Ho tsoa mali ka mor'a Tonsillectomy: Letsatsi la 5 ho isa ho la 10 Ho Sloughing le ho Hemorrhage Triage¶

Tonsillectomy (e nang le adenoidectomy kapa e se nang eona) ke e 'ngoe ea liopereishene tse atisang ho etsoa ho bana le bacha lefatšeng ka bophara, leha ho le joalo e na le kotsi e ikhethang, e ka behang bophelo kotsing ea ho lieha ho tsoa mali tseleng ea moea ho fihlela libeke tse peli tse felletseng kamora hore mokuli a khutlele hae. Hobane lithane tsa palatine li lutse betheng e nang le mesifa ea 'metso e fanoang ke makala a mahlano a khatello e phahameng ea methapo ea methapo e ka ntle ea carotid, le hobane maqeba a ka morao a molomo a ke ke a rokoa a koalehile ka ho feletseng kapa a koaheloa ka bandage, fossae e tala ea tonsillar e fola ka ho etsa likhopo tse teteaneng, tse tšoeu-tsehla tsa fibrinous.eschars). Pakeng tsa ka mor'a ts'ebetso Matsatsi a 5 le 10, ha letlalo le lecha la mucosal le ntse le hōla ka tlas'a, likhopo tsena tse sireletsang lia lokoloha ebe lia theoha. Haeba lekhoa le arohana pele ho nako kapa le taboha mothapo o ka tlas'a mali, mali a tsoa ka potlako ka holim'a monyako oa pompo ea moea (trachea). Mali leha e le afe a bonahalang a bofubelu bo khanyang a tsoang molomong kapa nkong, ho koenya ka makhetlo-khetlo ho ngoana ea robetseng, kapa ho hlatsa mali a lefifi a fatše ka kofi ka mor'a tonsillectomy ke tšohanyetso ea ho buuoa. Letsetsa sebakeng sa heno dinomoro tsa tshohanyetso hang-hang 'me u ikopanye le litataiso tsa rona tse amanang le tsona ho khohlela mali le ho tsoa mali ka tsela ea moea, ho hlatsa madi le madi a ka mpeng, le ho tšoha ha hypovolemic.

Etsa sena hona joale¶

1. Letsa 911, 112, kapa 999 hang-hang bakeng sa ho tsoa mali leha e le afe a bofubelu bo khanyang, maqeba a mali, kapa ho hlatsa mali ka mor'a tonsillectomy: Le ka mohla u se ke ua emela lapeng ho bona hore na mali a tsoang ka mor'a tonsillectomy a khaotsa ka boona, 'me le ka mohla u se ke ua khanna ngoana ea tsoang mali a potlakile ho ea sepetlele setulong se ka morao sa koloi ea poraefete moo ho seng motho ea ka hemang moea kapa ho lahleheloa ke moea.
2. Lulisa mokuli a otlolohile 'me u sekamise hlooho le 'mele ka pele holim'a sekotlolo kapa thaole e tšoeu: Le ka mohla u se ke ua lumella motho ea nang le mali a tsoang 'metsong hore a paqame ka mokokotlo oa hae. Ho lula u otlolohile ho fokotsa khatello ea mali ea venous le ea methapo ea mali molaleng, ha ho sekamela pele ho lumella mali hore a tsoe ka hanong ho kena ka sekotlolo e le hore a se ke a kopana holim'a methapo ea lentsoe kapa a theohela ka mpeng.
3. ** E-ba le ngoana ea seng a hōlile kapa motho e moholo ea nang le tšebelisano-'moho a soasele ka bonolo ebe a tšoela metsi a batang a leqhoa**: Haeba mokuli a falimehile ka ho feletseng, a falimehile, 'me a khona ho latela litaelo ntle le ho khangoa, ka bonolo a phunyeletsa metsi a leqhoa ka mor'a molomo le ho a tšoela ka sinking e tšoeu kapa sekotlolo se etsa hore reflex vasoconstriction ea lijana tse nyenyane tsa bethe li tsoe 'me u khone ho tsoela pele ho bona hore na mali a tsoa maling. Se se qobelle maro ho ngoana ea llang, lesea, kapa mokuli ea otselang.
4. ** Kenya leqhoa kapa pakete e batang ka pele le mahlakoreng a molala 'me u anyesa leqhoa **: Ho tšoara leqhoa le phuthetsoeng ka lesela khahlanong le molala o ka holimo oa lateral (ka tlas'a lehlakoreng la mohlahare) ho thusa ho pholisa makala a ka ntle a carotid a fepa tonsillar fossa ha a ntse a emetse baoki ba liphallelo.
5. Laela mokuli hore a ntše lerotholi le leng le le leng la mali le mathe ho e-na le ho a koenya: Ho koenya mali ho pata palo ea 'nete ea ho tsoa ha mali ho batsoali le lingaka, ho halefisa lera la mpa ka matla, 'me ho etsa hore motho a hlatse ka tšohanyetso.hematemesis) e ka phallang tselana ea moea le ho tabola bethe ea 'metso e folisang ho feta.
6. Itokisetse boemo ba ho fola haeba mokuli a otsela, a soaba, kapa a akheha: Haeba ngoana ea tsoang mali kapa motho e moholo a khathala, a hlotsa, kapa a sa arabele ha a ntse a emetse litšebeletso tsa bongaka tsa tšohanyetso, li phutholle hang-hang lehlakoreng la tsona **me sefahleho se sekametse tlase hanyane hore mali a tsoe hukung ea molomo ho e-na le ho khangoa ke matšoafo.

