I-Post-Tonsillectomy Ukopha: Usuku lwe-5 ukuya kwi-10 ye-Scb Sloughing kunye ne-Airway Hemorrhage Triage¶

I-tonsillectomy (ekunye okanye ngaphandle kwe-adenoidectomy) yenye yezona nkqubo zixhaphakileyo zenziwa utyando ebantwaneni nakubantu abadala kwihlabathi jikelele, kodwa inomngcipheko owahlukileyo, onokuthi ube sengozini yokulibaziseka kokuphuma kwegazi ukuya kuthi ga kwiiveki ezimbini ezigcweleyo emva kokuba isigulana sibuyele ekhaya. Ngenxa yokuba iitoni zepalatine zihlala kumandlalo womqala onezihlunu ezibonelelwa ngamasebe amahlanu oxinzelelo oluphezulu lwenkqubo ye-carotid yangaphandle, kwaye ngenxa yokuba amanxeba otyando angasemva komlomo akanakuthungwa avalwe ngokupheleleyo okanye agqunywe ngebhandeji, ifossae ekrwada iyaphilisa ngokwenza amaxolo efibrinous angqindilili, amhlophe-tyheli.eschars). Phakathi kwe-post-operative ** Iintsuku ze-5 kunye ne-10 **, njengoko ulusu olutsha lwe-mucosal lukhula ngaphantsi, ezi zikhuni ezikhuselayo zikhulula kwaye zikhuphe. Ukuba ukhwekhwe lwahlula phambi kwexesha okanye lukrazula imithambo engaphantsi, ukopha ngokukhawuleza ngaphaya kwesango loqhoqhoqho.trachea). Naliphi na igazi elibomvu elibonakalayo elikhanyayo emlonyeni okanye empumlweni, ukuginya rhoqo kumntwana oleleyo, okanye ukugabha igazi elimnyama lekofu emva kwe-tonsillectomy yimeko engxamisekileyo yotyando. Fowunela indawo yakho amanani kaxakeka ngokukhawuleza kwaye uqhagamshelane nezikhokelo zethu ezinxulumeneyo ukukhohlela igazi kunye nokuphuma kwegazi emoyeni, ukuhlanza igazi kunye nokopha kwesisu, kwaye ukothuka kwe-hypovolemic.

Yenza oku ngoku¶

1. Fowunela u-911, 112, okanye u-999 ngoko nangoko ngako nakuphi na ukopha okubomvu okuqaqambileyo, amahlwili egazi, okanye ukugabha igazi emva kwe-tonsillectomy: Ungaze ulinde ekhaya ukuze ubone ukuba ukopha kwe-post-tonsillectomy kuyeka ngokwakho, kwaye ungaze uqhubele umntwana owophayo esibhedlele kwisihlalo esingasemva semoto yabucala apho kungekho mntu unokufunxa umoya okanye aphulukane nomoya.
2. Hlalisa isigulana sime nkqo kwaye ungqiyame intloko nomzimba wakho phambili phezu kwesitya okanye itawuli emhlophe: Ungaze umvumele umntu owopha umqala alale phantsi ngomqolo. Ukuhlala ngokuthe tye kunciphisa uxinzelelo lwegazi lwe-venous kunye ne-arterial entanyeni, ngelixa ukuthembela phambili kuvumela igazi ukuba liphume emlonyeni kwisitya ukuze lingadibanisi phezu kweentambo zezwi okanye lihle liye esiswini.
3. Yiba nomntwana omdala osebenzisanayo okanye umntu omdala ajiwuze ngobunono aze atshice amanzi abandayo ngumkhenkce: Ukuba isigulana sivukile ngokupheleleyo, sithe qwa, kwaye siyakwazi ukulandela imiyalelo ngaphandle kokukrwitshwa, ukutyhutyha ngobunono amanzi omkhenkce ngasemva komlomo kwaye uwatshifulele kwisinki emhlophe okanye isitya sixhokonxa i-reflex vasoconstriction yemithambo emincinci ye-tonsillar bed kwaye ucoca ukuze ukwazi ukubona ukuba kukho ukopha. Su**** ukunyanzelisa ulwelo kumntwana osahambayo, usana, okanye isigulana esozelayo.
4. Faka i-ice collar okanye ipakethe ebandayo ngaphambili kunye namacala entamo kwaye ufunxe i-ice pop: Ukubamba ipakethe ye-ice ehlanganiswe ngelaphu ngokuchasene nentamo yecala eliphezulu (ngaphantsi nje kwe-angle yomhlathi) inceda ukupholisa amasebe angaphandle e-carotid ondla i-tonsillar fossa ngelixa ulindele i-paramedics.
5. Yalela isigulana ukuba sitshice lonke ithontsi legazi namathe kunokuba siliginye: Ukuginya igazi kufihla umthamo wokwenyani wokuphuma kwegazi kubazali nakoogqirha, kucaphukisa udonga lwesisu ngogonyamelo, kwaye kubangela ukugabha ngequbuliso (hematemesis) enokukhukulisa umzila womoya kwaye ikrazule ibhedi ephilisayo yomqala uvule ngakumbi.
6. Lungiselela indawo yokuchacha ukuba isigulana siyozela, sibe luthuthu, okanye sisiqaqadeke: Ukuba umntwana owophayo okanye umntu omdala uye waphelelwa ngamandla, aqhwalele, okanye angaphenduli ngelixa elinde iinkonzo zonyango ezingxamisekileyo, ziqengqele ngoko nangoko kwicala labo kwindawo yokuchacha ecaleni ubuso buthe tyeke phantsi kancinci ukuze igazi liphume ngekona yomlomo kunokuba litshone imiphunga.

