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Скачать презентацию 1 کﺎﺭگﺎﻩ کﺸﻮﺭی کﺪگﺬﺍﺭی ﻣﺮگ ﻭ ﻣیﺮ
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1 کﺎﺭگﺎﻩ کﺸﻮﺭی کﺪگﺬﺍﺭی ﻣﺮگ ﻭ ﻣیﺮ ﻣﺮﺿیﻪ ﻣﻌﺮﺍﺟی ﺩﺍﻧﺸﺠﻮی ﺩکﺘﺮی ﻣﺪیﺮیﺖ ﺍﻃﻼﻋﺎﺕ ﺑﻬﺪﺍﺷﺘی ﺩﺭﻣﺎﻧی ﺩﻭﻣیﻦ گﺮﺩﻫﻤﺎﻳﻲ ﻣﺴﺌﻮﻟﻴﻦ ﻭ ﻛﺎﺭﺷﻨﺎﺳﺎﻥ آﻤﺎﺭ ﻭ ﻣﺪﺍﺭﻙ پﺰﺷﻜﻲ ﺩﺍﻧﺸگﺎﻩ ﻫﺎﻱ ﻋﻠﻮﻡ پﺰﺷﻜﻲ ﻛﺸﻮﺭ ﻭﺯﺍﺭﺕ ﺑﻬﺪﺍﺷﺖ ﺩﺭﻣﺎﻥ ﻭآﻤﻮﺯﺵ پﺰﺷکی 61 ﺍﺳﻔﻨﺪ 1931
2 ﺭﺋﻮﺱ ﻣﻄﺎﻟﺐ • • • ﺍﻫﻤیﺖ ﺛﺒﺖ ﻋﻠﻞ ﻣﺮگ ﻭ ﻣیﺮ گﻮﺍﻫی ﺑیﻦ ﺍﻟﻤﻠﻠی ﻓﻮﺕ ﺗﻌﺮیﻒ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﻗﻮﺍﻧیﻦ ﺍﻧﺘﺨﺎﺏ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻗﻮﺍﻧیﻦ ﺍﻧﺘﺨﺎﺏ ﻭ ﺗﻌﺪیﻞ ﻋﻠﺖ ﻣﺮگ
3 ﺷﻜﻞ ﻭ ﺍﺟﺰﺍی گﻮﺍﻫﻲ ﻓﻮﺕ پﻴﺸﻨﻬﺎﺩﻱ ﺳﺎﺯﻣﺎﻥ ﺟﻬﺎﻧﻲ ﺑﻬﺪﺍﺷﺖ ﻛﻪ ﺑﻪ ﻣﻨﻈﻮﺭ ﺛﺒﺖ ﻋﻠﺖ ﻣﺮگ ﺑﺮ ﺍﺳﺎﺱ ﺗﻌﺮﻳﻒ ﻓﻮﻕ ﻃﺮﺍﺣﻲ ﺷﺪﻩ ﺍﺳﺖ
ﻓﺮﻡ ﺑﻴﻦ ﺍﻟﻤﻠﻠی گﻮﺍﻫی پﺰﺷکی ﻋﻠﺖ ﻣﺮگ 1 آﺨﺮﻳﻦ ﺑﻴﻤﺎﺭی ﻳﺎ ﻭﺿﻌﻴﺘی کﻪ ﺑﻼﻓﺎﺻﻠﻪ پﻴﺶ ﺍﺯ ﻣﺮگ ﻭﺟﻮﺩ ﺩﺍﺷﺖ * ﺑﻴﻤﺎﺭﻳﻬﺎی ﻗﺒﻠی ﺯﻣﺎﻥ ﺗﻘﺮﻳﺒی ﺑﻴﻦ ﺷﺮﻭﻉ ﺗﺎ ﻣﺮگ ﺍﻟﻒ: ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺏ: ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺝ: ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺩ: 2 ﺳﺎﻳﺮ ﺑﻴﻤﺎﺭﻳﻬﺎﻳی کﻪ ﺑﻪ ﻣﺮگ کﻤک کﺮﺩﻩﺍﻧﺪ ﻭﻟی ﻭﺟﻮﺩ آﻨﻬﺎ ﺑﻪ ﺗﻨﻬﺎﻳی ﻣﻮﺟﺐ ﻣﺮگ ﻧﻤﻲﺷﺪ * ﻧﺎﻡ ﺑﻴﻤﺎﺭی، آﺴﻴﺐ ﻳﺎ ﻋﻮﺍﺭﺽ آﻨﻬﺎ کﻪ ﻣﻮﺣﺐ ﻣﺮگ ﺷﺪﻩ ﺍﺳﺖ. ﺩﺭ ﺍﻳﻦ ﻗﺴﻤﺖ ﻧﻤی ﺗﻮﺍﻥ ﺗﺎﺑﻠﻮی ﻣﺮگ ﻣﺎﻧﻨﺪ ﺍﻳﺴﺖ ﻗﻠﺒی ﻳﺎ ﻧﺎﺭﺳﺎﻳی ﺗﻨﻔﺴی ﺭﺍ ﻭﺍﺭﺩ کﺮﺩ. 4
5 ﺟﻬﺖ ﺭﻭﺷﻦ ﺷﺪﻥ ﻣﻄﻠﺐ ﺑﻪ ﻃﺮﺡ ﻳﻚ ﻣﺜﺎﻝ ﻣﻲپﺮﺩﺍﺯﻳﻢ. ﻣﺜﺎﻝ 1: ﺧﺎﻧﻢ 54 ﺳﺎﻟﻪ ﺍﻱ ﺩﺭ ﺳﺎﻋﺖ 9 ﺻﺒﺢ 41 ﺧﺮﺩﺍﺩ ﻣﺎﻩ ﺑﻪ ﻋﻠﺖ ﺷﻜﺴﺘگﻲ ﺍﺳﺘﺨﻮﺍﻥ ﺭﺍﻥ ﺩﺭ ﻣﻨﺰﻝ ﺧﻮﻳﺶ، ﺑﻪ ﺩﺭﻣﺎﻧگﺎﻩ ﺍﺭﺗﻮپﺪﻱ ﻳﻚ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻣﻨﺘﻘﻞ ﺷﺪﻩ ﻭ ﺑﺴﺘﺮﻱ ﻣﻲﺷﻮﺩ. پﺲ ﺍﺯ ﺍﻗﺪﺍﻣﺎﺕ ﺩﺭﻣﺎﻧﻲ ﻣﻨﺎﺳﺐ ﺩﺭ ﻫﺸﺘﻤﻴﻦ ﺭﻭﺯ ﺑﺴﺘﺮﻱ ﺑﺎ ﺗﺸﺨﻴﺺ آﻤﺒﻮﻟﻲ ﺭﻳﻪ ﻓﻮﺕ ﻣﻲﻛﻨﺪ. ﺩﺭ ﺑﺮﺭﺳﻲ ﻫﺎﻱ ﺑﻴﺸﺘﺮ ﻣﺸﺨﺺ ﻣﻲﺷﻮﺩ ﻛﻪ ﻣﺘﻮﻓﻲ چﻬﺎﺭ ﺳﺎﻝ ﻗﺒﻞ ﺩﺍﺭﺍﻱ ﻛﺎﺭﺳﻴﻨﻮﻡ پﺴﺘﺎﻥ ﺑﻮﺩ ، ﻛﻪ ﺑﻪ ﻓﻤﻮﺭ ﻣﺘﺎﺳﺘﺎﺯ ﺩﺍﺩﻩ ﺑﻮﺩ.
ﻓﺮﻡ ﺑﻴﻦ ﺍﻟﻤﻠﻠی گﻮﺍﻫی پﺰﺷکی ﻋﻠﺖ ﻣﺮگ 1 آﺨﺮﻳﻦ ﺑﻴﻤﺎﺭی ﻳﺎ ﻭﺿﻌﻴﺘی کﻪ ﺑﻼﻓﺎﺻﻠﻪ پﻴﺶ ﺍﺯ ﻣﺮگ ﻭﺟﻮﺩ ﺩﺍﺷﺖ * ﺑﻴﻤﺎﺭﻳﻬﺎی ﻗﺒﻠی ﺍﻟﻒ: آﻤﺒﻮﻟﻲ ﺭﻳﻮﻱ ﺯﻣﺎﻥ ﺗﻘﺮﻳﺒی ﺑﻴﻦ ﺷﺮﻭﻉ ﺗﺎ ﻣﺮگ چﻨﺪ ﺳﺎﻋﺖ ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺏ: ﺷﻜﺴﺘگﻲ پﺎﺗﻮﻟﻮژﻴﻚ ﻓﻤﻮﺭ 8 ﺭﻭﺯ ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺝ: : ﻣﺘﺎﺳﺘﺎﺯ ﺳﺮﻃﺎﻥ ﺑﻪ ﻓﻤﻮﺭ 2 ﺭﻭﺯ ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺩ: : ﺳﺮﻃﺎﻥ پﺴﺘﺎﻥ 4 ﺳﺎﻝ 2 ﺳﺎﻳﺮ ﺑﻴﻤﺎﺭﻳﻬﺎﻳی کﻪ ﺑﻪ ﻣﺮگ کﻤک کﺮﺩﻩ ﺍﻧﺪ ﻭﻟی ﻭﺟﻮﺩ آﻨﻬﺎ ﺑﻪ ﺗﻨﻬﺎﻳی ﻣﻮﺟﺐ ﻣﺮگ ﻧﻤﻴﺸﺪ * ﻧﺎﻡ ﺑﻴﻤﺎﺭی، آﺴﻴﺐ ﻳﺎ ﻋﻮﺍﺭﺽ آﻨﻬﺎ کﻪ ﻣﻮﺣﺐ ﻣﺮگ ﺷﺪﻩ ﺍﺳﺖ. ﺩﺭ ﺍﻳﻦ ﻗﺴﻤﺖ ﻧﻤی ﺗﻮﺍﻥ ﺗﺎﺑﻠﻮی ﻣﺮگ ﻣﺎﻧﻨﺪ ﺍﻳﺴﺖ ﻗﻠﺒی ﻳﺎ ﻧﺎﺭﺳﺎﻳی ﺗﻨﻔﺴی ﺭﺍ ﻭﺍﺭﺩ کﺮﺩ. 6
7 ﻣﺜﺎﻝ 2 - آﻘﺎﻱ 22 ﺳﺎﻟﻪ ﺍﻱ ﺑﻼﻓﺎﺻﻠﻪ ﺑﻌﺪ ﺍﺯ ﺗﺼﺎﺩﻑ ﺑﺎ ﺍﺗﻮﻣﺒﻴﻞ، ﺑﻪ ﺍﻭﺭژﺎﻧﺲ آﻮﺭﺩﻩ ﺷﺪﻩ ﺍﺳﺖ. ﻫﻨگﺎﻡ پﺬﻳﺮﺵ ﻓﺎﻗﺪ ﻧﺒﺾ ﻭ ﺗﻨﻔﺲ ﺑﻮﺩﻩ ﻭ ﻋﻤﻠﻴﺎﺕ ﺍﺣﻴﺎ ﻣﺆﺜﺮ ﻭﺍﻗﻊ ﻧﻤﻲﺷﻮﺩ. ﺩﺭ ﻻپﺎﺭﺍﺳﻜﻮپﻲ ﻣﺸﺨﺺ ﻣﻲﺷﻮﺩ ﻛﻪ ﻛﺒﺪ ﺑﻴﻤﺎﺭ پﺎﺭﻩ ﺷﺪﻩ ﻭ پﺮﻳﺘﻮﺍﻥ پﺮ ﺍﺯ ﺧﻮﻥ ﺍﺳﺖ. ﺑﻪ ﻧﻈﺮ ﻣﻲآﻴﺪ، ﺑﻴﻤﺎﺭ ﺑﻪ ﻋﻠﺖ ﺷﻮﻙ ﻫﻴپﻮﻭﻟﻤﻴﻚ ﺩﺭ ﺍﺛﺮ ﺧﻮﻧﺮﻳﺰﻱ، ﺩچﺎﺭ ﺍﻳﺴﺖ ﻗﻠﺒﻲ ﺷﺪﻩ ﻭ ﻓﻮﺕ ﻛﺮﺩﻩ ﺍﺳﺖ. ﻧﻤﻮﻧﻪ ﺗﻜﻤﻴﻞ ﺷﺪﻩ ﻗﺴﻤﺖ ﻋﻠﺖ ﻣﺮگ گﻮﺍﻫﻲ پﺰﺷﻜﻲ ﺩﺭ ﺷﻜﻞ ﺯﻳﺮ ﻧﺸﺎﻥ ﺩﺍﺩﻩ ﻣﻲﺷﻮﺩ.