Sefate sa ho etsa qeto: Triage ea post-tonsillectomy le karabelo ea moea¶

flowchart TD
    PostOp["Mokuli oa Post-Tonsillectomy (Letsatsi la 0 ho isa Letsatsi la 14)"] --> SignCheck{"Na ho na le Mali A Mafubelu a Khanyang, Mathe a Methapo ea Mali, Lesela le Lefifi, kapa Mahlatsa a Kofi?"}
    SignCheck -->|"E, ho Hlatsoa ka Matla, Maqeba, Mali a Hlatsa, kapa Pallor"| CallEMS["LETSA 911 / 112 / 999 HANG-HANG: Kopa Ambulense ea Ts'ehetso ea Bophelo bo Haufi"]
    CallEMS --> Conscious{"Na Mokuli o Falimehile 'me o Laola Tsela ea Bona ea Lifofane?"}
    Conscious -->|"Ee"| Upright["Lula U Itšetlehile Pele; Tšoela Mali 'Ohle ka Besineng; Ice Pack to Neck; Leqhoa-Metsi Swish Haeba Ale hloko"]
    Conscious -->|"Che, Ho Otsela, Ho Otsela, kapa Ho Gurgling"| Lateral["Roll On Side (Recovery Position) Molomo o kobehile fatše; Hlakola Maqeba a Bonahalang; Itokisetse CPR"]
    SignCheck -->|"E, Letheba le Lenyane la Mali le Ileng la Ema ('Herald Bleed')"| GoToER["U SE KE UA LETA LAPENG: Lipalangoang tsa Lefapha la Tšohanyetso bakeng sa Tlhahlobo le Tlhokomelo ea ENT"]
    SignCheck -->|"Ha ho Mali a Bonahalang"| SubtleCheck{"Ho Koenya Khafetsa, Mometso o Ho kokobetsa, Tachycardia e Ncha, Kapa Ho Hloka Boikhutso ka Tšohanyetso?"}
    SubtleCheck -->|"Ee"| TorchLook["Lebone le Khanyang Molomong: Batla Lerako la Mali a thellang ka morao ho Pharyngeal kapa Lesela le Fossa."]
    TorchLook -->|"Madi kapa Leqeba le Bone"| GoToER
    TorchLook -->|"Ho Boneha Makhopo a Masoeu/Masehla Feela"|HydrationCheck{"Bohloko bo Bohloko ba Tsebe / 'metso, ho hana ho noa ka lihora tse 12+, kapa feberu e phahameng> 38.9 C (102 F)?"}
    HydrationCheck -->|"Ee"| UrgentContact["Ikopanye le Ngaka ea ENT kapa Pediatric ER bakeng sa IV Hydration le Pain / Infection Management"]
    HydrationCheck -->|"Che"| NormalCare["ESCHAR E TLOAELEHANG HO PHELANG: Tsoela pele ho futhumatsa metsi ka nako e telele ka nako, acetaminophen, le lijo tse bonolo."]

Pathophysiology: Hobaneng ha makhopho a tonsillectomy a tsoa mali beke e felletseng kamora ho buuoa¶

Hangata batsoali le bakuli ba baholo ba makala ha 'metso o tsoa mali ka mor'a matsatsi a 7 kapa a 8 ka mor'a ho buuoa, nakong eo mokuli a neng a qala ho ikutloa a le betere kapa a khutlela mesebetsing e tloaelehileng. Ho utloisisa mehato e meraro ea ho folisa maqeba a oropharynx ho hlalosa hore na ke hobane'ng ha fensetere ena e liehang e le nako ea kotsi e phahameng.