Umthi wesigqibo: I-post-tonsillectomy triage kunye nempendulo yomoya¶

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I-Pathophysiology: Kutheni i-tonsillectomy scabs yopha iveki epheleleyo emva kotyando¶

Abazali kunye nezigulana ezikhulileyo zothuka rhoqo xa ukopha komqala kusenzeka kwiintsuku ezisi-7 okanye ezisi-8 emva kotyando, kanye xa isigulana sasiqala ukuziva singcono kancinci okanye siphinde siqalise imisebenzi eqhelekileyo. Ukuqonda inkqubo yokuphulukisa amanxeba amanqanaba amathathu e-oropharynx ichaza ukuba kutheni le festile ilibazisekile lixesha lengozi enkulu.

1. Ubonelelo olutyebileyo lwe-arterial ye-tonsillar fossa¶

I-Palatine tonsil ihlala kwindawo enzulu ye-muscular cradle phakathi kwentsika ye-tonsillar yangaphambili (palatoglossus muscle) kunye nentsika yetoni yangasemva (palatopharyngeus muscle), ukuphumla ngokuthe ngqo phezu kwe-superior pharyngeal constrictor muscle . Amasebe amahlanu ahamba phezulu emithanjeni yecarotid yangaphandle* atyhoboza le bhedi enezihlunu ukondla ithoni:

• Isebe le-Tonsillar ye-facial artery (owona mthombo mkhulu kunye nowona uxhaphakileyo we-hemorrhage ye-arteri ephantsi kakhulu).
• Ukunyuka kwesebe le-palatine kumthambo wobuso.
• Amasebe e-Dorsal lingual of the lingual artery (ukubonelela ngepali engaphantsi ecaleni kwesiseko solwimi).
• Ukunyuka komthambo wepharyngeal (ukubonelela ngodonga olungasemva).
• Ukuhla komthambo wepalatine (isebe le-maxillary artery elibonelela ngepali ephezulu).

Ngapha koko, i-paratonsillar vein enkulu (vein of Denis Browne)* ibaleka ngokuthe nkqo phantsi kwebhedi ye-tonsillar esecaleni nje ngaphantsi kodonga olubhityileyo lwemisipha, kwaye umboko oyintloko wemithambo yangaphakathi nengaphandle yecarotid idlula kuphela i-1.5 ukuya kwi-2.5 centimeters (0.6 ukuya kwi-1.0 intshi) ecaleni ukuya kwi-capsule ye-tonsillar enzulu.

