Pengaruh Laktat,Base Defisit, Hipotensi Sistolik Pada Trauma Tumpul Abdomen

7/23/2019 Pengaruh Laktat,Base Defisit, Hipotensi Sistolik Pada Trauma Tumpul Abdomen

http://slidepdf.com/reader/full/pengaruh-laktatbase-defisit-hipotensi-sistolik-pada-trauma-tumpul-abdomen 1/39

1

NAN J

UGIKAMWHWAI

1)1 Ha{a~ Nghalaib Ugighj{jai

Kj Acg~jla {~awca cg~wualai ugizgnan lg ; {g~ngta~ ka~j lgca{jai kai

ugizgnan lgca{jai {g~naizal uaka wtja kj naram ;7 {amwi( hgnjm ka~j tg{gibam

uaka {~awca zaib cgizgnanlai lgca{jai kjtgnanlai la~gia lgdghalaai

lgika~aai ng~c`{`~ ( ugizgnan zaib hajiiza tgug~{j oa{wm ka~j lg{jibbjai ( hwla

{gcnal a{aw hwla {gcnwt ( lg~adwiai ( hwla nala~ kai {gibbghac) [~awca

ank`cgi kaua{ ng~wua {~awca {wcuwh kai {~awca {aoac )1

Kjabi`tjt zaib dgua{ {g~oakjiza ug~ka~amai ji{~ank`cgi uaka {~awca

{wcuwh ank`cgi akaham mah gtgitjah wi{wl cgcjijcahjtj~ c`~njkj{at a{awuwi

c`~{ahj{at( ;5 ' lgca{jai aljna{ {~awca ank`cgi kjtgnanlai `hgm {~awca {wcuwh

ank`cgi zaib kjtgnanlai lgdghalaai hahw hji{at iacwi tgngia~iza maiza 17 — >5

' kgibai {~awca {wcuwh ank`cgi zaib cgcg~hwlai ji{g~vgitj ùg~a{jf )1(>

Laka~ hal{a{ tg~wc kaua{ kjualaj tgnabaj ua~acg{g~ ug~fwtj oa~jibai uaka

latwt#latwt {g~{gi{w( namlai kjualaj tgnabaj u~gkjltj c`~{ahj{at uatjgi kgibai

tgutjt kai {~awca ng~a{) Cgiw~w{ matjh t{wkj zaib kjhalwlai `hgm D`dm~ai kll (

kjkaua{lai matjh laka~ hal{a{ tg~wc jijtjah cgijibla{ uaka uatjgi {~awca

ank`cgi zaib cgijibbah) Kj tacujib j{w( t{wkj {g~tgnw{ cgiza{alai namra

ugijibla{ai laka~ hal{a{ tg~wc tghaca ;= oac ug~{aca cg~wualai fal{`~ ~jtjl`

c`~{ahj{at)>(7



>

Natg kgfjdj{ cg~wualai ua~acg{g~ cg{an`hjl zaib taiba{ tgitj{jf kjbwialai

tgnabaj jikjla{`~ {g~oakjiza lgmjhaibai ka~am kgibai cghahwj ugibwlw~ai ug~fwtj

oa~jibai( Ugijibla{ai natg kgfjdj{ jij kaua{ {g~oakj uahjib arah tgoal njha {g~oakj

tz`l mgc`~abjl) Kaj~` cgclhatjfjlatjlai natg kgfjdj{ jij lg kahac 4 la{gb`~j?

Cjhk -#4 t/k #7*( C`kg~a{g -#6 t/k #:* kai Tgvg~g -8#15* kjcaia ugiblhatjfjlatjai

kaua{ cgiwiowlai l`~ghatj zaib lwa{ kgibai lgnw{wmai {~aifwtj( lgbabahai `~bai

kai lgca{jai) Iacwi ugighj{jai zaib cgibbanwiblai lg{jba ua~acg{g~

cgidalwu laka~ hal{a{( natg kgfjdj{ kai mju`{gitj tjt{`hjl uaka uatjgi kgibai

ug~ka~amai ji{~a#ank`cgi {~awca {wcuwh ank`cgi nghwc ug~iam kjhalwlai

tgnghwciza);

Ng~kata~lai w~ajai {g~tgnw{( ugiwhjt {g~{a~jl wi{wl cgighj{j hgnjm haiow{

cgibgiaj ugiba~wm laka~ hal{a{ tg~wc( natg kgfjdj{ ( kai mju`{gitj tjt{`hjl

{g~makau {jibla{ c`~{ahj{at uaka latwt ug~ka~amai ji{~a#ank`cgi aljna{ {~awca

{wcuwh ank`cgi zaib kj~ara{ kj ^TWU K~) Matai Takjlji)

1)> ^wcwtai Cataham

Nabajcaia ugiba~wm laka~ hal{a{ tg~wc( natg kgfjtj{ ( kai mju`{gitj tjt{`hjl

kgibai aibla c`~{ahj{at uaka uatjgi kgibai ug~ka~amai ji{~a#ank`cgi

aljna{ {~awca {wcuwh ank`cgi zaib kj~ara{ kj ^TWU K~) Matai Takjlji

ug~j`kg 1 Oaiwa~j >511 — 41 Kgtgcng~ >511)



4

1)4 [wowai Ugighj{jai

Cgibg{amwj ugiba~wm laka~ hal{a{ tg~wc( natg kgfjtj{ ( kai mju`{gitj tjt{`hjl




1); Lgbwiaai Ugighj{jai

1);)1 Lgbwiaai Jhcjam

Cgibg{amwj ugiba~wm laka~ hal{a{ tg~wc ( natg kgfjtj{ ( kai mju`{gitj tjt{`hjl




1);)> Lgbwiaai U~al{jt

Laka~ hal{a{ tg~wc( natg kgfjdj{( kai mju`{gitj tjt{`hjl kaua{ kjualaj tgnabaj

taham ta{w uaikwai wi{wl cgijhaj u~`bi`tjt uaka uatjgi {~awca {wcuwh

ank`cgi)



;

NAN JJ

LAOJAI UWT[ALA( LGÂIBLA UGCJLJÂI KAI MJU@[GTJT

>)1 Laojai Uwt{ala

>)1)1 Ugikamwhwai

Kj Acg~jla {~awca cg~wualai ugizgnan lg ; {g~ngta~ ka~j

lgca{jai kai ugizgnan lgca{jai {g~naizal uaka wtja kj naram ;7 {amwi(

hgnjm ka~j tg{gibam uaka {~awca zaib cgizgnanlai lgca{jai kjtgnanlai

la~gia lgdghalaai lgika~aai ng~c`{`~ ( ugizgnan zaib hajiiza tgug~{j

oa{wm ka~j lg{jibbjai ( hwla {gcnal a{aw hwla {gcnwt ( lg~adwiai ( hwla

nala~ kai {gibbghac) [~awca ank`cgi kaua{ ng~wua {~awca {wcuwh kai

{~awca {aoac) [~awca ank`cjiùghvjl cg~wualai nabjai {g~ngta~ ka~j

ugizgnan lgca{jai kai ugizgnan lgca{jai zaib njta kjdgbam)1

Kjabi`tjt zaib dgua{ {g~oakjiza ug~ka~amai ji{~a#ank`cgi uaka

{~awca {wcuwh ank`cgi akaham mah gtgitjah wi{wl cgcjijcahjtj~

c`~njkj{at a{awuwi c`~{ahj{at( ;5 ' lgca{jai aljna{ {~awca ank`cgi

kjtgnanlai `hgm {~awca {wcuwh ank`cgi zaib kjtgnanlai lgdghalaai hahw

hji{at iacwi tgngia~iza maiza 17 — >5 ' kgibai {~awca {wcuwh

ank`cgi zaib cgcg~hwlai ji{g~vgitj ̀ ug~a{jf )1(>

Cglaijtcg {~awca ( h`latj dgkg~a kai t{a{wt mgc`kjiacjl uatjgi

cgigi{wlai ugikgla{ai kjabi`t{jl kai ral{w ugijhajai {~awca ank`cgi)

[~awca {gcnwt ank`cgi hgnjm oghat kahac u~gtgi{atjiza ( tgmjibba



7

kjabi`tjtiza hgnjm cwkam kai cgcuwizaj lgcwibljiai zaib ngta~

{g~oakj dgkg~a ji{~a#ank`cgi) Tgnahjliza {~awca {wcuwh ank`cgi

njataiza {g~oakj ng~tacaai kgibai {~awca cwh{j tjt{gc ( tgmjibba

kjabi`tjtiza hgnjm l`cuhglt kai cgiai{aib) Kjtacujib ugcg~jltaai

fjtjl( c`kahj{at kjabi`t{jl w{aca zaib kaua{ kjbwialai akaham ?kjabi`t{jd

ug~j{ìgah havabg -KUH*( d`cuw{gk {`c`b~aumz -D[*( wh{~atì`b~aumz

-WTB*( kai haua~`tdùz kjabi`t{jd)>(4

Kjug~lj~alai maiza 17 — >5 ' ka~j tgcwa ugikg~j{a kgibai

{~awca {wcuwh ank`cgi zaib cgcg~hwlai haua~`{`cj( {g~w{aca

ug~ka~amai `~bai uaka{ aljna{ lgdghalaai hahw hji{at( kai tgugka c`{`~(

tgmjibba kjabi`t{jl zaib alw~a{ cwiblji wi{wl cgibmjika~j haua~`{`cj

igba{jf) Rahawuwi kgcjljai kgibai ugijibla{ai ugcalajai tanwl

ugibacai( {~awca `~bai ng~ìbba cahamai cgijibla{( alai {g{auj {~awca

haji kai ng~a{iza {jibla{ {~awca oawm cgiw~wi) Kgibai cgijibla{lai

lgcacuwai kg{gltj kjij kai {jikalai zaib dgua{ tg~{a {gua{( alai cacuw

cgibmatjhlai u~`bi`ta zaib cgcwatlai)1(>

>)1)> Aia{`cj

4

Davwc ank`cjiahjt akaham ~ìbba na{aib {wnwm zaib {g~kaua{ kj

ai{a~a kjaf~abca kai aug~{w~g ughvjt twug~j`~) Davwc ank`cjiahjt

cg~wualai ~ìbba zaib {g~ngta~ ka~j lg{jba ~ìbba {wnwm zaib {g~kj~j a{at



6

davwc d~aija( davwc {m`~adahjt( kai davwc ughvjdwc) Davwc ank`cjiahjt

kjna{atj ̀ hgm?