1. Phepelo e ngata ea methapo ea methapo ea lithane tsa fossa¶

Palatine tonsil e lutse ka har'a mokokotlo o tebileng oa mesifa e khutlo-tharo lipakeng tsa tšiea ea lithane tse ka pele (palatoglossus muscle) le tšiea e ka morao ea tonsillar (palatopharyngeus muscle), ho phomola ka ho toba holim'a **sifa e phahameng ea pharyngeal constrictor **. Makala a mahlano a phallo e phahameng ea mali a ** artery ea ka ntle ea carotid ** a phunyeletsa bethe ena ea mesifa ho fepa tonsil:

• Lekala la tonsillar la mothapo oa sefahleho (mohloli o moholo le o atileng haholo oa ho tsoa mali a mali a tlase a tlase).
• Lekala le nyolohang la palatine la mothapo oa sefahleho.
• **Makala a lipuo tsa mokokotlo oa mothapo oa lipuo ** (ho fana ka palo e tlaase haufi le motheo oa leleme).
• Ho nyoloha mothapo oa pharyngeal (ho fana ka lebota le ka morao).
• Mothapo o theohang oa palatine (kalana ea mothapo o moholo o fanang ka palo e phahameng).

Ho feta moo, mothapo o moholo oa paratonsillar (vein of Denis Browne) e theosa ka ho theosa ho theosa le bethe ea lateral tonsillar ka tlas'a lerako le tšesaane la mesifa, 'me kutu e kholo ea methapo ea ka hare le e ka ntle ea carotid e feta feela 1.5 ho 2.5 centimeters (0.6 ho 1.0 inch) ka thōko ho capsule ea tonsillar e tebileng.

2. Phallo ea mali ea mantlha le ea bobeli ka mor'a tonsillectomy¶

Lingaka li khetholla ho tsoa mali ka mor'a tonsillectomy (PTH) ka mekhahlelo e 'meli e ikhethileng e ipapisitseng le nako le mochini:

3. Sekhopo se sesoeu sa 'metso (eschar) le hore na ke hobane'ng ha dehydration e etsa hore ba tsoe mali¶

Ka mor'a lihora tse 12 ho isa ho tse 24 ka mor'a ho buuoa, likotopo tse tala tsa mesifa moo ho tlositsoeng lithane li apesoa ka kobo e teteaneng, e bosoeu, e bosoeu kapa bosehla bo bosehla bo entsoeng ka fibrin, liplatelete, lisele tse tšoeu tsa mali le lisele tse ka holim'a metsi.

• Ponahalo e tlwaelehileng (Eseng tshwaetso): Batsoali ba shebang ka hanong la ngoana oa bona ka Letsatsi la 3 hangata ba tšoha ha ba bona maqeba a mabeli a teteaneng, a nkhang hampe a bosehla bo bosoeu a koahetseng ka morao ’metsong, ba nka hore ke strep pus kapa thrush. fibrinous eschar ke lekhoaba le metsi le tloaelehileng le le sireletsang, le moea o mobe o matla.halitosis) e lebelletsoe matsatsi a 10 ho isa ho a 14.
• Kamoo ho thethefatsang ho etsahalang ka teng (Matsatsi a 5 ho isa ho a 10): Ka tlas'a kobo ena ea fibrin, epithelium e ncha e pinki ea squamous mucosal e kena butle-butle ka hare ho tloha lintšing tsa litšiea tsa tonsillar. Pakeng tsa Matsatsi a 5 ho isa ho a 10, 'mele o qhibilihisa sekhomaretsi se pakeng tsa letlalo le lecha le lekhoakhoa la fibrin e le hore lekhoa le ka fofa ka likotoana tse nyane mme la metsoa ho sa hlokomeloe ka mathe.
• Hobaneng ha ho haella ha metsi mmeleng ho baka ho dutla ha madi: Ho fapana le lekhopho lengoleng la hao le fodisang hantle moyeng o omileng, eschar ya mmetso e tlameha ho dula e le e kolobile e sa kgaotse e bile e le bonolo. Haeba ngoana a hana ho noa metsi ka lebaka la 'metso le bohloko ba tsebe, 'metso oa omella.pharyngeal desiccation). Eschar e ommeng ea honyela, e thatafala ho ba lekhapetleng le thata, 'me e hula ka matla methapong ea mali e folisang nako le nako ha mesifa ea 'metso e hoholeha ho koenya kapa ho khohlela. Ho e-na le ho qhibiliha hamonate, lekhoakhoa le omisitsoeng le hohola ka lekhapetla le le leng, le petsola lebota la arteriole e fokolang ka tlas'a mocheso.