2. Iprayimari vs. i-post-tonsillectomy ye-hemorrhage yesibini¶

Oogqirha bahlela ukopha emva kwe-tonsillectomy (PTH) kwiindidi ezimbini ezahlukeneyo ezisekwe kwixesha kunye nendlela:

3. Yintoni ukhwekhwe emqaleni omhlophe (eschar) kukho kwaye kutheni ukuphelelwa ngamanzi emzimbeni kubenza bophe¶

Kwiiyure nje ezili-12 ukuya kwezingama-24 emva kotyando, imingxuma yezihlunu ekrwada apho zisuswe iitoni ziye zagqunywa yingubo eshinyeneyo, ethe shinyi, engwevu-mhlophe okanye etyheli-tan eyenziwe yifibrin, iiplatelets, iiseli ezimhlophe zegazi, kunye neeseli ezingaphezulu.

• Inkangeleko eqhelekileyo (Ayilulo usulelo): Abazali abajonga emlonyeni womntwana wabo ngoSuku lwesi-3 basoloko bephakuzela xa bebona amabala amabini angqindilili, anuka kakubi amhlophe atyheli agqume umva womqala, ecinga ukuba anobubovu obubukhali okanye ithrush. Le fibrinous eschar yinto eqhelekileyo, ukhwekhwe olumanzi olukhuselayo, kunye nempefumlo embi enamandla (halitosis) kulindeleke iintsuku ezili-10 ukuya kwezili-14.
• Indlela okwenzeka ngayo ukuthotywa (Iintsuku 5 ukuya kweye-10): Ngaphantsi kwale ngubo yefibrin, i-epithelium entsha epinki enesquamous mucosal epithelium ichwechwela ngaphakathi ukusuka kwincam yeentsika zeetonsillar. Phakathi kweeNtsuku ze-5 kunye ne-10, umzimba unyibilikisa ukuncamathela okuphakathi kwesikhumba esitsha kunye nokhwekhwe lwefibrin engaphezulu efileyo ukuze ukhwekhwe lugqabhuke lube ngamaqhekeza amancinci amancinci kwaye uginywe ungabonwa ngamathe.
• Kutheni ukuphelelwa ngamanzi emzimbeni kubangela ukopha: Ngokungafaniyo nokhwekhwe edolweni oluphola kakuhle emoyeni owomileyo, i-eschar yomqala kufuneka ihlale imanzi rhoqo kwaye ithambile. Ukuba umntwana uyala ukusela ulwelo ngenxa yomqala kunye neentlungu ezidluliselwa kwindlebe, umqala uyoma.pharyngeal desiccation). I-eschar eyomileyo iyancipha, iqine ibe yi-crust eqinile, kwaye idonsa ngamandla kwimithambo yegazi ephilisayo rhoqo xa izihlunu zomqala zifinyela ukuginya okanye ukukhohlela. Endaweni yokunyibilika kakuhle, ukhoko olomileyo lukrazuka lube sisiqwengana esinye, lukrazule udonga lwe-arteriole ebuthathaka ngokushushu ngaphantsi.

Ukuqaphela ukopha okufihliweyo kwiintsana, abancinci, kunye nabantwana abalele¶

Ngelixa umntu omdala okanye okwishumi elivisayo ekhawuleza angene ekhitshini aze akuxelele ukuba incasa igazi elifudumeleyo, elinesinyithi ngasemva komqala wabo, abantwana abancinci (ingakumbi abangaphantsi kweminyaka emi-6) kunye nabantwana abakhubazekileyo ekukhuleni phantse ** bangaze batshice igazi ngaphandle **. Kunoko, i-reflex yabo ezenzekelayo kukuginya yonke into engena kwi-pharynx yabo.

Iimpawu ezifihlakeleyo zokopha okuthe cwaka emqaleni emntwaneni¶

Umntwana unokuginya ngokuthe cwaka ama-20 ukuya kuma-30 ekhulwini egazi lakhe lilonke elijikeleza esiswini ngaphambi kokuba kuvele nethontsi legazi kumqamelo okanye emilebeni yakhe. Jonga ngononophelo ezi zikhokelo zokuziphatha kunye nezomzimba:

