ʻO ke koko ma hope o ka Tonsillectomy: La 5 a 10 Scab Sloughing a me ka ho'āʻo ʻana i ka hemorrhage.¶

ʻO ka tonsillectomy (me ka adenoidectomy a i ʻole ʻole) kekahi o nā kaʻina hana ʻokiʻoki i hana pinepine ʻia i nā keiki a me nā ʻōpio o ka honua holoʻokoʻa, eia naʻe ke lawe nei i kahi pilikia ʻokoʻa a hiki ke hoʻoweliweli i ke ola o ka hoʻopaneʻe ʻana i ke kahe koko a hiki i ʻelua pule ma hope o ka hoʻi ʻana o ka mea maʻi i ka home. Ma muli o ka noho ʻana o ka palatine tonsils i loko o kahi moena puʻu muscular i hoʻolako ʻia e nā lālā ʻelima kiʻekiʻe o ke aʻaʻa carotid waho, a no ka mea ʻaʻole hiki ke humuhumu ʻia nā ʻeha ma hope o ka waha a paʻa a uhi ʻia paha me kahi kāʻei, hoʻōla ka tonsillar fossae ma ka hana ʻana i nā ʻōpala fibrinous mānoanoa, keʻokeʻo melemele.eschars). Ma waena o ka hana ʻana La 5 a me 10, i ka ulu ʻana o ka ʻili mucosal hou ma lalo, ua hemo kēia mau ʻōpala pale a maloʻo. Inā kaʻawale ka pehu ma mua a i ʻole e hāmama nā waimaka i kahi moku aʻa lalo, hiki ke kahe koko ma luna pono o ka puka makani (trachea). ʻO ke koko ʻulaʻula ʻulaʻula e ʻike ʻia mai ka waha a i ʻole ka ihu, ka ʻai pinepine ʻana i kahi keiki hiamoe, a i ʻole ka luaʻi ʻana i ke koko ʻeleʻele ʻeleʻele ma hope o ka tonsillectomy he hana ulia pōpilikia. Kāhea i kou wahi helu pilikia koke a nīnau i kā mākou alakaʻi pili ma ʻaʻa koko a me ke kahe koko, luaʻi koko a me ka ʻōpū koko, a haʻalulu hypovolemic.

E hana i kēia i kēia manawa¶

1. Kahea koke iā 911, 112, a i ʻole 999 no ke kahe ʻana o ke koko ʻulaʻula ʻulaʻula, ke koko koko, a i ʻole ka luaʻi koko ma hope o ka tonsillectomy: Mai kali ma ka home e ʻike inā pau ke koko ma hope o ka tonsillectomy, ʻaʻole hoʻi e hoʻokele i kahi keiki kahe koko i ka haukapila ma ka noho hope o ke kaʻa kaʻa ʻaʻole hiki ke hoʻokuʻu i ka ea.
2. Noho pololei i ka mea maʻi a hoʻolei i ke poʻo a me ka lama i mua ma luna o ke pola a i ʻole ke kāwele keʻokeʻo: Mai ʻae i ke kanaka me ke koko ʻāʻī e moe palahalaha ma kona kua. ʻO ka noho pololei ʻana e hoʻemi i ke koko venous a me ke koko ma ka ʻāʻī, ʻoiai e hilinaʻi ana i mua e hiki ai i ke koko ke kahe mai ka waha i loko o ke kīʻaha i ʻole ia e ʻauʻau ma luna o nā kaula leo a i ʻole e holo i lalo i ka ʻōpū.
3. E hoʻokuʻu mālie a kuha i ka wai hau i kahi keiki nui a makua paha i hui pū me ia: Inā ʻala loa ka mea maʻi, makaʻala, a hiki iā ia ke hahai i nā ʻōlelo aʻoaʻo me ka ʻole o ka ʻuʻuku ʻana, e hoʻoheheʻe mālie i ka wai hau ma hope o ka waha a kuha ʻia i loko o kahi poho keʻokeʻo a i ʻole ke kīʻaha e hoʻoulu ai i ka vasoconstriction o ka ipu liʻiliʻi a maʻemaʻe paha ka moe. e hoomau ana. Mai ** mai** hoʻoikaika i ka wai i loko o kahi kamaliʻi uē, pēpē, a i ʻole maʻi hiamoe.
4. E kau i ka hau hau a i ʻole ka ʻeke anu i mua a me nā ʻaoʻao o ka ʻāʻī a omo i ka pop hau: ʻO ka hoʻopaʻa ʻana i kahi ʻeke hau i uhi ʻia i ka lole ma ka ʻāʻī ʻaoʻao o luna (ma lalo pono o ka kihi o ka ʻāʻī) kōkua i ka hoʻomaha ʻana i nā lālā carotid waho e hānai ana i ka fossa tonsillar i ke kali ʻana i nā mea lapaʻau.
5. E aʻo i ka mea maʻi e kuha i kēlā me kēia kulu o ke koko a me ke kohu ma mua o ka ʻai ʻana: ʻO ka ʻai ʻana i ke koko e hūnā i ka nui maoli o ka hemorrhage mai nā mākua a me nā kauka, hoʻonāukiuki i ka ʻōpū o ka ʻōpū, a hoʻoulu i ka luaʻi hikiwawe o ka projectile (hematemesis) hiki ke hoʻokahe i ke ala ea a haehae i ka moena ʻāʻī hoʻōla.
6. E hoʻomākaukau no ka hoʻonohonoho hoʻolaʻa ʻana inā hiamoe ka mea maʻi, ʻeleʻele, a maule paha: Inā lilo ke keiki koko a i ʻole ke kanaka makua i ka lethargic, liʻiliʻi, a i ʻole ka pane ʻole ʻoiai e kali ana i nā lawelawe lapaʻau pilikia, e ʻōwili koke iā lākou ma ko lākou ʻaoʻao ma ka ** kūlana hoʻihoʻi ʻaoʻao ** me ka hiʻi iki ʻana o ka maka i lalo i kahe ke koko ma ke kihi o ka waha ma mua o ka maloʻo ʻana o ka māmā.