Ho lemoha mali a ipatileng ho masea, bana ba banyenyane, le bana ba robetseng¶

Le hoja motho e moholo kapa mocha a tla kena ka kichineng hang-hang 'me a u bolelle hore ba latsoa mali a futhumetseng, a tšepe ka morao molaleng oa bona, bana ba banyenyane (haholo-holo ba ka tlaase ho lilemo tse 6) le bana ba nang le bokooa ba tsoelo-pele hoo e ka bang ** ha ho mohla ba tšollang mali **. Ho e-na le hoo, reflex ea bona e itekanetseng ke ho metsa ntho e 'ngoe le e' ngoe e kenang pharynx ea bona.

Matšoao a poteletseng a lemosang a ho tsoa mali a khutsitseng 'metsong ho ngoana¶

Ngoana a ka koenya karolo ea 20 ho ea ho 30 lekholong ea mali a hae a potolohang ka khutso ka mpeng pele lerotholi le le leng la mali le hlaha mosamong kapa melomong ea hae. Sheba ka hloko lintlha tsena tsa boitšoaro le tsa 'mele:

1. Ho koenya khafetsa, ho pheta-pheta ha u robetse kapa u phomotse: Sheba karolo e ka pele ea molala oa ngoana. Haeba ngoana ea robetseng kapa ea phomotseng a metsa metsotsoana e meng le e meng e 5 ho isa ho e 15 ha a sa noe letho, mali a metsi a phalla ka matla ho tloha betheng ea tonsillar kapa betheng ea adenoid.nasopharynx) ho theosa bokamorao ba mmetso.
2. Ho korotla ho kolobileng, ho hloeka ha 'metso, kapa ho khohlela ka tšohanyetso bosiu ho kena: Mali a kopaneng ka har'a hypopharynx a tsikinyetsa kono ea laryngeal, e bakang molumo o metsi, o kang oa ho phefumoloha nakong ea ho hema kapa ho tsoha hang-hang ka ho khohlela.
3. Ho hloka botsitso ho sa hlaloseheng, ho tšoenyeha, kapa letlalo le phophomang ka tšohanyetso: Ha bana ba tšohile ka lebaka la hypovolemic shock, bana ba boloka khatello e tloaelehileng ea mali e thetsang ho fihlela ba lahleheloa ke karolo ea 25 ho ea ho 30 lekholong ea molumo oa mali a bona. Ho tsieleha kapele ho bonahala joalo ka lebelo la pelo le lebelo (tachycardia), menoana le menoana e phodileng, marinini a bosoeu bo bosehla le mahlo a ka hare a mahlo, le ho ferekana ka tšohanyetso kapa ho hloka botsitso.
4. Ho nyekeloa ke pelo ka tšohanyetso le ho hlatsa ha lintho tse lefifi tsa "coffee-ground" kapa maroon clots: Ha mali a koetsoe a tsoakana le hydrochloric acid (HCl) ka mpeng, tšepe e hemoglobin e kenngoa ka oxidized ho hematin e sootho e sootho. Nakong ea metsotso e 15 ho isa ho e 45 ka mor'a ho koenya ka khutso, mpa e ea kokobela 'me e teneha, e leng ho etsang hore ngoana a hlatse ka tšohanyetso metsi a mangata a sootho a sootho a fatše a kopantsoeng le mela e khubelu e khanyang kapa maqeba a kang jelly.

Liketso tsa hang-hang tsa thuso ea pele ha u ntse u emetse ambulense¶

Hang ha u se u bitsitse 911, 112, kapa 999, lintho tse tlang pele bophelong ba hau nakong ea 5 ho metsotso ea 15 pele baoki ba liphallelo ba fihla ** ho thibela takatso ea mali matšoafong **, ho thibela mali ho metsa **, le ** ho khothaletsa vasoconstriction ea sebakeng seo **.

