Post-Tonsillectomy Kubuda ropa: Zuva 5 kusvika 10 Scab Sloughing uye Airway Hemorrhage Triage¶

A tonsillectomy (ine kana isina adenoidectomy) ndeimwe yenzira dzinowanzoitwa kuvhiya muvana nevechidiki vechidiki pasi rose, asi ine njodzi yakasiyana, inogona kuuraya hupenyu hwekunonoka kubuda kweropa kusvika mavhiki maviri azere mushure mekunge murwere adzokera kumba. Nekuda kwekuti palatine tonsils inogara pahuro ine tsandanyama mubhedha inopihwa neshanu-high-pressure mapazi ekunze kwe carotid artery system, uye nekuti maronda ekuvhiya ari kumashure kwemuromo haagone kusonwa akavharwa zvachose kana kuvharwa nebhandeji, mbishi fossae inopora nekugadzira makobvu, machena-yellow fibrinous scabs (eschars) Pakati pemashure ekushanda ** Mazuva 5 ne10 **, sezvo ganda idzva remucosal rinokura pasi, makanda ekudzivirira aya anosunungura uye anononoka. Kana chikwebhu chikapatsanuka nguva isati yakwana kana kuti kubvaruka ikavhura tsinga iri pasi petsinga, kubuda ropa nekukasira kunoitika pamusoro pemusuwo wepipe yemhepo (trachea) Chero chero ropa dzvuku rinoonekwa kubva mumuromo kana mumhino, kudzokorora kumedza mumwana akarara, kana kurutsa kweropa rakasviba rekofi mushure mekuvhiyiwa tonsillectomy injodzi yekuvhiya. Fonera munharaunda yako nhamba dze emergency nekukasira uye bvunza edu ane hukama madhairekitori pa kukosora ropa uye kubuda ropa mumhepo, kurutsa ropa uye kubuda ropa mudumbu,uye hypovolemic shock.

Ita izvi ikozvino¶

1. Fonera 911, 112, kana 999 nekukasika kuti uwane chero kubuda ropa kwakatsvuka-kupenya, kugwamba kweropa, kana kurutsa ropa mushure mekuvhiyiwa tonsillectomy: Usambofa wakamirira kumba kuti uone kana kubuda ropa kwepashure-tonsillectomy kunomira wega, uye usambofa watyaira mwana ari kubuda ropa kuchipatara ari kuchigaro chekumashure chemotokari yakazvimirira pasina anogona kufefetera kana kurasikirwa nemhepo.
2. Garisa murwere akati twasu wozembera musoro nemuviri mberi pamusoro pendiro kana tauro jena: Usambobvumira munhu ari kubuda ropa pahuro kuti arare pasi nemanhede. Kugara wakatwasuka kunoderedza venous uye arterial blood pressure mugotsi, ukuwo kuzembera mberi kunobvumira ropa kubuda mumuromo richipinda mubheseni kuitira kuti risadhure pamusoro pemanzwi kana kudzika mudumbu.
3. Itai kuti mwana akura anoshandira pamwe kana munhu mukuru akwikwidze zvinyoronyoro uye asvipire mvura inotonhora nechando: Kana murwere akamuka, akasvinura, uye achikwanisa kutevedzera mirayiridzo pasina kukachidzwa, achivheyesa zvinyoronyoro mvura yeaizi kuseri kwemuromo woipfira mudhishi chena kana mundiro zvinokonzeresa reflex vasoconstriction yemidziyo midiki yematonsillar yemubhedha uye kuenderera mberi uchibvisa mavharopu. Usa**manikidze zvinwiwa mumwana mudiki ari kuchema, mucheche, kana murwere ane hope.
4. ** Isa ice collar kana inotonhora paki kumberi nemativi emutsipa uye kuyamwa pachando pop **: Kubata jira-rakaputirwa ice pack kutarisana nepamusoro lateral mutsipa (pazasi pekona yeshaya) kunobatsira kutonhorera ekunze matavi ecarotid achidyisa tonsillar fossa uchimirira varapi.
5. **Rayirira murwere kuti asvipire donhwe rose reropa nemate pane kurimedza **: Kumedza ropa kunovanza huwandu hwechokwadi hwekubuda kweropa kubva kuvabereki nevarapi, kunoshatirisa dumbu rinogara nechisimba, uye kunokonzeresa kurutsa kwekamwe kamwe (hematemesis) iyo inogona kufashamira nzira yemhepo uye kubvarura mubhedha wehuro inopora kuvhurika mberi.
6. Gadzirirai nzvimbo yekupora kana murwere akabatwa nehope, kucheneruka, kana kupera simba: Kana mwana ari kubuda ropa kana kuti munhu mukuru akaneta, akakamhina, kana kusapindura achimirira rubatsiro rwechimbichimbi, muumburudzire parutivi pake mu lateral recovery position chiso chakarerekera pasi zvishoma kuitira kuti ropa ribude nepakona yemuromo pane kunyudza mapapu.