Ka lāʻau hoʻoholo: ʻO ka hoʻāʻo ʻana ma hope o ka tonsillectomy a me ka pane ʻana o ke ea¶

flowchart TD
    PostOp["ʻO ka maʻi ma hope o ka Tonsillectomy (La 0 a i ka lā 14)"] --> SignCheck{"He Koko ʻulaʻula ʻulaʻula paha, Koko-koko kohu, ʻeleʻele ʻeleʻele, a i ʻole ka luaʻi ʻāina kofe?"}
    SignCheck -->|"ʻAe, Hoʻohuʻi ʻana, ʻAha, Puʻi koko, a i ʻole Pallor"| CallEMS["KELE KĀWAI 911 / 112 / 999 KOKE: E noi i ka Ambulance Support Life Advanced"]
    CallEMS --> Conscious{"Ua ala ka mea maʻi a me ka mālama ʻana i ko lākou ala ea?"}
    Conscious -->|"ʻAe"| Upright["Noho Pono e Hili Imua; E kuha i ke koko a pau i loko o ka ipu wai; Hui hau i ka ai; ʻO ka hau hau inā makaʻala"]
    Conscious -->|"ʻAʻole, Limp, Drowsy, or Gurgling"| Lateral["Kaʻa i ka ʻaoʻao (Ke kūlana hoʻihoʻi) me ka waha i lalo; Mākaʻikaʻi ʻike ʻia nā clots; E hoʻomākaukau no ka CPR"]
    SignCheck -->|"ʻAe, wahi liʻiliʻi o ke koko i kū ('Herald Bleed')"| GoToER["MAI KAALI MA KA HOME: E lawe koke i ka 'Oihana Ho'opi'i no ka nānā 'ana a me ka nānā 'ana"]
    SignCheck -->|"ʻAʻohe Koko ʻIke ʻia"| SubtleCheck{"ʻO ka ʻai pinepine ʻana, ka ʻāʻī ʻana, ka tachycardia hou, a i ʻole ka hoʻomaha ʻana?"}
    SubtleCheck -->|"ʻAe"| TorchLook["Ke kukui uila ma ka waha: E ʻimi i ke koko e kahe ana ma lalo o ka pā pharyngeal hope a i ʻole ka clot ma Fossa"]
    TorchLook -->|"ʻIke ʻia ke koko a i ʻole ka clot"| GoToER
    TorchLook -->|"ʻIke ʻia nā ʻōpala keʻokeʻo/melemele wale nō"|HydrationCheck{"ʻEha Pepeiao/Puʻu Koʻikoʻi, Hōʻole i ka inu ʻana no 12+ mau hola, a i ʻole ke kuni kiʻekiʻe > 38.9 C (102 F)?"}
    HydrationCheck -->|"ʻAe"| UrgentContact["Hoʻokaʻaʻike i ke Kauka ENT a i ʻole Pediatric ER no IV Hydration and Pain/Infection Management"]
    HydrationCheck -->|"ʻAʻole"| NormalCare["NOMAL HEALING ESCHAR: E hoʻomau i ka hoʻoheheʻe ʻana i ka manawa a puni, Acetaminophen, a me ka meaʻai palupalu."]