ﻓﺮﻡ ﺑیﻦ ﺍﻟﻤﻠﻠی گﻮﺍﻫی پﺰﺷکی ﻋﻠﺖ ﻣﺮگ ﺯﻣﺎﻥ ﺗﻘﺮیﺒی ﺑیﻦ ﺷﺮﻭﻉ ﺗﺎ ﻣﺮگ ﺍﻟﻒ: ﺷﻮﻙ ﻫیپﻮﻭﻟﻤیک 1 آﺨﺮیﻦ ﺑیﻤﺎﺭی یﺎ ﻭﺿﻌیﺘی کﻪ ﺑﻼﻓﺎﺻﻠﻪ پیﺶ ﺍﺯ ﻣﺮگ ﻭﺟﻮﺩ ﺩﺍﺷﺖ * ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ چﻨﺪ ﺩﻗیﻘﻪ ﺏ: ﺧﻮﻧﺮﻳﺰﻱ ﺩﺭ پﺮﻳﺘﻮﺍﻥ ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ ﺝ : پﺎﺭگﻲ ﻛﺒﺪ ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ چﻨﺪ ﺩﻗیﻘﻪ ﺑیﻤﺎﺭیﻬﺎی ﻗﺒﻠی ﺩ: : ﺗﺼﺎﺩﻑ ﺑﺎ ﺍﺗﻮﻣﺒﻴﻞ 2 ﺳﺎیﺮ ﺑیﻤﺎﺭیﻬﺎیی کﻪ ﺑﻪ ﻣﺮگ کﻤک کﺮﺩﻩ ﺍﻧﺪ ﻭﻟی ﻭﺟﻮﺩ آﻨﻬﺎ ﺑﻪ ﺗﻨﻬﺎیی ﻣﻮﺟﺐ ﻣﺮگ ﻧﻤیﺸﺪ چﻨﺪ ﺩﻗیﻘﻪ ﻋﻠﺖ ﻣﺮگ ﻫ ﻤﺎﻥ ﻋﻠ ﺖ ﺯﻣﻴﻨﻪ ﺍﻱ ﺍﺳ ﺖ چﻨﺪ ﺩﻗیﻘﻪ * ﻧﺎﻡ ﺑیﻤﺎﺭی، آﺴیﺐ یﺎ ﻋﻮﺍﺭﺽ آﻨﻬﺎ کﻪ ﻣﻮﺣﺐ ﻣﺮگ ﺷﺪﻩ ﺍﺳﺖ. ﺩﺭ ﺍیﻦ ﻗﺴﻤﺖ ﻧﻤی ﺗﻮﺍﻥ ﺗﺎﺑﻠﻮی ﻣﺮگ ﻣﺎﻧﻨﺪ ﺍیﺴﺖ ﻗﻠﺒی یﺎ ﻧﺎﺭﺳﺎیی ﺗﻨﻔﺴی ﺭﺍ ﻭﺍﺭﺩ کﺮﺩ. 8
9 ﻣﺜﺎﻝ 3 – آﻘﺎﻱ 45 ﺳﺎﻟﻪ ﺍﻱ ﺑﻪ ﻋﻠﺖ ﺍﺳﺘﻔﺮﺍﻍ ﺧﻮﻧﻲ ﺷﺪﻳﺪ ﺑﺎ ﺯﺭﺩﻱ ﻭﺍﺿﺢ ﻣﺮﺍﺟﻌﻪ ﻣﻲﻛﻨﺪ. ﺩﺭ ﺑﺮﺭﺳﻲ ﻣﻌﻠﻮﻡ ﻣﻲﺷﻮﺩ ﻛﻪ ﻣﻨﺸﺎﺀ ﺧﻮﻧﺮﻳﺰﻱ، ﻣﺮﻱ ﺍﺳﺖ. ﺩﺭ ﻣﻌﺎﻳﻨﻪ ﺑﺎﻟﻴﻨﻲ آﺴﻴﺖ ﺷﻜﻤﻲ ﻭﺟﻮﺩ ﺩﺍﺭﺩ. آﻤﻮﻧﻴﺎﻙ ﺧﻮﻥ ﺑﻴﻤﺎﺭ ﺑﺎﻻ گﺰﺍﺭﺵ ﻣﻲﺷﻮﺩ. ﻫﻤچﻨﻴﻦ ﺍﻓﺰﺍﻳﺶ ﻓﺸﺎﺭ پﻮﺭﺕ ﻭ ﺳﻴﺮﻭﺯ ﻛﺒﺪﻱ ﺍﺛﺒﺎﺕ ﻣﻲﺷﻮﺩ. ﺩﺭ ﻧﻬﺎﻳﺖ ﺑﻴﻤﺎﺭ ﺩچﺎﺭ آﻨﺴﻔﺎﻟﻮپﺎﺗﻲ ﻛﺒﺪﻱ ﺷﺪﻩ ﻭ ﺩﺭ ﺭﻭﺯ ﺑﻴﺴﺖ ﻭ ﺩﻭﻡ ﺑﺴﺘﺮﻱ ﺑﻪ ﻛﻤﺎ ﺭﻓﺘﻪ ﻭ ﺑﻪ ICU ﻣﻨﺘﻘﻞ ﻣﻲﺷﻮﺩ. ﺩﻭ ﺭﻭﺯ ﺑﻌﺪ ﺑﺎ ﺍﻳﺴﺖ ﻗﻠﺒﻲ ﻭ ﺗﻨﻔﺴﻲ ﻓﻮﺕ ﻣﻲﻛﻨﺪ. ﺟﺪﻭﻝ ﺯﻳﺮ ﻛﻠﻤﺎﺗﻲ ﺭﺍ ﻛﻪ ﻣﻤﻜﻦ ﺍﺳﺖ ﺑﺮﺍﻱ ﺛﺒﺖ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻣﻨﺎﺳﺐ ﺑﻨﻈﺮ ﺑﺮﺳﺪ ﻧﺸﺎﻥ ﻣﻲﺩﻫﺪ. ﺑﻪ ﺗﻮﺿﻴﺤﺎﺗﻲ ﻛﻪ ﻣﻮﺟﺐ ﺭﺩ ﺑﺮﺧﻲ ﻛﻠﻤﺎﺕ ﻭ ﺍﻧﺘﺨﺎﺏ ﺑﻴﻤﺎﺭﻳﻬﺎ، ﻭﺿﻌﻴﺖﻫﺎﻱ ﻧﺎﺧﻮﺷﻲ ﻣﻨﺎﺳﺐ ﺟﻬﺖ ﺩﺭﺝ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﺗﻮﺟﻪ ﻓﺮﻣﺎﺋﻴﺪ.
ﻭﺿﻌﻴﺖ ﺗﻮﺿﻴﺤﺎﺕ ﺍﻳﺴﺖ ﻗﻠﺒی ﺗﺎﺑﻠﻮﻱ ﻣﺮگ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ. ﺍﻳﺴﺖ ﺗﻨﻔﺴی ﺗﺎﺑﻠﻮﻱ ﻣﺮگ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ. آﻨﺴﻔﺎﻟﻮپﺎﺗﻲ ﻛﺒﺪﻱ آﺨﺮﻳﻦ ﺑﻴﻤﺎﺭﻱ ﺗﺸﺨﻴﺺ ﺩﺍﺩﻩ ﺷﺪﻩ ﻗﺒﻞ ﺍﺯ ﻣﺮگ ﺍﺳﺖ ﻭ ﻣﻘﺎﺑﻞ ﺍﻟﻒ ﻧﻮﺷﺘﻪ ﻣﻲﺷﻮﺩ ﺍﺳﺘﻔﺮﺍﻍ ﺧﻮﻧﻲ ﺷﻜﺎﻳﺖ ﻳﺎ ﻋﻼﻣﺖ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ. Hyperammonemia ﻳﺎﻓﺘﻪ آﺰﻣﺎﻳﺸگﺎﻫﻲ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ ﻋﻼﻣﺖ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ ﺍﻓﺰﺍﻳﺶ ﻓﺸﺎﺭ پﻮﺭﺕ ﻛﻤﺎﻱ ﻫپﺎﺗﻴﺖ ﻋﻼﻣﺖ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ آﺴﻴﺖ ﺷﻜﻤﻲ ﺷﻜﺎﻳﺖ ﻳﺎ ﻋﻼﻣﺖ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ. ﺯﺭﺩﻱ ﺷﻜﺎﻳﺖ ﻳﺎ ﻋﻼﻣﺖ ﺍﺳﺖ ﻭ ﺩﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﻭﺍﺭﺩ ﻧﻤﻲﺷﻮﺩ. ﺳﻴﺮﻭﺯ ﻛﺒﺪﻱ ﺍﻳﻦ ﺑﻴﻤﺎﺭﻱ ﻋﻠﺖ ﺍﻟﻒ ﺍﺳﺖ ﻭ ﻣﻘﺎﺑﻞ ﺏ ﻧﻮﺷﺘﻪ ﻣﻲﺷﻮﺩ. 01
ﻓﺮﻡ ﺑیﻦ ﺍﻟﻤﻠﻠی گﻮﺍﻫی پﺰﺷکی ﻋﻠﺖ ﻣﺮگ 1 آﺨﺮیﻦ ﺑیﻤﺎﺭی یﺎ ﻭﺿﻌیﺘی کﻪ ﺑﻼﻓﺎﺻﻠﻪ پیﺶ ﺍﺯ ﻣﺮگ ﻭﺟﻮﺩ ﺩﺍﺷﺖ * ﺑیﻤﺎﺭیﻬﺎی ﻗﺒﻠی ﺍﻟﻒ: آﻨﺴﻔﺎﻟﻮپﺎﺗﻲ ﺯﻣﺎﻥ ﺗﻘﺮیﺒی ﺑیﻦ ﺷﺮﻭﻉ ﺗﺎ ﻣﺮگ چﻨﺪ ﺭﻭﺯ ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ ﺏ : ﺳﻴﺮﻭﺯ ﻛﺒﺪﻱ چﻨﺪ ﺳﺎﻝ ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ ﺝ: ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ ﺩ: : 2 ﺳﺎیﺮ ﺑیﻤﺎﺭیﻬﺎیی کﻪ ﺑﻪ ﻣﺮگ کﻤک کﺮﺩﻩ ﺍﻧﺪ ﻭﻟی ﻭﺟﻮﺩ آﻨﻬﺎ ﺑﻪ ﺗﻨﻬﺎیی ﻣﻮﺟﺐ ﻣﺮگ ﻧﻤیﺸﺪ * ﻧﺎﻡ ﺑیﻤﺎﺭی، آﺴیﺐ یﺎ ﻋﻮﺍﺭﺽ آﻨﻬﺎ کﻪ ﻣﻮﺣﺐ ﻣﺮگ ﺷﺪﻩ ﺍﺳﺖ. ﺩﺭ ﺍیﻦ ﻗﺴﻤﺖ ﻧﻤی ﺗﻮﺍﻥ ﺗﺎﺑﻠﻮی ﻣﺮگ ﻣﺎﻧﻨﺪ ﺍیﺴﺖ ﻗﻠﺒی یﺎ ﻧﺎﺭﺳﺎیی ﺗﻨﻔﺴی ﺭﺍ ﻭﺍﺭﺩ کﺮﺩ. 11
21 ﻣﺜﺎﻝ 4 – آﻘﺎﻱ 16 ﺳﺎﻟﻪﺍﻱ ﺍﺯ پﻨﺞ ﺳﺎﻝ ﻗﺒﻞ ﺑﺎ ﺗﺸﺨﻴﺺ ﺩﻳﺎﺑﺖ ﻧﻮﻉ ﺩﻭﻡ ﺭﻭﺯﺍﻧﻪ ﺩﻭ ﻗﺮﺹ گﻠﻲ ﺑﻦ ﻛﻼﻣﻴﺪ ﻣﺼﺮﻑ ﻣﻲﻛﺮﺩ. ﻫﻤچﻨﻴﻦ ﺍﺯ چﻬﺎﺭ ﺳﺎﻝ ﻗﺒﻞ ﺑﻌﻠﺖ ﺍﻧﺴﺪﺍﺩ ﻧﺴﺒﻲ ﻋﺮﻭﻕ ﻗﻠﺐ ) (CAD ﻭ ﻓﺸﺎﺭ ﺧﻮﻥ ﺯﻳﺮ ﻧﻈﺮ ﻣﺘﺨﺼﺺ ﻗﻠﺐ ﺗﺤﺖ ﺩﺭﻣﺎﻥ ﺩﺍﺭﻭﻳﻲ ﺑﻮﺩ ﻭ ﻳﻜﺒﺎﺭ ﻧﻴﺰ ﺩﺭ CCU ﺑﺴﺘﺮﻱ ﺷﺪﻩ ﺑﻮﺩ. ﺩﻩ ﺭﻭﺯ ﻗﺒﻞ ﺍﺯ ﻓﻮﺕ ﺑﻪ ﻋﻠﺖ ﺍﺳﻬﺎﻝ آﺒﻜﻲ ﺷﺪﻳﺪ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺑﺴﺘﺮﻱ ﺷﺪﻩ ﻭ ﺑﺎ ﻛﺸﺖ ﻣﺪﻓﻮﻉ ﺗﺸﺨﻴﺺ ﻭﺑﺎ ﺩﺍﺩﻩ ﻣﻲﺷﻮﺩ. چﻬﺎﺭ ﺭﻭﺯ ﺑﻌﺪ ﺍﺯ ﺑﺴﺘﺮﻱ ﺩچﺎﺭ ﺍﻭﺭﻣﻲ ﺷﺪﻩ ﻭ ﻛﺮﺍﺗﻴﻨﻴﻦ ﻭﻱ ﺗﺎ 21 ﺑﺎﻻ ﻣﻲﺭﻭﺩ ﻭ ﺗﺤﺖ ﻫﻤﻮﺩﻳﺎﻟﻴﺰ ﻗﺮﺍﺭ ﻣﻲگﻴﺮﺩ. ﻭﻟﻲ ﻧﺎﺭﺳﺎﻳﻲ ﻛﻠﻴﻪ ﺑﻴﻤﺎﺭ ﺍﺻﻼﺡ ﻧﺸﺪﻩ ﻭ ﺩﺭ ﺭﻭﺯ ﺩﻫﻢ ﺑﺴﺘﺮﻱ ﺑﺎ ﺍﻳﺴﺖ ﻗﻠﺒﻲ ﻓﻮﺕ ﻣﻲﻛﻨﺪ.