1. Ukuginya rhoqo, okuphindaphindayo xa elele okanye ephumle: Jonga umphambili wentamo yomntwana. Ukuba umntwana oleleyo okanye ophumlileyo uginya yonke imizuzwana emi-5 ukuya kwe-15 xa engaseli nantoni na, igazi elimanzi lihamba ngokukhawuleza ukusuka kwibhedi ye-tonsillar okanye ibhedi ye-adenoid.nasopharynx) ezantsi komqala wabo.
2. Ukugruzuka okumanzi, ukucocwa komqala, okanye ukukhohlela kwasebusuku ngesiquphe kungena: Ukudityaniswa kwegazi kwi-hypopharynx kunyakazisa indawo yokungena kwilaryngeal, kubangele isandi esimanzi, esinegwebu ngexesha lokuphefumla okanye ukuvuka ngesiquphe ngokukhohlela okukrwitsha.
3. Ukungazinzi ngequbuliso okungaqondakaliyo, ukuxhalaba, okanye ukuphaphatheka, ulusu oluluthuthu: Kwimeko yomothuko wabantwana obangelwa yi-hypovolemic, abantwana bagcina uxinzelelo lwegazi oluqhelekileyo olukhohlisayo de balahlekelwe ngama-25 ukuya kuma-30 ekhulwini kumthamo wegazi labo. Umothuko wangethuba ubonakala njengesantya sentliziyo ebalekayo (tachycardia), iminwe neenzwane eziluthuthu ezipholileyo, iintsini ezimhlophe eziluthuthu neenkophe zangaphakathi, kunye nokuphazamiseka ngequbuliso okanye ukungabi naludwe.
4. Isicaphucaphu ngesiquphe kunye nokugabha kwemathiriyeli emnyama "yomhlaba wekofu" okanye amahlwili e-maroon: Xa igazi eliginyiweyo lixutywa ne-hydrochloric acid (HCl) esiswini, i-iron kwi-hemoglobin i-oxidized ibe yi-hematin emnyama ye-asidi. Kwimizuzu eli-15 ukuya kwengama-45 emva kokuginya okuthe cwaka, isisu siyaphuma kwaye siyacaphuka, nto leyo ebangela ukuba umntwana agabhe ngephanyazo umthamo omkhulu wolwelo olumdaka olumdaka lwekofu oluxutywe nemivimbo ebomvu eqaqambileyo okanye amahlwili afana nejeli.

Izenzo zoncedo lokuqala ngokukhawuleza ngelixa ulinde i-ambulensi¶

Emva kokuba ubize i-911, i-112, okanye i-999, izinto eziphambili zakho ngexesha le-5 ukuya kwi-15 imizuzu ngaphambi kokuba i-paramedics ifike ** ukuthintela ukulangazelela igazi kwimiphunga **, ** ukuthintela ukugwinya kwegazi **, kunye ** nokukhuthaza i-vasoconstriction yendawo **.

1. Eyona ndawo ikuyo indlela yomoya: Ithe tye kwaye ingqiyame phambili¶

• Hlala umntwana okanye umntu omdala ngokuthe tye esihlalweni, esofeni, okanye ethangeni lomzali kunye nentloko kunye nesifuba esiphezulu sixhomekeke phambili kwi-angle ye-30-to-45-degree.
• Bamba isitya esimhlophe, isitya seplastiki esimhlophe, okanye itawuli emhlophe ngaphantsi kwesilevu sabo. Ukusebenzisa i-container emhlophe kukuvumela kunye nee-paramedics ezifikayo ukuba zigwebe ngokuchanekileyo zombini ** umthamo ** wegazi elilahlekileyo kunye ne-** umbala ** (i-arterial ebomvu ebomvu vs. i-dark venous clots vs. pink saliva).
• Thetha ngelizwi elizolileyo, elizolileyo, elizolileyo. Ukukhala, ukukhala, kunye noloyiko lwesantya sentliziyo kunye noxinzelelo lwegazi lwe-systolic, ukumpompa igazi ngaphandle kwesitya esivulekileyo se-tonsillar ngokukhawuleza.

2. Ubuchule bokuswish-and-spit-amanzi omkhenkce (Izigulana ezisebenzisanayo kuphela)¶

Ukuba isigulana ngumntu omdala, okwishumi elivisayo, okanye umntwana osesikolweni (odla ngokuba neminyaka esi-7 ubudala nangaphezulu) othe qwa ngokupheleleyo, uzolile, kwaye akakrwitshwa:

• Gcwalisa ikomityi ngamanzi abandayo kunye nomkhenkce otyumkileyo.
• Cela isigulana sithathe intwana yamanzi abandayo emkhenkceni, sikekele intloko kancinci ukuze amanzi abandayo ahlambe umva womlomo kwi-3 ukuya kwimizuzwana emi-5, kwaye ** utshice amanzi ngobunono ngaphandle ** kwisitya (ungaze ugrumbe ngamandla, njengoko ukungcangcazela komqala okunamandla kunokushukumisa amahlwili akhululekileyo kwisitya).
• Phinda kwakhona imizuzwana engama-30 ukuya kwengama-60. Izithinteli zamanzi abandayo ziveze ii-arterioles ze-mucosal kunye neecapillaries kwi-tonsillar fossa ngelixa kuhlanjululwa ii-enzymes ze-fibrinolytic ngaphakathi kwamahlwili egazi.