Pathophysiology: No ke aha e kahe ai ke koko o ka tonsillectomy scabs i hoʻokahi pule ma hope o ka ʻoki ʻana¶

Pīhoihoi pinepine nā mākua a me nā poʻe maʻi i ka wā e kahe koko ai ka ʻāʻī ma hope o 7 a i ʻole 8 mau lā ma hope o ke ʻoki ʻana, i ka wā i hoʻomaka ai ka mea maʻi e hoʻomaikaʻi iki a hoʻomaka paha i nā hana maʻamau. ʻO ka hoʻomaopopo ʻana i ke kaʻina hana hoʻōla ʻeha ʻekolu o ka oropharynx e wehewehe i ke kumu o kēia puka makani lohi ka manawa o ka pōʻino kiʻekiʻe.

1. ʻO ka hāʻawi ʻana i ke aʻa nui o ka fossa tonsillar¶

Noho ka palatine tonsil i loko o kahi moʻo ʻiʻo triangular hohonu ma waena o ke kia tonsillar mua (palatoglossus muscle) a me ke kia tonsillar hope (palatopharyngeus muscle), e hoʻomaha pololei ana ma luna o ka superior pharyngeal constrictor muscle. ʻElima mau lālā aʻaʻa kiʻekiʻe o ka aʻaʻa carotid waho e hoʻohā i kēia moena ʻiʻo no ka hānai ʻana i ka tonsil:

• Lalā tonsillar o ke aʻa o ke alo (ke kumu nui a maʻamau o ke kahe koko koko haʻahaʻa).
• Lalā palatine piʻi o ke aʻa alo.
• Nā lālā lingual hope o ke aʻa lingual (e hoʻolako ana i ka pou haʻahaʻa e pili ana i ke kumu o ke alelo).
• **Aaʻa pharyngeal piʻi ** (hoʻolako i ka paia hope).
• Ke aʻa palatine iho i lalo (he lālā o ke aʻaʻa maxillary e hāʻawi ana i ka pou kiʻekiʻe).

Eia kekahi, ʻo ka nui paratonsillar vein (vein of Denis Browne) holo pololei i lalo o ka moena tonsillar ʻaoʻao ma lalo pono o ka paia ʻiʻo lahilahi, a ʻo ke kumu nui o nā ʻaʻaʻa carotid kūloko a me waho e hele wale i ka 1.5 a i ka 2.5 kenimika (0.6 a 1.0 ʻīniha) ma ka ʻaoʻao i ka capsule tonsillar hohonu.

2. Ka hemorrhage ma hope o ka tonsillectomy ma ke kula mua vs¶

Hoʻokaʻawale nā kauka i ke koko ma hope o ka tonsillectomy (PTH) i ʻelua ʻāpana ʻokoʻa e pili ana i ka manawa a me ka mīkini:

3. He aha ka pehu keʻokeʻo (eschar) a no ke aha e hoʻokahe koko ai ka wai¶

I loko o 12 a i 24 mau hola ma hope o ka ʻoki ʻana, ua uhi ʻia nā lua muscular maka kahi i wehe ʻia ai nā tonsils i loko o kahi pākeʻe mānoanoa, shaggy, hina keʻokeʻo a melemele paha i haku ʻia me ka fibrin, platelets, keʻokeʻo keʻokeʻo, a me nā ʻili o ka ʻili.

• He hiʻohiʻona maʻamau (ʻAʻole he maʻi): ʻO nā mākua nāna e nānā i ka waha o kā lākou keiki i ka lā 3 e hopohopo pinepine i ka wā e ʻike ai i ʻelua ʻāpana keʻokeʻo-melemele mānoanoa, ʻala ʻino e uhi ana i ke kua o ka ʻāʻī, me ka manaʻo he strep pus nui a i ʻole ka maʻi. ʻO kēia fibrinous eschar kahi maʻamau, pale pulu pulu, a me ka hanu ʻino ikaika (halitosis) manaʻo ʻia no 10 a 14 mau lā.
• Pehea ka hili ʻana (Nā lā 5 a hiki i ka 10): Ma lalo o kēia pākeʻe fibrin, ke kolo mālie nei ka epithelium mucosal squamous ʻulaʻula hou mai nā kihi o nā pou tonsillar. Ma waena o nā lā 5 a me 10, hoʻoheheʻe ke kino i ka hoʻopili ʻana ma waena o ka ʻili hou a me ka pehu fibrin make ma luna aʻe i hiki ai i ka pehu ke ʻoki i loko o nā ʻāpana liʻiliʻi liʻiliʻi a moni ʻia me ka ʻike ʻole ʻia me ka kohu.
• No ke aha e hoʻomaka ai ka hemorrhage o ka wai wai: ʻAʻole e like me ka pehu ma kou kuli e hoʻōla maikaʻi loa i ka ea maloʻo, pono e noho ka eschar ʻāʻī ** pulu mau a palupalu**. Inā hōʻole ke keiki i ka inu wai no ka ʻāʻī a me ka ʻeha pepeiao, maloʻo ka ʻāʻī (pharyngeal desiccation). ʻO ka eschar maloʻo e emi, paʻakikī i loko o ka ʻōpala ʻoʻoleʻa, a huki ikaika i nā kīʻaha koko hoʻōla i lalo i kēlā me kēia manawa a ʻae nā ʻiʻo o ka ʻāʻī e ale a ʻā paha. Ma kahi o ka hoʻoheheʻe ʻana me ka maʻemaʻe, ua ʻoki ʻia ka ʻōpala maloʻo i ka ʻāpana hoʻokahi, e haehae ana i ka paia o kahi arteriole nāwaliwali wela ma lalo.

