof], # xf]Og h'g eg]sf] Psbd}
Go"gtd xf] . t/ arfpg] ;Defjgf w]/} sd
lyof] . xfdLn] oyf;Dej /fd|f] pkrf/sf] k|of; /
s'g} rdTsf/ g} x'g;Sg] df}sf l;h{gf ug'{kg]{ lyof] .
o'j/fhsf]
pkrf/df Psbd} s'zn :jf:YosdL{x¿ ;+nUg lyP .
xfdLn] o'j/fhnfO{ s[lqd Zjf;–k|Zjf; pks/0fdf
(mechanical ventilator) df /fVof}F / ck/];gsf] nflu
rf/kf]sf /ut h'6fof}F . xfdL;Fu ;}lgs c:ktfnsf
Go"/f];h{g 8fS6/ zdf{ x'g'x'GYof], jL/ c:ktfnsf
Knfli6s ;h{g 8fS6/ hf]zLnfO{ af]nfOof] / ;f}efUojz,
ck/];g lyP6/sf ;xof]uLx¿ klxn] d;Fu} Pe/]i6 gl;{ª
xf]ddf sfd u/]sf :jf:YosdL{x¿ lyP . pgLx¿
d]/f] sfd ug]{ tl/sf;Fu kl/lrt ePsfn] ;lhnf] eof] .
t/ ck/];gdf xft xfNg'cl3 d}n] Go"/f];lh{sn
s];sf c¿ 3fOt]x¿ klg 5g\ ls eg]/ x]/]F . wL/]Gb|
xf];d} x'g'x'GYof], t/ pxfF a9L :jfF–:jfF ul//xg'ePsf]
lyof] . clw/fhs'df/L sf]dnsf] 5ftLdf 3fp lyof],
uf]nLn] wGg d'6' e]6]sf] /x]g5 . s'df/ uf]/v
klg ToxLF x'g'x'GYof] . s]tsL r]i6/sf] s'ddf
rf]6 nfu]sf] lyof] / pxfF clncln af]Ng ;Sg'x'GYof] .
o'j/fhsf]
b]a|] sfgsf] 7Ls k5fl8 uf]nL l5/]sf] Ps ;]lG6ld6/
rf}8f 3fp lyof] . bflxg]kl§ sfgeGbf dfly rflxF
cln 7"nf] uf]nL lg:s]sf] 3fp lyof] . ToxfF
d}n] la/fdLnfO{ /fd|f] pks/0f / bIf hgzlQm ePsf] jL/
c:ktfnsf] Go"/f];h{/L ;3g pkrf/ sIf
-cfO{;Lo"_ df n}hfg' k5{ ls eGg]af/] lg0f{o
lng'kg]{ eof] . t/ :yfgfGt/0fn] lj/fdLsf] afFRg]
l‰gf] cfzf c‰} sd ul/lbg ;S5 eGg] dnfO{ nfUof] .
xfdLn] kl5 Pd\cf/cfO{ ug{ afwf gxf];\ eg]/ 6fpsf]df
wft'sf 6'qmfx¿ 5g\ ls 5}gg\ yfxf kfpg o'j/fhsf]
dlitissf] PS;–/] u¥of}F . 6fpsf]df wft'
/x]g5 . leq wft' /x]sf] cj:yfdf Pd\cf/cfO{ ug'{
7"nf] e"n x'GYof] . xfdLn] b]a|]kl§sf]
3fp vf]n]/ 7"nf] kf¥of}F, lubLsf d[t tGt'x¿
x6fof}F, 3fp l;nfof}F, la/fdLnfO{ csf]{lt/ kmsf{of}F
/ lgwf{l/t k|lqmof cg';f/, ck/];g ubf{ sfl6Psf]
7fpFdf x'g] /Qm;|fj /f]Sg sf6]sf] efu 8fd]/ 89fpFb}
hfg] (cauterising), xf8sf 6'qmf6'qmL x6fpg] / kl5
x'g;Sg] ;+qmd0fsf] pkrf/sf nflu dlitissf] cfj/0fnfO{
clnslt v'nf /fVg] sfd u¥of}F . To;kl5 8fS6/
hf]zLn] 5fnfsf] aflx/L kq ldnfOlbg'eof] .
