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DIRECTED BY:DIRECTED BY: COMPLETEDBY:COMPLETEDBY:
DR.B.S.SHARMA MUKHTAR ALAMDR.B.S.SHARMA MUKHTAR ALAM
DR.ARTIMAL BAMS FIN...
PneumoniaPneumonia
Pneumonia is an inflammatory process which involves the lungPneumonia is an inflammatory process which ...
4.Immunological defense mechanism
Phagocytosis,Cell mediated and humoral
Entry of microorganismEntry of microorganism
Vaso...
Four stagesFour stages::
1.Stage of congestion1.Stage of congestion
Entry of bacteriaEntry of bacteria
VasodilationVasodil...
4.Stage of resolution4.Stage of resolution
Activation of macrophagesActivation of macrophages
Inflammation subsideInflamma...
ClassificationClassification
A. AnatomicalA. Anatomical
1. Lobar or lobular pneumonia-1. Lobar or lobular pneumonia- Chara...
Causative Agents in PneumoniaCausative Agents in Pneumonia
Infective Pneumonia
Bacterial
Atypical Pneumonia
Viral Pneumoni...
Difference between viral and bacterial pneumonia
Features Bacterial Pneumonia Viral Pneumonia
Onset Abrupt Gradual
Epidemi...
D.D. Based of ImmunityBased of Immunity
1. Primary Pneumonia-1. Primary Pneumonia- It is caused by organisms of high purul...
Types of Pneumonia Causative Agent
Community Acquired
- Typical
Atypical
S. Pneumoniae
H. Infleunzae
S. Aureus
Mycoplasma
...
Organisms Neonates 1 month to 5years Above 5 years
Bacteria Group B
Streptococci
E. Coli
Listeria
S. Aureus
S. pneumoniae
...
AETIOLOGYAETIOLOGY
The causative organism depends on the following factors-The causative organism depends on the following...
Common Organisms causing Pneumonia in ImmunoCommon Organisms causing Pneumonia in Immuno
compromised Children.compromised ...
Pre-Disposing FactorsPre-Disposing Factors
1.1. Age-below 6 monthsAge-below 6 months
2.2. Neonatal factors – preterm, low ...
Environmental FactorsEnvironmental Factors
1.1. OvercrowdingOvercrowding
2.2. Number of siblings (order of birth)Number of...
SignsSigns
1.1. TachypnoeaTachypnoea
2.2. Chest retractionChest retraction
3.3. Grunting and stridorGrunting and stridor
4...
InvestigationsInvestigations
1.Chest radiography- PA and lateral view1.Chest radiography- PA and lateral view
2.Total and ...
Indications for AdmissionIndications for Admission
1.1. Severe malnutritionSevere malnutrition
2.2. ImmunodeficiencyImmuno...
Supportive TreatmentSupportive Treatment
In mild cases it should be givenIn mild cases it should be given
AntihistaminicAn...
Management:Management:
1.Severe pneumonia1.Severe pneumonia
O2 inhalation ,Maintain good hydration, good nutrition with an...
General Protocol:General Protocol:
1.Luke warm water-shunthi/aadrak sidhh1.Luke warm water-shunthi/aadrak sidhh
2.Haldi,aa...
PreventionPrevention
1.Immunization1.Immunization
2.Health education to mother2.Health education to mother
3.Proper implem...
Typical PneumoniaTypical Pneumonia
It is also known as 'walking pneumonia'. The children with theseIt is also known as 'wa...
Radiological findings in various types of pneumoniaRadiological findings in various types of pneumonia
Radiological Change...
Classification of Pneumonia according WHOClassification of Pneumonia according WHO
Classification Clinical Features
No pro...
ComplicationsComplications
System Complications
1. Respiratory
Pulmonary Suppurative lung diseases & Collapse
Bronchiectas...
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BIBLIOGRAPHYBIBLIOGRAPHY
1.Kaumarbhritya –Prof.Devendranath Mishra1.Kaumarbhritya –Prof.Devendranath Mishra
Chowkhamba pub...