ʻO ka ʻike ʻana i ke koko huna i nā pēpē, nā kamaliʻi, a me nā keiki hiamoe¶

ʻOiai e hele koke ana kahi kanaka makua a ʻōpio paha i ka lumi kuke a haʻi iā ʻoe ua ʻono lākou i ke koko mehana ma ke kua o ko lākou ʻāʻī, nā keiki liʻiliʻi (ʻoi loa ma lalo o 6 mau makahiki) a me nā keiki me ke kino kīnā ʻole ** ʻaʻole e kuha i ke koko. Akā, ʻo kā lākou reflex maʻalahi e ale i nā mea a pau i komo i ko lākou pharynx.

Nā hōʻailona hōʻailona o ke kahe koko ʻana o ka ʻāʻī i loko o kahi keiki¶

Hiki i ke keiki ke ale malie i ka 20 a 30 ka nui o ka nui o ke koko e kaa ana i loko o kona opu ma mua o ka puka ʻana o kahi kulu koko ma kona pahu uluna a i ʻole nā lehelehe. E nānā pono i kēia mau hōʻailona hana a me ke kino:

1. Ke ale pinepine a hoʻomaha i ka wā e hiamoe ai a hoʻomaha paha: E nānā i mua o ka ʻāʻī o ke keiki. Ina e ale ana kekahi keiki hiamoe a hoomaha paha i na 5 a 15 kekona ke inu ole ia i kekahi mea, e kahe ikaika mai ana ke koko wai mai ka moena tonsillar a i ole moena adenoid.nasopharynx) ma ke kua o ko lakou puu.
2. ** ʻO ka hū ʻana o ka ʻāʻī, ka ʻāʻī ʻana, a i ʻole ka ʻū ʻana i ka pō**: ʻO ke kahe ʻana o ke koko i loko o ka hypopharynx e hoʻolili i ka puka laryngeal, e hoʻoheheʻe ʻia ka leo pulu i ka wā e hanu ana a i ʻole e ala koke ana me ka ʻāʻī ʻana.
3. ** ʻO ka hoʻomaha ʻole i wehewehe ʻole ʻia, ka hopohopo, a i ʻole ka ʻili haikea a me ka ʻili**: I ka haʻalulu hypovolemic pediatric, mālama nā keiki i ke koko maʻamau maʻamau a hiki i ka nalowale ʻana o ka 25 a 30 ka nui o ka nui o ko lākou koko. Hōʻike ʻia ka haʻalulu mua ma ke ʻano he heihei puʻuwai (tachycardia), nā manamana lima haikea a me nā manamana wāwae, nā ʻāʻī keʻokeʻo keʻokeʻo a me nā lihilihi o loko, a me ka haʻalulu a i ʻole ka papa inoa.
4. Nausea a me ka luaʻi koke ʻana o nā mea ʻeleʻele "kopa-kopa" a i ʻole nā ʻōpala maroon: Ke ale ʻia ke koko e hui pū me ka waika hydrochloric (HCl) i loko o ka ʻōpū, ua oxidized ka hao i loko o ka hemoglobin i ʻeleʻele ʻeleʻele ʻakika hematin. I loko o 15 a 45 mau minuke o ka ʻai leo ʻana, ʻaʻa a huhū ka ʻōpū, no laila e luaʻi koke ke keiki i ka nui o ka wai kofe ʻeleʻele ʻeleʻele i hui pū ʻia me nā ʻulaʻula ʻulaʻula a i ʻole nā ​​ʻōpala e like me ka jelly.

ʻO nā hana kōkua mua koke i ka wā e kali ana i ka ambulance¶

Ke kāhea ʻoe i ka 911, 112, a i ʻole 999, ʻo kāu mau mea nui i ka 5 a 15 mau minuke ma mua o ka hōʻea ʻana o nā paramedics ʻo ** ka pale ʻana i ke koko i loko o nā māmā **, ** ka pale ʻana i ke ale ʻana i ke koko **, a ** ka hoʻoikaika ʻana i ka vasoconstriction kūloko **.