3. Ukupholisa intamo yangaphandle¶

• Songa ingxowa yomkhenkce otyumkileyo okanye iiertyisi ezikhenkcezileyo kwitawuli ebhityileyo, efumileyo kwaye uyibeke ngobunono ecaleni kwentamo engaphezulu nje ngaphantsi komhlathi (submandibular triangle), okanye ngaphaya kwentamo.
• Ungaze ubophe nantoni na ngokuqinileyo entanyeni okanye ucinezele ngamandla kuqhoqhoqho okanye i-carotid pulse.

4. YINTONI ONGAMAKWENZI ngexesha le-post-tonsillectomy yokopha¶

• Ungaze uncamathelise iminwe, iipadi zeyasuyasu, iibhola zomqhaphu, okanye izinto zesilivere emva komlomo ekhaya ukuzama ukucinezela ibhedi yetonsil: Ukutyhala ngobumfama igauze kwipharynx yomntwana kubangela igag enobundlobongela kunye nokugabha reflex, ukukrazula i-eschar eseleyo kwibhedi yetonsil echaseneyo, kwaye kube sengozini yokulahla i-pad-pad.
• Ungaze unike i-aspirin, ibuprofen (ngaphandle kokuba icaciswe-ikhangelwe, kwaye ungalokothi ngexesha lokopha okusebenzayo), i-naproxen, okanye i-herbal blood thinners: Amachiza achasene nokudumba (Nonsteroidal anti-inflammatory drugs)NSAIDsnjenge aspirin ngokungenakuguquleka inhibit ukudityaniswa kweplatelet (COX-1). Nangona abanye oogqirha bevumela ibuprofen ecwangcisiweyo kunye ne-acetaminophen yokulawula intlungu emva kwe-op, ** bayeke zonke ii-NSAID ngokukhawuleza ** ukuba kukho ukopha okwenzekayo.
• ** Ungaze unike isigulana nantoni na yokutya okanye ukusela ** (ngaphandle kwe-swish-and-spit ice amanzi angaginywanga): Isigulane sinokudinga i-anesthesia jikelele yengxakeko kwigumbi lokusebenza ngaphakathi kweyure, kwaye isisu esipheleleyo sandisa kakhulu ingozi ye-pulmonary aspiration ngexesha lokulandelelana ngokukhawuleza kwe-intubation.

Isibhedlele kunye nolawulo lotyando: Yintoni onokuyilindela kwi-ER¶

Ukwazi indlela oogqirha abangxamisekileyo, ii-anesthesiologists, kunye ne-otolaryngologists (ENT surgeons) ukulawula ukopha kwe-post-tonsillectomy kunceda iintsapho zilungiselele xa zifika esibhedlele.

Ukulinganisa ubunzima be-post-tonsillectomy hemorrhage (Stammberger / Windfuhr Classification)¶

Ukuthintela ukuphuma kwegazi okwesibini ngexesha le-14-day recovery window¶

Ngelixa ukopha okwesibini kusenzeka ngaphandle kokhathalelo olufanelekileyo lwasekhaya, ukulandela imigaqo engqongqo yokubuyisela emva kotyando ngexesha elipheleleyo leentsuku ezili-14 emva kotyando kwehlisa kakhulu umngcipheko we-eschar sloughing.

