himdah

frostbite hii tvachechi eka dukhapat aahe jee atyant qamee tapmanachya samparkat aalyavar hote, jyamule tvacha kinwa itar ootee gothatat, samanyatah bote, payachi bote, naak, qaan, gaal aanee hanuvatichya bhagavar parinam hoto. bahutek vela, haat aanee payanmadhye himdah hoto. suruvatichi lakshane samanyatah sardi aanee kalakal kinwa sunn hone hii asatat. yanantar tvachevar pandhara kinwa nila rung asalelya anakalaniyapanachi sthitee udbhavu shakate. upcharanantar sooj kinwa phood yeu shakatat. guntaguntinmadhye hypothermia kinwa compartment syndromecha samavesh asoo shakato.
jeey lock dirghkal qamee tapmanachya samparkat asatat, jase qee hiwali creeda utsahi, lashkari karmchari aanee beghar vyakti, tyanna sarvat jaast dhoka asato. itar jokhamichya ghatakanmadhye madyapan, dhoomrapan, mansik aarogyachya samasya, kahee aushadhe aanee sardimule purvi jhalelya dukhapatincha samavesh hoto. yaa antarnihit yantranet barfatil sfatikanmule dukhapat aanee vitalalyanantar lahan raktavahinyanmadhye raktachya guthalya hone samavisht aahe. nidan heey lakshananvar aadharit asate. tivrata varvarchi (pahili aanee dusari degree) kinwa khol (tisari aanee chauthi degree) ashee vibhagali jaau shakate. hadanche scan kinwa emm. aar. aay. dukhapatichi vyapti nirdharit karnyat madat karoo shakate.
pratibandhamadhye yogya, purnapane jhakalele kapade ghalane, qamee tapman aanee vaara talhane, jalsanchayan aanee poshan rakhane aanee thakwa naan yeta mukhya tapman rakhanyasathi pureshi sharirik halchal karane yancha samavesh hoto. punha garam karoon, ubdar panyat (sharirachya tapmanachya jawal) visarjit karoon kinwa sharirachya samparkat yeuun upchar kele jaatat aanee jevha tapman satatyapurn thewale jaau shakate tevhach kele pahije jenekarun punha gothan honyacha dhoka nahee. jalad garam karane kinwa thund karane talhale pahije kaaran yamule jaljal kinwa hriday tanav houu shakato. prabhavit bhagavar ghasane kinwa jorane lavane talhale pahije kaaran tyamule gharshanasarkhe aanakhi nuksan houu shakate. vedna qamee karnyasathi kinwa sooj kinwa jaljal qamee karnyasathi ibuprofen aanee tetanus toxoidcha vapar karanyachi shifaras kelee jaate. gambhir dukhapatinsathi, eloprost kinwa thrombolyticscha vapar keela jaau shakato. kadhikadhi shastrakriya aavashyak asate. dukhapatichi vyapti kayamswarupi nuksan aahe qee nahee yacha vichar karnyasathi aanee tyamule kathor upcharanchi aavashyakta aahe yacha vichar karnyasathi, sansarganantar kahee mahinyanni angvichedan vicharat ghetale pahije.
lokanmadhye himdahadarmyan himdahancha purava 5,000 varshe juna aahe. andicemadhye sapadalelya purv-columbian mamimadhye puravyache dastaivajikaran karnyat aale hote. himdah jhalelya prakarananchi sankhya adnyat aahe. giryarohakanmadhye darr varshala 40 takkyanparyant asoo shakatat. 30 teey 50 varshe vayogatatil lock sarvat samanyapane prabhavit hotat. anek lashkari sangharshanmadhyehi himdahane mahattvachi bhoomika bajavali aahe. yaa sthitiche pahile aupcharik varnan 1813 madhye nepoliyanchya sainyatil doctor dominiq jeane larry yanni russiachya aakramanadarmyan kele hote.
chinhe aanee lakshane.
samanyatah prabhavit himdahadarmyan bhaganmadhye gaal, qaan, naak aanee bote aanee bote yancha samavesh hoto. himdah honyapurvi anekada himdah hoto. dirghkal sardichya samparkat rahilyane himdah honyachi lakshane vadhatat. aitihasikdrushtya, bernschya vargikarananpramanech, himdah heey tvacha aanee sanvedana badalannusar anshanusar vargikrut kele gele aahe. tathapi, hii matra dirghakalin nukasanichya pramanashi julat nahee. yaa vargikaran pranaliche saralikaran varvarche (pratham kinwa dviteey shreni) kinwa khol dukhapat (truteey kinwa chaturth shreni) aahe.