1. ʻO ke kūlana ea maikaʻi loa: Kū pololei a hilinaʻi i mua¶

• E hoʻonoho pololei i ke keiki a i ʻole ke kanaka makua ma luna o ka noho, ka moe, a i ʻole ma ka ʻūhā o ka makua me ke poʻo a me ka umauma luna e hilinaʻi ana i mua ma kahi kihi 30-45-degere.
• E paʻa i ke kīʻaha keʻokeʻo, ke kīʻaha keʻokeʻo keʻokeʻo, a i ʻole ke kāwele keʻokeʻo ma lalo o ko lākou auwae. ʻO ka hoʻohana ʻana i kahi ipu keʻokeʻo e hiki ai iā ʻoe a me nā mea lapaʻau hōʻea mai ke hoʻoholo pololei i ka volume o ke koko i nalowale a me kona ** kala** (bright arterial red vs. dark venous clots vs. pink saliva).
• E kamaʻilio me ka leo mālie, mālie, paʻa. ʻO ka uē ʻana, ka uē ʻana, a me ka makaʻu i hoʻonui i ka puʻuwai a me ke koko systolic, ʻoi aku ka wikiwiki o ka puhi ʻana i ke koko mai loko mai o ka ipu tonsillar hāmama.

2. ʻO ka ʻenehana swish-and-spit wai hau (nā maʻi hui wale nō)¶

Inā he kanaka makua, ʻōpio, a ʻoi paha ka mea maʻi ma ke kula (maʻa mau makahiki 7 a ʻoi aku) e makaʻala loa, mālie, a ʻaʻole e ʻoki ʻia:

• E hoʻopiha i ke kīʻaha me ka wai anuanu a me ka hau hau.
• E inu ka mea maʻi i ka wai hau anuanu, e hoʻohuli iki i ke poʻo i ʻauʻau ka wai anuanu i ke kua o ka waha no 3 a 5 kekona, a kumu mālie i ka wai i waho i loko o ke kīʻaha (ʻaʻole hiki ke kāmu ikaika, no ka mea, hiki i ka haʻalulu ikaika o ka ʻāʻī ke hoʻoluliluli i nā ʻōpala o ka moku).
• E hana hou i kēlā me kēia 30 a 60 kekona. Hoʻopili ka wai anuanu i nā arteriole mucosal a me nā capillaries i loko o ka fossa tonsillar i ka wā e holoi ana i nā enzyme fibrinolytic i loko o nā ʻāpana koko.

3. Hoʻoluʻu ʻāʻī waho¶

• E wīwī i ka ʻeke hau a i ʻole ka pī paʻa i loko o kahi kāwele ʻuʻuku a pulu a kau mālie ma ka ʻaoʻao o ka ʻāʻī luna ma lalo iho o ka ʻāʻī (submandibular triangle), aiʻole ma ke kua o ka ʻāʻī.
• Mai hoʻopaʻa paʻa i kekahi mea ma ka ʻāʻī a i ʻole e kaomi ikaika i ka ʻili makani a i ʻole ka pulina carotid.

4. He aha ka mea ʻaʻole e hana i ka wā o ke koko ma hope o ka tonsillectomy¶

• Mai hoʻopaʻa i nā manamana lima, nā pāpaʻi, nā pōlele pulupulu, a i ʻole nā mea kālā i ke kua o ka waha ma ka home e hoʻāʻo e kaomi ma luna o ka moena tonsil.
• Mai hāʻawi i ka aspirin, ibuprofen (koe ke nānā ʻole ʻia, a ʻaʻole loa i ka wā o ke koko ikaika), naproxen, a i ʻole nā lāʻau hoʻoheheʻe koko: Nonsteroidal anti-inflammatory drugs (NSAIDs) e like me ka aspirin hiki ʻole ke kāohi i ka hōʻuluʻulu platelet (COX-1). ʻOiai ua ʻae kekahi mau kauka lapaʻau i ka ibuprofen i hoʻopaʻa ʻia me ka acetaminophen no ka hoʻomalu ʻana i ka ʻeha ma hope o ka hana maʻamau, ** hoʻōki koke i nā NSAID āpau ** inā loaʻa ke koko.
• Mai hāʻawi i ka mea maʻi i mea e ʻai ai a inu (koe i ka wai hau hau ʻaʻole i ale ʻia): Pono paha ka mea maʻi i ka maʻi maʻi maʻi maʻi maʻi maʻi i loko o ka lumi hana i loko o ka hola, a ʻo ka piha ʻana o ka ʻōpū e hoʻonui nui i ka pōʻino o ka pulmonary aspiration i ka wā o ka intubation wikiwiki.

ʻO ka hale maʻi a me ka hoʻokele ʻana: He aha ka mea e manaʻo ai i ka ER¶

ʻIke i ke ʻano o nā kauka ulia pōpilikia, anesthesiologists, a me otolaryngologists (ENT surgeons) mālama i ka hemorrhage post-tonsillectomy kōkua i nā ʻohana e hoʻomākaukau i ka wā e hōʻea ai i ka haukapila.