1. Boemo bo nepahetseng ba tsela ea moea: E otlolohile le ho sekamela pele¶

• Lulisa ngoana kapa motho e moholo a otlolohile setulong, betheng, kapa holim'a lirope tsa motsoali ka hlooho le sefuba se ka holimo se itšetlehileng ka lehlakoreng la 30-45-degree.
• Tšoara sekotlolo se sesoeu, beisine ea polasetiki e tšoeu, kapa thaole e tšoeu ka tlas'a selelu sa bona. Ho sebelisa setshelo se sesoeu ho u fa monyetla le baoki ba fanang ka thuso ea bongaka maemong a tšohanyetso hore ba ahlole ka nepo hore na bolumo ea mali a lahlehileng le mala oa eona (bofubelu bo bofubelu bo khanyang vs. matheba a mafi a venous vs. mathe a pinki).
• Bua ka lentsoe le khutsitseng, le khutsitseng, le tsitsitseng. Ho lla, ho hoeletsa, le ho tšoha ho otla ha pelo le khatello ea mali ea systolic, ho pompa mali ka ntle ho sekepe sa tonsillar se bulehileng ka potlako haholo.

2. Mokhoa oa ho swish-and-spit-metsi a leqhoa (Bakuli ba Tšebelisano-'moho feela)¶

Haeba mokuli e le motho e moholo, mocha, kapa ngoana ea kenang sekolo e moholo (hangata a le lilemo li 7 ho ea holimo) ea falimehileng ka ho feletseng, a khobile matšoafo, a sa khangoe:

• Tlatsa kopi ka metsi a batang le leqhoa le pshatlehileng.
• Etsa hore mokuli a noe hanyenyane metsing a batang a leqhoa, a sekamise hlooho hanyenyane e le hore metsi a batang a hlape bokamorao ba molomo bakeng sa metsotsoana e 3 ho isa ho e 5, ebe **a tšoela metsi ka bonolo ka ntle ** ka har'a beisine (le ka mohla u se ke ua hula ka matla, kaha ho thothomela ho matla ho ka sisinya maqeba a hlephileng a sekepe).
• Pheta metsotsoana e meng le e meng e 30 ho isa ho e 60. Metsi a batang a pepesa li-mucosal arterioles le capillaries ka har'a tonsillar fossa ha a ntse a hlatsoa li-enzyme tsa fibrinolytic ka har'a maqeba a hlephileng a mali.

3. Pholiso ea ka ntle ea molala¶

• Koahela mokotla oa leqhoa kapa lierekisi tse leqhoa ka thaole e tšesaane, e mongobo 'me u e behe ka bonolo lehlakoreng la molala o ka holimo ka tlas'a mohlahare (submandibular triangle), kapa ka nqane ho molala.
• Le ka mohla u se ke ua phuthela ntho leha e le efe ka thata molaleng kapa ua hatella ka matla ho windpipe kapa carotid pulse.

4. SEO U SA LOKELANG HO se etsa ka mor'a tonsillectomy ho tsoa mali¶

• Le ka mohla u se ke ua kenya menoana, lipeipi tsa gauze, libolo tsa k'hothone, kapa lisebelisoa tsa silevera ka morao ha molomo lapeng ho leka ho hatella bethe ea tonsil: Ho sutumelletsa lesela ka bofofu ka har'a pharynx ea ngoana ho etsa hore ngoana a be le lekhalo le matla le ho hlatsa, ho hohola eschar e setseng betheng e fapaneng ea tonsil, 'me ho ipeha kotsing ea ho oela ka har'a lesapo la mali.
• Le ka mohla u se ke ua fana ka aspirin, ibuprofen (ntle le haeba e hlahlobiloe, 'me le ka mohla u se ke ua tšolla mali), naproxen, kapa litlama tse fokotsang mali: Lithethefatsi tse thibelang ho ruruha (Nonsteroidal anti-inflammatory drugs)NSAIDsjoalo ka aspirin e thibela ho kopana ha liplatelete (COX-1). Le hoja lingaka tse ling li lumella ibuprofen e hlophisitsoeng hammoho le acetaminophen bakeng sa ho laola bohloko ba ka mor'a op, ** emisa li-NSAID tsohle hang-hang ** haeba mali leha e le afe a hlaha.
• ** Le ka mohla u se ke ua fa mokuli ntho leha e le efe ea ho ja kapa ea ho noa ** (ntle le metsi a leqhoa a swish-and-spit a sa metsoang): Mokuli a ka 'na a hloka anesthesia ea tšohanyetso ea tšohanyetso kamoreng ea ho buuoa nakong ea hora,' me mpa e tletseng mpeng e eketsa haholo kotsi ea pulmonary aspiration nakong ea ho intubation ka tatellano e potlakileng.