ﻓﺮﻡ ﺑیﻦ ﺍﻟﻤﻠﻠی گﻮﺍﻫی پﺰﺷکی ﻋﻠﺖ ﻣﺮگ ﺯﻣﺎﻥ ﺗﻘﺮیﺒی ﺑیﻦ ﺷﺮﻭﻉ ﺗﺎ ﻣﺮگ ﺍﻟﻒ : ﻧﺎﺭﺳﺎﻳﻲ ﺣﺎﺩ ﻛﻠﻴﻪ 1 آﺨﺮیﻦ ﺑیﻤﺎﺭی یﺎ ﻭﺿﻌیﺘی کﻪ ﺑﻼﻓﺎﺻﻠﻪ پیﺶ ﺍﺯ ﻣﺮگ ﻭﺟﻮﺩ ﺩﺍﺷﺖ * ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ ﺏ : ﻭﻳﺒﺮﻳﻮ ﻛﻠﺮﺍ ﺑیﻤﺎﺭیﻬﺎی ﻗﺒﻠی ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ ﺝ: ﺑﻪ ﺳﺒﺐ یﺎ پیﺎﻣﺪ ﺩ: : 2 ﺳﺎیﺮ ﺑیﻤﺎﺭیﻬﺎیی کﻪ ﺑﻪ ﻣﺮگ کﻤک کﺮﺩﻩ ﺍﻧﺪ ﻭﻟی ﻭﺟﻮﺩ آﻨﻬﺎ ﺑﻪ ﺗﻨﻬﺎیی ﻣﻮﺟﺐ ﻣﺮگ ﻧﻤیﺸﺪ ﺩﻳﺎﺑﺖ ﻏﻴﺮ ﻭﺍﺑﺴﺘﻪ ﺑﻪ ﺍﻧﺴﻮﻟﻴﻦ ﺑﻴﻤﺎﺭﻱ ﻋﺮﻭﻕ ﻛﺮﻭﻧﺮﻱ، پﺮﻓﺸﺎﺭﻱ ﺧﻮﻥ پﻨﺞ ﺳﺎﻝ چﻬﺎﺭ ﺳﺎﻝ * ﻧﺎﻡ ﺑیﻤﺎﺭی، آﺴیﺐ یﺎ ﻋﻮﺍﺭﺽ آﻨﻬﺎ کﻪ ﻣﻮﺣﺐ ﻣﺮگ ﺷﺪﻩ ﺍﺳﺖ. ﺩﺭ ﺍیﻦ ﻗﺴﻤﺖ ﻧﻤی ﺗﻮﺍﻥ ﺗﺎﺑﻠﻮی ﻣﺮگ ﻣﺎﻧﻨﺪ ﺍیﺴﺖ ﻗﻠﺒی یﺎ ﻧﺎﺭﺳﺎیی ﺗﻨﻔﺴی ﺭﺍ ﻭﺍﺭﺩ کﺮﺩ. 31
41 ﻣﺜﺎﻝ 5– ﺩﺭ ﺗﺎﺭﻳﺦ 31 ﺩﻱ ﻣﺎﻩ 2831، ﻳﻚ ﻣﺮﺩ 12 ﺳﺎﻟﻪ ﻛﻪ ﺩﺭ ﺗﺼﺎﺩﻑ ﺍﺗﻮﻣﺒﻴﻞ ﺑﻪ ﺷﺪﺕ ﻣﺠﺮﻭﺡ ﺷﺪﻩ ﺑﻮﺩ، ﺑﻌﻠﺖ ﺿﺮﺑﻪ ﻣﻐﺰﻱ ﺩﺭ ﺍﺛﺮ ﺷﻜﺴﺘگﻲ ﺟﻤﺠﻤﻪ ﻣﺪﺕ ﻛﻮﺗﺎﻫﻲ ﺑﻌﺪ ﺍﺯ ﻭﺭﻭﺩ ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﻓﻮﺕ ﻛﺮﺩ. ﺣﺴﺐ گﺰﺍﺭﺵ پﻠﻴﺲ، ﻣﺘﻮﻓﻲ ﺭﺍﻧﻨﺪﻩ ﺍﺗﻮﻣﺒﻴﻠﻲ ﺑﻮﺩ ﻛﻪ ﺩﺭ ﺳﺎﻋﺖ 2/51 ﺻﺒﺢ ﺩﺭ ﺗﻘﺎﻃﻊ ﺧﻴﺎﺑﺎﻥ ﺍﻟﻒ ﺑﺎ ﺏ، پﺲ ﺍﺯ گﺬﺷﺘﻦ ﺍﺯ ﺧﻂ ﻭﺳﻂ ﺧﻴﺎﺑﺎﻥ ﺍﺯ ﺭﻭﺑﺮﻭ ﺑﺎ ﺍﺗﻮﻣﺒﻴﻠﻲ ﻛﻪ ﺍﺯ ﻃﺮﻑ ﻣﻘﺎﺑﻞ ﻣﻲ آﻤﺪﻩ ﺑﺮﺧﻮﺭﺩ ﻧﻤﻮﺩﻩ ﺍﺳﺖ. ﺍﺗﻮپﺴﻲ ﻧﺸﺎﻥ ﺩﺍﺩ ﻛﻪ ﺍﺗﺎﻧﻮﻝ ﺧﻮﻥ 0/42 گﺮﻡ ﺩﺭﺻﺪ ﺑﻮﺩ.
ﻓﺮﻡ ﺑیﻦ ﺍﻟﻤﻠﻠی گﻮﺍﻫی پﺰﺷکی ﻋﻠﺖ ﻣﺮگ ﺯﻣﺎﻥ ﺗﻘﺮیﺒی ﺑیﻦ ﺷﺮﻭﻉ ﺗﺎ ﻣﺮگ ﺍﻟﻒ : ﻛﻮﻓﺘگﻲ ﻣﻐﺰﻱ 1 آﺨﺮیﻦ ﺑیﻤﺎﺭی یﺎ ﻭﺿﻌیﺘی کﻪ ﺑﻼﻓﺎﺻﻠﻪ پیﺶ ﺍﺯ ﻣﺮگ ﻭﺟﻮﺩ ﺩﺍﺷﺖ * ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺏ : ﺷﻜﺴﺘگﻲ ﺟﻤﺠﻤﻪ ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺑیﻤﺎﺭیﻬﺎی ﻗﺒﻠی ﺝ : ﺍﺻﺎﺑﺖ ﺳﺮ ﺑﻪ ﺟﺴﻢ ﺳﺨﺖ ﺑﻪ ﺳﺒﺐ ﻳﺎ پﻴﺎﻣﺪ ﺩ : ﺗﺼﺎﺩﻑ ﺩﻭ ﻭﺳﻴﻠﻪ ﻧﻘﻠﻴﻪ ﻣﻮﺗﻮﺭﻱ 2 ﺳﺎیﺮ ﺑیﻤﺎﺭیﻬﺎیی کﻪ ﺑﻪ ﻣﺮگ کﻤک کﺮﺩﻩ ﺍﻧﺪ ﻭﻟی ﻭﺟﻮﺩ آﻨﻬﺎ ﺑﻪ ﺗﻨﻬﺎیی ﻣﻮﺟﺐ ﻣﺮگ ﻧﻤیﺸﺪ ﻣﺴﻤﻮﻣﻴﺖ ﺣﺎﺩ ﺑﺎ ﺍﻟﻜﻞ چﻨﺪ ﺩﻗﻴﻘﻪ ﻳﻚ ﺳﺎﻋﺖ * ﻧﺎﻡ ﺑیﻤﺎﺭی، آﺴیﺐ یﺎ ﻋﻮﺍﺭﺽ آﻨﻬﺎ کﻪ ﻣﻮﺣﺐ ﻣﺮگ ﺷﺪﻩ ﺍﺳﺖ. ﺩﺭ ﺍیﻦ ﻗﺴﻤﺖ ﻧﻤی ﺗﻮﺍﻥ ﺗﺎﺑﻠﻮی ﻣﺮگ ﻣﺎﻧﻨﺪ ﺍیﺴﺖ ﻗﻠﺒی یﺎ ﻧﺎﺭﺳﺎیی ﺗﻨﻔﺴی ﺭﺍ ﻭﺍﺭﺩ کﺮﺩ. 51
61 ﺍﺟﺰﺍﺀ ﺗﺸﻜﻴﻞ ﺩﻫﻨﺪﻩ گﻮﺍﻫﻲ ﻓﻮﺕ ﺩﻭﺭﻩ ﺣﻮﻝ ﺗﻮﻟﺪ : ﻧﻈﺮ ﺑﻪ ﺍﻳﻨﻜﻪ ﻣﺮگ ﺩﺭ ﺩﻭﺭﻩ ﺣﻮﻝ ﺗﻮﻟﺪ ﺍﺭﺗﺒﺎﻁ ﺧﻴﻠﻲ ﻧﺰﺩﻳﻜﻲ ﺑﺎ ﺷﺮﺍﻳﻂ ﻭ ﺑﻴﻤﺎﺭﻳﻬﺎ ﻣﺎﺩﺭ ﺩﺍﺭﺩ، گﻮﺍﻫﻲ ﻓﻮﺕ ﺍﻳﻦ ﺩﻭﺭﻩ ﺷﺎﻣﻞ ﺑﻴﻤﺎﺭﻳﻬﺎ ﻭ ﺷـﺮﺍﻳﻂ ﻧﻮﺯﺍﺩ ﻭ ﻣـﺎﺩﺭ ﺍﻭﺳﺖ. ﺍﺯ ﺍﻳﻦ ﺭﻭ ﺳﺎﺯﻣـﺎﻥ ﺟﻬﺎﻧﻲ ﺑﻬﺪﺍﺷﺖ گﻮﺍﻫﻲ ﻓﻮﺕ ﺟﺪﺍگﺎﻧﻪ ﺍﻱ ﺭﺍ ﺑﺮﺍﻱ ﺍﻳﻦ ﺩﻭﺭﻩ ﺗﻮﺻﻴﻪ ﻣﻲ ﻧﻤﺎﻳﺪ.
71 ﻣﺜﺎﻝ 1 – ﺧﺎﻧﻤﻲ 62 ﺳﺎﻟﻪ ﺑﺮﺍﻱ ﺯﺍﻳﻤﺎﻥ ﻣﺮﺍﺟﻌﻪ ﻛﺮﺩﻩ ﺑﻮﺩ. ﺩﺍﺭﺍﻱ ﺳﺎﺑﻘﻪ ﺩﻭ ﺣﺎﻣﻠگﻲ ﻗﺒﻠﻲ ﺑﻮﺩ ﻛﻪ ﻫﺮ ﺩﻭ ﺩﺭ 21 ﻭ 81 ﻫﻔﺘگﻲ ﺑﻄﻮﺭ ﺧﻮﺩﺑﺨﻮﺩﻱ ﺳﻘﻂ ﺷﺪﻩ ﺑﻮﺩﻧﺪ. ﺣﺎﺻﻞ ﺯﺍﻳﻤﺎﻥ ﻃﺒﻴﻌﻲ ﻧﻮﺯﺍﺩﺍﻥ ﺑﺎ ﻭﺯﻥ 007 گﺮﻡ ﺑﻮﺩ ﻛﻪ ﺩﺭ ﺍﻭﻟﻴﻦ ﺭﻭﺯ ﺗﻮﻟﺪ ﻓﻮﺕ ﻛﺮﺩ. ﺑﺮﺭﺳﻲ ﻫﺎ ﻧﺸﺎﻥ ﺩﻫﻨﺪﻩ Pulmonary immaturity ﺑﻮﺩ.