l~aijah ? kjaf~abca

vgi{~`ha{g~ah ? `{`{ kjikjib ug~w{ kai c)jhjalwt

k`~tah ? d`hwcia vg~{gn~ahjt( c)utàt caz`~ kai

cji`~( c)qwak~a{wt hwcn`~wc)

Lawkah ? aug~{w~g ughvjt twug~j`~ cgidalwu ughvjt

cao`~

Haujtai kjikjib ak`cgi {g~kj~j a{at t{~a{wc twug~fjtjahjt zaib

{g~kj~j a{at lw{jt( twnlw{jt - fatdja dacug~j kai fatdja tda~uag*< t{~a{wc

ji{g~cgkjwt zaib {g~kj~j a{at fatdja ank`cjiahjt( `{`{ kjikjib ank`cgi(

auìgw~`tjt `{`{ kjikjib ug~w{< t{~a{wc u~`fwika zaib {g~kj~j a{at fatdja

{~aivg~tahjt( uaiijdwhwt akju`twt u~gug~j{ìgahjt( kai ug~j{ìgwc ua~jg{ah)

Aia{`cj kahac ~ìbba ank`cgi {g~kj~j a{at 4 ~gbj` zaib ng~hajiai

zalij( ~ìbba ug~j{ìgah( ~waib ~g{~ùg~j{ìgah( kai ~ìbba ughvjt) ^ìbba

ughvjt jij cgibaikwib nabjai nabjai ka~j ~ìbba ug~j{ìgah cawuwi ~waib

~g{~ùg~j{ìgah

a) ^ìbba ug~j{ìgah

^ìbba ug~j{ìgah {g~nabj cgioakj > nabjai( zaj{w nabjai a{at

kai naram) ^ìbba ug~j{ìgah a{at kjhjikwibj `hgm nabjai

naram ka~j kjikjib {m`~al zaib cgidalwu kjaf~abca( mgua~(



2

hjgi( bat{g~( kai l`hì {~aivg~twc) Nabjai jij owba kjtgnw{

l`cuìgi {`~alànk`cjiah ka~j ank`cgi) ^ìbba ug~j{ìgwc

naram ng~jtjlai wtwt mahwt( nabjai l`hì atgikgit( l`hì

kgtgikgi( l`hì tjbc`jk kai uaka raij{a ng~jtjlai `~bai

~gu~`kwltj ji{g~iah)

n) ^ìbba ughvjt

^ìbba ughvjt cg~wualai nabjai naram ka~j ~ìbba

ji{~aug~j{ìgah tglahjbwt nabjai naram ka~j ~ìbba

~g{~ùg~j{ìgah kjcaia kj kahaciza {g~kaua{ ~gl{wc( vgtjla

w~jia~ja( ugcnwhwm ugcnwhwm jhjala( kai `~bai ~gu~`kwltj

ji{g~ia uaka raij{a)

d) ^ìbba ~g{~ùg~j{ìgwc

Dgkg~a uaka `~bai ~g{~ùg~j{ìgah twhj{ kjlgiahj la~gia kag~am

jij oawm ka~j oaiblawai ugcg~jltaai fjtjl kai njataiza dgkg~a

uaka kag~am jij {jkal alai cgcug~hjma{lai {aika a{aw bgoaha

ug~j{ìj{jt) ^ìbba ug~j{ìgah kjnabj cgioakj 4 ìa wi{wl

{wowai gltuh`~atj ?

_ìa J ? kag~am tgi{~ah nabjai a{at ~g{~ùg~j{ìgwc -

~g{~ùg~j{ìgwc tgi{~` cgkjah * ( ka~j mja{wt a`~{a kai

`gtùmabwt tacuaj u~`cì{`~jwc tal~ahjt) T{~wl{w~

u~jcg~iza akaham a`~{a( vgia lava ( ugcnwhwm#ugcnwhwm



=

ka~am bjioah nabjai u~`ltjcah ( vgia u`~{a ( uail~gat kai

kw`kgiwc)

_ìa JJ ? {g~kj~j ka~j ujibbaib lj~j kai ujibbaib laiai -

~g{~ùg~j{ìgwc ha{g~ah* ( zaib ng~jtj lgkwa bjioah kai

w~g{g~ nabjai twu~aughvjt( kj tgngham laiai owba ng~jtj

l`hì laiai kai cgt`l`hì tgkaiblai kj tgngham lj~j

ng~jtj l`hì lj~j kai cgt`l`hì )

_ìa JJJ ? {g~kj~j ka~j ughvjt -~g{~ùg~j{ìgwc ughvjt* kai

ng~jtj l`h`c tjbc`jk kai ~gl{wc( vgtjla w~jia~ja ( lgkwa

w~g{g~ tgbcgi ughvjt nabjai kjt{ah)

>)1)4 Ua{`fjtj`h`bj kai G{j`h`bj>(4

[~awca {wcuwh njta kjtgnanlai `hgm ngi{w~ai haibtwib ( baza

kgtghg~atj ( baza ~`{atj kai baza tmga~ ) Ngi{w~ai haibtwib kaua{

cgizgnanlai dgkg~a zaib ng~a~{j kai ng~a{iza dgkg~a kaua{ kjug~lj~alai

kgibai cgibg{amwj lglwa{ai kai kw~atj ka~j ngi{w~ai kai owba catta

ka~j nabjai {wnwm zaib ng~lì{al)

Fal{`~#fal{`~ zaib cgigi{wlai dgkg~a akaham lgdgua{ai lgika~aai

ng~c`{`~ ( u`tjtj ugikg~j{a ( aualam tgnabaj ugibgcwkj a{aw ugiwcuaib

kai kg~aoa{ kgf`~cj{at ka~j lgika~aai {g~tgnw{( {g~hgcua~ lghwa~ ( {g~ngi{w~

t{j~ c`njh ( {g~ngi{w~ lada kguai c`njh a{aw jit{~wcgi{ c`njh ( kai

{g~ngi{w~ nabjai nghalaib c`njh cgizgnanlai dgkg~a jij) Ngi{w~ai



:

haibtwib kaua{ cgibaljna{lai dgkg~a {glaiai uaka jtj ank`cgi ( zaib

kaua{ cg~wtal ngi{wl `~bai uaka{ a{aw ng~ìbba kai cgizgnanlai ~wu{w~

( lmwtwtiza uaka `~bai zaib cgibbgcnwib tgug~{j w{g~wt zaib macjh (

kgibai ug~ka~amai kai ug~j{ìj{jt)

Dgkg~a kgtghg~atj uahjib tg~jib {g~oakj uaka lgdghalaai ng~c`{`~

kgibai lgdgua{ai {jibbj kai oa{wm ka~j lg{jibbjai) Taa{ {wnwm {g~ngi{w~ (

`~bai zaib ng~bg~al tgug~{j mgua~ kai hjgi {g~wt ng~bg~al lg kguai uaka

lgdgua{ai {g~cjiah ( cg~`ngl ugcnwhwm#ugcnwhwm ka~am kai oa~jibai#

oa~jibai ka~j {gcua{ ug~hgla{aiiza -t{~wl{w~ zaib {g{au* ) Baza ~`{atj owba

cgizgnanlai dgkg~a ~`nglai aljna{ bg~alai zaib ng~bwhjib#bwhjib) Baza

tmga~ cgizgnanlai dgkg~a kgbh`vjib tgug~{j zaib cwiblji {g~oakj lg{jla

ugikg~j{a {g~hjikat lgika~aai ngta~) Taa{ lgika~aai cghgra{j {wnwm

ugikg~j{a ( lwhj{ kai oa~jibai twnlw{jt {g~k`~ìb lg kguai ( cg~`ngl twuhaj

ka~am ka~j twcng~ kjnaramiza kai cgcjtamlai oa~jibai hgcal twnlw{jt

ka~j fatdja zaib {g~hg{al kjnaramiza) Cglaijtcg jij kaua{ owba

kjaljna{lai `hgm baza tmga~ ka~j tanwl ugibacai zaib kjualaj kgibai

da~a zaib taham uaka lgdghalaai lgika~aai ng~c`{`~ kgibai lgdgua{ai

{jibbj) Tg{gham dgkg~a tmga~ njataiza {g~oakj igl~`tjt kai lgmjhaibai

oa~jibai hwial)