Ka helu ʻana i ka paʻakikī o ka hemorrhage post-tonsillectomy (Stammberger / Windfuhr Classification)¶

Ka pale ʻana i ka hemorrhage lua ma ka pukaaniani hoʻōla 14 lā¶

ʻOiai e loaʻa ana kekahi mau koko lua ma muli o ka mālama ʻana i ka home, ma muli o nā kaʻina hoʻihoʻi ma hope o ka hana ʻana i nā lā piha he 14 mau lā ma hope o ke kaʻina e hoʻohaʻahaʻa loa i ka pilikia o ka eschar sloughing.

1. Hoʻomaʻemaʻe mau ʻia ("Wet scabs heal; dry scabs bleed")¶

• E ʻai i ke keiki a i ʻole ke kanaka makua i ka wai liʻiliʻi, ka wai ʻāpala i hoʻoheheʻe ʻia, ka solution electrolyte, a i ʻole ka hau hau i kēlā me kēia 15 a 30 mau minuke i nā hola ala.
• E holo i kahi mea hoʻoheheʻe noe-hue ma ka ʻaoʻao o ka moe o ka mea maʻi i kēlā me kēia pō no 14 lā. Ma muli o ka pehu ʻana o ka ʻāʻī a me ka moena adenoid e hoʻomoe ai i ka poʻe maʻi ma hope o ka hana ʻana me ka hāmama o ko lākou waha, ua maloʻo ka ea lumi moe maloʻo i ka ʻāʻī i ka pō, e wehewehe ana i ke kumu o ka nui o ke koko post-tonsillectomy ma waena o 2:00 AM a 6:00 AM.

2. Hoʻopaʻa ʻia, hoʻoponopono i ka ʻeha o ka uaki no laila e inu mau ka mea maʻi¶

• ʻEha puʻu a me ** ʻeha pepeiao i ʻōlelo ʻia** (ma muli o nā lālā ʻike like o ke aʻalolo glossopharyngeal, Cranial Nerve IX, a me ke aʻalolo vagus, Cranial Nerve X, ka mea e hoʻolako i ka moena tonsillar a me ka pepeiao waena) ** ʻino pinepine i nā lā 4 a hiki i 8 ** i ka wā e hoʻomaka ai ka wehe ʻana o nā ʻōpala.
• Hāʻawi i ka acetaminophen ma muli o ke kaumaha (paracetamol) (a i ʻae ʻia e ke kauka lapaʻau e hoʻololi i ka ibuprofen inā kauoha ʻia, ʻoiai ** ʻaʻole loa he aspirin** a ** ʻaʻole loa he codeine a tramadol **, e lawe ana i ka FDA/EMA black-box contraindications i nā keiki ma hope o ka tonsillectomy ma muli o ka ultra-wikiwiki. CYP2D6 metabolism i loko o nā doses morphine lethal) ma ka papa hana koʻikoʻi o ka hola ma mua o ka kali ʻana a hiki i ka uē ʻana o ke keiki i ka ʻeha a hōʻole i ka ʻai ʻana i ka wai.

3. E pale ana i na mea hana mechanical a me ke koko no na la piha 14¶

• ʻAʻohe meaʻai ʻuʻuku, ʻoi, ʻāwīwī, a wela paha no nā lā 14: Hōʻalo i nā ʻāpana tortilla, nā ʻuala ʻuala, nā ʻuala ʻuala paʻakikī, ka cereal maloʻo, nā pahū, nā ʻuala pizza, nā nati, popcorn, nā ʻāpala/kāloti maka, a me nā sopa wela a i ʻole nā wai citrus/matomato acidic. ʻO nā ʻaoʻao meaʻai ʻoi ke ʻoki kino i ka eschar keʻokeʻo mai ka moena tonsillar ma mua o ka hoʻopaʻa ʻia ʻana o nā aʻa koko lalo.
• Hoʻomaha kino koʻikoʻi no nā lā 14: ʻOiai inā manaʻo ke keiki i ka ikaika i ka lā 6, pāpā i ka holo ʻana, ka lele ʻana ma luna o nā trampolines, ka hale ʻawaʻawa, nā haʻuki hoʻopili, ka papa haʻuki, ka hāpai kaumaha, a i ʻole ka hoʻoikaika ikaika ʻana a hiki i ka hala ʻana o ka hōʻailona 14 mau lā a nalowale kēlā me kēia meheu o ka pehu keʻokeʻo mai ka ʻāʻī. ʻO kēlā me kēia hana e hoʻonui i ka puʻuwai a me ke koko systolic hiki ke puhi i kahi moku tonsillar ho'ōla.