THANKSTHANKS
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Pneumonia

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Pneumonia

  1. 1. DIRECTED BY:DIRECTED BY: COMPLETEDBY:COMPLETEDBY: DR.B.S.SHARMA MUKHTAR ALAMDR.B.S.SHARMA MUKHTAR ALAM DR.ARTIMAL BAMS FINAL PROF.DR.ARTIMAL BAMS FINAL PROF. ROLL.NO.74411ROLL.NO.74411 2014-20152014-2015 .. Project on: Pneumonia
  2. 2. PneumoniaPneumonia Pneumonia is an inflammatory process which involves the lungPneumonia is an inflammatory process which involves the lung parenchyma.parenchyma. Pathogenesis:Pathogenesis: 1.Anatomical defense mechanism1.Anatomical defense mechanism Length of airways include nose,trachea,pharynxLength of airways include nose,trachea,pharynx 2.Mechanical defense mechanism2.Mechanical defense mechanism Cough,sneezingCough,sneezing 3.Chemical defense mechanism -Alfa 1 antitrypsin -Lactoferron -Lysozymes -Interferon
  3. 3. 4.Immunological defense mechanism Phagocytosis,Cell mediated and humoral Entry of microorganismEntry of microorganism VasodilationVasodilation Leads to outpouring of exudates or fluidsLeads to outpouring of exudates or fluids InflammationInflammation (proliferation of bacteria .toxins released which cause inflammation )(proliferation of bacteria .toxins released which cause inflammation ) PhagocytosisPhagocytosis MacrophagesMacrophages Clearance of bacteria debrisClearance of bacteria debris
  4. 4. Four stagesFour stages:: 1.Stage of congestion1.Stage of congestion Entry of bacteriaEntry of bacteria VasodilationVasodilation OutpouringOutpouring ProliferationProliferation 1-2 days upto onset1-2 days upto onset 2.Stage of Red hepatisation2.Stage of Red hepatisation Infilteration of polymorph,RBC,fibrinInfilteration of polymorph,RBC,fibrin 2-4 days after onset2-4 days after onset 3.Stage of Grey hepatisation3.Stage of Grey hepatisation Consolidation stageConsolidation stage Active phagocytosisActive phagocytosis 4-8 days4-8 days
  5. 5. 4.Stage of resolution4.Stage of resolution Activation of macrophagesActivation of macrophages Inflammation subsideInflammation subside Bacterial debris wash outBacterial debris wash out Estabilishing normal parenchyma of lungEstabilishing normal parenchyma of lung 8-9 days8-9 days Pneumonia results from-Pneumonia results from- 1.1. AspirationAspiration 2.2. Contiguous spread of virulent agents from upper airways.Contiguous spread of virulent agents from upper airways. 3.3. Secondary infection when there is disruption of protectiveSecondary infection when there is disruption of protective mechanism.mechanism. 4.4. Haematogenous spreadHaematogenous spread
  6. 6. ClassificationClassification A. AnatomicalA. Anatomical 1. Lobar or lobular pneumonia-1. Lobar or lobular pneumonia- Characterized by replacementCharacterized by replacement of alveolar air with cellular exudates.of alveolar air with cellular exudates. 2. Interstitial pneumonia-2. Interstitial pneumonia- Characterized by massive proliferationCharacterized by massive proliferation andand desquamation of alveolar cells.desquamation of alveolar cells. 3. Bronchopneumonia-3. Bronchopneumonia- Characterized by spreading inflammation ofCharacterized by spreading inflammation of the terminal bronchioles.the terminal bronchioles. 4. Multi lobar Pneumonia4. Multi lobar Pneumonia B. Based on duration of symptomsB. Based on duration of symptoms 1. Persistent pneumonia-1. Persistent pneumonia- persistence of symptoms andpersistence of symptoms and xx-- abnormalities for more than 4 weeks.abnormalities for more than 4 weeks. 2. Recurrent pneumonia-2. Recurrent pneumonia- two episodes of pneumonia in 1 year ortwo episodes of pneumonia in 1 year or more than three episodes at any time withmore than three episodes at any time with xx-ray clearance between two-ray clearance between two episodes of illness.episodes of illness. C. Based f Etiological factorsC. Based f Etiological factors 1.1. Infective-Infective- Pneumonia occurs as a result of invasion of lungs due toPneumonia occurs as a result of invasion of lungs due to micro-organisms such as bacteria and ruses.micro-organisms such as bacteria and ruses. 2.2. Non-infective-Non-infective- ChemicalChemical
  7. 7. Causative Agents in PneumoniaCausative Agents in Pneumonia Infective Pneumonia Bacterial Atypical Pneumonia Viral Pneumonia Etiological Agents Streptococcus pneumonia H. influenza Staphylococcus aureus M. Tuberculosis Chlamydia Mycoplasma Legionella Respiratory syncytial virus Para influenza virus Influenza virus Rhinovirus Adenovirus
  8. 8. Difference between viral and bacterial pneumonia Features Bacterial Pneumonia Viral Pneumonia Onset Abrupt Gradual Epidemic Not Seen Common Associated Conditions Infectionate other sites, Associated with URI, coryza septicemia Fever High grade May be absent Toxemia Common Absent Respiratory Distress Common Common in infants Lung signs Crackles ++ Wheeze ++ Chest x-ray Confluent infiltrates Diffuse in Peripheral areas Pleural involvement May be seen Not common Prognosis Complications such as Self-limiting, usually resolve in empyema, pneumatoidal about a week. Hyperinflation septicemia may be seen seen in RSV infection.