گﻮﺍﻫﻲ ﻓﻮﺕ ﺗﻜﻤﻴﻞ ﺷﺪﻩ ﺑﻪ ﺻﻮﺭﺕ ﺯﻳﺮ ﺍﺳﺖ : ﺍﻟﻒ – ﻧﺎﺭﺳﻲ ﺭﻳﻮﻱ ﺏ- ﺯﺍﻳﻤﺎﻥ ﺯﻭﺩﺭﺱ ﺝ – ﺳﻘﻂ ﺟﻨﻴﻦ ﺗﻜﺮﺍﺭﻱ ﺩ- ﻩ- 81
DEATH • Mode of Death( )ﺗﺎﺑﻠﻮی ﻓﻮﺕ • Cause of Death( )ﻋﻠﺖ ﻓﻮﺕ • Manner of Death( )ﻣکﺎﻧیﺴﻢ ﻓﻮﺕ
02 ﻫﺮ پﺰﺷﻜﻲ ﻣﺠﺎﺯ ﺍﺳﺖ ﺑﺮﺍﻱ ﻫﺮ ﻓﺮﺩ ﻓﻮﺕ ﺷﺪﻩ ﺍﻱ ﺩﺭ ﻫﺮ ﺷﺮﺍﻳﻄﻲ گﻮﺍﻫﻲ ﻓﻮﺕ ﺻﺎﺩﺭ ﻧﻤﺎﻳﺪ ﻭﻟﻲ ﺑﺎﻳﺪ ﺗﻮﺟﻪ ﺩﺍﺷﺖ ﻛﻪ ﺻﺪﻭﺭ گﻮﺍﻫﻲ ﻓﻮﺕ، ﺑﻪ ﻣﻨﺰﻟﻪ پﺬﻳﺮﺵ ﺗﻤﺎﻡ ﻣﺴﺌﻮﻟﻴﺘﻬﺎ ﻭ ﻋﻮﺍﻗﺐ ﺍﺣﺘﻤﺎﻟﻲ آﻦ ﺍﺳﺖ. ﻧﺪﺍﺷﺘﻦ آگﺎﻫﻲ ﻫﺎﻱ ﻻﺯﻡ ﺭﺍﻓﻊ ﻣﺴﺌﻮﻟﻴﺖ ﻗﺎﻧﻮﻧﻲ ﻧﻴﺴﺖ. ﺑﻄﻮﺭ ﻣﻌﻤﻮﻝ ﺩﺭ ﺗﺸﺨﻴﺺ ﻭ ﺩﺭﻣﺎﻥ ﺑﻴﻤﺎﺭﻱ ﻭ ﺻﺪﻭﺭ گﻮﺍﻫﻲ پﺰﺷﻜﻲ ﻭ ﻓﻮﺕ ﺑﻪ ﺍﻋﺘﺒﺎﺭ گﻮﺍﻫﻲ ﻧﺎﻣﻪ پﺰﺷﻜﻲ، ﺍﺻﻞ ﺑﺮ ﺑﺮﺍﺋﺖ پﺰﺷﻚ ﺍﺳﺖ ﻭ ﻣﺎﺩﺍﻣﻲ ﻛﻪ ﺧﻮﺍﻫﺎﻥ ﻭﺟﻮﺩ ﻧﺪﺍﺷﺘﻪ ﺑﺎﺷﺪ، ﻣﺸﻜﻠﻲ پﻴﺶ ﻧﻤﻲ آﻴﺪ ﻭﻟﻲ ﺑﻌﻠﺖ ﻓﻘﺪﺍﻥ ﻗﻮﺍﻧﻴﻦ ﻣﺪﻭﻥ ﺩﺭ ﻣﻮﺭﺩ ﺣﻴﻄﻪ ﺻﺪﻭﺭ گﻮﺍﻫﻲ ﻓﻮﺕ، ﻻﺯﻡ ﺍﺳﺖ پﺰﺷﻜﺎﻥ ﺑﺎ ﺭﻭﻳﻪ ﻗﻀﺎﻳﻲ ﻣﺤﻠﻲ ﻛﻪ ﺑﻪ ﻃﺒﺎﺑﺖ ﻣﺸﻐﻮﻝ ﻫﺴﺘﻨﺪ آگﺎﻫﻲ ﻛﺎﻣﻞ ﺩﺍﺷﺘﻪ ﺑﺎﺷﻨﺪ.
12 ﺗﻮﺻﻴﻪ ﻣﻲ ﺷﻮﺩ ﺩﺭ ﻣﻮﺍﺭﺩ ﺯﻳﺮ ﺑﺮﺍﻱ پﻴﺸگﻴﺮﻱ ﺍﺯ ﻋﻮﺍﻗﺐ ﻗﺎﻧﻮﻧﻲ ﺍﺣﺘﻤﺎﻟﻲ، ﻣﺘﻮﻓﻲ ﺟﻬﺖ ﺻﺪﻭﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﺑﻪ پﺰﺷﻜﻲ ﻗﺎﻧﻮﻧﻲ ﺍﺭﺟﺎﻉ ﺩﺍﺩﻩ ﺷﻮﺩ : 1. ﻗﺘﻞ 2. ﺧﻮﺩکﺸی 3. ﻣﺮگ ﺑﻪ ﺩﻧﺒﺎﻝ ﻫﺮ گﻮﻧﻪ ﻣﻨﺎﺯﻋﻪ)ﺍﻋﻢ ﺍﺯ ﺩﺭگﻴﺮی ﻓﻴﺰﻳکی ﻳﺎ ﻟﻔﻈی( 4. ﻣﺮگ ﻧﺎﺷی ﺍﺯ ﺻﺪﻣﺎﺕ ﻫﺮ ﻧﻮﻉ ﺳﻼﺡ ﺳﺮﺩ ﻳﺎ گﺮﻡ 5. ﻣﺮگ ﺑﻪ ﺩﻧﺒﺎﻝ ﺣﻮﺍﺩﺙ ﺭﺍﻧﻨﺪگی ﻭ ﺗﺼﺎﺩﻑ)ﺑﻪ ﻫﺮ ﺷکﻞ ﻭ ﺑﺎ ﻫﺮ ﻓﺎﺻﻠﻪ ﺯﻣﺎﻧی ﺍﺯ ﺣﺎﺩﺛﻪ کﻪ ﻣﺮگ ﺭﺥ ﺩﻫﺪ( 6. ﻣﺮگ ﺑﻪ ﺩﻧﺒﺎﻝ ﻣﺴﻤﻮﻣﻴﺖ)ﺷﻴﻤﻴﺎﻳﻲ، ﺩﺍﺭﻭﻳﻲ، گﺎﺯگﺮﻓﺘگی ﻭ. . . (
22 ﺗﻮﺻﻴﻪ ﻣﻲ ﺷﻮﺩ ﺩﺭ ﻣﻮﺍﺭﺩ ﺯﻳﺮ ﺑﺮﺍﻱ پﻴﺸگﻴﺮﻱ ﺍﺯ ﻋﻮﺍﻗﺐ ﻗﺎﻧﻮﻧﻲ ﺍﺣﺘﻤﺎﻟﻲ، ﻣﺘﻮﻓﻲ ﺟﻬﺖ ﺻﺪﻭﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﺑﻪ پﺰﺷﻜﻲ ﻗﺎﻧﻮﻧﻲ ﺍﺭﺟﺎﻉ ﺩﺍﺩﻩ ﺷﻮﺩ : 7. ﻣﺮگ ﺑﻪ ﺩﻧﺒﺎﻝ ﺳﻮﺀ ﻣﺼﺮﻑ ﻣﻮﺍﺩ ﻣﺨﺪﺭ 8. ﻣﺮگ ﺑﻪ ﺩﻧﺒﺎﻝ ﺣﻮﺍﺩﺙ ﻏﻴﺮﻣﺘﺮﻗﺒﻪ)ﺯﻟﺰﻟﻪ، ﺳﻴﻞ، ﺳﺮﻣﺎﺯﺩگی، گﺮﻣﺎﺯﺩگی، ﺻﺎﻋﻘﻪ( 9. ﻣﺮگ ﻧﺎﺷی ﺍﺯ کﺎﺭ)ﺣﻮﺍﺩﺙ ﺷﻐﻠی، ﻣﻮﺍﺩ آﻼﻳﻨﺪﻩ ﻣﺤﻴﻂ کﺎﺭ ﻭ. . . ( 01. ﻣﺮگ ﺩﺭ ﺯﻧﺪﺍﻥ، ﺑﺎﺯﺩﺍﺷﺘگﺎﻩ، پﺮﻭﺭﺷگﺎﻩ، ﺍﺭﺩﻭگﺎﻩ، پﺎﺩگﺎﻥ، آﺴﺎﻳﺸگﺎﻩ، ﻣﻬﻤﺎﻧﺴﺮﺍ ﻭ. . . 11. ﻣﺮگ ﺩﺭ ﻣﻌﺎﺑﺮ ﻭ ﻣﺠﺎﻣﻊ ﻋﻤﻮﻣی ﻭ پﺎﺭکﻬﺎ 21. ﻣﺮگ ﻧﺎﺷی ﺍﺯ ﺍﻗﺪﺍﻣﺎﺕ ﺗﺸﺨﻴﺼی ﻭ ﺩﺭﻣﺎﻧی، ﻣﺮگ ﺣﻴﻦ ﻳﺎ ﻣﺘﻌﺎﻗﺐ ﺯﺍﻳﻤﺎﻥ ﻳﺎ ﺳﻘﻂ
32 ﺗﻮﺻﻴﻪ ﻣﻲ ﺷﻮﺩ ﺩﺭ ﻣﻮﺍﺭﺩ ﺯﻳﺮ ﺑﺮﺍﻱ پﻴﺸگﻴﺮﻱ ﺍﺯ ﻋﻮﺍﻗﺐ ﻗﺎﻧﻮﻧﻲ ﺍﺣﺘﻤﺎﻟﻲ، ﻣﺘﻮﻓﻲ ﺟﻬﺖ ﺻﺪﻭﺭ گﻮﺍﻫﻲ ﻓﻮﺕ ﺑﻪ پﺰﺷﻜﻲ ﻗﺎﻧﻮﻧﻲ ﺍﺭﺟﺎﻉ ﺩﺍﺩﻩ ﺷﻮﺩ : 31. ﻣﺮگ ﺣﻴﻦ ﻳﺎ ﻣﺘﻌﺎﻗﺐ ﻭﺭﺯﺵ 41. ﻣﺮگﻬﺎی ﻧﺎگﻬﺎﻧی، ﻏﻴﺮﻣﻨﺘﻈﺮﻩ ﻭ ﻏﻴﺮﻗﺎﺑﻞ ﺗﻮﺟﻴﻪ 51. ﻫﺮ ﻣﺮگی کﻪ ﺍﺣﺘﻤﺎﻝ ﺷکﺎﻳﺖ ﺍﺯ کﺴی ﻣﻄﺮﺡ ﺑﺎﺷﺪ 61. ﻫﺮ ﻧﻮﻉ ﻣﺮگ ﻣﺸکﻮک ﻭ ﻣﺮگ ﺑﺎ ﻋﻠﺖ ﻧﺎﺷﻨﺎﺧﺘﻪ 71. ﻫﺮ ﻧﻮﻉ ﻣﺮگ ﺍﻓﺮﺍﺩ ﻧﺎﺷﻨﺎﺱ ﻭ ﻣﺠﻬﻮﻝ ﺍﻟﻬﻮﻳﻪ 81. ﻣﺮگ ﺍﺗﺒﺎﻉ ﺑﻴگﺎﻧﻪ 91. ﻫﺮ ﻣﺮگی کﻪ ﺍﺣﺘﻤﺎﻝ ﺟﻨﺤﻪ ﻳﺎ ﺟﻨﺎﻳﺖ ﺩﺭ آﻦ ﺑﺮﻭﺩ
24 • The medical practitioner or other qualified certifier should use his or her clinical judgment in completing the medical certificate of cause of death. • Automated systems must not include lists or other prompts to guide the certifier as these necessarily limit the range of diagnoses and therefore have an adverse effect on the accuracy and usefulness of the report.
25 Rules and guidelines for mortality and morbidity coding
26 In 1967, the Twentieth World Health Assembly defined the causes of death to be entered on the medical certificate of cause of death as • “all those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced any such injuries”
72 ﺗﻌﺮیﻒ ﻋﻠﺖ ﻣﺮگ • ﻫﻤﻪ ﺑﻴﻤﺎﺭﻱ ﻫﺎ، ﻭﺿﻌﻴﺖ ﻫﺎی ﻧﺎﺧﻮﺷی ﻭ آﺴﻴﺒﻬﺎﻳی کﻪ ﺧﻮﺩ ﻣﻮﺟﺐ ﻣﺮگ ﺷﺪﻩﺍﻧﺪ ﻭ ﻳﺎ ﺑﻪ ﻭﻗﻮﻉ آﻦ کﻤک کﺮﺩﻩ ﺍﻧﺪ. • آﺴیﺒﻬﺎیی کﻪ ﺑﻌﻠﺖ ﺣﻮﺍﺩﺙ ﻏیﺮﻋﻤﺪی یﺎ ﺧﺸﻮﻧﺖ ﻫﺎی ﻋﻠیﻪ ﺧﻮﺩ یﺎ ﺑﻮﺳیﻠﻪ ﺩیگﺮی ﻫﻢ پﺪیﺪ آﻤﺪﻩ ﻭ ﻣﻨﺠﺮ ﺑﻪ ﻣﺮگ ﺷﺪﻩ ﺍﺳﺖ ﺭﺍ ﻧیﺰ ﻋﻠﻞ ﻣﺮگ ﻣی ﻧﺎﻣﻨﺪ.