Muti wechisarudzo: Post-tonsillectomy triage uye mhinduro yemhepo¶

flowchart TD
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    SignCheck -->|"Ehe, Kuchururuka Kunoshanda, Kuvhara, Kurutsa Ropa, kana Pallor"| CallEMS["FANA 911 / 112 / 999 PAMWARI: Kumbira Hupenyu Hwepamusoro Hutsigiro Amburenzi"]
    CallEMS --> Conscious{"Murwere Akamuka uye Kudzora Nzira Yavo Yemhepo?"}
    Conscious -->|"Hongu"| Upright["Gara Wakatwasuka Wakasendamira Mberi; Dura Ropa Rose Mubheseni; Ice Pack kuMutsipa; Ice-Mvura Swish kana Alert"]
    Conscious -->|"Kwete, Kukamhina, Kurara, kana Gurgling"| Lateral["Kukungurukira paSide (Recovery Position) Muromo wakarerekera Pasi; Kujeka Kunooneka Clots; Gadzirira CPR"]
    SignCheck -->|"Hongu, Diki Diki reRopa Rakamira ('Herald Bleed')"| GoToER["USAMIRIRA PAMBA: Pakarepo Dhipatimendi Emergency Yekutakura yeENT Kuongorora uye Kuona"]
    SignCheck -->|"Hapana Ropa Rinooneka"| SubtleCheck{"Kugara Uchidzokorora Kumedza, Gurgling Huro, New Tachycardia, kana Kusagadzikana Pakarepo?"}
    SubtleCheck -->|"Hongu"| TorchLook["Penyera Tochi mumuromo: Tarisa Ropa Rinodonhedza Pasi Posterior Pharyngeal Wall kana Clot muFossa."]
    TorchLook -->|"Ropa kana Clot Yaonekwa"| GoToER
    TorchLook -->|"Makwapa Machena/Yero Chete Akaonekwa"|HydrationCheck{"Kurwadza Kwenzeve/Huro Yakakomba, Kuramba Kunwa Kwemaawa 12+, kana Fever Yakanyanya > 38.9 C (102 F)?"}
    HydrationCheck -->|"Hongu"| UrgentContact["Bata ENT Surgeon kana Pediatric ER yeIV Hydration uye Pain / Infection Management"]
    HydrationCheck -->|"Aihwa"| NormalCare["ZVAKANAKA KUPORA ESCHAR: Ramba Round-the-Clock Hydration, Acetaminophen, uye Soft Diet"]

Pathophysiology: Nei tonsillectomy scabs ichibuda ropa vhiki yakazara mushure mekuvhiyiwa¶

Vabereki nevarwere vakura vanowanzo vhunduka kana kubuda ropa pahuro papera mazuva manomwe kana masere mushure mekuvhiyiwa, murwere achangotanga kunzwa zviri nani kana kutangazve mabasa enguva dzose. Kunzwisisa matanho matatu-matanho ekupora ronda reoropharynx kunotsanangura kuti sei iyi yakanonoka hwindo iri nguva yenjodzi yepamusoro.