karane.
jokhim ghatak.
bhoogol, vyavasay aanee/kinwa karamanukidware thandichya samparkat yene haah himdahasathicha pramukh jokhim ghatak aahe. apuri vastre aanee niwara heey jokhamiche pramukh ghatak aahet. jevha sharirachi ushnata nirman karanyachi kinwa tikavoon thevanyachi kshamata qamee hote tevha himdah honyachi shakyata jaast asate. sharirik, vartanukiche aanee paryavaraniy ghatak heey serve himdah vadhanyas hatbhar lavu shakatat. sthairya aanee sharirik taana (jase qee kuposhan kinwa nirjalikaran) heey dekhil jokhamiche ghatak aahet. madhumeh, reynoudchi ghatana, tambakhu aanee alcoholcha vapar yasah rakt parisancharan bighadavanare vikar aanee padarth yogdan detat. beghar vyakti aanee kahee mansik aajaar asalelya vyaktinna jaast dhoka asoo shakato.
yantrana.
sheet.
himdahamadhye, sharirachya thund honyamule raktavahinya sankuchit hotat (vasoconstriction). khalchya tapmanachya dirghkal samparkat rahilyane uutinmadhye barfache sphatik tayar houu shakate aanee khalchya tapmanachya dirghkal samparkat rahilyane raktat barfache sphatik tayar houu shakate. barfache sphatik dukhapat jhalelya thikani lahan raktavahinyanna haanee pohochavu shakatat. samanyatah, qamee tapmanachya dirghkal samparkat rahilyane himdah houu shakato.
punha taap.
punha tapman vadhalyane referfusion dukhapatimule uutinche nuksan hote, jyamadhye vasodilation, sooj (sooj) aanee kharab rakt pravah (sthairya) yancha samavesh asato. platelet ektrikaran hii dukhapatichi aanakhi eka sambhavya yantrana aahe. punha taplyanantar raktavahinyanche phood aanee aakadi (vasospasm) vikasit houu shakatat.
gothan naan honari sardichi dukhapat.
himdah prakriya hii gothan nasalelya sardichya dukhapatichya (aine. eff. see. aay.) prakriyepeksha vegali asate. aine. eff. see. aay. madhye, uutinmadhil tapman haloohaloo qamee hote. yaa mand tapmanatil ghatmule sharirala raktavahinya bund karnyachya aanee ughadanyachya (vasoconstriction aanee vasodilation) paryayi chakrandware bharpai karnyacha prayatna karata yeto. hii prakriya suru rahilyas, dahak mast peshi tyaa bhagat karya karatat. lahan guthalya (microthromby) tayar hotat aanee prabhavit bhagat rakt (ischemia mhanoon olakhale jaate) kapoon takoo shakatat aanee majjatantunchya tantunche nuksan karoo shakatat. punha tapman vadhalyane prostaglandinsarkhya dahak rasayananchi malika tayar hote jyamule sthanik guthalya vadhatat.
pathophysiology.
jyaa rogshastriy yantranedvare himdahamule shariratil uutinna dukhapat hote, tee chaar tappyandvare darshavili jaau shakateh purv-gothvan, gothvan-vitalane, raktavahinyansambandhi sthairya aanee usheera ischemic tappa.
nidan.
varr varnan kelyapramane chinhe aanee lakshananvar aanee rugnachya itihasavar aadharit himdahche nidan kele jaate. samaan samaan kinwa ekach velee udbhavu udbhavu itar paristhitinmadhye khaleel goshtincha samavesh hotoh
hypothermia asalelya lokanna anekada himdah dekhil hoto. hypothermia haah jivghena asalyane pratham yavar upchar kele pahijet. nidanasathi technitium-99 kinwa emm. aar. scanchi aavashyakta nasate, parantu teey purvasuchanatmak karanansathi upayukt tharoo shakatat.
pratibandh.