1. Ukufakwa kwamanzi okungapheliyo ("Ukhwekhwe olumanzi luyaphilisa; ukhoko olomileyo luyopha")¶

• Cela umntwana okanye umntu omdala asele amanzi amancinane, incindi yeapile exutyiweyo, umxube we-electrolyte, okanye umkhenkce rhoqo emva kwemizuzu eli-15 ukuya kwengama-30 ebudeni beeyure zokulala.
• Sebenzisa isifuma-manzi esipholileyo kanye ecaleni kwebhedi yesigulana rhoqo ebusuku kangangeentsuku ezili-14. Ngenxa yokuba ukudumba kwenkalakahla kunye nebhedi ye-adenoid kunyanzela izigulane zasemva kotyando ukuba zilale imilomo yazo ivulekile, umoya wegumbi elomileyo ususa ukhoko lomqala ngobusuku, ucacisa ukuba kutheni ukopha okuninzi kwe-post-tonsillectomy kwenzeka phakathi kwe-2:00 AM kunye ne-6:00 AM.

2. Okucwangcisiweyo, ulawulo lweentlungu zewashi ukuze isigulane siqhubeke sisela¶

• Iintlungu zomqala kunye ** neentlungu ezibhekiselele kwindlebe ** (ezibangelwa ngamasebe eemvakalelo ekwabelwana ngazo kwi-nerve ye-glossopharyngeal, Cranial Nerve IXkunye ne-vagus nerve, Cranial Nerve X, ezinikezela zombini ibhedi ye-tonsillar kunye nendlebe ephakathi) rhoqo ** ziba mbi kakhulu kwiiNtsuku ze-4 ukuya kwi-8** njengokuba ukhoko luqala ukwahlukana.
• Lawula ubunzima obusekwe i-acetaminophen (paracetamol) (kunye nogqirha wotyando-evunyiweyo etshintsha ibuprofen ukuba iyalelwe, nangona ungaze ube ne-aspirin kwaye ** ungaze ube necodeine okanye i-tramadol **, ephethe i-FDA/EMA i-black-box contraindications ebantwaneni emva kwe-tonsillectomy ngenxa ye-ultra-rapid CYP2D6 i-metabolism ibe yi-ethal morphine doses) kwishedyuli engqongqo ye-clock-clock kunokulinda de umntwana akhale ngeentlungu kwaye ale ukuginya ulwelo.

3. Ukuphepha oomatshini kunye noxinzelelo lwegazi olubangela iintsuku ezili-14 ezipheleleyo¶

• Akukho ukutya okukrunkqisayo, okubukhali, okukrwempayo, okanye okushushu kangangeentsuku ezili-14: Ziphephe iitshiphusi ze-tortilla, iitapile crisps, i-hard toast crusts, i-cereal eyomileyo, ii-crackers, i-pizza crust, i-nuts, i-popcorn, ii-apile ezikrwada/ikherothi, kunye nesuphu eshushu okanye ijusi ye-asidi yetomato. Imiphetho yokutya ebukhali ikhuhla i-eschar emhlophe kwibhedi ye-tonsillar phambi kokuba imithambo yegazi engaphantsi ivalwe.
• ** Ukuphumla okungqongqo ngokomzimba kwiintsuku ze-14 **: Nokuba umntwana uziva enamandla ngoSuku lwe-6, thintela ukubaleka, ukutsiba kwi-trampolines, ukuhlambalaza, ukuqhagamshelana nemidlalo, iklasi yokuzivocavoca, ukuphakamisa okunzima, okanye ukunyamezela ngamandla de kube kudlule uphawu olupheleleyo lweentsuku ezili-14 kwaye yonke i-scab emhlophe iphelile emqaleni. Nawuphi na umsebenzi onyusa izinga lentliziyo kunye noxinzelelo lwegazi lwe-systolic unokuvuthela inqanawa yokuphilisa i-tonsillar.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

Ngalo lonke ixesha gcina zombini iyure ezingama-24 inombolo ye-ENT yotyando ekufowuneni* kunye nenombolo yakho ye-ambulensi kaxakeka egcinwe kwifowuni yakho kangangeentsuku ezili-14 emva kotyando:

Imibuzo ebuzwa qho¶

Kutheni umqala womntwana wam waqala ukopha ngoSuku lwe-7 xa utyando lwaluyiveki yonke edlulileyo?¶

Ngexesha le-tonsillectomy, ugqirha wotyando uvala imithambo yegazi kumqala, kwaye kwiiyure zokuqala ezingama-24 umzimba ugquma imingxuma yezihlunu ekrwada ngokhwekhwe olukhuselayo olumhlophe-tyheli olubizwa ngokuba yi-fibrinous eschar. Phakathi kweeNtsuku ze-5 kunye ne-10 emva kotyando, ulusu olutsha olupinki luyakhula ngaphantsi kwaye ukhoko olukhuselayo luyakhululeka kwaye luxobuke. Ukuba ukhwekhwe loma okanye lwahlukana phambi kokuba umthambo wegazi ongaphantsi uphole ngokupheleleyo, okanye ukuba ukutya okurhabaxa kuyawukhuhla, inqanawa engaphakathi iyavuleka kwaye ibangele ukulibaziseka ("kwesibini") ukopha kwiveki epheleleyo emva koqhaqho.