1. Iyo yakawanda arterial inopa ye tonsillar fossa¶

Iyo palatine tonsil inogara mune yakadzika triangular muscular cradle pakati peanterior tonsillar pillar (palatoglossus muscle) uye posterior tonsillar mbiru (palatopharyngeus muscle), achizorora zvakananga pamusoro pe ** yepamusoro pharyngeal constrictor muscle **. Matavi mashanu epamusoro-anoyerera e-*external carotid artery ** anoputira uyu mubhedha une tsandanyama kudyisa tonsil:

• Tonsillar bazi refacial artery (yakakura uye yakajairika sosi yeyakadzika-pole arterial hemorrhage).
• Kukwira palatine bazi refacial artery.
• **Dorsal lingual mapazi etsinga yemutauro ** (kupa danda rakaderera pedyo nechepasi perurimi).
• ** Inokwira pharyngeal artery ** (inopa iyo posterior rusvingo).
• ** Inodzika palatine artery ** (bazi remaxillary artery rinopa danda repamusoro).

Uyezve, iyo hombe paratonsillar vein (vein of Denis Browne) inomhanya ichidzika pasi pe lateral tonsillar bed iri pasi pemadziro muscular mutete, uye hunde huru yemukati nekunze ye carotid arteries inopfuura chete 1.5 kusvika 2.5 centimeters (0.6 kusvika 1.0 inch) lateral kune yakadzika tonsillar capsule.

2. Primary vs. second post-tonsillectomy hemorrhage¶

Vanachiremba vanoisa post-tonsillectomy kubuda ropa (PTH) muzvikamu zviviri zvakasiyana zvichienderana nenguva uye maitiro:

3. Ko makwapa epahuro machena (eschar) vari uye nei kupera mvura mumuviri kuchiita kuti vabude ropa¶

Mukati memaawa gumi nemaviri kusvika kumakumi maviri nemana mushure mekuvhiyiwa, mhasuru dzakasvibirira dzakabviswa matonsi dzinoputirwa mugumbeze gobvu, rine shaggy, grey-white kana yero-tan rinoumbwa nefibrin, maplatelet, masero machena eropa, uye masero epamusoro anotsemuka.

• Chitarisiko chamazuva ose (Kwete utachiona): Vabereki vanotarisa mumukanwa memwana wavo paZuva 3 vanowanzovhunduka pavanoona zvigamba zviviri zvakakora, zvinonhuwa zvichena-yero zvakavhara kuseri kwehuro, vachifunga kuti ane strep pus kana thrush. Iyi fibrinous eschar yakajairwa, inodzivirira yakanyorova gako, uye mweya wekufema wakashata.halitosis) inotarisirwa kwemazuva gumi kusvika gumi nemana.
• Kutsvedza kunoitika sei (Mazuva 5 kusvika 10): Pasi pegumbeze refibrin iri, new pink squamous mucosal epithelium inopinda mukati zvishoma nezvishoma kubva mumicheto yembiru dzematoni. Pakati peMazuva 5 ne10, mutumbi unonyungusa chinonamira chiri pakati peganda idzva nepakafa fibrin scab kuitira kuti gwako rikwanise kubva muzvidimbu zvidiki-diki zvomedzwa zvisingaonekwe nemate.
• Nei kupera mvura mumuviri kuchikonzera kubuda ropa: Kusiyana negwaro riri pabvi rako rinopora zvakanyanya mumhepo yakaoma, huro eschar inofanira kuramba ichingonyorova uye ichipfava**. Kana mwana akaramba kunwa mvura nekuda kwehuro uye kurwadziwa nenzeve, huro inooma (pharyngeal desiccation) Eschar yakaoma inodzinyana, inoomesa kuita goko rakaomarara, uye inokweva zvine chisimba pamitsipa yeropa inopora pese apo tsandanyama dzehuro dzinobatana kumedza kana kukosora. Panzvimbo yekunyungudika zvakanaka, gako rakaomeswa rinobvarura muchidimbu chimwe chete, richibvarura madziro e arteriole isina simba iri pasi.