Uaka {~awca {wcuwh ank`cgi (`~bai zaib uahjib tg~jib dgkg~a

akaham hjgi -;5#75'* ( mgua~ -47#;7' * kai mgca{`c ~g{~ùg~j{ìgwc -17

'*)



15

>)1); Kjabi`tjt1(4(7

Kgibai cgibaikahlai maiza ugcg~jltaai fjtjl( kjabi`tjt {~awca

ank`cgi catjm taiba{ twhj{ kj{gballai) Rahawuwi kjhalwlai `hgm k`l{g~

zaib ng~ugibahacai( kg~aoa{ alw~atj maiza 67'( aljna{ naizaliza fal{`~

zaib kaua{ cgcugiba~wmj bgoaha lhjijt( cjtahiza < izg~j( ugiw~wiai

lgtaka~ai( tg{gham cjiwc ahd`m`h( {~awca lguaha( dgkg~a haji zaib kaua{

cgibadawlai bgoaha lhjijt) @hgm la~gia j{w kjug~hwlai ugcg~jltaai fjtjl

zaib hgnjm {ghj{j uaka ugikg~j{a zaib kjdw~jbaj akaiza dgkg~a ji{~a

ank`cgi) ^``{ kll cgcug~lgiahlai ug~j{ìgah kjabi`t{jl havabg tgnabaj

cg{`kg gvahwatj) Kjabi`t{jd ug~j{ìgah havabg cg~wualai u~`tgkw~ ngkam

zaib kaua{ kjhalwlai kj ~waib ~gtwtj{atj) Lgwi{wibai da~a jij( kaua{

kjhalwlai tgda~a dgua{ kgibai l`cuhjlatj cjijcah( kai ijhaj

kjabi`t{jliza tgitj{jf kai tugtjfjl wi{wl ug~ka~amai ji{~a ank`cjiah

-9:5'* {g{auj {jkal cacuw cgibjkgi{jfjlatj ogijt `~bai zaib dgkg~a tg~{a

lghajiai ~g{~ùg~j{ìgah {jkal kjkg{gltj( kai cwiblji cgcng~jlai fahtg

u`tj{jf uaka f~al{w~ ughvjt) Tgmjibba njha ng~ugbaib uaka ug~j{ìgah havabg

kjabi`t{jl zaib u`tj{jf taoa -g~j{~`tj{ 9 155)555/cc4* cala alai {g~oakj

haua~`{`cj igba{jf) Kjabi`t{jd Ug~j{ìgah Havabg -KUH* cg~wualai

{jikalai jivatjf tgmjibba ma~wt kjhalwlai kgibai u~`tgkw~ ugcngkamai

zaib ngia~)) [jikalai KUH ma~wt kjhalwlai `hgm tugtjahjt ngkam zaib

ng~{aibbwib oaran kahac {g~auj kgfjij{jf auanjha matjhiza u`tj{jf) T{wkj

zaib kjhalwlai uaka haua~`{`cj igba{jf( cgcnwl{jlai ka~j >7; ugikg~j{a



11

-tgma~wtiza zaib {jkal ug~hw haua~`{`cj kai {g~haiow~ ùg~atj*( ;1'

cgibahacj l`cuhjlatj ai{a~a haji < a{ghgl{atjt( mju`{gitj u`t{ ùg~a{jf(

gfwtj uhgw~a( uigwc`{`~alt( jhgwt ng~lguaioaibai( uigwcìja( jifgltj hwla

ùg~atj( ̀ nt{~wltj wtwt( jifgltj uaka {~al{wt kjbgt{jvwt)

Fgkghhg cgcug~lgiahlai ugcg~jltaai D[#Tdai ank`cgi uaka

{~awca {wcuwh ank`cgi) Kgibai D[#Tdai jij kaua{ cgibg{amwj `~bai

zaib cgibahacj dgkg~a kai kg~aoa{ lg~wtalaiiza( dgkg~a ji{~a kai ~g{~`

ug~j{ìgah( tg~{a kaua{ cgcug~lj~alai owcham ug~ka~amai ji{~a ank`cgi)

Ugcg~jltaai D[#Tdai tgda~a tg~jah kaua{ uwha kjbwialai wi{wl cgibjlw{j

ug~lgcnaibai dgkg~a `~bai kai owcham ug~ka~amai( cjtahiza dgkg~a

`~bai cgcnajl a{aw owcham ka~am calji naizal) Lg~wbjai kgibai

ugcg~jltaai D[#Tdai jij akaham ugikg~j{a ug~hw kjujikam lg~waib

ugcg~jltaai ~akj`h`bj kai cgcg~hwlaiai ral{w hgnjm haca( ~gha{jf camah

kai cwiblji ahg~bj kgibai namai lì{~at zaib kjcatwllai) Kgibai D[#

Tdai jij ugijhajai dgkg~a wtwt lw~aib tgitj{jvg( {auj kaua{ cgijhaj <

ugignahai kjikjib wtwt( wka~a ngnat kai akaiza daj~ai ji{~a ug~j{ìgah

kjcaia `~bai uaka{ {jkal aka lghajiai( cgiwiowllai akaiza hgtj uaka

wtwt kai cacuw cgikg{gltj {~awca uail~gat uaka fatg kjij) Rahawuwi

kgcjljai D[#Tdai catjm cg~wualai c`kahj{at ujhjmai uaka gvahwatj

ugikg~j{a {~awca {wcuwh ank`cgi kgibai mgc`kjiacjl t{anjh / ugijhajai

{g~auj tgda~a lìtg~va{jf)



1>

Wh{~atì`b~afj cg~wualai aha{ kjabi`t{jl zaib taiba~ uùwha~ kj

G~ùa kai Dmjia rahawuwi ugibbwiaaiiza catjm {g~na{at) Wh{~atì`b~afj

kaua{ kjlg~oalai kja{at {gcua{ {jkw~ ugikg~j{a( kaua{ kjwhaib( iì jivatjf

kai ~gha{jf gfgl{jf) Lg~wbjai ugcg~jltaai wh{~atì`b~afj( ijhaj

tgitj{jfj{atiza lw~aib uaka hgtj zaib {jkal cgcu~`kwltj daj~ai

ug~j{ìgwc kai alw~atjiza ùg~a{`~ kgugikgi{ -{g~bai{wib {giaba

~akj`h``b a{aw ugibahacai k`l{g~ zaib cgcg~jlta*)

>)1)7 Natg Kgfjtj{( Hal{a{( Mju`{gitj uaka [~awca;

Jkgi{jfjlatj {g~oakj lghajiai ji{~aank`cjiah uaka uatjgi kgibai

{~awca {wcuwh ank`cgi cg~wualai {ai{aibai zaib taiba{ ngta~ nabj

k`l{g~ zaib nglg~oa {g~w{aca kj dgi{g~ {~awca) Lgnaizaai dgkg~a jij {jkal

ng~caijfgt{atj tghaca ugcg~jltaai arah kai tghaca ug~j`kg ugib`na{ai(

cglaijtcg {~awca owba tg~jib {g~oakj ng~tacaai kgibai dgkg~a `~bai

hajiiza tgmjibba njta cgibanw~lai kjabi`tjt ug~ka~amai ji{~aank`cgi

zaib u`{gitjah cgizgnanlai {g~oakjiza lgca{jai) Ugcg~jltaai {aika vj{ah

cgtljuwi dwlwu tugtjfjl ( {auj {jkalham tgitj{jf kahac cgikg{gltj

{g~oakjiza ug~ka~amai) Gvahwatj ~w{ji cgibbwialai ugcg~jltaai ka~am

~w{ji( ugcg~jltaai fjtjl( KUH( WTB ( kai D[ tdai cgcjhjlj lghgcamaiiza

catjib#catjib kahac gvahwatj ank`cgi)

Natg kgfjdj{ cg~wualai ua~acg{g~ cg{an`hjl zaib taiba{ tgitj{jf

kjbwialai tgnabaj jikjla{`~ {g~oakjiza lgmjhaibai ka~am kgibai cghahwj



14

ugibwlw~ai ug~fwtj oa~jibai( ugijibla{ai natg kgfjdj { jij kaua{ {g~oakj

uahjib arah tgoal njha {g~oakj tz`l mgc`~abjl) Kaj~` cgclhatjfjlatjlai

natg kgfjdj{ jij lg kahac 4 la{gb`~j? cjhk -#4 t/k #7*( c`kg~a{g -#6 t/k #:*

kai tgvg~g -8#15* kjcaia ugiblhatjfjlatjai kaua{ cgiwiowlai l`~ghatj

zaib lwa{ kgibai lgnw{wmai {~aifwtj( lgbabahai `~bai kai lgca{jai)

Ngng~aua ugighj{jai cgiwiowllai njha natg kgfjdj{ 8 #6 cgiwiowllai

l`~ghatj zaib lwa{ {g~oakj l`cuhjlatj aljna{ tz`l kai jikjla{`~

kjnw{wmlaiiza {~aifwtj tgbg~a)