28 Rules for selection of the originating antecedent cause • Sequence • The term ‘sequence’refers to two or more conditions entered on successive lines of Part I, each condition being an acceptable cause of the one entered on the line above it.
29 • Example 1: ▫ I (a) Bleeding of oesophageal varices ▫ (b) Portal hypertension ▫ (c) Liver cirrhosis ▫ (d) Hepatitis B
30 • Example 2: ▫ I (a) Coma ▫ (b) Myocardial infarction and cerebrovascular accident ▫ (c) Atherosclerosis hypertension • The sequences are: • atherosclerosis (leading to) myocardial infarction (leading to) coma; • atherosclerosis (leading to) cerebrovascular accident (leading to) coma; • hypertension (leading to) myocardial infarction (leading to) coma; • hypertension (leading to) cerebrovascular accident (leading to) coma.
31 General Principle The General Principle states that when more • than one condition is entered on the certificate, the condition entered alone on the lowest used line of Part I should be selected only if it could have given rise to all the conditions entered above it. • ﻭﻗﺘی ﺑیﺶ ﺍﺯ یک ﻭﺿﻌیﺖ ﺩﺭ گﻮﺍﻫی ﻓﻮﺕ ﺛﺒﺖ ﺷﺪﻩ ﺑﺎﺷﺪ، ﺗﻨﻬﺎ ﻭﺿﻌیﺖ ﺛﺒﺖ . ﺷﺪﻩ ﺩﺭ آﺨﺮیﻦ ﺧﻂ ﺑﺨﺶ یک ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺍﻧﺘﺨﺎﺏ کﻨیﺪ • ﺍگﺮ آﻦ ﻭﺿﻌیﺖ ﺑﺘﻮﺍﻧﺪ ﻋﻠﺖ ﺑﻮﺟﻮﺩ آﻮﺭﻧﺪﻩ ﺗﻤﺎﻡ ﻭﺿﻌیﺖ ﻫﺎی ﺛﺒﺖ ﺷﺪﻩ ﺩﺭ ﺧﻄﻮﻁ ﺑﺎﻻیی ﺧﻮﺩﺵ ﺑﺎﺷﺪ
32 • Example 3: I (a) Uraemia (b) Hydronephrosis (c) Retention of urine (d) Hypertrophy of prostate • Example 4: ▫ I (a) Bronchopneumonia ▫ (b) Chronic bronchitis ▫ II Chronic myocarditis
33 • Example 5: ▫ I (a) Generalized metastases 5 weeks ▫ (b) Bronchopneumonia 3 days ▫ (c) Lung cancer 11 months
34 • Example 6: ▫ I (a) Abscess of lung ▫ (b) Lobar pneumonia • Select lobar pneumonia (J 18. 1)
35 • Example 8: ▫ ▫ I (a) Cerebral haemorrhage (b) Hypertension (c) Chronic pyelonephritis (d) Prostatic adenoma • Select prostatic adenoma (D 29. 1). • Example 9: ▫ I (a) Traumatic shock ▫ (b) Multiple fractures ▫ (c) Pedestrian hit by truck (traffic accident) • Select pedestrian hit by truck (V 04. 1). • Example 10: ▫ I (a) Bronchopneumonia ▫ II Secondary anaemia and chronic lymphatic leukaemia Selectbronchopneumonia.
63 ﻋﺪﻡ کﺎﺭﺑﺮﺩ ﻗﺎﻧﻮﻥ ﻋﻤﻮﻣی • ﻭﻗﺘی ﺑیﺶ ﺍﺯ یک ﻭﺿﻌیﺖ ﺩﺭ آﺨﺮیﻦ ﺧﻂ ﺑﺨﺶ یک گﻮﺍﻫی ﺛﺒﺖ ﺷﺪﻩ ﺑﺎﺷﺪ. • ﺯﻣﺎﻧی کﻪ ﺗک ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺩﺭ آﺨﺮیﻦ ﺧﻂ ﻧﺘﻮﺍﻧﺪ ﻭﺿﻌیﺖ ﻫﺎی ﺑﺎﻻی ﺧﻮﺩ ﺭﺍ ﺍیﺠﺎﺩ ﻧﻤﺎیﺪ.
37 Rule 1 • If the General Principle does not apply and there is a reported sequence terminating in the condition first entered on the certificate, select the originating cause of this sequence. If there is more than one sequence terminating in the condition mentioned first, select the originating cause of the first - mentioned sequence.
83 • ﻗﺎﻧﻮﻥ یک ﺍگﺮ ﺍﺻﻞ ﻋﻤﻮﻣی کﺎﺭﺑﺮﺩ ﻧﺪﺍﺷﺘﻪ ﺑﺎﺷﺪ، ﻭ ﺑﺮﺍی ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی گﻮﺍﻫی یک ﺗﻮﺍﻟی ﻭﺟﻮﺩ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ، ﻋﻠﺖ آﻐﺎﺯ کﻨﻨﺪﻩ ﺍیﻦ ﺗﻮﺍﻟی ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ. ﺍگﺮ ﺑیﺶ ﺍﺯ یک ﺗﻮﺍﻟی کﻪ ﺑﻪ ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺫکﺮ ﺷﺪﻩ ) ﺭﻭی ﺧﻂ (a ﻭﺟﻮﺩ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ، ﻋﻠﺖ آﻐﺎﺯیﻦ ﺍﻭﻟیﻦ ﺗﻮﺍﻟی ﺭﺍ کﻪ ﻣی ﺗﻮﺍﻧﺪ ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a ﺭﺍ ﺑﻮﺟﻮﺩ آﻮﺭﺩ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ.
39 • Example 11: ▫ I (a) Bronchopneumonia ▫ (b) Cerebral infarction and hypertensive heart disease Example 12: I (a) Oesophageal varices and congestive heart failure (b) Chronic rheumatic heart disease and cirrhosis of liver Example 13: I (a) Acute myocardial infarction (b) Atherosclerotic heart disease (c) Influenza
40 Rule 2 • If there is no reported sequence terminating in the condition first entered on the certificate, select this first mentioned condition.
14 • ﺍگﺮ ﻫیچ ﺗﻮﺍﻟی ﻣﺨﺘﻮﻡ ﺑﻪ ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺩﺭ گﻮﺍﻫی ﻓﻮﺕ )ﺧﻂ (a ﻭﺟﻮﺩ ﻧﺪﺍﺷﺘﻪ ﺑﺎﺷﺪ، ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ.
42
43 • Example 16: I (a) Pernicious anaemia and gangrene of foot (b) Atherosclerosis Select pernicious anaemia (D 51. 0) • Example 17: ▫ I (a) Rheumatic and atherosclerotic heart disease Select rheumatic heart disease (I 09. 9). • Example 18: ▫ I (a) Fibrocystic disease of the pancreas ▫ (b) Bronchitis and bronchiectasis
44 Rule 3 • If the condition selected by the General Principle or by Rule l or Rule 2 is obviously a direct consequence of another reported condition, whether in Part I or Part II, select this primary condition.
54 • ﺍگﺮ ﻭﺿﻌیﺖ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﺗﻮﺳﻂ ﻗﺎﻧﻮﻥ ﻋﻤﻮﻣی یﺎ ﻗﻮﺍﻧیﻦ یک ﻭ ﺩﻭ ﺑﻪ ﻭﺿﻮﺡ ﺧﻮﺩﺵ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﻭﺿﻌیﺖ ﺩیگﺮی ﺑﺎﺷﺪ، ﺧﻮﺍﻩ ﺍیﻦ ﻭﺿﻌیﺖ ﺩﺭ ﺑﺨﺶ I گﻮﺍﻫی یﺎ ﺩﺭ ﺑﺨﺶ II گﻮﺍﻫی ﺛﺒﺖ ﺷﺪﻩ ﺑﺎﺷﺪ، ﺩﺭ ﺍیﻦ ﺻﻮﺭﺕ ﻫﻤیﻦ ﻭﺿﻌیﺖ ﺍﻭﻟیﻪ ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ.
64 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -1 ﺳﺎﺭکﻮﻣﺎ کﺎﺭپﻮﺳی، ﺗﻮﻣﻮﺭ ﺑﻮﺭکیﺖ ﻭ ﺗﻤﺎﻣی ﺳﺮﻃﺎﻥ ﻫﺎی ﺑﺪﺧیﻢ ﻣﺮﺑﻮﻁ ﺑﻪ ﺑﺎﻓﺖ ﻟﻨﻔﺎﻭی ﻭ ﺧﻮﻥ ﺳﺎﺯ ﻗﺎﺑﻞ ﻃﺒﻘﻪ ﺑﻨﺪی ﺩﺭ ﺭﺩﻩ ﻫﺎی -. 64 C ﻭ 69 C 81 -C ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ ﻧﺘﺎیﺞ ﻭ پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ ﻭ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺑیﻤﺎﺭی HIV ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ.
74 • I (a) Kaposi’s sarcoma II AIDS ﺩﺭ ﺑﺨﺶ یک ﻫیچگﻮﻧﻪ ﺗﻮﺍﻟی Example ﻋﻠﺖ ﺩﺭ ﺧﻂ a ﺛﺒﺖ ﺷﺪﻩ ﺍﺳﺖ ﻟﺬﺍ ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ ﻭ ﻓﻘﻂ یک ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﺩﻭ ﻫﻤﺎﻥ کﺎپﻮﺳی ﺳﺎﺭکﻮﻣﺎ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی ﺷﻮﺩ ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ ﺳﻪ ) ﺑﻨﺪ 1 پیﺎﻣﺪﻫﺎ( کﺎپﻮﺳی ﺳﺎﺭکﻮﻣﺎ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﺍیﺪﺯ ﻣی ﺑﺎﺷﺪ کﻪ ﺩﺭ ﻗﺴﻤﺖ ﺩﻭ گﻮﺍﻫی ﺛﺒﺖ ﺷﺪﻩ ﺍﺳﺖ. ﻟﺬﺍ کﺎپﻮﺳی ﺳﺎﺭکﻮﻣﺎی ﻧﺎﺷی ﺍﺯ ﺑیﻤﺎﺭی HIV ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 0. 12 B ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
84 Example • I (a) Cancer of ovary II HIV disease ﺳﺮﻃﺎﻥ ﺑﺪﺧیﻢ ﺗﺨﻤﺪﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 65 C ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ. ﺗﺬکﺮ: ﺑﺨﺎﻁ ﺩﺍﺷﺘﻪ ﺑﺎﺷیﺪ کﻪ ﺗﻤﺎﻣی ﺳﺮﻃﺎﻧﻬﺎ پیﺎﻣﺪ ﺑیﻤﺎﺭی HIV ﻧﺴیﺘﻨﺪ ﻭ ﻓﻘﻂ ﺳﺮﻃﺎﻥ ﻫﺎی ﺫکﺮ ﺷﺪﻩ ﺩﺭ ﺑﻨﺪ 1 پیﺎﻣﺪﻫﺎ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﻧﺎﺷی ﺍﺯ HIV پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﻧﺪ.