Sepetlele le tsamaiso ea ho buoa: Seo u ka se lebellang ho ER¶

Ho tseba hore na lingaka tsa maemo a tšohanyetso, li-anesthesiologists le otolaryngologists (ENT surgeons) ho laola ho tsoa ha mali ka mor'a tonsillectomy ho thusa malapa ho itokisetsa ha a fihla sepetlele.

Ho lekanya botebo ba ho tsoa mali ka mor'a tonsillectomy (Stammberger / Windfuhr Classification)¶

Ho thibela tšollo ea mali ea bobeli nakong ea matsatsi a 14 a ho hlaphoheloa¶

Le ha ho tsoa mali ha bobeli ho etsahala leha ho na le tlhokomelo e nepahetseng ea lapeng, ho latela melaoana e tiileng ea ho hlaphoheloa ka mor'a ts'ebetso matsatsing a 14 a felletseng ka mor'a ho buuoa ho theola haholo kotsi ea ho slough pele ho nako.

1. Relentless hydration ("Makhopho a metsi a folisa; makhopho a ommeng a tsoa mali")¶

• E-re ngoana kapa motho e moholo a noe metsi hanyenyane, lero la apole le hlapolotsoeng, motsoako oa electrolyte, kapa leqhoa metsotsong e meng le e meng e 15 ho isa ho e 30 nakong eohle ea ho robala.
• Mathisa mongobo o pholileng oa moholi haufi le bethe ea mokuli bosiu bo bong le bo bong ka matsatsi a 14. Hobane ho ruruha ho pota-potile mahalapa le bethe ea adenoid ho qobella bakuli ba ka mor'a ho buuoa hore ba robale ba butse melomo, moea o omileng oa kamoreng o senya lekhopho la 'metso ka bosiu bo le bong, ho hlalosa hore na ke hobane'ng ha ho tsoa mali a mangata hakana ka mor'a tonsillectomy pakeng tsa 2:00 AM le 6:00 AM.

2. Ho laola bohloko bo hlophisitsoeng, clockwork e le hore mokuli a 'ne a noe¶

• Bohloko ba 'metso le **mahlaba a tsebe a buuoang ** (a bakoang ke makala a kutlo a arolelanoang a methapo ea glossopharyngeal, Cranial Nerve IXle mothapo oa vagus, Cranial Nerve X, e fanang ka bethe ea tonsillar le tsebe e bohareng) hangata e mpefala ka Matsatsi a 4 ho isa ho a 8 ha likhoele li qala ho arohana.
• Laola boima ba 'mele acetaminophen (paracetamol) (le ngaka e buprofen e lumelletsoeng ho fapanyetsana ibuprofen haeba e laetsoe, leha ho le joalo ** ha ho mohla aspirini ** le ** ha ho mohla codeine kapa tramadol **, e nang le li-contraindication tsa FDA/EMA ho bana ka mor'a tonsillectomy ka lebaka la ho potlaka haholo. CYP2D6 metabolism into lethal morphine doses) ka kemiso e thata ea bosiu le motšehare ho e-na le ho ema ho fihlela ngoana a lla ka bohloko 'me a hana ho metsa metsi.

3. Ho qoba lintho tse bakang khatello ea mali bakeng sa matsatsi a 14 a tletseng¶

• Ha ho lijo tse hlabang, tse bohale, tse khoahlapisitsoeng, kapa tse chesang ka matsatsi a 14: Qoba lichipisi tsa tortilla, crisps ea litapole, li-crusts tse thata, lijo-thollo tse omeletseng, li-crackers, crust ea pizza, linate, li-popcorn, liapole tse tala/lihoete le sopho e chesang kapa lero la tamati. Melapo e bohale ea lijo e hohola eschar e tšoeu holim'a bethe ea tonsillar pele methapo ea mali e ka tlase e koala.
• ** Phomolo e tiileng ea 'mele bakeng sa matsatsi a 14**: Esita le haeba ngoana a ikutloa a le mahlahahlaha ka Letsatsi la 6, thibela ho matha, ho qhomela holim'a trampoline, ho qhoqhoa, lipapali tsa ho kopana, sehlopha sa boikoetliso, ho phahamisa boima, kapa ho ikitlaetsa ka matla ho fihlela letšoao le feletseng la matsatsi a 14 le fetile 'me mohlala o mong le o mong oa khola e tšoeu o nyametse 'metsong. Ts'ebetso efe kapa efe e eketsang lebelo la pelo le khatello ea mali ea systolic e ka ntša sejana sa tonsillar se folisang.