Uaka ugighj{jai zaib kjhalwlai C`fjkj kjnaikjiblai namra

ugcg~jltaai natg kgfjdj{ -8#6* cgcjhjlj aibla tgitj{jfj{at zaib hgnjm

{jibbj kjnaikjiblai kgibai WTB -==(>' ng~naikjib 26(7'*) WTB owba

{jkal njta cgikg{gltj akaiza lghajiai uaka ~g{~ùg~j{ìgah) Uaka

ugighj{jai jij kjkaua{lai 1> latwt ug~ka~amai ~g{~ùg~j{ìgah 155'

cgiwiowllai natg kgfjt{ 8 #6) Ugighj{jai jij cgizjcuwhlai namra natg

kgfjtj{ cg~wualai jikjla{`~ zaib taiba{ ugi{jib wi{wl cgibjkgi{jfjlatj

{g~oakjiza ug~ka~amai ji{~ank`cgi uaka uatjgi kgibai {~awca {wcuwh

ank`cgi)

Ugcg~jltaai hal{a{ jij ug~{aca lahj kjug~lgiahlai `hgm Babhj`

uaka {amwi 1:=6( ugibwlw~ai laka~ hal{a{ jij cgcg~hwlai 155#>55 dd

ka~am kai cgcnw{wmlai ngng~aua ma~j tgmjibba {gmijl ugcg~jltaai jij

taiba{ oa~aib kjbwialai) Uaka {amwi 1:6; N~`kg~ kai Rghh cgibbwialai

{gmijl f`{`tugl{~`cg{~jl wi{wl ugibwlw~ai laka~ hal{a{ kai maiza



1;

cgcnw{wmlai ra{w > cgij{ wi{wl cgikaua{lai matjhiza tgmjibba

{gli`h`bj jij cgcwibljilai wi{wl kjbwialai uaka uatjgi kgibai dgua{

kai cwkam) Mwnwibai ai{a~a ugijibla{ai laka~ hal{a{ kahac ka~am kai

mju`ltja uaka oa~jibai uaka uatjgi kgibai tz`l ug~{aca lahj kjlg{amwj

uaka {amwi 1:>2)

Uaka tgh i`~cah( bhwl`ta alai kjcg{an`hjtcg aj~ kai

la~nìkj`ltjka) Tgda~a wcwc( mah {g~tgnw{ cghahwj > {amauai u~`tgt)

[amau ug~{aca( bhwl`ta alai kjugdam cgioakj uj~wva{ cghahwj u~`tgt

bhjl`hjtjt) [amau lgkwa( cj{`lìk~ja alai cgib`ltjkatj uj~wva{ cghahwj

tjlhwt L~gn kai f`tf`~jhatj `ltjka{jf cgibmatjhlai aj~ kai

la~nìkj`ltjka)11

Hal{a{ cg~wualai u~`kwl cg{an`hjtcg aiag~`n zaib

cgijibla{ uaka lgakaai mjuùg~fwtj lg{jla uj~wva{ {jkal kaua{ cgcatwlj

tjlhwt L~gn kai cghahwj u~`tgt f`tf`~jhatj `ltjka{jf kj cj{`lìk~ja zaib

kjtgnanlai la~gia twuhaj `ltjbgi lg tgh zaib {jkal akglwa{) Tgnabaj

aljna{iza( uj~wva{ alai kjwnam cgioakj hal{a{ `hgm gijc hal{a{

kgmjk~`bgiatg kai cgibmatjhlai > c`hglwh akgi`tjig {~jf`tfa{ -A[U*

zaib ng~fwibtj wi{wl gig~bj) Mah jij taiba{ cg~wbjlai cgibjiba{ uaka

cg{an`hjtcg ag~`n -dwlwu `ltjbgi* alai kjmatjhlai 4= A[U):(15

Lìtgi{~atj hal{a{ tg~wc cgidg~cjilai lgtgjcnaibai ai{a~a

u~`kwltj kai cg{an`hjtcg hal{a{)Laka~ i`~cah hal{a{ tg~wc akaham 5)4 — 1)4

cc`h hj{~g∞1) U~`kwltj natah hal{a{ uaka {wnwm caiwtja akaham 5)= cc`h

lb∞1m∞1

-1455 cc`h kaz∞1*)

45Uaka lgakaai mjuùg~fwtj a{aw tz`l( cala



17

cg{an`hjtcg aig~`n alai k`cjiai) U~`kwltj hal{a{ alai cghgnjmj

lgdgua{ai cg{an`hjtcgiza kj ma{j kai bjioah tgmjibba laka~ hal{a{ kj

kahac ka~am alai cgijibla{)11

Ugijibla{ai laka~ hal{a{ tg~wc ng~l`~ghatj g~a{ kgibai c`~{ahj{at

kj ng~nabaj {jug tz`l)17(16

Lgdgua{ai ral{w lgcnahjiza laka~ hal{a{ lg

ijhaj i`~cah cghahwj ~gtwtj{atj daj~ai ng~l`~ghatj lwa{ kgibai c`~{ahj{at(

lgbabahai `~bai( kai jifgltj) U~`bi`tjt {g~najl uatda ~gtwtj{atj uaka latwt

tz`l akaham lg{jla hal{a{ lgcnahj i`~cah kahac ral{w 1>#>; oac)

Mju`ltja oa~jibai kjkgfjijtlai auanjha lgnw{wmai `ltjbgi {jkal

kjjcnaibj kgibai uat`lai `ltjbgi( ugiw~wiai mgc`bh`nji kai ta{w~atj

`ltjbgi njataiza alai kjl`cugitatj kgibai ugijiba{ai da~kjad `w{uw{

tgmjiibba mju`ltja oa~jibai {jkal {g~oakj) La~gia {glaiai ka~am cgcjhjlj

~gi{aib zaib dwlwu ngta~ {g~makau da~kja `w{uw{ ( cala tgda~a lhjijt

mju`ltja oa~jibai {jkal tghahw kj{gcwlai) Cg~gbghj kll cgiwiowllai

laka~ hal{a{ uaka uatjgi kgibai mgc`kjiacjl t{anjh kaua{ cgcngkalai

aibla ma~auai mjkwu uaka 1> oac ug~{aca akcjttjì cgtljuwi uaka

uatjgi kgibai mgc`kjiacjl zaib taca( ugighj{j cgizjcuwhlai

mjug~hal{a{gcja alai {g{au {g~oakj uaka mjuùg~fwtj cgtljuwi kgibai

mgc`kjiacjl zaib t{anjh) Nh`r kll cgiwiowllai namra laka~ hal{a{

kahac {glaiai ka~am zaib i`~cah uaka uatjgi {~awca kgibai

mgc`kjiacjl zaib t{anjh tgoal >; oac ug~{aca catwl ^T kjmwnwiblai

kgibai ugijibla{ai aibla ma~auai mjkwu) ^gtwtj{atj uaka uatjgi jij





12

>)1)6 Ugia{ahaltaiaai [~awca [wcuwh Ank`cgi>(4

a) U~g# ~wcam talj{

Ugia{ahaltaiaai u~g ~wcam talj{ kjf`lwtlai wi{wl

cgibgvahwatj kgibai dgua{ cataham#cataham zaib cgijcnwhlai

aidacai lgca{jai( ~gtwtj{atj arah( kai ug~tjauai {~aitu`~{ lg

{gcua{ ~wowlai) Uatjgi cgcjhjlj ~gtjl` cgibahacj ug~nw~wlai

aljna{ ug~ka~amai zaib aka kai cgcnw{wmlai u~`tgkw~ ~gtwtj{atj

tghaca ug~oahaiai) [jikalai arah zaib kaua{ kjhalwlai akaham

kgibai cgcngnatlai oahai iafat( ugcataibai jv hjig( kai

ugcng~jai daj~ai) Ugighj{jai zaib kjhalwlai Ij~wha kll

cgiwiowllai ugi{jibiza u~`{`l`h jij ( kjcaia uatjgi zaib {jkal

kjhalwlai ug~{`hìbai arah jij ng~gtjl` 4(= lahj hgnjm ngta~

cgibahacj lgca{jai)

Wi{wl cgcngnatlai oahai iafat njta kjbwialai ujua

gik`{~algah zaib lgcwkjai kjjlw{j ugcataibai d`hha~ igdl wi{wl

jc`njhjtatj tg~vjlah( lgcwkjai kjng~jlai vgi{jhatj cgibbwialai

Fj@> zaib {jibbj uaka uatjgi kgibai baibbwai ~gtu`~atj tacuaj

ta{w~atj `ltjbgi uaka ~gi{aib hgnjm ka~j :5#:>') Ug~ka~amai

glt{g~iah njataiza cgioakj dgkg~a ugizg~{a uaka {~awca {wcuwh

ank`cgi( cala ka~j j{w kjhalwlai lì{~`h ug~ka~amai kgibai

{glaiai haibtwib kai ugcng~jai daj~ai l~jt{ah`jk)

n) ^wcam talj{



1=

U~j`~j{at ug~{aca akaham cgcg~jlta whaib oahai iafat(

cgcu~`{gltj tg~vjlah( ugcng~jai twuhgcgi{atj `ltjbgi( ~gtwjt{atj

daj~ai kjjlw{j kgibai dì{~`h ug~ka~amai glt{g~iah)