Umntwana wam utshice ihlwili legazi elilingana nekota kwimizuzu eli-10 eyadlulayo, kwaye ngoku amathe abo acace gca. Ngaba ngokwenene kufuneka siye kwigumbi likaxakeka?¶

Ewe, kufuneka uye kwisebe likaxakeka esibhedlele ngokukhawuleza nokuba ukopha kubonakala kuyekile ngokupheleleyo. Kwi-otolaryngology, isiqephu esifutshane, esincinci sokopha phakathi kweeNtsuku ze-5 kunye ne-10 zaziwa njenge "herald bleed" okanye i-sentinel bleed. Kuthetha ukuba umkhumbi we-arterial okanye we-venous okwibhedi ye-tonsil ukhukulisekile njengoko ukhoko lwahluliwe kwaye okwangoku luxhuzulwa kuphela lihlwili legazi elibuthathaka, lethutyana. Ngaphandle kokuhlolwa kwesibhedlele, i-cauterization, okanye ukujongwa ebusuku, elo hlwili lexeshana lidla ngokuvuthuza kwiiyure ezininzi kamva ezinzulwini zobusuku, nto leyo ebangela ukopha okusongela ubomi.

Kutheni umntwana wam eqaqanjelwa kakhulu indlebe kwiintsuku ezi-5 emva kwe-tonsillectomy, kwaye ngaba oko kuthetha ukuba unosulelo lwendlebe okanye ukopha?¶

Iintlungu ezibuhlungu zendlebe eziphakamileyo phakathi kweeNtsuku ze-4 kunye ne-8 emva kokuba i-tonsillectomy iphantse ihlale "intlungu ebhekiswayo" kunokuba usulelo lwendlebe okanye uphawu lokopha. I-cranial nerve kanye kanye (i-glossopharyngeal nerve, i-Cranial Nerve IX) inika imvakalelo kumqolo womqala kunye nombindi wendlebe ngemithambo kaJacobson. Xa izihlunu zomqala ziqaqamba kunye nokhoko luqala ukuxobuka ngoSuku lwesi-5, ingqondo iyazitolika ngendlela engeyiyo ezo mpawu zentlungu yomqala njengeziphuma nzulu ngaphakathi ezindlebeni. Nika iyeza leentlungu ezicwangcisiweyo, faka ipakethe efudumeleyo okanye epholileyo phezu kweendlebe, kwaye ukhuthaze itshungama okanye ukurhabula ulwelo ukuphumza izihlunu zomhlathi nomqala.

Ndingawubona njani umahluko phakathi kokhwekhwe oluqhelekileyo lokunyanga okumhlophe kunye nosulelo lomqala emva kwe-tonsillectomy?¶

Ukhwekhwe oluqhelekileyo lwe-post-tonsillectomy (eschars) lukhangeleka lungqindilili, lube luhlaza, mhlophe, ngwevu, okanye lutyheli-tan, luhlala luvalelwe kwiipokotho ezimbini apho iitoni zazifudula zikho, kwaye zibangela umoya omdaka onamandla (`halitosis`) ukuya kuthi ga kwiiveki ezimbini. Ayilosulelo kwaye ayifuni antibiotics. Kufuneka uqhagamshelane nogqirha we-ENT ukuze ufumane usulelo olunokubakho okanye ukuphelelwa ngamanzi emzimbeni kuphela ukuba isigulana sinobushushu obuphezulu obuzingileyo obungaphezu kwama-38.9 degrees celcius (102.0 degrees Fahrenheit), sisasaza ububomvu obuqaqambileyo kunye nokudumba kwinkalakahla ethambileyo nentamo, okanye ukungakwazi ngokupheleleyo ukuginya ulwelo.