Kuziva kubuda ropa kwakavanzika muvacheche, vadiki, uye vana vakarara¶

Nepo munhu mukuru kana wechidiki achangopinda mukicheni okuudza kuti vanoravira ropa rinodziya, resimbi kumashure kwehuro yavo, vana vadiki (kunyanya vari pasi pemakore matanhatu) uye vana vane hurema hwekukura vanenge ** havambosvipi ropa kunze**. Pane kudaro, yavo otomatiki reflex ndeye kumedza zvese zvinopinda mu pharynx yavo.

Zviratidzo zvisinganyatsooneki zvekubuda ropa kwakanyarara mumwana¶

Mwana anogona kumedza chinyararire 20 kusvika ku30 muzana yeropa rake rose riri kutenderera mudumbu make donhwe rimwe chete reropa risati raoneka papiro yake kana kuti pamiromo. Tarisa zvakanyanya kune aya maitiro uye emuviri zviratidzo:

1. **Kakawanda, kudzokorora kumedza wakarara kana kuzorora **: Tarisa kumberi kwegotsi remwana. Kana mwana akarara kana akazorora achimedza ese mashanu kusvika kumasekondi gumi nemashanu paanenge asiri kunwa chero chinhu, ropa remvura riri kuyerera richiyerera kubva pamubhedha wetonsillar kana mubhedha weadenoid.nasopharynx) kuseri kwehuro yavo.
2. Kukoira kwemvura, kuchenesa pahuro, kana kukasira kukosora kweusiku kunokwana: Ropa rakaungana muhypopharynx rinokwenya padokoriro, zvichikonzera kunyorova, ruzha panguva yekufema kana kumuka kamwe kamwe nechikosoro chinodzipwa.
3. Kusagadzikana kusingatsananguriki kusingatsananguriki, kuzvidya mwoyo, kana kuti kucheneruka, ganda rakapfava: Mukuvhunduka kwevana, vana vanoramba vaine BP inonyengera kusvikira varasikirwa ne25 kusvika ku30 muzana yehuwandu hweropa ravo. Kuvhunduka kwekutanga kunoratidza sekumhanya kwemoyo (tachycardia), zvigunwe nezvigunwe zvakacheneruka zvinotonhorera, mazamu machena akacheneruka uye maziso emukati memaziso, uye kungoerekana abvongodzwa kana kusava nehanya.
4. Kukurumidza kusvotwa uye kurutsa zvinhu zvakasviba zve "coffee-ground" kana maroon clots: Kana rakamedzwa ropa rinosanganiswa nehydrochloric acid (HCl) mudumbu, iron iri muhemoglobin inoiswa oxidized kuita rima dema asidhi hematin. Mukati memaminetsi 15 kusvika ku45 ekumedza chinyararire, mudumbu unorembera uye unoshatirwa, zvichiita kuti mwana angoerekana arutsa mvura zhinji yekofi yakasvibirira yakasanganiswa nemitsetse mitsvuku yakajeka kana kuti magwamba akafanana nejelly.

Pakarepo zviito zvekubatsira kwekutanga uchimirira ambulensi¶

Kana uchinge wadana 911, 112, kana 999, zvaunonyanya kukoshesa panguva ye5 kusvika kumaminitsi e15 vasati vasvika vanobatsira varwere vari ** kudzivirira kushuva kweropa mumapapu **, ** kudzivirira ropa kumedza **, uye ** kukurudzira vasoconstriction yemunharaunda **.