  9. 9. D.D. Based of ImmunityBased of Immunity 1. Primary Pneumonia-1. Primary Pneumonia- It is caused by organisms of high purulent andIt is caused by organisms of high purulent and as such, it even affects those with good immunity.as such, it even affects those with good immunity. 2. Secondary Pneumonia-2. Secondary Pneumonia- this occurs with organisms of lowthis occurs with organisms of low virulence. Either the immunity of host is diminished or somevirulence. Either the immunity of host is diminished or some predisposing factor is present such as aspiration.predisposing factor is present such as aspiration. E.E. Based on Source of InfectionBased on Source of Infection 1.1. Community acquired pneumonia-Community acquired pneumonia- is caused by organisms presentis caused by organisms present in the community in children who have not been hospitalized in thein the community in children who have not been hospitalized in the recent past.recent past. 2.2. Hospital acquired pneumonia-Hospital acquired pneumonia- is caused by organisms present inis caused by organisms present in hospital. It occurs after at least 48-72 hours of being admitted in thehospital. It occurs after at least 48-72 hours of being admitted in the hospital.hospital. 3.3. Opportunistic pneumonia-Opportunistic pneumonia- is seen in children with decreasedis seen in children with decreased immunity and is caused by organisms which usually do not causeimmunity and is caused by organisms which usually do not cause pneumonia.pneumonia.
  10. 10. Types of Pneumonia Causative Agent Community Acquired - Typical Atypical S. Pneumoniae H. Infleunzae S. Aureus Mycoplasma Chlamydia Legionella Hospital Acquired E. coli Proteins Klebsiella S. aureus Pseudomonas Opportunistic P. Carinii Cytomegalouirus (CMV) Varicella Zoster
  11. 11. Organisms Neonates 1 month to 5years Above 5 years Bacteria Group B Streptococci E. Coli Listeria S. Aureus S. pneumoniae S. aureus H. influenza Group A Streptococus Klebsiella Pseudomonas M. Tuberculosis S. Pneumonia S. Aureus H. Influenzae M. Tuberculosis Viruses CMV Herpes CMV RSV Influenza virus Adenovirus Influenza Virus Varicella Atypical Organisms Chlamydia Mycoplasma Mycoplasma Legionella Chlamydia
  12. 12. AETIOLOGYAETIOLOGY The causative organism depends on the following factors-The causative organism depends on the following factors- 1. Age1. Age 2. Congenital anomalies2. Congenital anomalies such as cleft palate and tracheo-such as cleft palate and tracheo- oesophageal fistula predispose to aspiration pneumonia by organismsoesophageal fistula predispose to aspiration pneumonia by organisms present in oral cavity.present in oral cavity. 3. Immunity status-3. Immunity status- Klabsiella infection is common isKlabsiella infection is common is immunocompromised children.immunocompromised children. 4. Underlying lung disease-4. Underlying lung disease- S. auceus, H. influenzae and P.S. auceus, H. influenzae and P. aeruginosa are the three most common organisms causing lungaeruginosa are the three most common organisms causing lung infections in cystic fibrosis patients.infections in cystic fibrosis patients. 5. H/o exposure to infection-5. H/o exposure to infection- When one of the family member isWhen one of the family member is infected with an organism, the possibility of the same infection in otherinfected with an organism, the possibility of the same infection in other child become more.child become more.