Linomoro tsa libaka tsa tšohanyetso le liprothokholo tsa mekhatlo¶

Kamehla boloka **nomoro ea hau ea mohala ea ENT ea lihora tse 24 le nomoro ea hau ea ambulense ea boemo ba tšohanyetso e bolokiloe fonong ea hau matsatsi a 14 kamora ho buuoa:

Lipotso tse botsoang khafetsa¶

Ke hobane'ng ha 'metso oa ngoana oa ka o ile oa qala ho tsoa mali ka Letsatsi la 7 ha opereishene e ne e le beke e fetileng?¶

Nakong ea ho buuoa ka tonsillectomy, ngaka e buoang e koala methapo ea mali e betheng ea ’metso, ’me ka lihora tse 24 tse qalang ’mele o koahetse liphaphatha tse tala tsa mesifa ka lekhoa le letenya le lesehla le sireletsang le bitsoang fibrinous eschar. Pakeng tsa Matsatsi a 5 le a 10 ka mor'a ho buuoa, letlalo le lecha le pinki lea mela ka tlas'a 'me makhopho a sireletsang ka tlhaho a hlephisa ebe a ebola. Haeba lekhopho le omella kapa le arohana pele mothapo oa mali o ka tlase o fola ka ho feletseng, kapa haeba lijo tse makukuno li o hohola, sejana se ka tlaase sea buleha ebe se baka ho tsoa mali ho liehang ("secondary") beke e tletseng ka mor'a opereishene.

Ngoana oa ka o ile a tšoela leqeba le lenyenyane la mali le lekanang le kotara metsotso e 10 e fetileng, 'me joale mathe a bona a hlakile ka ho feletseng. Na re hlile re hloka ho ea kamoreng ea tšohanyetso?¶

E, u tlameha ho ea lefapheng la tšohanyetso sepetlele hang-hang esita le haeba ho tsoa mali ho bonahala eka ho emisitse ka ho feletseng. Ho otolaryngology, karolo e khutšoane, e nyane ea ho tsoa mali lipakeng tsa Matsatsi a 5 le 10 e tsejoa e le "herald bleed" kapa "sentinel bleed". Ho bolela hore sejana sa methapo ea mali kapa sa venous se betheng ea tonsil se senyehile ha lekhoa le arohana 'me hajoale le hokeloa feela ke leqeba le pshatlehang, la nakoana la mali. Ka ntle le tlhahlobo ea sepetlele, cauterization, kapa ho shebella bosiu bo le bong, leqeba leo la nakoana le atisa ho tsoa lihora tse 'maloa hamorao har'a mp'a bosiu, ho baka tšollo ea mali e behang bophelo kotsing.

Ke hobane'ng ha ngoana oa ka a e-na le bohloko bo boholo ba tsebe matsatsi a 5 ka mor'a tonsillectomy, 'me na seo se bolela hore o na le tšoaetso ea tsebe kapa ho tsoa mali?¶

Bohloko bo matla ba tsebe bo phahamang pakeng tsa Matsatsi a 4 le a 8 ka mor'a tonsillectomy hangata ke "bohloko bo buuoang" ho e-na le tšoaetso ea tsebe kapa letšoao la ho tsoa mali. Mothapo o tšoanang oa cranial (mothapo oa glossopharyngeal, Cranial Nerve IX) o fana ka maikutlo karolong e ka morao ea 'metso le ea tsebe e bohareng ka methapo ea Jacobson. Ha mesifa ea 'metso e hoholeha le likhopo li qala ho epolla ka Letsatsi la 5, boko bo hlalosa ka phoso matšoao ao a 'metso e le a tsoang botebong ba litsebe. Fana ka meriana e reriloeng ea ho opeloa, tšela litsebe ka mokotla o futhumetseng kapa o pholileng, 'me u khothalletse ho hlafuna chepisi kapa ho noa lino tse metsi ho khatholla mesifa ea mohlahare le ea 'metso.

Nka etsa phapang joang lipakeng tsa makhopho a tloaelehileng a masoeu a pholiso le tšoaetso ea 'metso ka mor'a tonsillectomy?¶

Makhopho a tloaelehileng a post-tonsillectomy (eschars) a shebahala a le tenya, a shaggy, a bosoeu bo bosootho, a bohlooho, kapa a bosehla, a lula a koaletsoe lipokothong tse peli moo litone li neng li le teng, 'me a baka moea o mobe o matla.`halitosis`) ho fihlela libeke tse peli. Ha se tšoaetso ebile ha e hloke lithibela-mafu. U lokela ho ikopanya le ngaka ea ENT bakeng sa tšoaetso e ka bang teng kapa ho felloa ke metsi 'meleng hafeela mokuli a e-ba le feberu e matla e sa khaotseng ho feta likhato tse 38.9 tsa Celsius (102.0 degrees Fahrenheit), a jala bofubelu bo khanyang le ho ruruha mahalapeng le molala o bonolo, kapa ho se khone ho feletseng ho koenya maro.