Kutheni ugqirha esixelele ukuba singaze sinike i-codeine okanye i-aspirin emva kwe-tonsillectomy?¶

I-Aspirin ivalela ngokusisigxina iiplatelets zegazi ekubambeni kunye kulo lonke ixesha lokuphila kwe-7-to-10-day ye-platelet, kwandisa kakhulu umngcipheko we-post-tonsillectomy hemorrhage. I-Codeine (kunye ne-tramadol) ivaliwe ngokungqongqo emva kwe-tonsillectomy yabantwana ngenxa yokuguqulwa kofuzo kwi-enzymes yesibindi (`CYP2D6 ultra-rapid metabolizers`) kubangela ukuba abanye abantwana baguqule iidosi ezisemgangathweni zecodeine zibe kumanqanaba aphezulu ayingozi emorphine egazini labo, nto leyo enokumisa ukuphefumla kwabo ngelixa belele, ngakumbi kubantwana abasuswe iitoni zabo ngenxa ye- obstructive sleep apnea.

Kuthetha ntoni ukugabha ulwelo olumdaka omnyama "olumhlaba wekofu" emva kwetonsillectomy?¶

Ukugabha izinto ezintsundu ezimdaka ezijongeka njengemihlaba yekofu emanzi, okanye ukugabha amahlwili amnyama e-maroon-jelly, yimeko engxamisekileyo yezonyango ethetha ukuba isigulana siye saphuma sithe cwaka emqaleni okanye empumlweni kwaye siginya igazi esiswini. Xa igazi lihleli kwi-asidi yesisu kangangemizuzu eli-15 ukuya kwengama-45, iasidi ijika intsimbi ebomvu eqaqambileyo esegazini ibentsundu ibe mnyama kwaye icaphukisa umgca wesisu de isigulana sigabhe. Fowunela u-911, 112, okanye u-999 ngoko nangoko, nokuba awuzange ubone igazi elibomvu eliqaqambileyo elithontsiza emlonyeni ngaphambili.

Izikhokelo ezinxulumeneyo¶

• Ukukhohlela igazi (hemoptysis) kunye nokopha okukhulu kwendlela yomoya
• Ukugabha igazi (hematemesis), i-melena, kunye nokopha kwesisu
• Ithumba le-Peritonsillar, i-angina kaLudwig, kunye nosulelo olunzulu lwentamo
• Ukopha ngeempumlo (epistaxis) kunye nokopha kwempumlo yangasemva
• Ukuqaphela ukothuka kwe-Hypovolemic kunye ne-hemorrhagic

Imithombo kunye nezikhokelo ezisemthethweni¶

• ** I-American Academy ye-Otolaryngology - Utyando lweNtloko kunye neNtamo (AAO-HNS, eUnited States): ** *Isikhokelo sokuSebenza kweKlinikhi: I-Tonsillectomy kubantwana (Uhlaziyo) - ukuHlolwa kwe-Hemorrhage ye-Postoperative, uLawulo lweentlungu, kunye ne-Codeine Contraindication *.
• I-ENT UK kunye neKholeji yaseRoyal yaseNgilani (eUnited Kingdom): UPhicotho lweSizwe olulindelekileyo lweTonsillectomy kunye noLawulo oluNgxamisekileyo lwe-Post-Tonsillectomy Haemorrhage Guidelines.
• Umanyano lwee-Anesthetists zaBantwana baseGreat Britain nase-Ireland (APAGBI): ISikhokelo seMvumelwano kwi-Emergency Anesthetic and Airway Management of Post-Tonsillectomy Haemorrhage (Bleeding Tonsil).
• ISibhedlele saBantwana saseRoyal eMelbourne (eOstreliya): ISikhokelo sokuSebenza kweKlinikhi: I-Tonsillectomy kunye ne-Adenoidectomy ye-Post-Operative Care kunye ne-Haemorrhage Grading.
• I-U.S. ULawulo lokuTya kunye neDrugs (i-FDA, eUnited States) kunye ne-Arhente yeMithi yaseYurophu (EMA): *UNxibelelwano loKhuseleko lweDrug: Isixwayiso esiBoxed Contraindicting Codeine kunye neTramadol ye-Post-Tonsillectomy Pain Management kubantwana *.