  13. 13. Common Organisms causing Pneumonia in ImmunoCommon Organisms causing Pneumonia in Immuno compromised Children.compromised Children. Protozoa Bacteria Viral Fungal P. Carinii Gram + ve - S. Pneumoniae - S. Aureus Gram – Ve - Klebsiella - Pseudomonas - H. influenza - Legionella CMV Varicella zoster Measles giant cell pneumonia RSV Hespes simplex HIV Candidiasis Aspergillus
  14. 14. Pre-Disposing FactorsPre-Disposing Factors 1.1. Age-below 6 monthsAge-below 6 months 2.2. Neonatal factors – preterm, low birth weight babies.Neonatal factors – preterm, low birth weight babies. 3.3. Congenital defects (may predispose to aspiration)- cleft palate, toCongenital defects (may predispose to aspiration)- cleft palate, to Fistula, ciliary dyskinesia.Fistula, ciliary dyskinesia. 4.4. Bad child hearing practices- bottles feeding, lack of breast-feeding.Bad child hearing practices- bottles feeding, lack of breast-feeding. 5.5. Nutritional factors- protein energy malnutrition vit. A deficiency (severe),Nutritional factors- protein energy malnutrition vit. A deficiency (severe), iron deficiency anemia, zinc deficiency and so on.iron deficiency anemia, zinc deficiency and so on. Systemic factorsSystemic factors Cardiovascular causes- congenital heart diseases, left to right shunts. Chronic lung diseases- asthma, cystic fibrosis Others- measles, diarrhoea, sinusitis, otitis media 7. Immunological status- immunosuppressed states 8. Malignancy 9. Iatrogenic – anesthesia 10. Trauma
  15. 15. Environmental FactorsEnvironmental Factors 1.1. OvercrowdingOvercrowding 2.2. Number of siblings (order of birth)Number of siblings (order of birth) 3.3. Indoor air pollutionIndoor air pollution 4.4. SanitationSanitation 5.5. Passive smokingPassive smoking 6.6. Educational statusEducational status Clinical FeaturesClinical Features SymptomsSymptoms 1.1. Fever with chillsFever with chills 2.2. Fast and difficult breathingFast and difficult breathing 3.3. CoughCough 4.4. Chest painChest pain 5.5. Abdominal painAbdominal pain 6.6. Poor feedingPoor feeding 7.7. IrritabilityIrritability 8.8. Excessive sleepinessExcessive sleepiness
  16. 16. SignsSigns 1.1. TachypnoeaTachypnoea 2.2. Chest retractionChest retraction 3.3. Grunting and stridorGrunting and stridor 4.4. Nasal flaringNasal flaring 5.5. CyanosisCyanosis 6.6. Dullness on percussionDullness on percussion 7.7. Diminished breath sounds, wheeze and crackles onDiminished breath sounds, wheeze and crackles on auscultationauscultation 8.8. May be associated with meningismus, paralytic ileus.May be associated with meningismus, paralytic ileus. 9.9. Right lower lobe pneumonia causes diaphragmatic irritationRight lower lobe pneumonia causes diaphragmatic irritation which may present as hiccoughswhich may present as hiccoughs
  17. 17. InvestigationsInvestigations 1.Chest radiography- PA and lateral view1.Chest radiography- PA and lateral view 2.Total and differential blood count, haemoglobin2.Total and differential blood count, haemoglobin 3.3. Tests to identify organismsTests to identify organisms (a)(a) Microscopic examination – gMicroscopic examination – g ram staining and AFB stainingram staining and AFB staining (b)(b) Serological tests for bacteria and virusesSerological tests for bacteria and viruses (c)(c) Urinary antigen tests for bacterial and viral antigensUrinary antigen tests for bacterial and viral antigens (d)(d) Rapid antigen detection tests such as direct fluorescent antibody testRapid antigen detection tests such as direct fluorescent antibody test (e)(e) Polymerase chain reaction for mycobacteriumPolymerase chain reaction for mycobacterium (f)(f) Culture studies in sputum and blood.Culture studies in sputum and blood. Specimens to identify the organisms are taken from nasopharyngealSpecimens to identify the organisms are taken from nasopharyngeal aspirate, the oat swab, bronchoalveolar lavage and lung aspirates.aspirate, the oat swab, bronchoalveolar lavage and lung aspirates.