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

E mālama mau i kāu helu kelepona 24-hour ENT surgical on-call number a me kāu helu ambulance ulia pōpilikia i mālama ʻia ma kāu kelepona no 14 mau lā ma hope o ke ʻoki ʻana:

Nīnau pinepine¶

No ke aha i hoʻomaka ai ke koko o ka ʻāʻī o kaʻu keiki i ka lā 7 i ka wā o ka ʻoki ʻana i hoʻokahi pule i hala?¶

I ka wā o ka tonsillectomy, hoʻopaʻa ke kauka lapaʻau i nā kīʻaha koko ma ka ʻāʻī, a ma nā hola 24 mua e uhi ke kino i nā lua o ka ʻiʻo maka me kahi ʻōpala pale keʻokeʻo melemele mānoanoa i kapa ʻia he fibrinous eschar. Ma waena o nā lā 5 a me 10 ma hope o ka ʻoki ʻana, ulu aʻe ka ʻili ʻulaʻula hou ma lalo a hemo maoli nā ʻōpala pale a ʻili. Inā maloʻo a kaʻawale paha ka pehu ma mua o ka ola ʻana o ke kīʻaha koko ma lalo, a i ʻole i ʻoki ʻia e ka meaʻai ʻōpala, wehe aʻe ka moku lalo a hoʻokaʻulua ("kekona") ke koko i hoʻokahi pule ma hope o ka hana.

Ua kuha aku kaʻu keiki i kahi ʻāpana koko liʻiliʻi he 10 mau minuke i hala aku nei, a i kēia manawa ua akaka loa ko lākou kohu. Pono anei mākou e hele i ka lumi pilikia?¶

ʻAe, pono ʻoe e hele koke i kahi keʻena pilikia o ka haukapila inā ʻike ʻia ua pau ke koko. I loko o ka otolaryngology, ʻike ʻia kahi ʻāpana pōkole liʻiliʻi o ke koko ma waena o nā lā 5 a me 10 he "herald bleed" a i ʻole he sentinel bleed. ʻO ia hoʻi, ua ʻā ʻia ka moku ʻākea a i ʻole ka venous i loko o ka moena tonsil i ka wā i hoʻokaʻawale ʻia ai ka scab a i kēia manawa ua hoʻopili wale ʻia e kahi ʻāpana koko palupalu. Me ka ʻole o ka nānā ʻana i ka haukapila, cauterization, a i ʻole ka nānā ʻana i ka pō, puhi pinepine ʻia kēlā clot manawa pōkole i kekahi mau hola ma hope o ke aumoe, e hoʻoulu ai i ka hemorrhage weliweli.

No ke aha e loaʻa ai ka ʻeha pepeiao nui o kaʻu keiki i nā lā 5 ma hope o ka tonsillectomy, a ʻo ia hoʻi he maʻi pepeiao a he koko paha?¶

ʻO ka ʻeha pepeiao koʻikoʻi e piʻi ana ma waena o nā lā 4 a me 8 ma hope o ka tonsillectomy ʻaneʻi he "ʻeha i kuhikuhi ʻia" ma mua o ka maʻi pepeiao a i ʻole kahi hōʻailona o ke koko. ʻO ke aʻalolo cranial like (ke aʻalolo glossopharyngeal, Cranial Nerve IX) hāʻawi i ka manaʻo i ke kua o ka ʻāʻī a me ka pepeiao waena ma o ke aʻalolo o Jacobson. Ke hoʻomaka ka ʻiʻo o ka ʻāʻī i ka ʻili ʻana i ka lā 5, ua kuhi hewa ka lolo i kēlā mau hōʻailona ʻeha o ka ʻāʻī mai loko mai o nā pepeiao. Hāʻawi i ka lāʻau ʻeha i hoʻopaʻa ʻia, kau i ka ʻeke mehana a i ʻole maʻalili ma luna o nā pepeiao, a paipai i ka nau ʻana a i ʻole ke inu wai e hoʻomaha ai ka ʻāʻī a me nā ʻiʻo o ka ʻāʻī.

Pehea e hiki ai iaʻu ke ʻike i ka ʻokoʻa ma waena o nā ʻōpala hoʻōla keʻokeʻo maʻamau a me kahi maʻi ʻāʻī ma hope o ka tonsillectomy?¶

ʻO nā ʻōpala maʻamau ma hope o ka tonsillectomy (eschars) ke nānā aku i ka mānoanoa, ʻulaʻula, keʻokeʻo keʻokeʻo, hina, a i ʻole melemele-ʻeleʻele, e hoʻopaʻa ʻia i nā ʻeke ʻelua kahi i noho ai nā tonsils ma mua, a hoʻoulu i ka hanu ʻino (`halitosis`) a hiki i ʻelua pule. ʻAʻole lākou he maʻi a ʻaʻole pono lākou i nā lāʻau antibiotic. Pono ʻoe e hoʻokaʻaʻike i ke kauā ENT no ka maʻi a i ʻole dehydration wale nō inā loaʻa ka mea maʻi i ke kuni kiʻekiʻe mau ma luna o 38.9 degere Celsius (102.0 degere Fahrenheit), e hohola ana i ka ʻulaʻula a me ka pehu ma ka ʻāʻī palupalu a i ʻole hiki ʻole ke ale i ka wai.