1. Optimal airway positioning: Yakatwasuka uye yakazendamira mberi¶

• Gadzirisa mwana kana munhu mukuru akarurama pachigaro, mubhedha, kana pamakumbo emubereki nemusoro wavo uye chifuva chepamusoro chakasendamira mberi pane 30-to-45-degree angle.
• Bata ndiro chena, bheseni jena repurasitiki, kana tauro jena pasi pechirebvu chavo. Kushandisa chigadziko chichena kunobvumira iwe uye vanosvika vanobatsira varwere kuti vatonge zvakarurama zvose ** volume ** yeropa rakarasika uye ** ruvara ** (bright arterial red vs. dark venous clots vs. pink saliva).
• Taura nenzwi rakadzikama, rakanyarara, rakadzikama. Kuchema, kuridza mhere, uye kutya kurova kwemoyo uye systolic blood pressure, kupomba ropa kubva mumudziyo wakashama wetonsillar nekukurumidza.

2. The ice-water swish-and-spit technique (Cooperative varwere chete)¶

Kana murwere ari munhu mukuru, pwere, kana mwana mukuru wezera rechikoro (kazhinji ane makore 7 zvichikwira) akanyatsosvinura, akadzikama, uye asingadzimbi:

• Zadza kapu nemvura inotonhora uye yakapwanyika ice.
• Itai kuti murwere atore zvishoma mvura inotonhora yechando, adzorere musoro zvishoma kuitira kuti mvura inotonhora igeze shure kwemuromo kwemasekonzi matatu kusvika ku5, uye ** svipa mvura yacho zvinyoronyoro kunze ** mubheseni (usambofa wakagukuchira nechisimba, sezvo kudengenyeka kwehuro kwakasimba kunogona kuzunungusa magwamba akasununguka kubva mumudziyo).
• Dzokorora ose 30 kusvika 60 masekonzi. Mvura inotonhora inoputira yakafumura mucosal arterioles uye capillaries mu tonsillar fossa uku ichisuka fibrinolytic enzymes mukati meropa rakasununguka.

3. Kutonhora kwekunze kwemutsipa¶

• Putira bhegi rechando chakapwanyika kana peas dzakaomeswa mumucheka mutete, wakanyorova uye woisa zvinyoro nyoro padivi pemutsipa wepamusoro pazasi pejawline (submandibular triangle), kana kuseri kwegotsi.
• Usambofa wakaputira chero chinhu zvakasimba pamutsipa kana kudzvanya zvakasimba pamhepo kana carotid pulse.

4. ZVAUSINGAite panguva yekubvisa ropa¶

• Usafe wakanamatira zvigunwe, mapedhi emucheka, mabhora edonje, kana midziyo yesirivha kuseri kwemuromo kumba kuti uedze kudzvanya pamubhedha wematonsi: Kusundidzira gauze muhuro yemwana noupofu kunoita kuti pave nehasha nemarutsi reflex, kukwenya eschar yasara kubva pamubhedha wetonsil wakatarisana, uye njodzi yekudonhedza pacheya yeropa.
• ** Usambofa wakapa aspirin, ibuprofen (kunze kwekunge yajekesa-yakaongororwa, uye usambofa panguva yekubuda ropa kunoshanda), naproxen, kana mishonga yeropa yemishonga **: Nonsteroidal anti-inflammatory drugs (NSAIDsseAspirin isingachinji inodzivisa kuunganidzwa kweplatelet (COX-1) Kunyange zvazvo vamwe vanachiremba vanobvumira ibuprofen yakarongwa pamwe chete neacetaminophen nokuda kwemaitiro ekugadzirisa kurwadziwa kwemashure, ** kumisa maNSAID ose pakarepo ** kana kubuda ropa kupi zvako kuchiitika.
• ** Usambofa wakapa murwere chero chinhu chekudya kana kunwa ** (kunze kwekutsvaira-uye-kupfira mvura yechando isina kumedzwa): Murwere angada emergency general anesthesia mukamuri yekuvhiya mukati meawa, uye dumbu rakazara rinowedzera zvakanyanya njodzi yepulmonary aspiration panguva yekukurumidza-sequence intubation.