Jikjlatj haua~`{`cj gltuh`~atj uaka {~awca kaua{ kjhalwlai

ng~kata~lai uaka {gcwai ugcg~jltaai fjtjl a{aw ng~kata~lai uaka

lgtjcuwhai kjabi`t{jl) Tgda~a lhjijt kaua{ kj{gcwlai {aika

ug~j{ìj{jt zaib oghat uaka ugcg~jltaai fjtjl( mju`{gitj kgibai

ank`cgi zaib kjt{gitj uaka ugcg~jltaai fjtjl( hwla {gcnal uaka

ank`cgi( hwla {wtwl ank`cgi kjtg~{aj gvjtg~atj ( mju`{gitj a{aw

ug~j{ìj{jt) [gcwai kjabi`t{jl cghahwj matjh u`tj{jvg KUH kai

akaiza {gcwai kgibai ugcg~jltaai kjabi`t{jl hajiiza {~awca

ank`cgi zaib cgcg~hwlai ug~najlai tgug~{j {m`~a} um`{` -aka

~wu{w~g kjaf~abca ( uigwcùg~j{ìgwc *( FAT[( D[#tdai ( a{aw

haua~`tlùj)

Haua~`{`cj zaib kjhalwlai uaka ugikg~j{a cwh{j {~awca

catjm lì{~`vg~tj( alai {g{auj kjnaram jij kaua{ kjualaj tgnabaj

ugk`cai ?

a) Wi{wl ugikg~j{a zaib {jkal t{anjh kgibai dw~jba ug~ka~amai ji{~a

ank`cgi ma~wt tgbg~a kjhalwlai ùg~atj) Njha ugikg~j{a kjtg~{aj

{~awca lguaha kgibai BDT 8=( cala {glaiai ji{~al~aijah ma~wt



1:

kaua{ kjcìj{`~ ral{w haua~`{`cj( la~gia ‘tgdìka~z n~aji

jiow~z– kaua{ kjtgnanlai ̀ hgm mju`{gitj)

n) Ugikg~j{a {jkal t{anjh kgibai ug~ka~amai ji{~a ank`cgi kai ughvjt

kjcaia havabg u`tj{jf cg~am a{aw wh{~atì`b~afj cgiacuallai

daj~ai owcham naizal kahac lavwc C`~~jtì‚t( haua~`{`cj tgbg~a

kjhalwlai) Njha ugikg~j{a kgibai havabg maiza ~jibai kai WTB

cgiwiowllai ka~am kjughvjt taoa( cala kaua{ kjhalwlai aibj`b~afj

u~gùg~a{jvg)

d) Ugikg~j{a kahac lìkjtj mgc`kjiacjl t{anjh kjtg~{aj kgibai

{~awca lguaha( kaka( ank`cgi( kjabi`tjt kaua{ tgbg~a kj{gballai

kgibai D[#Tdai) Ka~j =55 ugikg~j{a {~awca lguaha kai kaka maiza

7> ugikg~j{a {~awca lguaha zaib cgcg~hwlai l~aij`{`cj( ;5

ugikg~j{a cgcg~hwlai haua~`{`cj) Kai maiza 4 zaib cgcg~hwlai

l~aij`{`cj kai haua~`{`cj) @hgm la~gia j{w D[#Tdai lguaha kai

ank`cgi ng~tacaai( taiba{ ug~hw kjhalwlai uaka ugikg~j{a cwh{j

{~awca lguaha kai ug~w{ kgibai havabg igba{jf)

k) Ugikg~j{a cwh{j {~awca -dgkg~a lguaha( {`~alt( ank`cgi* kgibai

kjtg~{aj ua{am {whaib {g~nwla cawuwi {g~{w{wu( tgcgi{a~a {~awca

lguaha( {`~alt cawuwi ank`cgi cgcg~hwlai ùg~atj( wi{wl ua{am

{whaibiza kjhalwlai ugcnjkajai a{aw kgn~jkgcgi kwhw) [g{auj njha

mju`{gitj kai mju`ltja kaua{ kja{atj( fjltatj kjij kaua{

kjug~{jcnaiblai)



>5

>)> Lg~aibla Ugcjlj~ai

Uaka {~awca {wcuwh ank`cgi lgcwibljiai {g~oakj ug~ka~amai

ji{~ank`cgi) Mah#mah {g~tgnw{ uaka almj~iza alai cgijcnwhlai mjuùg~fwtj

`~bai) Mjuùg~fwtj oa~jibai twkam cwhaj {g~oakj tgoal lgoakjai( iacwi

caijfgt{atjiza ng~wua mju`{gitj {jcnwh hgnjm hacna{)1(4(

Uaka lgakaai mjuùg~fwtj a{aw tz`l( cala cg{an`hjtcg aig~`n alai

k`cjiai) U~`kwltj hal{a{ alai cghgnjmj lgdgua{ai cg{an`hjtcgiza kj ma{j kai

bjioah tgmjibba laka~ hal{a{ kj kahac ka~am alai cgijibla{)7

@hgm la~gia j{w(

laka~ hal{a{ tg~wc kaua{ kjualaj tgnabaj taham ta{w ua~acg{g~ ug~fwtj oa~jibai(

kjcaia laka~ hal{a{ tg~wc zaib {jibbj cgiaikalai mjuùg~fwtj `~bai zaib hgnjm

ng~a{) Iacwi( laka~ hal{a{ tg~wc jij alai ng~wnam tgtwaj ug~wnamai fjtj`h`bj

{wnwm zaib {g~oakj uaka tg{jau fatg ug~oahaiai ugizalj{) Natg kgfjdj{ cg~wualai

ua~acg{g~ cg{an`hjl zaib taiba{ tgitj{jf kjbwialai tgnabaj jikjda{`~ {g~oakjiza

lgmjhaibai ka~am kgibai cghahwj ugibwlw~ai ug~fwtj oa~jibai( ugijibla{ai natg

kgfjdj{ jij kaua{ {g~oakj uahjib arah tgoal njha {g~oakj tz`l mgc`~abjl)

Ng~kata~lai lg~aibla ugcjlj~ai {g~tgnw{ kaua{ kjtwtwi u~gcjt#u~gcjt

tgnabaj ng~jlw{ ?

U~gcjt 1? Uaka {~awca {wcuwh ank`cgi {g~oakj ug~ka~amai uaka ~ìbba

ji{~ank`cgi

U~gcjt >? Ug~ka~amai uaka ~ìbba ji{~ank`cgi alai cgijcnwhlai mjuùg~fwtj

oa~jibai



>1

U~gcjt 4? Mjuùg~fwtj oa~jibai twkam cwhaj {g~oakj tgoal {wnwm cgibahacj

ug~ka~amai aljna{ {~awca {wcuwh ank`cgi( iacwi caijfgt{atjiza

ng~wua mju`{gitj {jcnwh hgnjm hacna{)

U~gcjt ; ? Uaka mjuùg~fwtj `~bai {g~oakj ugijibla{ai cg{an h̀jtcg aiag~`n zaib

cgcu~`kwltj hal{a{ kjcaia laka~ hal{a{ tg~wc zaib {jibbj

cgiaikalai mjuùg~fwtj `~bai zaib hgnjm ng~a{ {g~oakj ugijibla{ai

laka~ natg kgfjdj{( kai ugiw~wiai {glaiai ka~am tjt{`hjl

U~gcjt 7 ? Ugibwlw~ai laka~ hal{a{ tg~wc( natg kgfjdj{ ( kai mju`{gitj tjt{`hjl

cg~wualai cg{`kg na~w wi{wl cgcu~gkjltj c`~{ahj{at zaib

cgioaiojlai)

>)4 Mju`{gtjt

Ng~kata~lai u~gcjt {g~tgnw{ kj a{at( cala kjnwa{ tgnwam mju`{gtjt?

[g~kaua{ ugiba~wm zaib lwa{ ai{a~a ug~wnamai laka~ hal{a{ tg~wc( natg

kgfjdj{ ( kai mju`{gitj tjt{`hjl kgibai {jibla{ c`~{ahj{at uaka uatjgi {~awca {wcuwh

ank`cgi)

Ugibwojai mju`{gtjt tgda~a ua~tjah uaka kata~iza cgiwiowllai aualam

laka~ natg kgfjdj{ ( mju`{gitj tjt{`hjl kai hal{a{ ng~ugiba~wm {g~makau aibla

c`~{ahj{at uaka uatjgi kgibai ug~ka~amai ji{~a#ank`cgi aljna{ {~awca {wcuwh

ank`cgi)

Akauwi mju`{gtjt zaib kjbwialai zaib alai kjwoj akaham?



>>

M`1? Laka~ natg kgfjtj{ {jkal cgcuwizaj ugiba~wm zaib tjbijfjlai {g~makau

aibla c`~{ahj{at)

Ma1? Laka~ natg kgfjdj{ cgcuwizaj ugiba~wm zaib tjbijfjlai {g~makau aibla

c`~{ahj{at)

M`>? Tjt{`hjl {jkal cgcuwizaj ugiba~wm zaib tjbijfjlai {g~makau aibla

c`~{ahj{at)

Ma>? Tjt{`hjl cgcuwizaj ugiba~wm zaib tjbijfjlai {g~makau aibla c`~{ahj{at)

M`4? Hal{a{ {jkal cgcuwizaj ugiba~wm zaib tjbijfjlai {g~makau aibla

c`~{ahj{at)

Ma4? Hal{a{ cgcuwizaj ugiba~wm zaib tjbijfjlai {g~makau aibla c`~{ahj{at)

5(57

L~j{g~ja woj?