No ke aha i ʻōlelo mai ai ke kauka iā mākou ʻaʻole e hāʻawi i ka codeine a i ʻole aspirin ma hope o ka tonsillectomy?¶

Hoʻopaʻa mau ʻo Aspirin i nā platelets koko mai ka hoʻopili ʻana no ka 7-a-10 mau lā o ke ola o ka platelet, e hoʻonui nui ana i ka hopena o ka hemorrhage post-tonsillectomy. Hoʻopaʻa loa ʻia ʻo Codeine (a me tramadol) ma hope o ka tonsillectomy pediatric no ka mea he hoʻololi genetic i nā enzymes ate (`CYP2D6 ultra-rapid metabolizers`) ka mea e hoʻohuli ai kekahi mau keiki i nā ʻano maʻamau o ka codeine i mau kiʻekiʻe weliweli o ka morphine i loko o ko lākou kahe koko, hiki ke hoʻōki i ko lākou hanu ʻana i ka wā e hiamoe ai lākou, ʻoi aku hoʻi i nā keiki i wehe ʻia ko lākou tonsils no ka hoʻopiʻi ʻana i ka hiamoe hiamoe.

He aha ke ʻano o ka luaʻi ʻana i ka wai ʻeleʻele ʻeleʻele "kofe-ground" ma hope o ka tonsillectomy?¶

ʻO ka luaʻi ʻana i nā mea ʻeleʻele ʻeleʻele e like me ke kīpē mākū, a i ʻole ka luaʻi ʻana i nā ʻōpala ʻeleʻele ʻeleʻele e like me ka jelly ʻeleʻele, he lāʻau ulia pōpilikia ʻo ia hoʻi, ua kahe mālie ke koko mai ka ʻāʻī a i ka ihu paha a ale i ke koko i loko o ko lākou ʻōpū. Ke noho ke koko i loko o ka ʻakika o ka ʻōpū no 15 a 45 mau minuke, hoʻohuli ka waika i ka hao ʻulaʻula i loko o ke koko ʻeleʻele ʻeleʻele a hoʻonāukiuki i ka uhi o ka ʻōpū a hiki i ka luaʻi ʻana o ka mea maʻi. E kelepona koke iā 911, 112, a i ʻole 999, ʻoiai inā ʻaʻole ʻoe i ʻike i ke kahe ʻana o ke koko ʻulaʻula ʻulaʻula mai ka waha ma mua.

Nā alakaʻi pili¶

• ʻO ka ʻāʻī ʻana i ke koko (hemoptysis) a me ke kahe nui o ke ea
• ʻO ka luaʻi ʻana i ke koko (hematemesis), melena, a me ke koko o ka ʻōpū
• Peritonsillar abscess, Ludwig's angina, a me nā maʻi ʻāʻī hohonu
• Nose koko (epistaxis) a me ka nasal hemorrhage hope
• ʻO ka ʻike haʻalulu a me ka hemorrhagic

Nā kumu a me ke alakaʻi kūhelu¶

• **American Academy of Otolaryngology - ʻO ke poʻo a me ka ʻāʻī (AAO-HNS, ʻAmelika Hui Pū ʻIa): ** * Ke alakaʻi hoʻomaʻamaʻa lāʻau lapaʻau: Tonsillectomy i nā keiki (Hoʻohou) - Ka nānā ʻana i ka Hemorrhage Postoperative, Pain Control, a me Codeine Contraindication *.
• ENT UK & Royal College of Surgeons of England (United Kingdom): National Prospective Tonsillectomy Audit and Emergency Management of Post-Tonsillectomy Haemorrhage Guidelines.
• Association of Pediatric Anesthetists of Great Britain and Ireland (APAGBI): Consensus Guideline on the Emergency Anesthetic and Airway Management of Post-Tonsillectomy Haemorrhage (Bleeding Tonsil).
• Royal Children's Hospital Melbourne (Australia): Alakaʻi Hoʻomaʻamaʻa Kauka: Tonsillectomy a me Adenoidectomy Ma hope o ka mālama ʻana a me ka helu ʻana i ka hemorrhage.
• U.S. Food and Drug Administration (FDA, United States) & European Medicines Agency (EMA): Drug Safety Communication: Boxed Warning Contraindicated Codeine and Tramadol for Post-Tonsillectomy Pain Management in Children.