Chipatara uye manejimendi ekuvhiya: Chii chekutarisira muER¶

Kuziva maitiro ekukurumidzira vanachiremba, anesthesiologists, uye otolaryngologists (ENT surgeons) kubata post-tonsillectomy hemorrhage inobatsira mhuri kugadzirira pakusvika kuchipatara.

Kuyera kuoma kwe post-tonsillectomy hemorrhage (Stammberger / Windfuhr Classification)¶

Kudzivirira kubuda ropa kwechipiri panguva ye14-day recovery window¶

Nepo kumwe kubuda ropa kwechipiri kuchiitika kunyangwe kutarisirwa kwakanaka kwemumba, kutevedzera zvimiro zvepashure-operation yekudzoreredza mukati memazuva gumi nemana akazara mushure mekuvhiyiwa kunoderedza zvakanyanya njodzi yenguva isati yakwana eschar sloughing.

1. Relentless hydration ("Makwapa akanyorova anopora; scabs rakaoma rinobuda ropa")¶

• Ita kuti mwana kana munhu mukuru anwe mvura shoma, muto weapuro wakanyungudutswa, mushonga we electrolyte, kana kuti ice pops pamaminetsi 15 kusvika ku30 ega ega pakumuka.
• ** Mhanyai inotonhorera-mhute humidifier ** pedyo chaipo nemubhedha wemurwere manheru ega ega kwemazuva gumi nemana. Nekuti kuzvimba kwakatenderedza mukanwa uye mubhedha weadenoid zvinomanikidza varwere vepashure kuti varare vakashama miromo, mweya wakaoma wemukamuri yekurara unobvisa maronda ehuro husiku humwe, uchitsanangura kuti sei post-tonsillectomy yakawanda ichibuda kubva pakati pe2:00 AM na6:00 AM.

2. Yakarongwa, clockwork pain control kuitira kuti murwere arambe achinwa¶

• Kurwadziwa kwehuro uye ** kurehwa kurwadziwa kwenzeve ** (yakakonzerwa nematavi ekunzwa akagovana eiyo glossopharyngeal nerve, Cranial Nerve IXuye vagus nerve, Cranial Nerve X, iyo inopa mubhedha wetonsillar neyepakati kwenzeve) kazhinji inowedzera paMazuva 4 kusvika 8 panongotanga kupatsanurwa.
• Tonga uremu-based ** acetaminophen (paracetamol)** (uye chiremba anovhiya-akatenderwa alternating ibuprofen kana akarairwa, asi ** never aspirin ** uye ** never codeine kana tramadol **, iyo inotakura FDA/EMA black-box contraindications muvana post-tonsillectomy nekuda kwekukurumidza-kukurumidza CYP2D6 metabolism into inouraya morphine doses) pachirongwa chakasimba chenguva yese pane kumirira kusvikira mwana achichema nekurwadziwa uye achiramba kumedza zvinwiwa.

3. Kudzivisa mechanical uye blood-pressure inokonzera kwemazuva gumi nemana akazara¶

• Hapana zvakakanyira, zvinopinza, zvinokwenya, kana zvinopisa kwemazuva gumi nemana: Dzivisa tortilla machipisi, mbatatisi crisps, yakaoma toast crusts, zviyo zvakaoma, crackers, pizza crust, nzungu, popcorn, maapuro mbishi/makarotsi, uye sopu inopisa-inopisa kana acidic citrus/tomato. Micheto yakapinza yechikafu inokwenya chena eschar kubva pamubhedha wetonsillar tsinga dzeropa dzepasi dzisati dzavharika.
• Kuzorora kwemuviri kwakasimba kwemazuva gumi nemana: Kunyangwe kana mwana akanzwa aine simba paZuva rechitanhatu, rambidza kumhanya, kusvetuka pane trampolines, roughhousing, mitambo yekusangana, kirasi yekurovedza muviri, kusimudza zvinorema, kana kusveta nesimba kudzamara chiratidzo chemazuva gumi nemana chapfuura uye chese chegaya chichena chanyangarika pahuro. Chero chiitiko chinokwidza kurova kwemoyo uye systolic yeropa inogona kuburitsa inoporesa tonsillar mudziyo.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