Ke hobane'ng ha ngaka e ile ea re bolella hore le ka mohla re se ke ra fana ka codeine kapa aspirin ka mor'a tonsillectomy?¶

Aspirin e thibela ka ho sa feleng liplatelete tsa mali hore li se ke tsa khomarelana bakeng sa nako eohle ea bophelo ea matsatsi a 7 ho isa ho a 10 ea platelet, e leng ho eketsang haholo kotsi ea ho tsoa mali a mangata ka mor'a tonsillectomy. Codeine (le tramadol) e thibetsoe ka thata ka mor'a tonsillectomy ea bana ka lebaka la phapang ea liphatsa tsa lefutso ho li-enzyme tsa sebete (`CYP2D6 ultra-rapid metabolizers`) e etsa hore bana ba bang ba fetole litekanyetso tse tloaelehileng tsa codeine hore e be tekanyo e kotsi ea morphine maling a bona, e ka thibelang ho hema ha bona ha ba robetse, haholo-holo ho bana ba ileng ba ntšoa lithane tsa bona bakeng sa ho koaleha moea ka nakoana borokong.

Ho hlatsa "mokelikeli oa kofi" o sootho o lefifi ho bolela'ng ka mor'a tonsillectomy?¶

Ho hlatsa lintho tse sootho tse bosootho tse shebahalang joaloka sebaka sa kofi se metsi, kapa ho hlatsa maqeba a matšo a maroon a kang jelly, ke boemo ba tšohanyetso ba bongaka bo bolelang hore mokuli o ntse a tsoa mali a khutsitse 'metsong kapa linkong' me a koenya mali ka mpeng. Ha mali a lutse ka mpeng ea asiti ka metsotso e 15 ho isa ho e 45, asiti eo e fetola tšepe e bofubelu bo khanyang maling e sootho bo lefifi ’me e halefisa lesela la mpa ho fihlela mokuli a hlatsa. Letsetsa 911, 112, kapa 999 hang-hang, le haeba u sa bona mali a khubelu a khanyang a rotha molomong esale pele.

Litataiso tse amanang¶

• Ho khohlela mali (hemoptysis) le ho tsoa mali ho hoholo ha moea
• Ho hlatsa mali (hematemesis), melena, le ho tsoa mali ka maleng
• Peritonsillar abscess, angina ea Ludwig, le mafu a tebileng a molala
• Ho tsoa mali ka nko (epistaxis) le ho tsoa mali ka morao ho nko
• Tlhokomeliso ea "hypovolemic" le "hemorrhagic shock".

Mehloli le tataiso ea semmuso¶

• American Academy of Otolaryngology - Opereishene ea Hlooho le Molala (AAO-HNS, United States): *Tlhahiso ea Tlhekefetso ea Kliniki: Tonsillectomy ho Bana (Ntlafatso) - Tlhahlobo ea Hemorrhage ea Postoperative, Taolo ea Bohloko, le Codeine Contraindication *.
• ENT UK & Royal College of Surgeons of England (United Kingdom): National Prospective Tonsillectomy Audit and Emergency Management of Post-Tonsillectomy Haemorrhage Guidelines.
• Mokhatlo oa Lingaka tsa Lingaka tsa Bana tsa Great Britain le Ireland (APAGBI): Taelo ea Tumellano mabapi le Tsamaiso ea Emergency Anesthetic and Airway of Post-Tonsillectomy Haemorrhage (Bleeding Tonsil).
• Royal Children's Hospital Melbourne (Australia): Taelo ya Boikwetliso ba Kliniki: Tonsillectomy le Adenoidectomy Post-Operative Care and Haemorrhage Grading.
• U.S. Tsamaiso ea Lijo le Lithethefatsi (FDA, United States) & European Medicines Agency (EMA): Puisano ea Tšireletseho ea Lithethefatsi: Temoso e Boxed Contraindicating Codeine le Tramadol bakeng sa Tsamaiso ea Bohloko ba Post-Tonsillectomy ho Bana.