aNn
d}n] ;h{gsf] sf]7fdf hfg] ;do kfPF . ToxfF uP/
s]xL ;fyLx¿;Fu s'/f u/]kl5 dfq yfxf eof]M ltg} o'j/fh,
h;sf] e/v/} d}n] ck/];g u/]F, af6 of] ;a} ePsf] /x]5 .
of] ;'g]kl5 dnfO{ Ps lx;fan] JolQmut ¿kdf s]xL /fxt
dx;"; eof] . lgZro g}, /fhkl/jf/sf] nflu
of] eoÍ/ ljklQ lyof], t/ s'g} aflx/L zlQmsf] sfd
eOlbPsf] eP b]zs} nflu ‰g\ clgi6s/ x'g;SYof] .
;do
lat]sf] kQ} kfPg5', aflx/ pHofnf] x'g yfln;s]5 .
xfdLn] Pd\cf/cfO{ u¥of}F . uf]nL dlitissf]
w]/} efudf Iflt k'¥ofO{ cfGtl/s /Qm;|fj ;d]t u/fP/
kf/ ePsf] /x]5 . of] ;a} ;fx|} g/fd|f] nIf0f
lyof] . pkrf/sf] of]hgf ;'lglZrt g} lyof]–
la/fdLnfO{ cfO;Lo"df n}hfg], PlG6afof]l6s hf/L
/fVg], dlitisdf kg]{ rfk 36fpg s[lqd Zjf;–k|Zjf;
hf/L /fVg], 6fpsf]nfO{ #) l8u|L sf]0fdf p7fOlbg] .
olt u/]kl5 8fS6/ >]i7 æxfdL ca 5'l§cf}F / ef]ln
laxfg bz ah] e]6f}FÆ eGb} x'g'x'GYof], TolQs}df clw/fhs'df/
1fg]Gb| s'g} klg avt cfOk'Ug ;Sg] va/ cfof] / kv]{/
a:of}F . casf] kl/l:ylt ;DxfNg sd;] sd /fhkl/jf/sf
Ps hgf t hLljt} 5g\ eGg] va/n] ;}lgs c:ktfndf s]xL /fxt
cg'ej u/fPsf] dx;"; x'GYof] .
clw/fhs'df/sf]
cfudg eof] . pxfF ;a} d[t / 3fOt]x¿sf]
l56f]l56f] lg/LIf0f ub}{ dfly k':tsfnodf ;jf/L eof]
/ 8fS6/ >]i7 / dnfO{ ToxLF af]nfOaS:of] .
clw/fhs'df/n] dnfO{ x]/]/ ;f]lwaS:of], æeGg';\, o'j/fhnfO{
s:tf] 5 <Æ d}n] lagf s'g} ;+zo l:ylt cjut
u/fPF, æ6fpsf]df lgwf/sf] k5fl8kl§ dlitis 5]l8Psf]
3fp ePsf] cj:yf ;fdfGotof 3fts g} x'G5 .Æ d}n]
o'j/fh c‰} hLljt eP klg afFRg] ;Defjgf Psbd} IfL0f
ePsf] atfPF . clw/fhs'df/ c;fWo} uDeL/ t/
cljrlnt xf]OaS;GYof] . pxfFnfO{ d}n] ;+oldt,
lg0f{o Ifdtf gu'dfPsf] / ;dok|lt ;hu kfPF .
pxfFx¿nfO{ hgtfnfO{ s] atfpg], ;~rf/dfWodnfO{ s]
hfgsf/L lbg] eGg] ;d:of lyof] . t/ d}n] s] eGg}
k5{ eg] cf}ifwf]krf/sf] dfldnfdf s'g} k|sf/sf]
x:tIf]k ePg .