  18. 18. Indications for AdmissionIndications for Admission 1.1. Severe malnutritionSevere malnutrition 2.2. ImmunodeficiencyImmunodeficiency 3.3. Severe anaemiaSevere anaemia 4.4. disseminated infection, septicemia and shockdisseminated infection, septicemia and shock 5.5. Drowsiness and altered senosoriumDrowsiness and altered senosorium 6.6. Decreased ODecreased O22 saturationsaturation 7.7. Leucopenia or leucocytosisLeucopenia or leucocytosis 8.8. Culture and sensitivity tests- result growth of staphylococcusCulture and sensitivity tests- result growth of staphylococcus aureusaureus
  19. 19. Supportive TreatmentSupportive Treatment In mild cases it should be givenIn mild cases it should be given AntihistaminicAntihistaminic AntipyreticAntipyretic Anti allergicAnti allergic There is no role in antibiotic in viralThere is no role in antibiotic in viral 1.1. OxygenOxygen 2.2. Intra venous fluidIntra venous fluid 3.3. Good nutritionGood nutrition 4.4. If fever is present then tepid sponging should be given ParacetamolIf fever is present then tepid sponging should be given Paracetamol will also be helpfulwill also be helpful 5.5. Predisposing factors should be avoidedPredisposing factors should be avoided 6.6. PhysiotherapyPhysiotherapy
  20. 20. Management:Management: 1.Severe pneumonia1.Severe pneumonia O2 inhalation ,Maintain good hydration, good nutrition with antibioticO2 inhalation ,Maintain good hydration, good nutrition with antibiotic therapytherapy 2.Viral pneumonia2.Viral pneumonia -vomiting (no antiemetics)-vomiting (no antiemetics) -loose motion (no intervention)-loose motion (no intervention) lathouh-lathouh- in case of feverin case of fever Anand bherav rasaAnand bherav rasa-in-in cace of loose motioncace of loose motion Laxmivilas rasaLaxmivilas rasa ––acute corhyzaacute corhyza Kafketu rasaKafketu rasa--productive corhyzaproductive corhyza RoutinelyRoutinely 1.Laxmivilas rasa ,Kafketu rasa1.Laxmivilas rasa ,Kafketu rasa 2.Vishan bhasm and shring bhasm –in2.Vishan bhasm and shring bhasm –in parshv shoolparshv shool 3.Kwath3.Kwath-Gojihvvadi,Panchkoiladi,Laookqe Sapista-Gojihvvadi,Panchkoiladi,Laookqe Sapista 4.Nasal decongestant4.Nasal decongestant-Ajvain fumes inhalation-Ajvain fumes inhalation 55..Talishadi churnaTalishadi churna
  21. 21. General Protocol:General Protocol: 1.Luke warm water-shunthi/aadrak sidhh1.Luke warm water-shunthi/aadrak sidhh 2.Haldi,aadrak,tulsi ptra,kalimirch-tea/kwath2.Haldi,aadrak,tulsi ptra,kalimirch-tea/kwath 3.Pind khajoor,adrak,pipli-chhir paka3.Pind khajoor,adrak,pipli-chhir paka 4.Local fomentation4.Local fomentation 3.Bacterial pneumonia3.Bacterial pneumonia 1.Makardhavaj/Rasasindoor1.Makardhavaj/Rasasindoor 2.Trilokya chintamani swaras not used in shirap awastha2.Trilokya chintamani swaras not used in shirap awastha 3.vrihat kasturi bherav rasa3.vrihat kasturi bherav rasa 4.bramhmi vati4.bramhmi vati 4.Severe stage convulsions4.Severe stage convulsions Mukta pishti,godanti-protect vital partsMukta pishti,godanti-protect vital parts Sitopladi churna-brinhan hetuSitopladi churna-brinhan hetu Balchaturbhadra churna-if diarrheaBalchaturbhadra churna-if diarrhea Kshir pak-Kshir pak- MunakkaMunakka Anjir,Kesar ,Shunthi,pipaliAnjir,Kesar ,Shunthi,pipali