94 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -2 ﺗﻤﺎﻣی ﺑیﻤﺎﺭیﻬﺎی ﻋﻔﻮﻧی ﻗﺎﺑﻞ ﻃﺒﻘﻪ ﺑﻨﺪی ﺩﺭ ﺭﺩﻩ ﻫﺎی aside from those listed in section 4. 2. 2 A • ﺑﻪ ﻋﻨﻮﺍﻥ ﻧﺘﺎیﺞ ﻭ پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ ﻭ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺑیﻤﺎﺭی HIV ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ. • ﺑﺮﺧی ﺍﺯ ﺍﺳﺘﺜﻨﺎﺋﺎﺕ ﻣیﺎﻥ ﺭﺩﻩ ﻫﺎی ﻓﻮﻕ کﻪ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ HIV ﻧیﺴﺘﻨﺪ ﻋﺒﺎﺭﺗﻨﺪ ﺍﺯ: ﻣﺎﻻﺭیﺎ )45 (B 50 -B ﺑیﻤﺎﺭی ﺷﺎگﺎﺱ )75 (B ﻋﻔﻮﻧﺖ ﻟیﺸﻤﺎﻧیﺎﺯ )55 (B ﺑیﻤﺎﺭی ﻫﺎی کﺮﻣی )38 (B 65 -B
05 Example • I (a) Tuberculosis II HIV disease ﺩﺭ ﺑﺨﺶ یک ﻫیچگﻮﻧﻪ ﺗﻮﺍﻟی ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ ﻭ ﻓﻘﻂ یک ﻋﻠﺖ ﺩﺭ ﺧﻂ a ﺛﺒﺖ ﺷﺪﻩ ﺍﺳﺖ ﻟﺬﺍ ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﺩﻭ ﺳﻞ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی ﺷﻮﺩ. ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ ﺳﻪ )ﺑﻨﺪ 2 پیﺎﻣﺪﻫﺎ( ﺳﻞ ﺑﻪ ﻋﻨﻮﺍﻥ یک ﺑیﻤﺎﺭی ﻋﻔﻮﻧی ﻭ پیﺎﻣﺪ ﺍیﺪﺯ ﻣی ﺑﺎﺷﺪ کﻪ ﺩﺭ ﻗﺴﻤﺖ ﺩﻭ گﻮﺍﻫی ﺛﺒﺖ ﺷﺪﻩ ﺍﺳﺖ ﻟﺬﺍ ﻋﻔﻮﻧﺖ ﻣیﻮﺑﺎکﺘﺮیﺎﻝ ﻧﺎﺷی ﺍﺯ ﺑیﻤﺎﺭی HIV ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 0. 02 B ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
15 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -3 ﻋﻮﺍﺭﺽ ﻣﺸﺨﺺ ﺑﻌﺪ ﺍﺯ ﺟﺮﺍﺣی ﺍﺯ ﻗﺒیﻞ ﻫﺮ ﻧﻮﻉ پﻨﻮﻣﻮﻧی، ﺧﻮﻧﺮیﺰی، ﺗﺮﻭﻣﺒﻮﻓﻠﺒیﺖ، آﻤﺒﻮﻟیﺴﻢ، ﺗﺮﻣﺒﻮﺯ، ﺳپﺘی ﺳﻤی، ﺍیﺴﺖ ﻗﻠﺒی،، ﻧﺎﺭﺳﺎیی ﺣﺎﺩ کﻠیﻪ، آﺴپیﺮﺍﺳیﻮﻥ، آﺘﻠکﺘﺎﺯی ﻭ ﺍﻧﻔﺎﺭکﺘﻮﺱ ﻣی ﺗﻮﺍﻧﺪ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ یک ﻋﻤﻞ ﺟﺮﺍﺣی ﺩﺭ ﻧﻈﺮ گﺮﻓﺘﻪ ﺷﻮﺩ. • ﻣگﺮ ﺍیﻨکﻪ ﻋﻤﻞ ﺟﺮﺍﺣی ﻣﺬکﻮﺭ ﺩﺭ ﻓﺎﺻﻠﻪ ﺯﻣﺎﻧی 4 ﻫﻔﺘﻪ ﻗﺒﻞ ﺍﺯ ﻣﺮگ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺑﺎﺷﺪ.
25 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -4 پﻨﻮﻣﻮﻧی ﻭ ﺑﺮﻧکﻮپﻨﻮﻣﻮﻧی ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﺎﺭﺿﻪ ﻣﻨﺘﺞ ﺍﺯ ﻫﺮ ﺑیﻤﺎﺭی ﺩﺭ ﻧﻈﺮ گﺮﻓﺘﻪ ﻭ پﺬیﺮﻓﺖ. ﻭﻟی ﺑﻪ ﻃﻮﺭ ﻭیژﻪ ﺑﺮﻭﻧکﻮپﻨﻮﻣی ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪﻣﺴﺘﻘیﻢ ﻭ ﻣﺸﺨﺺ ﺑیﻤﺎﺭی ﻫﺎی ﻭیﺮﺍﻧگﺮی ﺍﺯ ﻗﺒیﻞ ﺻﺪﻣﺎﺕ ﻣﻐﺰی ﻭ ﻃﻨﺎﺏ ﻧﺨﺎﻋی، ﺧﻮﻧﺮیﺰی ﻣﻐﺰی ﻭ ﺗﺮﻣﺒﻮﺯ ﻣﻐﺰی، پﻮﻟیﻮﻣیﻠیﺖ، ﻭ ﻫﻤچﻨیﻦ ﺑیﻤﺎﺭی ﻫﺎی ﻣﺴﺮی ﻭ ﺻﺪﻣﺎﺕ ﻏیﺮﺟﺰیی ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ.
35 Example • I (a) Hypostatic pneumonia (b) Cerebral Hemorrhage & Cancer of breast ﺗﻮﺍﻟی پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍی ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ. ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﺩﻭ، ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی ﺷﻮﺩ. ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ ﺳﻪ ﻭ ﺑﺮﺍﺳﺎﺱ ﺑﻨﺪ IV پیﺎﻣﺪﻫﺎ پﻨﻮﻣﻮﻧی ﻫیپﻮﺍﺳﺘﺎﺗیک ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﻫﺮ کﺪﺍﻡ ﺍﺯ ﺑیﻤﺎﺭی ﻫﺎی ﺛﺒﺖ ﺷﺪﻩ ﺩﺭ ﻗﺴﻤﺖ ﻫﺎی ﺩیگﺮ گﻮﺍﻧی ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ، کﻪ ﺩﺭ ﺍیﻦ گﻮﺍﻫی ﺩﻭ ﻭﺿﻌیﺖ ﺩﺭ ﺧﻂ b ﺛﺒﺖ ﺷﺪﻩ ﻭ کﺪگﺬﺍﺭ ﺑﺎیﺴﺘی ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ یﻌﻨی ﺧﻮﻧﺮیﺰی ﻣﻐﺰی ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 9. 16 I ﺭﺍ ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﺩﻫﺪ.
54 • Heart failure (I 50. -) and unspecified heart disease (I 51. 9) should be considered an obvious consequence of other heart conditions. • Pulmonary edema (J 81) should be considered an obvious consequence of heart disease (including pulmonary heart disease); of conditions affecting the lung parenchyma, such as lung infections, aspiration and inhalation, respiratory distress syndrome, high altitude, and circulating toxins; of conditions causing fluid overload, such as renal failure and hypoalbuminemia; and of congenital anomalies affecting the pulmonary circulation, such as congenital stenosis of pulmonary veins.
55 • Lobar pneumonia, unspecified (J 18. 1) should be considered an obvious consequence of dependence syndrome due to use of alcohol (F 10. 2). • Any pneumoniain J 12–J 18 should be considered an obvious consequence of conditions that impair the immune system. • Pneumonia in J 15. 0–J 15. 6, J 15. 8–J 15. 9, J 16. 8, J 18. 0 and J 18. 2–J 18. 9 should be considered an obvious consequence of wasting diseases (such as malignant neoplasm and malnutrition) and diseases causing paralysis (such as cerebral haemorrhage or thrombosis), as well as serious respiratory conditions, communicable diseases, and serious injuries. • Pneumonia in J 15. 0–J 15. 6, J 15. 8–J 15. 9, J 16. 8, J 18. 0 and J 18. 2–J 18. 9, J 69. 0, and J 69. 8 should also be considered an obvious consequence of conditions that affect the process of swallowing. • Pneumonia in J 18. - (except lobar pneumonia) reported with immobility or reduced mobility should be coded to J 18. 2.
56 • Dementia, without mention of a specified cause, should be considered a consequence of conditions that typically involve irreversible brain damage. However, when a specified cause is given, only a condition that may lead to irreversible brain damage should be accepted as cause of the dementia, even if irreversible brain damage is not a typical feature of the condition.
75 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -5 ﻫﺮ ﺑیﻤﺎﺭی کﻪ ﺑﺎ ﺻﻔﺖ آﻤﺒﻮﻟیک ﺗﻮﺻیﻒ ﺷﺪﻩ یﺎ ﺗﻌﺮیﻒ ﺷﺪﻩ ﺑﺎﺷﺪ ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﺗﺮﻣﺒﻮﺯ ﻭﺭیﺪی، ﻓﻠﺒیﺖ یﺎ ﺗﺮﻣﺒﻮﻓﻠﺒیﺖ، ﺑیﻤﺎﺭی ﺩﺭیچﻪ ﺍی ﻗﻠﺐ، ﻓیﺒﺮیﻼﺳیﻮﻥ ﺩﻫﻠیﺰی، ﺗﻮﻟﺪ ﻭ ﺯﺍیﻤﺎﻥ، ﻭ ﻫﺮ ﻋﻤﻞ ﺟﺮﺍﺣی ﺩﺭ ﻧﻈﺮ گﺮﻓﺘﻪ ﺷﻮﺩ.
85 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -6 ﻫﺮ ﺑیﻤﺎﺭی کﻪ ﺑﻪ ﻋﻨﻮﺍﻥ ﺛﺎﻧﻮیﻪ ﺗﻮﺻیﻒ ﺷﺪﻩ ﺑﺎﺷﺪ ﺑﺎیﺴﺘی ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﻣﺤﺘﻤﻞ ﺗﺮیﻦ ﻋﻠﺖ ﺍﻭﻟیﻪ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی گﻮﺍﻫی ﻓﻮﺕ ﺩﺭﻧﻈﺮ گﺮﻓﺘﻪ ﺷﻮﺩ.
95 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -7 آﻨﻤی ﻫﺎی ﻧﺎﻣﺸﺨﺺ یﺎ ﺛﺎﻧﻮیﻪ، ﺳﻮﺀﺗﻐﺬیﻪ، ﻣﺎﺭﺳﻤﻮﺱ)ﺳﻮﺀﺗﻐﺬیﻪ ﺷﺪیﺪ( یﺎ کﺎﺷکﺴی )ﺿﻌﻒ ﺷﺪیﺪ( ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﻫﺮ ﺳﺮﻃﺎﻥ ﺑﺪﺧیﻢ paralytic disease, or disease which limits the ability to care for oneself, including dementia . and degenerative diseases of the nervous system ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ.
06 Example • I (a) Bronchopneumonia II Secondary anemia and chronic lymphatic leukemia ﺩﺭ ﺑﺨﺶ یک آﻦ ﻫیچگﻮﻧﻪ ﺗﻮﺍﻟی پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍی ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ. ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﻋﻤﻮﻣی ﻭ ﻗﺎﻧﻮﻥ یک ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a یﻌﻨی ﺑﺮﻭﻧکﻮپﻨﻮﻣﻮﻧی ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی ﺷﻮﺩ ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ ﺳﻪ ﺑﺮﺍﺳﺎﺱ ﺑﻨﺪ IV پیﺎﻣﺪﻫﺎ ﺑﺮﻭﻧکﻮپﻨﻮﻣﻮﻧی ﻭ ﺑﺮﺍﺳﺎﺱ ﺑﻨﺪ VII پیﺎﻣﺪﻫﺎ آﻨﻤی ﺛﺎﻧﻮیﻪ ﻫﺮ ﺩﻭ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﻟﻮﺳﻤی ﻟﻨﻔﺎﺗیک ﻣﺰﻣﻦ ﻣی ﺑﺎﺷﻨﺪ کﻪ ﺩﺭ ﺑﺨﺶ ﺩﻭ گﻮﺍﻫی ﺛﺒﺖ ﺷﺪﻩ ﺍﺳﺖ، ﻟﺬﺍ ﻟﻮﺳﻤی ﻟﻨﻔﺎﺗیک ﻣﺰﻣﻦ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 1. 19 C ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
16 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -8 ﻫﺮ ﻧﻮﻉ پیﻠﻮﻧﻔﺮیﺖ ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﺍﻧﺴﺪﺍﺩ ﺍﺩﺭﺍﺭی ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ. ﺍﻧﺴﺪﺍﺩ ﺍﺩﺭﺍﺭی ﻣﻤکﻦ ﺍﺳﺖ ﻧﺎﺷی ﺍﺯ ﻭﺿﻌیﺖ ﻫﺎیی ﺍﺯ ﻗﺒیﻞ ﻫیپﺮپﻼﺯی پﺮﻭﺳﺘﺎﺕ یﺎ ﺗﻨگی ﺣﺎﻟﺐ ﺑﺎﺷﺪ.
26 Example • I (a) Cerebral hemorrhage (b) Hypertension (c) Chronic pyelonephritis & prostatic obstruction ﺗﻮﺍﻟی پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻭ آﻦ پیﻠﻮﻧﻔﺮیﺖ ﻣﺰﻣﻦ ﻣﻨﺠﺮ ﺑﻪ ﻓﺸﺎﺭ ﺧﻮﻥ ﻭ آﻨﻬﻢ ﻣﻨﺠﺮ ﺑﻪ ﺧﻮﻧﺮیﺰی ﻣﻐﺰی ﺷﺪﻩ ﺍﺳﺖ. ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ یک، ﻋﻠﺖ آﻐﺎﺯیﻦ ﺍیﻦ ﺯﻧﺠیﺮﻩ یﻌﻨی پیﻠﻮﻧﻔﺮیﺖ ﻣﺰﻣﻦ ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی ﻧﻤﺎییﻢ. ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ ﺳﻪ ﻭ ﺑﺮﺍﺳﺎﺱ ﺑﻨﺪ VIII پیﺎﻣﺪﻫﺎ پیﻠﻮﻧﻔﺮیﺖ ﻣﺰﻣﻦ ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﺍﻧﺴﺪﺍﺩ پﺮﻭﺳﺘﺎﺗیک ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ، ﻟﺬﺍ ﺍﻧﺴﺪﺍﺩ پﺮﻭﺳﺘﺎﺗیک ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 04 N ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
36 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -9 ﺳﻨﺪﺭﻡ ﻧﻔﺮﻭﺗیک ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻫﺮ ﻋﻔﻮﻧﺖ ﺍﺳﺘﺮپﺘﻮکﻮکی ﺍﺯ ﻗﺒیﻞ ﺗﺐ ﻣﺨﻤﻠک، ﺯﺧﻢ گﻠﻮی )گﻠﻮ ﺩﺭﺩ( ﺍﺳﺘﺮپﺘﻮکﻮکی ﻭ. . . ﺩﺭﻧﻈﺮ گﺮﻓﺖ.