jangalatil vaidyakeey sanstha tvacha aanee talhu jhakane, purese poshan ghene, kadak padatrane aanee kapade talhane aanee thakwa naan aanata sakriy rahanyachi shifaras karate. purak auxigen dekhil unchavar upayukt tharoo shakato. thund panyachya varanvar samparkat aalyane lokanna himdah honyachi shakyata jaast asate. himdah rokhanyasathichya atirikt upayayojananmadhye khaleel goshtincha samavesh hotoh
upchar.
himdah kinwa sambhavya himdah asalelya vyaktinni sanrakshit vatavaranat jaaun ubdar dravpadarth ghetale pahijet. jarr punha gothanyacha dhoka nasel, tarr sathidarachya mandee kinwa aateel hatamadhye toke ughadpane aanee garam kele jaau shakate. jarr tyaa bhagala punha gothavoo dile tarr uutinche adhik nuksan houu shakate. jarr kshetra vishvasarhpane ubdar thevata yet nasel, tarr tyaa vyaktila tyaa bhagala punha garam naan karata vaidyakeey suvidhet aanale pahije. prabhavit bhag cholalyane uutinche nuksan dekhil vadhu shakate. guthalya aanee jaljal talhanyasathi espirin aanee ibuprofen shetat dile jaau shakatat. espirinpeksha ibuprofenla anekada pradhanya dile jaate kaaran dukhapati durust karnyasathi mahatvache asalelya prostaglandinschya upasanchala espirin avarodhit karoo shakate.
sheetdah asalelya lokanmadhye hypothermia aanee sardichya samparkat yenyachya itar jivghenya guntaguntinche moolyankan karane heey pahile pradhanya asale pahije. himdahavar upchar karnyapurvi, mukhya tapman 35°seey. peksha jaast vadhavale pahije. tondawate kinwa antahshira (4) dravpadarth dile pahijet.
pramanit rugnalay vyavasthapanasathi itar babinmadhye khaleel babincha samavesh hotoh
punha taap.
jarr too bhag ajunahi anshatah kinwa purnapane gothalela asel, tarr too rugnalayat povidon iodine kinwa chlorhexidine antiseptics ubdar snan karoon punha garam keela pahije. sakriy rewarmingmule jakhami ootee jalat naan jaata shakya titkya lavkar garam hotat. ootee jitkya lavkar vitalatat, titkya qamee uutinche nuksan hote. handford aanee tyanchya tyanchya matey, "jangalatil vaidyakeey sanstha aanee alaska sheet dukhapatichya sthitichi margdarshak tattve 37-39 sase. tapmanachi shifaras karatat, jyamule rugnala anubhavanari vedna qamee hote aanee punha tapanyacha vel kinchit qamee hoto."tapman vadhanyas 15 minite teey 1 taas lagato. nall chaloo thewala pahije jenekarun paanee pasaru shakel. punha taap yene khoop vednadayak asoo shakate, mhanoon vedna vyavasthapan mahatvache aahe.
aushadhe.
mothya angvichedan honyachi shakyata asalelya aanee dukhapatichya 24 tasanchya aat upasthit asalelya lokanna heparines tii. pii. aii. dile jaau shakate. kahee matbhed asalyas hii aushadhe rokhali pahijet. nukasaniche moolyankan karnyasathi hadanche scan kinwa seaty angiography kelee jaau shakate.
eloprostsarkhi raktavahinya pasaravanari aushadhe raktavahinyanmadhye adthala aanoo shakatat. jevha lokanna 48 tasanchya aat upchar midatat, tevha haah upchar 2 teey 4 yaa shrenitil himdahamadhye yogya tharoo shakato. vasodilators vyatirikt, himdahadarmyan himdahadarmyan hanikarak paridhiy vasoconstruction pratikar karnyasathi sahanubhootipurn aushadhancha vapar keela jaau shakato.
eka paddhatshir punaravalokan aanee meta-vishleshanatun asey disun aale aahe qee ekte eloprost kinwa eloprost adhik punarsanyojit ootee plasminogen sakriyak (aar. tii. pii. aii.) heey gambhir himdah jhalyas, ekte buflomedilchya tulanet vichhedan darr qamee karoo shakate, jyat samavisht abhyasanmadhye eloprost kinwa eloprost adhik aar. tii. pii. aii. pasoon konatyahi mothya pratikool ghatananchi nond jhaleli nahee.
shastrakriya.