  22. 22. PreventionPrevention 1.Immunization1.Immunization 2.Health education to mother2.Health education to mother 3.Proper implementation of ART Control programme3.Proper implementation of ART Control programme 4.High risk factors should be avoided4.High risk factors should be avoided Recurrent and Persistent PneumoniaRecurrent and Persistent Pneumonia Etiology of recurrent and persistent PneumoniaEtiology of recurrent and persistent Pneumonia Causes Conditions Congenital Infections CMV Non-infections Cleft palate To fistula Gastro-oesophageal reflux Sickle cell anaemia Acquired Infections Otitis media, sinusitis, bronchietasis, CMV infection Non-infections Recurrent aspiration foreign body aspiration Asthma
  23. 23. Typical PneumoniaTypical Pneumonia It is also known as 'walking pneumonia'. The children with theseIt is also known as 'walking pneumonia'. The children with these infections present with atypical symptoms.infections present with atypical symptoms. Features Typical pneumonia A typical pneumonia Causative organisms S. Pneumoniae S. dureus H. influenza M. Pneumonae Chlmyadia Pneumoniae Legionella Onset Sudden Gradual Age Any age Usually > 5 years, except chlamyetia which commonly occurs without first 6 months. Fever common may be present cough productive dry symptoms pulmonary systemic x-ray chest findings localised diffuse
  24. 24. Radiological findings in various types of pneumoniaRadiological findings in various types of pneumonia Radiological Changes Type of Pneumonia 1. Lobar involvement Pneumococcal pneumonia 2. Right middle lobe pneumonia Aspiration pneumonia 3. Upper lobe pneumonia, cavitations, bronchopneumonia with hilar lymphadenopathy Tuberculosis pneumonia 4. Lower lobe pneumonia Chemical pneumonia 5. Multiple abscesses staphylococcal / klebsiella pneumonia 6. Bilateral interstitial pneumonia Viral pneumonia 7. B/L interstitial pneumonia Pneumocystic carinric
  25. 25. Classification of Pneumonia according WHOClassification of Pneumonia according WHO Classification Clinical Features No proumonia Cough & No fast breathing No chest indrawing & Feeding well Pneumonia Cough & No chest in drawing & Able to drink Fast breathing Severe pneumonia Lower chest in drawing present & Able to drink Fast breathing & Other signs may be present – nasal flaring, grunting, cyanosis Very severe pneumonia Not able to drink & Cyanosis Striders in calm child severe respiratory distress or grunting lethargy, excessive drowsiness convulsions