46 Example • I (a) Acute nephritis, Scarlet Fever ﺩﺭ ﺑﺨﺶ یک آﻦ ﻫیچگﻮﻧﻪ ﺗﻮﺍﻟی پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍی ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ. ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﺩﻭ ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a یﻌﻨی ﻧﻔﺮیﺖ ﺣﺎﺩ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی ﺷﻮﺩ ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ ﺳﻪ ﻭ ﺑﺮﺍﺳﺎﺱ ﺑﻨﺪ IX پیﺎﻣﺪﻫﺎ ﻧﻔﺮیﺖ ﺣﺎﺩ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﺗﺐ ﻣﺨﻤﻠک ﻣی ﺑﺎﺷﺪ، ﻟﺬﺍ ﺗﺐ ﻣﺨﻤﻠک ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 83 A ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
65 Acute renal failure should be assumed as an • obvious consequence of a urinary tract infection, provided that there is no indication that the renal failure was present before the urinary tract infection.
66 Primary atelectasis of newborn (P 28. 0) • should be considered an obvious consequence of congenital kidney conditions (Q 60, Q 61. 0– Q 61. 1, Q 61. 3– Q 61. 9, Q 62. 1, Q 62. 3, Q 62. 4), premature rupture of membranes (P 01. 1) and oligohydramnios (P 01. 2).
67 • Fetus and newborn affected by premature rupture of membranes or oligohydramnios (P 01. 1–P 01. 2) should be assumed to be a direct consequence of congenital kidney conditions (Q 60, Q 61. 0–Q 61. 1, Q 61. 3–Q 61. 9, Q 62. 1, Q 62. 3, Q 62. 4).
86 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -01 ﺩﻫیﺪﺭﺍﺳیﻮﻥ ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ پیﺎﻣﺪ ﻫﺮ ﺑیﻤﺎﺭی ﻋﻔﻮﻧی ﺭﻭﺩﻩ ﺍی ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ.
96 پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍﺯ ﺩیگﺮ ﻭﺿﻌیﺖ ﻫﺎ • -11 ﺟﺮﺍﺣی ﺭﻭی یک ﺍﺭگﺎﻥ ﺑﺎیﺴﺘی ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ یک ﻭﺿﻌیﺖ ﺟﺮﺍﺣی ﻣﺮﺑﻮﻁ ﺑﻪ ﻫﻤﺎﻥ ﺍﺭگﺎﻥ)ﺍﺯ ﻗﺒیﻞ ﺗﻮﻣﻮﺭ ﺑﺪﺧیﻢ یﺎ ﺟﺮﺍﺣﺖ( ﺩﺭ ﻧﻈﺮ گﺮﻓﺘﻪ ﺷﻮﺩ. ﺍیﻦ ﻭﺿﻌیﺖ ﻣﻤکﻦ ﺍﺳﺖ ﺩﺭ ﻫﺮ کﺠﺎی گﻮﺍﻫی ﻓﻮﺕ ﺛﺒﺖ ﺷﺪﻩ ﺑﺎﺷﺪ.
07 Example • I (a) Pulmonary Infarction II Left pneumonectoy for carcinoma of lung 3 weeks ago ﺩﺭ ﺑﺨﺶ یک ﺗﻮﺍﻟی پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﺍی ﻭﺟﻮﺩ ﻧﺪﺍﺭﺩ. ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﺩﻭﻑ ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a یﻌﻨی ﺍﻧﻔﺎﺭکﺘﻮﺱ ﺭیﻮی ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی ﺷﻮﺩ. ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ ﺳﻪ ﻭ ﺑﺮﺍﺳﺎﺱ ﺑﻨﺪ III پیﺎﻣﺪﻫﺎ، ﺍﻧﻔﺎﺭکﺘﻮﺱ ﺭیﻮی ﺭﺍ ﻣی ﺗﻮﺍﻥ ﺑﻪ ﻋﻨﻮﺍﻥ پیﺎﻣﺪ ﻣﺴﺘﻘیﻢ ﻋﻤﻞ ﺟﺮﺍﺣی ﺑﺮﺩﺍﺷﺘﻦ ﺭیﻪ چپ ﺩﺭ ﻧﻈﺮ گﺮﻓﺖ کﻪ ﺩﺭ 3 ﻫﻔﺘﻪ ﻗﺒﻞ ﺑﺮﺍی ﺑیﻤﺎﺭ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺖ ﻭ ﺩﺭ ﺑﺨﺶ ﺩﻭ گﻮﺍﻫی ﺛﺒﺖ ﺷﺪﻩ ﺍﺳﺖ. ﺍﺯ ﻃﺮﻓی ﺑﺮﺍﺳﺎﺱ ﺑﻨﺪ XI پیﺎﻣﺪﻫﺎی ﻣﺴﺘﻘیﻢ، ﻋﻤﻞ ﺟﺮﺍﺣی ﺑﺮﺩﺍﺷﺘﻦ ﺭیﻪ ﻣﺘﻌﺎﻗﺐ کﺎﺭﺳیﻨﻮﻣﺎی ﺭیﻪ ﺍﻧﺠﺎﻡ ﺷﺪﻩ ﺍﺳﺘﻒ ﻧﻬﺎیﺘ کﺎﺭﺳیﻨﻮﻣﺎی ﺭیﻪ ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 9. 43 C ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
71 • Haemorrhage should be considered an obvious consequence of anticoagulant poisoning or overdose. • However , haemorrhage should not be considered an obvious consequence of anticoagulant therapy without mention of poisoning or overdose. • Gastric haemorrhage should be considered an obvious consequence of steroid, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs)
72 • Mental retardation should be considered an obvious consequence of perinatal conditions in P 00–P 04 (Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery), P 05 (Slow fetal growth and fetal malnutrition), P 07 (Disorders related to short gestation and low birth weight, not elsewhere classified), P 10 (Intracranial laceration and haemorrhage due to birth injury), P 11. 0 (Cerebral oedema due to birth injury), P 11. 1 (Other specified brain damage due to birth injury), P 11. 2 (Unspecified brain damage due to birth injury), P 11. 9 (Birth injury to central nervous system, unspecified), P 15. 9 (Birth injury, unspecified), P 20 (Intrauterine hypoxia), P 21 (Birth asphyxia), P 35 (Congenital viral diseases), P 37 (Other congenital infectious and parasitic diseases), P 52 (Intracranial nontraumatic haemorrhage of fetus and newborn), P 57 (Kernicterus), P 90 (Convulsions of newborn) and P 91 (Other disturbances of cerebral status of newborn).
37 ﺗﻐییﺮ ﻭ ﺗﻌﺪیﻞ )ﺍﺻﻼﺡ( ﻋﻠﺖ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ گﺎﻫی ﺍﻭﻗﺎﺕ ﻻﺯﻡ ﺍﺳﺖ کﺪ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﺭﺍ ﺟﻬﺖ ﻣﻄﺎﺑﻘﺖ ﺑﺎ ﻧیﺎﺯﻫﺎی ﻃﺒﻘﻪ ﺑﻨﺪی ﺗﻌﺪیﻞ، ﺗﻐییﺮ ﻭ ﺍﺻﻼﺡ گﺮﺩﺩ. ﻫﻤچﻨیﻦ ﺩﺭ ﺭﺍﺳﺘﺎی ﺍیﻦ ﺗﻌﺪیﻞ گﺎﻫی ﺍﻭﻗﺎﺕ ﻣی ﺗﻮﺍﻥ ﺍﺯ یک کﺪ ﻣﻨﻔﺮﺩ ﺑﺮﺍی ﺩﻭ یﺎ چﻨﺪ ﻋﻠﺖ ﻣﺮگ ﻣﺮﺗﺒﻂ ﺑﻬﻢ ﺍﺳﺘﻔﺎﺩﻩ ﻧﻤﻮﺩ ﻭ یﺎ ﺑﻪ ﺟﺎی ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ یک ﻋﻠﺖ ﺟﺰیی ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ، ﻣی ﺗﻮﺍﻥ ﻋﻠﺖ ﻣﺸﺨﺺ ﻭ ﺧﺎﺹ ﺗﺮی ﺭﺍ ﺍﻧﺘﺨﺎﺏ ﻧﻤﻮﺩ.
47 ﻗﻮﺍﻧیﻦ ﺗﻐییﺮ ﻭ ﺗﻌﺪیﻞ • ﻗﺎﻧﻮﻥ : A پیﺮی ﻭ ﺳﺎیﺮ ﻭﺿﻌیﺖ ﻫﺎی ﺑﺪ ﺗﻌﺮیﻒ ﺷﺪﻩ ) (Senility ﺩﺭ ﻣﻮﺍﺭﺩی کﻪ ﻋﻠﺖ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ ﻣﺮگ ﺩﺭ ﻓﺼﻞ ﻫﺠﺪﻫﻢ 01 - ICD ﻗﺎﺑﻞ ﻃﺒﻘﻪ ﺑﻨﺪی ﺑﺎﺷﺪ، ﺑﻪ ﺍﺳﺘﺜﻨﺎﺀ کﺪ 59 ) R ﺳﻨﺪﺭﻡ ﻣﺮگ ﻧﺎگﻬﺎﻧی ﻧﻮﺯﺍﺩ(، ﻭ ﻫﻤﺰﻣﺎﻥ یک ﻭﺿﻌیﺖ ﺩیگﺮ ﻏیﺮ ﺍﺯ ﻭﺿﻌیﺖ ﻫﺎی ﻗﺎﺑﻞ ﻃﺒﻘﻪ ﺑﻨﺪی ﺩﺭ ﻓﺼﻞ ﻫﺠﺪﻩ )ﺑﻪ ﻋﺒﺎﺭﺗی ﻏیﺮ ﺍﺯ ﺭﺩﻩ ﻫﺎی 49 R 00 -R یﺎ 99 (R 96 -R ﺩﺭ گﻮﺍﻫی ﻓﻮﺕ گﺰﺍﺭﺵ ﺷﺪﻩ ﺑﺎﺷﺪ، ﺩﺭ ﺍیﻦ ﺻﻮﺭﺕ ﺑﺪﻭﻥ ﺩﺭ ﻧﻈﺮ گﺮﻓﺘﻦ ﻭﺿﻌیﺖ ﻗﺎﺑﻞ ﻃﺒﻘﻪ ﺑﻨﺪی ﺩﺭ ﻓﺼﻞ ﻫﺠﺪﻫﻢ، ﻋﻠﺖ ﻣﺮگ ﺭﺍ ﻣﺠﺪﺩ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ. ﺑﻪ ﻋﺒﺎﺭﺕ ﺩیگﺮ ﻭﺿﻌیﺖ ﺩﺍﺭﺍی کﺪ R ﺭﺍ ﺍﺯ گﻮﺍﻫی ﻓﻮﺕ ﺣﺬﻑ ﻭ ﻣﺠﺪﺩ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺭﺍ ﺑﺮﺍﺳﺎﺱ ﻗﻮﺍﻧیﻦ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ.
57 Example • I (a) Senility & Hypostatic pneumonia (b) Rheumatoid arthritis یک ﺗﻮﺍﻟی پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻭ آﻦ ﻋﺒﺎﺭﺕ ﺍﺳﺖ ﺍﺯ ﺭﻭﻣﺎﺗﻮییﺪ آﺮﺗﺮیﺖ ﻣﻨﺠﺮ ﺑﻪ پﻨﻮﻣﻮﻧی ﻫیپﻮﺍﺳﺘﺎﺗیک، ﻭﻟی ﻫیچ ﺗﻮﺍﻟی ﻧﺪﺍﺭیﻢ کﻪ ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﻟیﺴﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a یﻌﻨی پیﺮی ﺭﺍ ﺑﻮﺟﻮﺩ آﻮﺭﺩ، ﻟﺬﺍ ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﺩﻭ، ﺍﻭﻟیﻦ ﻭﺿﻌیﺖ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی ﺧﻂ a یﻌﻨی پیﺮی ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی گﺮﺩﺩ. ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ A پیﺮی ﺭﺍ ﺩﺭ ﻧﻈﺮ ﻧگﺮﻓﺘﻪ ﻭ ﺍﺯ گﻮﺍﻫی ﺣﺬﻑ ﻧﻤﻮﺩﻩ ﻭ ﺩﻭﺑﺎﺭﻩ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ گﺮﺩﺩ. ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی 9. 60 M ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
76 Example 34: • I (a) Anaemia • (b) Splenomegaly • Code to splenomegalic anaemia (D 64. 8). Splenomegaly, selected by the General Principle, is ignored but modifies the coding. Example 35: • I (a) Myocardial degeneration and • (b) emphysema • (c) Senility • Code to myocardial degeneration (I 51. 5). Senility, selected by the General Principle, is ignored and Rule 2 applied.