himdahamule jhalelya dukhapatimadhye, hanicha prakar aanee vyapti yavar avalambun vividh prakarchya shastrakriyanche sanket dile jaau shakatat. gangreen kinwa pranaligat sansarg (sepsis) asalyashivay necrotic uutinche vighatan kinwa angachhedan sahasa vilambit hote. yamule 'jaanevarit gothale, julaimadhye angachhed qaraa' hii mhan prachalit jhaali aahe. jarr compartment syndromechi lakshane vikasit jhaali tarr rakt pravah rakhanyacha prayatna karnyasathi faciotomy kelee jaau shakate.
purvasoochana.
uutinche nuksan aanee svayanchalit apapravartan heey himdah honyache sambhavya parinam aahet. bhavna qamee honyasah majjatantunche kayamswarupi nuksan houu shakate. uutinche konate bhag tikoon rahtil heey jaanun ghenyasathi anek aathvade lagoo shakatat. sardichya samparkat yenyachi vel hii tyaa vyaktichya samparkat aalelya tapmanapeksha kayamswarupi dukhapaticha adhik andaj lavnari asate. prarambhik punarushnatesathi uutinchya pratisadavar aadharit shrenichi vargikaran pranali aanee itar ghatak dirghakalin punarpraptichya pramanacha andaj lavnyasathi tayar kele aahet.
shreni.
shreni 1: jarr tyaa bhagavar prarambhik jakham nasel, tarr angvichedan kinwa kayamswarupi parinam apekshit naheet
shreni 2: jarr sharirachya durchya bhagavar jakham asel tarr ootee aanee botanchi nakhe nasht kelee jaau shakatat
shreni 3: jarr madhyavarti kinwa sharirachya jawalil bhagavar jakham asel tarr swatahun vaadh aanee karyat ghat houu shakate
grade 4: jarr sharirachya agadi jawal jakham asel (jase qee hatache carple), tarr avyav nasht houu shakato. sepsis aanee/kinwa itar pranaligat samasya apekshit aahet.
himdahanantar anek dirghakalin sequel udbhavu shakatat. yamadhye sanvedanatil kshanik kinwa kayamswarupi badal, paresthesia, gham yene, karkarog aanee prabhavit bhagatil hadey nasht hone/sandhivat yancha samavesh hoto.
mahamarishastra.
himdah rogachya mahamarishastrabaddal sarvasamaveshak aakadevaricha abhav aahe. united statesmadhye, uttarekadil rajyanmadhye himdah adhik samanya aahe. finlandmadhye, montriyalmadhye prati 100,000 madhye 3.2 chya tulanet nagarikanmadhye varshik ghatana prati 100,000 madhye 2.5 hotee. sanshodhan asey suchavate qee 30-49 vayogatatil purushanna sarvadhik dhoka asato, bahudha vyavsayik kinwa manoranjanatmak sardimule.
itihas.
lashkari itihasat sahasrabdipasun himdah jhalyache varnan kele gele aahe. greekanna ii. sha. puu. 400 chya suruvatilach himdah samasyecha samna karava lagla aanee tyavar charcha karavi lagali. sanshodhakanna andian mamimadhye 5,000 varshanpurvichya manavanmadhye himdah jhalyache purave sapadale aahet. 1800 chya dashakachya suruvatila nepolianche sainya heey mothya pramanat sardine jhalelya dukhapatiche pahile dastaivajikaran kelele udaharan hote. zaffrenchya matey, pahilya aanee aanee mahayuddhat aanee corian yuddhat sumare 10 laakh ladhvayye himdahala balee padale.
samaj aanee sanskruti.
himdahanchya anek ullekhaneey prakarananmadhye khaleel goshtincha samavesh hotoh 
sanshodhan disha.
hyperberric auxigen therapy hii eka sahayak upchar mhanoon ootee vachavanyat madat karoo shakate qee nahee heey nirdharit karnyasathi purave apure aahet. prakarane nondavali gelee aahet, parantu manavanvar konatihi yadruchchik niyantran chachani kelee gelee nahee.
antahshira resurpine vaparoon vaidyakeey sahanubhootipoorv shastrakriya karnyacha prayatna dekhil maryadit yashasah keela gela aahe. abhyasanni asey suchavale aahe qee tissue plasminogen activator (tii. pii. aii.) ektar shiranmadhye kinwa shiranmadhye dilyane angvichedan karanyachi shakyata qamee houu shakate.