  26. 26. ComplicationsComplications System Complications 1. Respiratory Pulmonary Suppurative lung diseases & Collapse Bronchiectasis Pleural Parapneumonic effusion & empyema Pneum othorax & Pyopneumothorax 2. Cardiovascular Acute circulatory failure due to bacteraemia Pericarditis & Endocarditis Miscellaneous Meningism & Shock due to bacteriaemia Multiorgan failure
  27. 27. mRQqfYydkmRQqfYydk mRQqfYydk 'kh"kZd ls O;kf/k&o.kZu ;ksxjRukdj esa fd;k x;kmRQqfYydk 'kh"kZd ls O;kf/k&o.kZu ;ksxjRukdj esa fd;k x;k gSA ;Fkk&gSA ;Fkk& vkèekuokrlEiqQYyh n{kdq{kkS f'k'kksHkZosr~AvkèekuokrlEiqQYyh n{kdq{kkS f'k'kksHkZosr~A mYQqfYydk lk fo[;krk 'okl'p;FkqlÄïmYQqfYydk lk fo[;krk 'okl'p;FkqlÄï°°ykAAykAA ¼;ks-j-ck-jks-fp-i`- 456½¼;ks-j-ck-jks-fp-i`- 456½  ckyd ds nkfgus dqf{k esa vkèeku gksdj ok;q ls lEQqYyckyd ds nkfgus dqf{k esa vkèeku gksdj ok;q ls lEQqYy ¼Qwyk ;k 'kksFk gks tkrk gS rFkk 'okl gks vkrk gS vkSj¼Qwyk ;k 'kksFk gks tkrk gS rFkk 'okl gks vkrk gS vkSj 'okluyh esa Hkh 'kksFk gks tkrk gSA bls mRQqfYydk O;kf/k'okluyh esa Hkh 'kksFk gks tkrk gSA bls mRQqfYydk O;kf/k dgrs gSaAdgrs gSaA  vk/kqfud vk;qosZn euhf"k;ksa us bl O;kf/k dks 'Pneumonia'vk/kqfud vk;qosZn euhf"k;ksa us bl O;kf/k dks 'Pneumonia' ds led{k ekuk gSA fo}kuksa esa ;ksxjRukdj ds iwoZ dsds led{k ekuk gSA fo}kuksa esa ;ksxjRukdj ds iwoZ ds xzUFkksa esa 'ys"eksYc.k fo"ke lfÂikrt Toj dh laKk nh gSAxzUFkksa esa 'ys"eksYc.k fo"ke lfÂikrt Toj dh laKk nh gSA vkpk;Z pjd us bl O;kf/k dh e;kZnk 12 fnu ¼p-fp-vkpk;Z pjd us bl O;kf/k dh e;kZnk 12 fnu ¼p-fp- 3@53&54½dh dgh gSA3@53&54½dh dgh gSA
  28. 28.  fpfdRlkn'kZ esa ia- jkts'oj nÙk 'kkL=h us blsfpfdRlkn'kZ esa ia- jkts'oj nÙk 'kkL=h us bls okr&'ys"eksYc.k lfÂikr Toj ;k 'olud Toj dh laKk nh gSAokr&'ys"eksYc.k lfÂikr Toj ;k 'olud Toj dh laKk nh gSA ckyxzgksa esa fir`xzg ds y{k.kksa dk vR;f/d lkeatL;ckyxzgksa esa fir`xzg ds y{k.kksa dk vR;f/d lkeatL; U;qeksfu;k ds y{k.kksa ls feyrk gSA ;fn le; ij mfpr mipkj uU;qeksfu;k ds y{k.kksa ls feyrk gSA ;fn le; ij mfpr mipkj u fd;k tk; rks 'kS'koh; e`R;q dk dkj.k Hkh curk gSAfd;k tk; rks 'kS'koh; e`R;q dk dkj.k Hkh curk gSA  okr'ys"eksYc.k lfuikr Toj esa ia- jkts'oj nÙk 'kkL=kh th usokr'ys"eksYc.k lfuikr Toj esa ia- jkts'oj nÙk 'kkL=kh th us fuEu fpfdRlk dgh g kfuEu fpfdRlk dgh g k 1- f=HkqoudhfrZ] J`axjkHkz J`axHkLe] 'k)q ujlkj ,oa jlflUnwj1- f=HkqoudhfrZ] J`axjkHkz J`axHkLe] 'k)q ujlkj ,oa jlflUnwj dk ;ksx o;kuqlkj cukdj fnu esa 6 ckj iku] lsagq.Mi=&Lojldk ;ksx o;kuqlkj cukdj fnu esa 6 ckj iku] lsagq.Mi=&Lojl rFkk e/qk ls nsaArFkk e/qk ls nsaA 2-2- 'oklÑPNª gksus ij lkSHkkX; oVh] 'okldklfpUrkef.k]'oklÑPNª gksus ij lkSHkkX; oVh] 'okldklfpUrkef.k] eYypUnzksn; J`axHkLe dk ;ksx fnu esa 6 ckjeYypUnzksn; J`axHkLe dk ;ksx fnu esa 6 ckj dkdM+kJ`axh ,oa eqysBh pw.kZ ls rFkk e/qk ls nsaAdkdM+kJ`axh ,oa eqysBh pw.kZ ls rFkk e/qk ls nsaA 3-3- dSjkrkfn DokFk dk iz;ksx djsaAdSjkrkfn DokFk dk iz;ksx djsaA 4-4- fiIiY;fn pw.kZ ¼;ks-j-½ Vad.kkfn ;ksx ¼fl-Hks-e-ek-½]fiIiY;fn pw.kZ ¼;ks-j-½ Vad.kkfn ;ksx ¼fl-Hks-e-ek-½] fgaXkqykfn oVh dk iz;ksx mRQqfYydk esa fd;k tk;AfgaXkqykfn oVh dk iz;ksx mRQqfYydk esa fd;k tk;A