Gara uchichengeta yako ** 24-awa ENT yekuvhiya pa-kufona nhamba yefoni ** uye yako yenyika emergency amburenzi nhamba yakachengetedzwa mufoni yako kwemazuva gumi nemana mushure mekuvhiyiwa:

Mibvunzo inowanzo bvunzwa¶

Sei huro yemwana wangu yakatanga kubuda ropa paZuva 7 apo kuvhiyiwa kwaive vhiki rese rapfuura?¶

Pakuvhiyiwa kwetonsillectomy, chiremba anovhiya anovhara tsinga dziri pahuro, uye kwemaawa 24 ekutanga muviri unovhara makorokoza etsandanyama mbishi negako gobvu chena-yero rinodzivirira rinonzi fibrinous eschar. Pakati peMazuva 5 ne10 mushure mekuvhiyiwa, ganda idzva repingi rinokura nechepazasi uye makwapa ekudzivirira anosununguka nekusvuuka. Kana ganda rikaoma kana kuti kupatsanurwa tsinga yeropa iri pasi isati yanyatsopora, kana kuti chikafu chakakasharara chikachikwenya, tsinga yemukati inovhurika uye inoita kuti kunonoke kubuda ropa vhiki yakazara mushure mekuvhiyiwa.

Mwana wangu akapfira tsinga yeropa rakaenzana nekota maminitsi gumi apfuura, uye zvino mate avo akanyatsojeka. Tinonyatsoda kuenda kukamuri yekukurumidzira?¶

Hongu, unofanira kuenda kuchipatara chedhipatimendi rekukurumidzira nekukurumidza kunyange kana kubuda ropa kuchiita sekunge kwamira zvachose. Muotolaryngology, kachikamu kadiki kekubuda ropa pakati peMazuva 5 ne10 inozivikanwa se "herald bleed" kana sentinel kubuda ropa. Zvinoreva kuti tsinga yetsinga kana tsinga iri pamubhedha wetonsil yakukurwa sezvo ganga rakapatsanurwa uye parizvino rakavharwa negwamba reropa risina kusimba, kwenguva pfupi. Pasina kuongororwa kwechipatara, cauterization, kana kutarisa kweusiku humwe, iro ropa renguva pfupi rinowanzoputika maawa akawanda gare gare pakati peusiku, zvichiita kuti ropa rive nengozi muupenyu.

Sei mwana wangu achirwadziwa zvakanyanya nzeve mazuva mashanu abviswa tonsillectomy, uye zvinoreva here kuti ane chirwere chenzeve kana kubuda ropa?¶

Kurwadza kwakanyanya kwenzeve kunowedzera pakati peMazuva 4 ne8 mushure metonillectomy inenge nguva dzose "kurwadza kunorwadza" pane hutachiona hwenzeve kana chiratidzo chekubuda ropa. Iyo chaiyo chaiyo cranial nerve (iyo glossopharyngeal nerve, Cranial Nerve IX) inopa kunzwa kuseri kwehuro uye nechepakati nzeve kuburikidza netsinga yaJacobson. Apo tsandanyama dzehuro padzinotanga kusvuuka paZuva rechishanu, uropi hunodudzira zvisizvo zviratidzo izvozvo zvehuro sezvinobva mukati-kati menzeve. Ipa mishonga yemarwadzo yakarongwa, isa paki inodziya kana inotonhorera panzeve, uye kurudzira kutsenga chingamu kana kunwa zvinwiwa kuzorodza shaya nehuro.