[`hal M` ojla u vahwg 5(57 kai {g~jca kahac mah hajiiza)



>4

NAN JJJ

TWNOGL KAI CG[@KG UGIGHJ[JAI

4)1 Twnogl Ugighj{jai

4)1)1 Ugcjhjmai Twnogl

Twnogl ugighj{jai akaham uatjgi zaib ka{aib lg JBK Ngkam ^T K~)Matai

Takjlji uaka nwhai Oaiwa~j>511 tacuaj kgibai Kgtgcng~ >511 kgibai kjabi`tjt

ug~ka~amai ji{~a#ank`cgi aljna{ {~awca {wcuwh ank`cgi)

4)1)> L~j{g~ja Jilhwtj

Uatjgi zaib cgcgiwmj l~j{g~ja jilhwtj akaham tgcwa uatjgi kgibai

kjabi`tjt {~awca {wcuwh ank`cgi kgibai matjh FAT[ -,* / D[ Tdai -,* a{aw

Haua~`{`cj -,* cgiwiowllai akaiza ug~ka~amai ji{~aank`cgi)

4)1)4 L~j{g~ja Gltlhwtj

1) Ug~ka~amai glt{g~ia

>) Mgca{`{`~alt

4) Lìtwctj ahl`m`h



>;

4)1); Ngta~ Tacugh kai Da~a Ugibacnjhai Tacugh

Tgtwaj {wowai ugighj{jai wi{wl cgibg{amwj ugiba~wm laka~ hal{a{ tg~wc(

natg kgfjdj{( kai mju`{gitj tjt{`hjl {g~makau {jibla{ c`~{ahj{at( cala tacugh

kjlwcuwhlai tghaca 1 {amwi cwhaj {aibbah 1 Oaiwa~j >511 — 41 Kgtgcng~ >511)

Da~a ugibacnjhai tacugh kjhalwlai tgda~a dìtgdw{jvg akcjttjì( zaj{w

ng~kata~lai lgka{aibai uatjgi lg JBK ̂ T K~) MataiTakjlji)

4)> Cg{`kg Ugighj{jai

Cg{`kg ugighj{jai cghjuw{j {jug( ~aidaibai ugighj{jai( kgfjijtj( kai

va~jangh ̀ ug~atjìah)

4)>)1 [jug kai âidaibai Ugighj{jai

Ugighj{jai jij cg~wualai ugighj{jai ~g{~`tugl{jf wi{wl cgibg{amwj

ugiba~wm ug~wnamai laka~ hal{a{ tg~wc( natg kgfjdj{ ( mju`{gitj tjt{`hjl {g~makau

{jibla{ c`~{ahj{at uaka uatjgi kgibai ug~ka~amai ji{~a#ank`cgi aljna{ {~awca

{wcuwh ank`cgi)

4)>)> Kgfjijtj Lìtgutjìah kai @ug~atjìah Va~jangh

4)>)>)1 Kgfjijtj Lìtgutjìah Va~jangh

Va~jangh ngnat akaham laka~ hal{a{ tg~wc( natg kgfjdj{ ( mju`{gitj tjt{`hjl

Va~jangh {g~jla{ akaham c`~{ahj{at



>7

4)>)>)> Kgfjijtj @ug~atjìah Va~jangh

Laka~ hal{a{ tg~wc akaham matjh ugibacnjhai ka~j tacugh ka~am a~{g~j)

[glijt ugibacnjhai hal{a{ tg~wc ?

# Kjhalwlai {jikalai atgu{jl)

# Nwaib wka~a ka~j 15 cH tz~jibg tgnghwc atuj~atj)

# Halwlai Atuj~atj ka~am tgkjlj{iza 7 cH)

# Ka~am kjcatwllai lg kahac lì{ajig~)

# Tgkjaai tgbg~a kjnara lg han`~a{`~jwc)

Ral{w ugibacnjhai tacugh ka~am kj{gi{wlai tgral{w uatjgi ka{aib lg

JBK)

Laka~ Natg kgfjdj{

Matjh ugibacnjhai ka~am a~{g~j kgibai cgibbwialai tuwj{ 1 dd kjdacuw~

kgibai mgua~ji lgcwkjai kj nara lg Han( kjcaia ral{w ugibacnjhai

ka~am kj{gi{wlai tgral{w uatjgi ka{aib lg JBK)

Mju`{gitj Tjt{`hjl

[glaiai ka~am zaib kjwlw~ cgibbwialai tujbc`cai`cg{g~ kjcaia

ral{w ugida{a{ai kjhalwlai tgral{w uatjgi ka{aib lg JBK) Kgfjijtj

mju`{gitj uaka ugighj{jai jij njha kjkaua{lai {glaiai ka~am tjt{`hjl 8 115

ccMb



>6

Ka{a c`~{ahj{at akaham ka{a cgibgiaj matjh almj~ zaib kjdauaj kahac

ral{w > cjibbw ug~ara{ai)

4)>)4 Aiahjtjt Ka{a

Aiahjtjt ^gb~gtj H`bjt{jl Cwh{jugh

1) C`kgh Ug~tacaai ^gb~gtj H`bjt{jl Cwh{jugh

Wi{wl cgibaiahjtjt ugiba~wm laka~ hal{a{( natg kgfjdj{( mju`{gitj tjt{`hjl

{g~makau aibla c`~{ahj{at uaka uatjgi kgibai ug~ka~amai ji{~a#ank`cgi aljna{

{~awca {wcuwh ank`cgi( kjbwialaiham c`kgh ~gb~gtj h`bjt{jl ng~baika)

Wi{wl cgcwkamlai kahac ug~mj{wibai( cala lj{a cgibbwialai t`f{ra~g

TUTT 14( zaj{w cghalwlai aiahjtjt ~gb~gtj h`bjt{jl ng~baika kgibai cgcatwllai

tgcwa u~gkjl{`~ -va~jangh ngnat* wi{wl kjaiahjtjt)

Akauwi ngi{wl ug~tacaai ~gb~gtj h`bjt{jliza akaham tgnabaj ng~jlw{ ?

h`bj{ 5 1 1 > > 4 4ˆ } n n ] n ] n ]

>) Woj Lgng~a~{jai C`kgh ^gb~gtj H`bjt{jl Cwh{jugh

Wi{wl cgibwoj lgng~a~{jai c`kgh ~gb~gtj h`bjt{jl kjiza{alai ~wcwtai

mju`{gtjt tgnabaj ng~jlw{?



>2

5? j

M` -C`kgh {jkal ng~a~{j< Laka~ natg kgfjtj{ ( mju`{gitj tjt{`hjl kai hal{a{

{jkal ng~ugiba~wm {g~makau aibla c`~{ahj{at*

5?1 j

M -C`kgh ng~a~{j< Laka~ natg kgfjtj{ ( mju`{gitj tjt{`hjl kai hal{a{

ng~ugiba~wm {g~makau aibla c`~{ahj{at*

5(57

4)>); [a{a Da~a Ugighj{jai

Tgcwa uatjgi zaib catwl lg JBK Ngkam ^TMT kgibai kjabi`tjt

ug~ka~amai ji{~a#ank`cgi aljna{ {~awca {wcuwh ank`cgi zaib cgcgiwmj l~j{g~ja

jilhwtj kai gltlhwtj kjhalwlai tw~vgj u~jcg~ kai tglwikg~( {g~catwl ugibacnjhai

tacugh ka~am wi{wl ugcg~jltaai laka~ hal{a{ tg~wc( natg kgfjdj{ ( kai mju`{gitj

tjt{`hjl)

Tghaca cgioahaij ug~ara{ai( uatjgi {~awca {wcuwh ank`cgi

cgikaua{lai {g~auj daj~ai kai ghgl{~`hj{( ai{jnj`{jl kai aiahbg{jl jiogltj( kai

{g~auj iw{~jtj ka~j tgtwaj kgibai u~`{au Ngkam Kjbgt{jf ^TWU K~) Matai Takjlji

zaib {gham kjtgtwajlai kgibai lgnw{wmai catjib#catjib uatjgi) U~`tgkw~

ugcngkamai kjhalwlai tgtwaj jikjlatj zaib {gham kj{g{aulai `hgm Twnnabjai

Ngkam Kjbgt{jf ^TWU K~) Matai Takjlji) Uatjgi kj f`hh`r wu tghaca > cjibbw

ug~ara{ai wi{wl cghjma{ `w{d`cg -c`~{ahj{at*)





>:

NAN JV

MATJH UGIGHJ[JAI KAI UGCNAMATAI

;)1 Matjh Ugighj{jai

Uaka ug~j`kg Oaiwa~j >511 tacuaj Kgtgcng~ >511 kjkaua{lai 115 latwt

ug~ka~amai ji{~ank`cgi aljna{ {~awca {wcuwh ank`cgi kgibai wtja ~a{a#~a{a

uatjgi akaham >:(= {amwi zaib ng~ljta~ uaka ~gi{aib 1>#21 {amwi)

[angh 1 Kjt{~jnwtj ng~kata~lai ogijt lghacji uaka uatjgi kgibai ug~ka~amai

ji{~ank`cgi aljna{ {~awca {wcuwh ank`cgi ug~j`kg Oaiwa~j >511 tacuaj

Kgtgcng~ >511

Ogijt Lghacji Owcham latwt '

Halj halj

Ug~gcuwai

=7

>7

22(>

>>(=

115 155

Ka~j ka{a kgc`b~afj kjkaua{lai matjh ug~ka~amai ji{~ank`cgi aljna{

{~awca {wcuwh ank`cgi {g~oakj uaka 22(> ' halj halj kai >>(= ' uaka raij{a)