  29. 29. mYQqfYydk dh 'kkL=kh; fpfdRlkmYQqfYydk dh 'kkL=kh; fpfdRlk f'k'kq dh fpfdRlkf'k'kq dh fpfdRlk ^fu% lkj;sTtykSdkHkh jDra p tBjkÙknk*^fu% lkj;sTtykSdkHkh jDra p tBjkÙknk* 1 f'k'kq ds mnj esa tykSdk yxkdj jDreks{k.k djsaA1 f'k'kq ds mnj esa tykSdk yxkdj jDreks{k.k djsaA 2 ckyd ds mnj ij vfXu ls Losnu djsaA2 ckyd ds mnj ij vfXu ls Losnu djsaA (hast sweda upto 6(hast sweda upto 6 months)months) ekrk dh fpfdRlkekrk dh fpfdRlk 11 LrU; 'kks/kuLrU; 'kks/ku ddksZV] 'kq.Bh] eqLrk] dadksy ,oa vfrfo"kk leHkkx ysdjddksZV] 'kq.Bh] eqLrk] dadksy ,oa vfrfo"kk leHkkx ysdj pw.kZ dj nw/k ds vuqiku ls ekrk ;k ?kk=h dks fiykdj nw/kpw.kZ dj nw/k ds vuqiku ls ekrk ;k ?kk=h dks fiykdj nw/k dks 'kq) dj nsaAdks 'kq) dj nsaA vfXuuk Losn;s}kvfXuuk Losn;s}kvvfi nkg;sPp 'kykd;kAfi nkg;sPp 'kykd;kA tBsj fcUnqdkdkja i`"BHkkxs ;Fkk /qzoea~AAtBsj fcUnqdkdkja i`"BHkkxs ;Fkk /qzoea~AA 2 ckyd ds mnj ij vfXu ls Losnu djsa ;k mnj ij vkSj ihB ij2 ckyd ds mnj ij vfXu ls Losnu djsa ;k mnj ij vkSj ihB ij 'kykdk dj fcUnq ds vkdkj dk nkg djsaA'kykdk dj fcUnq ds vkdkj dk nkg djsaA
  30. 30. vkH;Urj iz;qDr vkS"kf/k;k¡vkH;Urj iz;qDr vkS"kf/k;k¡ 1-1- fcYoewykfn DokFkfcYoewykfn DokFk fcYoewyda uhjnks o`dh f=Qyka rFkkfcYoewyda uhjnks o`dh f=Qyka rFkk flafgdk};e~flafgdk};e~ xkSMfefJra DofFkra lea ik;sfPN'kqaxkSMfefJra DofFkra lea ik;sfPN'kqa QqfYydkige~AAQqfYydkige~AA fcYoewykfn DokFk& fcYoewy] eqLrk] ikBk] f=QykfcYoewykfn DokFk& fcYoewy] eqLrk] ikBk] f=Qyk rFkk dVsjh}; leHkkx dk DokFk cukdj leHkkx xqM+rFkk dVsjh}; leHkkx dk DokFk cukdj leHkkx xqM+ dk e| feykdj f'k'kq dks ;Fkkek=k fiykus ls QqfYydkdk e| feykdj f'k'kq dks ;Fkkek=k fiykus ls QqfYydk O;kf/k Bhd gksrh gSaAO;kf/k Bhd gksrh gSaA 2-2- fiIiY;kfn pw.kZfiIiY;kfn pw.kZ fiIiyh] fiIiyhewy] xtfiIiyh] 'kq.Bh] =k;ek.k] nk:gfjnzk]fiIiyh] fiIiyhewy] xtfiIiyh] 'kq.Bh] =k;ek.k] nk:gfjnzk] HkkxõhZ] yox ] 'kq-Vad.k] ?k`rdqekjh] gjhrdh oHkkxõhZ] yox ] 'kq-Vad.k] ?k`rdqekjh] gjhrdh o
  31. 31. BIBLIOGRAPHYBIBLIOGRAPHY 1.Kaumarbhritya –Prof.Devendranath Mishra1.Kaumarbhritya –Prof.Devendranath Mishra Chowkhamba publicationChowkhamba publication 2.Bailey and Love – A short text book of Surgery2.Bailey and Love – A short text book of Surgery 3.Human Anatomy – B.D.Chaurasia3.Human Anatomy – B.D.Chaurasia 4.Human Physiology – Prof.A.K.Jain4.Human Physiology – Prof.A.K.Jain 5.Hutchison’s Clinical Methods5.Hutchison’s Clinical Methods 6.A Text Book Of pathology – William Boyd6.A Text Book Of pathology – William Boyd 7.WWW.GOOGLE.COM7.WWW.GOOGLE.COM 8.Meharban Singh paediatrics8.Meharban Singh paediatrics 9. OP Ghai Textbook of pediatrics9. OP Ghai Textbook of pediatrics 10.Medsape10.Medsape 11.11. ¼;ks-j-ck-jks-fp-i`- 456½¼;ks-j-ck-jks-fp-i`- 456½ 12.12. ¼p-fp- 3@53&54½¼p-fp- 3@53&54½
  32. 32. THANKSTHANKS

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