xfdL
laxfg bz ah] e]6\g] ;Nnfx u/]/ 5'l§of}F . 3/
uP/ g'xfOw'jfO ;s]]sf] dfq} lyPF c:ktfnaf6 la/fdLsf]
l:yltsf] k'gM d"NofÍgsf] nflu gf} ah] cfOk'Ug
kmf]g cfof] . d}n] c:ktfn kmf]g u/]F / la/fdLnfO{
n7\ofpg lbOPsf ;a} cf}iflwx¿ aGb ug{ cx|fPF .
d ToxfF gf} ah] k'Ubf o'j/fhsf] cj:yfdf s]xL ;'wf/
ePsf] lyof], pxfF v'§f rnfpg], ;f; km]g]{ / vf]Sg]
k|oTg ul/aS;Fb} lyof] . cj:yf Tolt /fd|f] geP
klg lxhf] hlQs} lyof] / xfd|f] cufl8 hf]8tf]8sf ;fy
pkrf/ hf/L /fVg] l;jfo c¿ ljsNk lyPg . xfdLn]
dfly oxL va/ u¥of}F, / d]/f] ljrf/df To;kl5 /fhf jL/]Gb|sf]
:juf{/f]x0f ePsf] / o'j/fh bLk]Gb|nfO{ >L % dxf/fhflw/fh
tyf clw/fhs'df/ 1fg]Gb|nfO{ /fHo;xfos 3f]if0ff ug]{
k|lqmofsf] ;'¿cft eof] .
cfOtaf/
Psbd} wk]8Lsf] lbg /Xof] . xfdLn] wL/]Gb|nfO{
x]g'{lyof] / lbgel/ s]xL vfg kfPsf lyPgf}F .
ToxL lbg ;fF‰kvb]lv /fhf bLk]Gb|sf] cj:yf b|'tultn]
v/fa x'Fb}uof] . :jf:YosdL{x¿sf] a}7s a:of] .
xfdLn] clw/fhs'df/ 1fg]Gb|nfO{ e]6\of}F, afFRg] cfzf
z"Go /x]sf] cjut u/fof}F / ljsNkx¿ atfof}FM kl/jf/hgsf]
k"0f{ ;xdltdf s[lqd Zjf;–k|Zjf; pks/0f aGb ug]{,
ls k|s[ltsf] lgodcg';f/ :jfefljs ¿kdf d'6' rNg
g5f8];Dd oyfjt /fVg] . clw/fhs'df/ 1fg]Gb|åf/f
;a} s'/f ;'lgaS:of] / x's'd eof], æd o;af/] d'df;Fu
;Nnfx u5'{ .Æ pxfF l5§} kmls{aS:of] / x's'd
eof], æ7Ls 5 8fS6/, k|fs[lts ¿kn] d'6' rNg
g5f8];Dd pkrf/ hf/L /fVg';\ .Æ ;fy} efO -wL/]Gb|_
nfO{ arfpg x/;Dej k|of; ug{ klg x's'd eof] .
;f]daf/
laxfg ;a]/} /fhf bLk]Gb|sf] d'6' rNg 5f8\of] .
s[lqd tl/sfaf6 Jo'Ftfpg ul/Psf] k|of; klg lgikmn /Xof] .
pxfFnfO{ xfdLn] o'j/fhsf] ¿kdf pkrf/ z'? u/]sf
lyof}F / /fhfsf] ¿kdf u'dfof}F .
Tof]
36gfdf s'g} if8oGq lyof] ls eg]/ ;f]Wg'x'G5 eg] d}n]
eGg} k5{, k|ToIftM lyPg . t/ of] b]zdf if8oGq 5 .
Tof] if8oGq xf], xfd|f o'jfx¿nfO{ nfu"
cf}ifwsf] s'ntdf kmF;fpg] . /fhkl/jf/ klg o;af6
c5'tf] /x]g5 . of] if8oGq nfu" kbfy{sf] wGbf ug]{
dflkmofsf] xf] .
-g]kfnL
6fOD;, cª\u|]hL ;fKtflxs -@@–@* h"g_ df
k|sflzt ljj/0fdf cfwfl/t . cg'jfb tyf k|:t'ltM ab|L
kf}8\ofn_
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