Ndingaziva sei mutsauko pakati pezvakajairwa chena kuporesa scabs uye chirwere chehuro mushure me tonsillectomy?¶

Normal post-tonsillectomy scabs (eschars) inoita seyakakora, shaggy, chalky jena, grey, kana yellowish-tan, inogara yakavharirwa muhomwe mbiri dzaimbova matonsi, uye ichikonzera kunhuhwirira kwakashata.`halitosis`) kwemavhiki maviri. Havasi utachiona uye havadi mishonga inorwisa mabhakitiriya. Unofanira kuonana nachiremba weENT kuti uwane utachiona kana kupera mvura mumuviri chete kana murwere aramba achiwedzera kupisa muviri kuri pamusoro pe38.9 degrees celsius (102.0 degrees Fahrenheit), achiparadzira hutsvuku hwakajeka uye kuzvimba pamuromo wakapfava nemuhuro, kana kusakwanisa kumedza zvinwiwa.

Sei chiremba akatiudza kuti tisambopa codeine kana aspirin mushure mekuvhiyiwa tonsillectomy?¶

Aspirin inovhara zvachose maplatelet eropa kuti asanamatirana kwehupenyu hwese hwemazuva manomwe kusvika gumi hweplatelet, zvichiwedzera zvakanyanya njodzi yekubuda kwakanyanya kwepost-tonsillectomy hemorrhage. Codeine (uye tramadol) inorambidzwa zvachose mushure mevana tonsillectomy nokuti kuchinja kwemajini muma enzymes echiropa (`CYP2D6 ultra-rapid metabolizers`) inokonzera kuti vamwe vana vashandure madosi akajairwa ecodeine kuva morphine yakakwira zvine ngozi muropa ravo, izvo zvinogona kumisa kufema kwavo pavanenge vakarara, kunyanya muvana vakabviswa matonsi nokuda kwekuvhara kufema kwehope.

Ko kurutsa mvura yakasviba ye "coffee-ground" inorevei mushure metonillectomy?¶

Kurutsa zvinhu zvakasvibira zvakasvibirira zvinoita kunge nzvimbo yekofi yakanyorova, kana kurutsa rima-maroon jelly-like clots, idambudziko rekurapa izvo zvinoreva kuti murwere anga achibuda ropa chinyararire kubva pahuro kana mumhino uye achimedza ropa mudumbu mavo. Kana ropa ragara muasidhi yemudumbu kwemaminetsi gumi nemashanu kusvika makumi mana nemashanu, asidhi yacho inoshandura iron yakatsvuka muropa yakasvibira uye inoshatirisa mudumbu kusvika murwere arutsa. Fonera 911, 112, kana 999 nekukasika, kunyangwe usina kuona ropa dzvuku rakajeka richidonha kubva mumuromo zvisati zvaitika.

Mazano anoenderana¶

• Kukosora ropa (hemoptysis) uye kubuda kukuru kwemhepo
• Kurutsa ropa (hematemesis), melena, uye kubuda ropa mudumbu
• Peritonsillar abscess, Ludwig's angina, uye zvirwere zvemutsipa zvakadzika
• Nosebleeds (epistaxis) uye posterior nasal hemorrhage
• Hypovolemic uye hemorrhagic kuvhunduka kucherechedzwa

Nzvimbo uye nhungamiro yepamutemo¶

• American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS, United States): *Clinical Practice Guideline: Tonsillectomy muvana (Update) - Postoperative Hemorrhage Monitoring, Pain Control, uye Codeine Contraindication *.
• ** ENT UK & Royal College yeVavhiyi veEngland (United Kingdom):** National Prospective Tonsillectomy Audit uye Emergency Management yePost-Tonsillectomy Haemorrhage Guidelines.
• Kubatanidzwa Kwevana Anesthetists veGreat Britain neIreland (APAGBI): Consensus Guideline pamusoro peEmergency Anesthetic uye Airway Management yePost-Tonsillectomy Haemorrhage (Bleeding Tonsil).
• Royal Children's Hospital Melbourne (Australia): Clinical Practice Guideline: Tonsillectomy uye Adenoidectomy Post-Operative Care and Haemorrhage Grading.
• U.S. Food and Drug Administration (FDA, United States) & European Medicines Agency (EMA): Drug Safety Communication: Boxed Warning Contraindicating Codeine and Tramadol for Post-Tonsillectomy Pain Management in Children.