Mah jij tgtwaj kgibai hj{g~a{w~ namra ug~ka~amai ji{~a#ank`cgi aljna{ {~awca

{wcuwh ank`cgi wcwciza {g~oakj uaka halj#halj) Ugighj{jai zaib kjhalwlai `hgm

C`fjkj kll owba cgiwiowllai matjh zaib {jkal ng~ngka oawm -62'* uaka halj#halj)



45

[angh > Kjt{~jnwtj ugizgnan {g~oakjiza uaka uatjgi kgibai ug~ka~amai

ji{~ank`cgi aljna{ {~awca {wcuwh ank`cgi ug~j`kg Oaiwa~j >511 tacuaj

Kgtgcng~ >511

Ugizgnan Owcham Ug~tgi{atg

Lgdghalaai hahw hji{at

Oa{wm

Mai{acai Ngika

:5

>

1=

=1

>(2

16(4

115 155

Ng~kata~lai ka{a kjkaua{lai namra ug~ka~amai ji{~aank`cgi kjtgnanlai

`hgm {~awca {wcuwh uaka ank`cgi kjtgnanlai :5 '( la~gia oa{wm ka~j lg{jibbjai

tgngta~ >(2 ' kai aljna{ uwlwhai ngika lg~at a{awuwi ngi{w~ai kgibai gig~bj

zaib dwlwu ngta~ tglj{a~ 16(4')

[angh 4 Kjt{~jnwtj dgkg~a `~bai zaib {g~oakj uaka uatjgi ug~ka~amai kgibai

{~awca {wcuwh ank`cgi ug~j`kg Oaiwa~j >511 tacuaj Kgtgcng~ >511

Dgkg~a Owcham Ug~tgi{atg

Bat{g~

@cgi{wc

Wtwt mahwt

Wtwt ngta~

^gl{wc

Mgua~

>

>

16

;

1

;7

1(6

1(6

14(4

4(4

5(=

42(7



41

Hjgi

Uaid~gat

Bjioah

Nwhj

[~al{wt njhjg~

>6

>

>5

1

1

>1(6

1(6

16(6

5(=

5(=

1>5 155

Dgkg~a `~bai t`hjk tgug~{j mgua~( hjgi ( kai bjioah cg~wualai ugizgnan

w{aca {g~oakjiza ug~ka~amai ji{~a#ank`cgi zaib uahjib tg~jib {g~oakj)

Ng~kata~lai ugighj{jai jij `~bai zaib uahjib tg~jib cgibahacj dgkg~a akaham

mgua~ -42(7'* ( hjgi ->1(6'*( kai bjioah -16(6 '*))

[angh ; Kjt{~jnwtj {g~auj ngkam uaka uatjgi ug~ka~amai ji{~a#ank`cgi aljna{

{~awca {wcuwh ank`cgi ug~j`kg Oaiwa~j >515 tacuaj Oaiwa~j >511)

[g~auj Owcham latwt Ug~tgi{atg

Iì ̀ ug~a{jvg caiabgcgi{

@ug~a{jf

;6

6;

;>

7=

115 155

Ng~kata~lai ka{a kjkaua{lai namra tgnabjai ngta~ kjhalwlai {jikalai

ùg~a{jf -7='* uaka uatjgi kgibai ug~ka~amai ji{~a#ank`cgi( {jikalai iì

ùg~a{jf caiaogcgi kjhalwlai uaka ;> ' uatjgi)



4>

[angh 7 Kjt{~jnwtj c ~̀{ahj{at uaka uatjgi ug~ka~amai ji{~a#ank`cgi aljna{

{~awca {wcuwh ank`cgi ug~j`kg Oaiwa~j >511 tacuaj Kgtgcng~ >511)

Matjh Owcham latwt Ug~tgi{atg

Cgijibbah

Mjkwu

12

:4

17(=

=;(7

115 155

Ng~kata~lai ka{a kjkaua{lai aibla c`~{ahj{at tgngta~ 17(= '( ugizgnan

lgca{jai tgnabjai ngta~ kjla~gialai u~`hìb tz`l ) Aibla c`~{ahj{at macuj~

taca kgibai zaib kj{whjt uaka hj{g~a{w~ zaib cgizgnw{ aibla 17#>5 ' lgca{jai

kjtgnanlai ̀ hgm {~awca {wcuwh ank`cgi)

[angh 6 Aiahjtjt ugiba~wm laka~ hal{a{( natg kgfjdj{( kai mju`{gitj tjt{`hjl



ng~kata~lai matjh aiahjtjt ~gb~gtj h`bjt{jl ng~baika)

Va~janhgt ji {mg Gqwa{jì

)5:5 )5>7 14)>;2 1 )555 1)5:;

)55> )577 )551 1 ):6: 1)55>

#)162 )14: 1);;5 1 )>45 )=;6

#6);15 >)744 6);5; 1 )511 )55>

]1

]>

]4

Dìt{ai{

T{gu 1

a

N T)G) Rahk kf Tjb) G}u-N*

Va~janhg-t* gi{g~gk ì t{gu 1? ]1( ]>( ]4) a)



44

Tgmjibba kjkaua{ ug~tacaai ~gb~gtj h`bjt{jl ng~baika tgnabaj ng~jlw{?

h`bj{ ˆ } 3 #6(;15 , 5(5:5 ]1 , 5(55> ]> — 5(162 ]4

T{a{jt{jl Woj?

Ng~kata~lai `w{uw{ kj a{at ijhaj — > -H5 — H1* akaham tgngta~ 6;(:26 kgibai

^>

tgngta~ ;;(5'( kgibai cgibbwialai l~j{g~ja woj ? {`hal M` ojla — > -H5 — H1*

> - *{angh ( {g~jca kahac mah hajiiza) La~gia — >-H5 — H1* 3 6;(:26 9

>><5(57 3 7(:: cala M` kj{`hal) Mah jij ng~a~{j laka~ natg kgfjdj{( hal{a{( kai

mju`{gitj tjt{`hjl ng~ugiba~wm {g~makau aibla c`~{ahj{at uaka uatjgi kgibai

ug~ka~amai ji{~a#ank`cgi aljna{ {~awca {wcuwh ank`cgi kgibai ugiba~wm

tgngta~ ;; ')

C`kgh Twcc a~z

6;):26

a

)>65 );;5

T{gu

1

#> H`b

hjlghjm``k

D`} & Tighh

^ Tqwa~g

Iabghlg~lg

^ Tqwa~g

Gt{jca{j̀ i {g~cjia{gk a{ j{g~a{jì iwcng~ 2 ngdawtg

ua~acg{g~ gt{jca{gt dmaibgk nz hgtt {mai )551)

a)



4;

[angh 2 Aiahjtjt ua~tjah ugiba~wm laka~ natg kgfjdj{ ( hal{a{( kai mju`{gitj tjt{`hjl



T{a{jt{jl woj

Ng~kata~lai {angh kj a{at( kaua{ kjtjcuwhlai namra ?

U vahwg wi{wl va~jangh laka~ natg kgfjtj{ akaham tgngta~ 5(555 hgnjm lgdjh

ka~j ijhaj 5(57 ) Mah jij cgizgnanlai ugi`halai M`( zaib ng~a~{j laka~

natg kgfjdj{ ng~ugiba~wm {g~makau aibla c`~{ahj{at uaka uatjgi kgibai


U vahwg wi{wl va~jangh mju`{gitj tjt{`hjl akaham tgngta~ 5(:6: hgnjm ngta~

ka~j ijhaj 5(57 ) Mah jij cgizgnanlai ugig~jcaai M`( zaib ng~a~{j

mju`{gitj tjt{`hjl {jkal ng~ugiba~wm {g~makau aibla c`~{ahj{at uaka uatjgi

kgibai ug~ka~amai ji{~a#ank`cgi aljna{ {~awca {wcuwh ank`cgi)

U vahwg wi{wl va~jangh hal{a{ akaham tgngta~ 5(>45 hgnjm ngta~ ka~j ijhaj

5(57 ) Mah jij cgizgnanlai ugig~jcaai M`( zaib ng~a~{j hal{a{ {jkal

Va~janhgt ji {mg Gqwa{jì

)5:5 )5>7 14)>;2 1 )555 1)5:;

)55> )577 )551 1 ):6: 1)55>

#)162 )14: 1);;5 1 )>45 )=;6

#6);15 >)744 6);5; 1 )511 )55>

]1

]>

]4

Dìt{ai{

T{gu

1a

N T)G) Rahk kf Tjb) G}u-N*

Va~janhg-t* gi{g~gk ì t{gu 1? ]1( ]>( ]4)a)



47

ng~ugiba~wm {g~makau aibla c`~{ahj{at uaka uatjgi kgibai ug~ka~amai ji{~a#

ank`cgi aljna{ {~awca {wcuwh ank`cgi)

;)> Ugcnamatai

Ka~j ka{a kgc`b~afj kjkaua{lai matjh ug~ka~amai ji{~ank`cgi aljna{

{~awca {wcuwh ank`cgi {g~oakj uaka 22(> ' halj halj kai >>(= ' uaka raij{a)

Mah jij tgtwaj kgibai hj{g~a{w~ namra ug~ka~amai ji{~a#ank`cgi aljna{ {~awca

{wcuwh ank`cgi wcwciza {g~oakj uaka halj#halj) Ugighj{jai zaib kjhalwlai `hgm

C`fjkj kll owba cgiwiowllai matjh zaib {jkal ng~ngka oawm -62'* uaka halj#

halj) Mah jij kjkata~lai namra halj halj njataiza hgnjm al{jf( hgnjm tg~jib

cgibbwialai lgika~aai ng~c`{`~( kai hgnjm tg~jib cgibahacj dgkg~a ka~juaka

raij{a cgtljuwi uaka igba~a#igba~a zaib cgcjhjlj lgnwkazaai zaib ng~ngka)

Ng~kata~lai ka{a kjkaua{lai namra ug~ka~amai ji{~aank`cgi kjtgnanlai

`hgm {~awca {wcuwh uaka ank`cgi kjtgnanlai :5 ' la~gia lgdghalaai hahw hji{at(

la~gia oa{wm ka~j lg{jibbjai tgngta~ >(2 ' kai aljna{ uwlwhai ngika lg~at

a{awuwi ngi{w~ai kgibai gig~bj zaib dwlwu ngta~ tglj{a~ 16(4') Mah jij tgtwaj

ka~j hj{g~a{w~ zaib aka( ugighj{jai zaib kj halwlai `hgm M`hcgt kj Laiaka owba

cgiwiowllai =2 ' {~awca {wcuwh ank`cgi kjtgnanlai `hgm lgdghalaai hahw

hji{at -uaka wcwciza lgdghalaai ng~c`{`~*)

Ng~kata~lai ka{a kjkaua{lai dgkg~a `~bai t`hjk tgug~{j mgua~( hjgi ( kai

bjioah cg~wualai ugizgnan w{aca {g~oakjiza ug~ka~amai ji{~a#ank`cgi zaib



46

uahjib tg~jib {g~oakj) Ng~kata~lai ugighj{jai jij `~bai zaib uahjib tg~jib

cgibahacj dgkg~a akaham mgua~ -42(7'* ( hjgi ->1(6'*( kai bjioah -16(6 '*)

Ugighj{jai zaib aka cgiwiowllai namra dgkg~a `~bai t`hjk hgnjm tg~jib {g~oakj

kjnaikjiblai dgkg~a `~bai ng~ìbba( uaka ugighj{jai zaib kjhalwlai `hgm T`hjcj

kll cgiwiowllai tglj{a~ >6 ' {~awca {wcuwh ank`cgi cgibgiaj hjgi)

Ng~kata~lai ka{a kjkaua{lai namra tgnabjai ngta~ kjhalwlai {jikalai

ùg~a{jf -7='* uaka uatjgi kgibai ug~ka~amai ji{~a#ank`cgi( {jikalai iì

ùg~a{jf caiaogcgi kjhalwlai uaka ;> ' uatjgi kgibai kjkaua{lai aibla

c`~{ahj{at tgngta~ 17(= '( ugizgnan lgca{jai tgnabjai ngta~ kjla~gialai

u~`hìb tz`l) Aibla c`~{ahj{at macuj~ taca kgibai zaib kj{whjt uaka hj{g~a{w~

zaib cgizgnw{ aibla 17#>5 ' lgca{jai kjtgnanlai `hgm {~awca {wcuwh

ank`cgi) Ugighj{jai zaib kjhalwlai `hgm Wkgaij kll kj Awt{~ahja cgikaua{lai

aibla c`~{ahj{at zaib hgnjm ~gikam( ng~ljta~ 15 ')

Ng~kata~lai aiahjta kgibai ~gb~gtj h`bjt{jl kjkaua{lai namra aka

ugiba~wm zaib dwlwu tjbijfjlai mju`{gitj tjt{`hjl( laka~ hal{a{( kai natg kgfjdj{

kgibai aibla c`~{ahj{at tgngta~ ;; '( {g{auj zaib cgcuwizaj mwnwibai

haibtwib tg{gham kjhalwlai aiahjta t{a{t{jl ua~tjah maiza laka~ natg kgfjdj{ ) Mah jij

tgcalji cgibwa{lai ugighj{jai tgnghwciza zaib kjhalwlai `hgm C`fjkj kll

cgibgiaj alw~atj laka~ natg kgfjdj{ {g~makau kjabi`tjt ug~ka~amai ji{~a#

ank`cgi) C`~{ahj{at ka~j ug~ka~amai ji{~a#ank`cgi jij lgnaizalai aljna{

kjabi`tjt zaib {g~hacna{( kjcaia ugcg~jltaai fjtjl -vj{ah tjbi* kai han`~a{`~jwc

haji cgcjhjlj tgitj{jfj{at zaib ~gikam) Natg kgfjdj{ cg~wualai ua~acg{g~



42

cg{an`hjl zaib taiba{ tgitj{jf {g~oakjiza ug~ka~amai kai ngng~aua ugighj{jai

cgiwiowllai mwnwibai zaib tjbijfjlai wi{wl kjhalwlai {~aifwtj arah kai

l`cuhjlatj tz`l aljna{ ug~ka~amai) Hal{a{ kai mju`{gitj tjt{`hjl tgda~a ua~tjah

nwlai cg~wualai fal{`~ u~gkjd{`~ {g~makau aibla c`~{ahj{at uaka uatjgi kgibai




4=

KAF[A^ UWT[ALA

1) Cadlgijg G( F`rhg~ D< Gujkgcj`h`bz `f {~awca) Kahac ? Fghjadjai` K(

Ca{{`} L( C``~g G( ugizwi{jib) [~wca) Gkjtj lg #6) Igr Z`~l ? Cdb~ar —

Mjhh & D`cuaijgt< >55=)

>) Kg Oìb G( Toactwmjkaoa{) Nwlw Aoa~ Jhcw Ngkam) Gkjtj ^gvjtj( ugig~nj{ nwlw

lgk`l{g~ai GBD) 1::2< Oala~{a

4) Njhhfh( Rah{g~) [~awca)Kahac ? N~wijda~kj D( ugizwi{jib Tdmra~{ U~jidjuhgt

`f Tw~bg~z) Igr Z`~l? CdB~ar Mjhh< >55=

;) C`fjkj( Mataij) Kg{g~cjijib {mg addw~adz `f natg kgfjdj{ji kjabi`tjt `f ji{~a#

ank`cjiah jiow~w ji ua{jgi{t rj{m nhwi{ ank`cjiah {~awca) [mg Acg~jdai

O`w~iah `f Gcg~bgidz Tw~bg~z >515 mah :44#:46

7) Ca~l G) Cjllghtgi( Aik~ga I) Cjh{jakgt( Kavjk F) Bajgtlj( Cwijtm B`zah(

Na~~z K) Fwdmt( Dmj~ab V) Tmam( g{ ah< Tg~wc had{a{g jt att`dja{gk rj{m

c`~{ahj{z ji tgvg~g tgutjt jikgugikgi{ `f `~bai fajhw~g aik tm`dl < d~j{jdah

da~g cgkjdjig >55:< mah 1625#1622

6) Mwtaji FA( Ca~{ji CO( Cwhhgij} UT( T{gghg T^( Ghhj`{{ KD) Tg~wc Had{a{g

aik Natg kgfjdj{at U~gkjd{`~t `f C`~{ahj{z aik C`~njkj{z) [mg Acg~jdai

O`w~iah `f Tw~bg~z 1=7( >554( mah ;=7 — ;:1

2) D`dm~ai( Acahja CK( CA< Gkghcai( Hjika T) CUmjh( NTI< Taffhg( Ogff~gz

^) CK( FADT< C`~~jt( T{gumgi G) CK( FADT) [mg ^gha{jìtmju `f Tg~wc



Had{a{g aik Natg kgfjdj{ ji Nw~i Ua{jgi{t {` C`~{ahj{z) O`w~iah Nw~it Da~g

^gtwtdj{a{jì v`h =->*( >552( mah >41#>;5

=) Ogib OD( Oanhìtlj L( N~jkbgcai A( O`~kai CM) Tg~wc had{a{g( i`{ natg

kgfjdj{( ~aujkhz u~gkjd{t tw~vjvah af{g~ cao`~ nw~it) O`w~iaht `f Nw~it v`h

>=->*( >55>( mah)161#166

:) An~actì K( Tdahga [C( Mj{dmd`dl ^( g{ ah) Had{a{g Dhga~aidg aik Tw~vjvah

F`hh`rjib Jiow~z) O [~awca v`h 47( 1::4( 7=; — =)

15) Vjidgi{ OH( Kwfazg U( Ng~~g O( g{ ah) Tg~jah Had{a{g Kg{g~cjia{jìt Kw~jib

Dj~dwha{`~z Tm`dl ) D~j{ Da~g Cgk 1:=4<11?;;: — 71)

11) Dha~jkbg OA( D~an{~gg [K( Ughhg{jg~ TO( g{ ah) Ug~tjt{gi{ @ddwh{ mzuùg~fwtjì

jt Att`dja{gk rj{m a Tjbijfjdai{ Jid~gatg ji Jifgd{jì â{g aik C`~{ahj{z ji

Cao`~ [~awca Ua{jgi{t) O [~awca >555<;=?= — 1;)

Pengaruh Laktat,Base Defisit, Hipotensi Sistolik Pada Trauma Tumpul Abdomen

Documents