77 • Example 36: • I (a) Cough and haematemesis Code to haematemesis (K 92. 0). • Cough, selected by Rule 2, is ignored. Example 37: • I (a) Terminal pneumonia • (b) Spreading gangrene and • (c) cerebrovascular infarction • Code to cerebrovascular infarction (I 63. 9). Gangrene, selected by Rule 1, is ignored and the General Principle is applied.
87 ﻗﻮﺍﻧیﻦ ﺗﻐییﺮ ﻭ ﺗﻌﺪیﻞ • ﻗﺎﻧﻮﻥ : B ﻭﺿﻌیﺖ ﻫﺎی ﺟﺰیی ) (Trivial Conditions ﺩﺭ ﻣﻮﺍﺭﺩی کﻪ ﻋﻠﺖ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ، یک ﻭﺿﻌیﺖ ﺟﺰیی ﻭ ﺧﻔیﻒ ﺑﺎﺷﺪ کﻪ ﻧﺎﻣﺤﺘﻤﻞ ﺍﺳﺖ ﺍیﻦ ﻭﺿﻌیﺖ ﺟﺰیی ﺑﺎﻋﺚ ﻣﺮگ ﺷﺪﻩ ﺑﺎﺷﺪ ﻭ ﺍﺯ ﻃﺮﻓی ﻭﺿﻌیﺖ ﺟﺪی ﺗﺮی ﻧیﺰ ﺩﺭ گﻮﺍﻫی ﻓﻮﺕ گﺰﺍﺭﺵ ﺷﺪﻩ ﺑﺎﺷﺪ، ﺩﺭ ﺍیﻦ ﺻﻮﺭﺕ ﻣﺎﻧﻨﺪ ﺍیﻨکﻪ ﻭﺿﻌیﺖ ﺟﺰیی گﺰﺍﺭﺵ ﻧﺸﺪﻩ ﺍﺳﺖ، ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺭﺍ ﻣﺠﺪﺩ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ. ﺑﻪ ﻋﺒﺎﺭﺗی ﺍیﻦ ﻭﺿﻌیﺖ ﺟﺰیی ﺭﺍ ﺍﺯ گﻮﺍﻫی ﻓﻮﺕ ﺣﺬﻑ ﻧﻤﻮﺩﻩ ﻭ ﻣﺠﺪﺩ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺭﺍ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ. ﺣﺎﻝ ﺍگﺮ ﻣﺮگ ﺩﺭ ﻧﺘیﺠﻪ یک ﻋکﺲ ﺍﻟﻌﻤﻞ ﺟﺎﻧﺒی ﻣﺮﺑﻮﻁ ﺑﻪ ﺩﺭﻣﺎﻥ یک ﻭﺿﻌیﺖ ﺟﺰیی ﺑﺎﺷﺪ، ﻋکﺲ ﺍﻟﻌﻤﻞ ﺟﺎﻧﺒی ﺭﺍ ﺑﻌﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ ﺍﻧﺘﺨﺎﺏ ﻧﻤﺎییﺪ
79 • • Example 38: I (a) Dental caries II Diabetes Code to diabetes (E 14. 9). Dental caries, selected by the General Principle, is ignored. • Example 39: • I (a) Ingrowing toenail and acute renal failure • Code to acute renal failure (N 17. 9). Ingrowing toenail, selected by Rule 2, is ignored.
80 • If the death was the result of an adverse reaction to treatment of the • trivial condition, select the adverse reaction.
81 • Example 40: 3 I (a) Intraoperative haemorrhage • • (b) Tonsillectomy • (c) Hypertrophy of tonsils • Code to haemorrhage during surgical operation (Y 60. 0). Code to the adverse reaction to treatment of the hypertrophy of tonsils, selected by the General Principle.
82 • (C) When a trivial condition is reported as causing any other condition, the trivial condition is not discarded, i. e. Rule B is not applicable. • Example 41: • I (a) Septicaemia • (b) Impetigo • Code to impetigo (L 01. 0). The trivial condition selected by the General Principle is not discarded since it is reported as the cause of another condition. • Example 42: • I (a) Respiratory insufficiency • (b) Upper respiratory infections • Code to upper respiratory infection (J 06. 9). The trivial condition selected by the General Principle is not discarded since it is reported as the cause of another condition.
38 ﻗﻮﺍﻧیﻦ ﺗﻐییﺮ ﻭ ﺗﻌﺪیﻞ • ﻗﺎﻧﻮﻥ : C ﺍﺭﺗﺒﺎﻁ ) (Linkage ﺩﺭ ﻣﻮﺍﺭﺩی کﻪ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ، ﺗﻮﺳﻂ ﻗﺎﻧﻮﻧی ﺩﺭ ﻃﺒﻘﻪ ﺑﻨﺪی یﺎ ﺗﻮﺳﻂ یﺎﺩﺩﺍﺷﺖ ﻫﺎی ﻣﻮﺭﺩ ﺍﺳﺘﻔﺎﺩﻩ ﺩﺭ کﺪگﺬﺍﺭی ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻣﺮگ، ﺑﺎ یک یﺎ چﻨﺪ ﻭﺿﻌیﺖ ﺩیگﺮ ﺛﺒﺖ ﺷﺪﻩ ﺭﻭی گﻮﺍﻫی ﻓﻮﺕ ﺍﺭﺗﺒﺎﻁ ﺩﺍﺷﺘﻪ ﺑﺎﺷﺪ، کﺪ ﺗﺮکیﺒی ﻣﺮﺑﻮﻁ ﺑﻪ ﻭﺿﻌیﺖ ﻫﺎ ﺭﺍ ﺍﺧﺘﺼﺎﺹ ﺩﻫیﺪ.
48 Example • I (a) Acute myocardial infarction (b) Atherosclerotic heart disease (c) Influenza ﺩﺭ ﺍیﻦ گﻮﺍﻫی یک ﺗﻮﺍﻟی پﺬیﺮﻓﺘﻪ ﺷﺪﻩ ﻭﺟﻮﺩ ﺩﺍﺭﺩ ﻭ آﻦ ﻋﺒﺎﺭﺕ ﺍﺳﺖ ﺍﺯ ﺑیﻤﺎﺭی آﺘﺮﻭﺍﺳکﻠﺮﻭﺗیک ﻗﻠﺒی کﻪ ﻣﻨﺠﺮ ﺑﻪ ﺍﻧﻔﺎﺭکﺘﻮﺱ ﺣﺎﺩ ﻣیﻮکﺎﺭﺩ ﺷﺪﻩ ﺍﺳﺖ) چﻮﻥ آﻨﻔﻠﻮﺍﻧﺰﺍ ﻋﻠﻞ ﺑﺎﻻیی ﺧﻮﺩ ﺭﺍ ﻧﻤی ﺗﻮﺍﻧﺪ ﺑﻮﺟﻮﺩ آﻮﺭﺩ ﻟﺬﺍ ﺍﺯ ﺯﻧﺠیﺮﻩ ﻋﻠﻞ ﺣﺬﻑ ﻣی گﺮﺩﺩ(. ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ یک، ﺑیﻤﺎﺭی آﺘﺮﻭﺍﺳکﻠﺮﻭﺗیک ﻗﻠﺒی ﺑﺎ کﺪ 1. 52 I ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﺍﻧﺘﺨﺎﺏ ﻣی گﺮﺩﺩ ﻭﻟی ﺑﺎﺗﻮﺟﻪ ﺑﻪ ﻗﺎﻧﻮﻥ C ﺑیﻤﺎﺭی آﺘﺮﻭﺍﺳکﻠﺮﻭﺗیک ﻗﻠﺒی ﺑﺎ ﺍﻧﻔﺎﺭکﺘﻮﺱ ﺣﺎﺩ ﻣیﻮکﺎﺭﺩ ﺍﺭﺗﺒﺎﻁ پیﺪﺍ ﻣی کﻨﺪ ﻟﺬﺍ ﺑﺮﺍﺳﺎﺱ ﻗﺎﻧﻮﻥ ﺍﺭﺗﺎﻁ ﺑیﻦ ﺍیﻦ ﺩﻭ ﺑیﻤﺎﺭی کﺪ ﻣﺮﺑﻮﻁ ﺑﻪ ﺍﻧﻔﺎﺭکﺘﻮﺱ ﺣﺎﺩﻣیﻮکﺎﺭﺩ ﺍﺭﺟﺢ ﺍﺳﺖ ﻭ آﻦ ﺭﺍ ﺑﻪ ﻋﻨﻮﺍﻥ ﻋﻠﺖ ﺯﻣیﻨﻪ ﺍی ﻧﻬﺎیی ﺍﻧﺘﺨﺎﺏ ﻭ کﺪ 9. 12 I ﺑﻪ آﻦ ﺍﺧﺘﺼﺎﺹ ﻣی یﺎﺑﺪ.
85 • • Example 43: I (a) Intestinal obstruction (b) Femoral hernia Code to femoral hernia with obstruction (K 41. 3). • Example 44: • I (a) Right bundle - branch block and Chagas disease • Code to Chagas disease with heart involvement (B 57. 2). Right bundle-branch block, selected by Rule 2, links with Chagas disease.
86 • • Example 47: I (a) Cardiac dilatation and renal sclerosis (b) Hypertension Code to hypertensive heart and renal disease (I 13. 9). All three conditions combine. Example 48: I (a) Stroke (b) Atherosclerosis and hypertensive heart disease Code to hypertensive heart disease (I 11. 9). Atherosclerosis, selected by Rule l, links with hypertensive heart disease since hypertensive heart disease would have been selected by the General Principle if atherosclerosis had not been reported.
87 • • • Example 49: I (a) Stroke and hypertensive (b) Heart disease (c) Atherosclerosis Code to stroke (I 64). Atherosclerosis, selected by the General Principle, links with stroke since this condition would have been selected by Rule 2 if atherosclerosis had not been reported. Example 50: I (a) Secondary polycythaemia (b) Pulmonary emphysema (c) Chronic bronchitis Code to obstructive chronic bronchitis (J 44. 8). Chronic bronchitis, selected by the General Principle, links with emphysema
88 ﻗﻮﺍﻧیﻦ ﺗﻐییﺮ ﻭ ﺗﻌﺪیﻞ • ﻗﺎﻧﻮﻥ : D ﻭﺿﻌیﺖ ﺗﺨﺼﺼی ﺗﺮ ) (Specificity ﺩﺭ ﻣﻮﺍﺭﺩی کﻪ ﻋﻠﺖ ﺍﻧﺘﺨﺎﺏ ﺷﺪﻩ، یک ﻭﺿﻌیﺖ ﺭﺍ ﺑﻪ ﺻﻮﺭﺕ ﺍﺻﻄﻼﺣﺎﺕ کﻠی ﺗﻮﺻیﻒ ﻣی کﻨﺪ ﻭ ﺍﺻﻄﻼﺣی کﻪ ﺍﻃﻼﻋﺎﺕ ﺩﻗیﻖ ﺗﺮی ﺭﺍ ﺩﺭ ﺑﺎﺭﻩ ﻣﺤﻞ یﺎ ﻣﺎﻫیﺖ ﺍیﻦ ﻭﺿﻌیﺖ ﺍﺭﺍﺋﻪ ﻣی کﻨﺪ، ﺩﺭ گﻮﺍﻫی ﻓﻮﺕ گﺰﺍﺭﺵ ﺷﺪﻩ ﺑﺎﺷﺪﻑ ﺍﺻﻄﻼﺣی کﻪ ﺩﺍﺭﺍی ﺍﻃﻼﻋﺎﺕ ﺑیﺸﺘﺮ ﻭ ﺗﺨﺼﺼی ﺗﺮ ﺍﺳﺖ ﺭﺍ ﺗﺮﺟیﺢ ﺩﻫیﺪ. ﺍیﻦ ﻗﺎﻧﻮﻥ ﺍﻏﻠﺐ ﺯﻣﺎﻧی ﺑکﺎﺭ ﺧﻮﺍﻫﺪ ﺭﻓﺖ کﻪ ﺍﺻﻄﻼﺡ کﻠی ﺑﻪ ﺻﻮﺭﺕ ﻭﺻﻔی آﻮﺭﺩﻩ ﺷﺪﻩ ﻭ ﺍﺻﻄﻼﺡ ﺩﻗیﻖ ﺗﺮی ﻭ ﺗﺨﺼﺼی ﺗﺮ ﺭﺍ ﺗﻮﺻیﻒ ﻣی ﻧﻤﺎیﺪ.
89 • • Example 57: I (a) Cerebral infarction (b) Cerebrovascular accident Code to cerebral infarction (I 63. 9). Example 58: I (a) Rheumatic heart disease, mitral stenosis Code to rheumatic mitral stenosis (I 05. 0). Example 59: • I (a) Meningitis • (b) Tuberculosis • Code to tuberculous meningitis (A 17. 0). The conditions are stated in the correct causal relationship.
90 • Example 60: • I (a) Severe hypertension in pregnancy • II Eclamptic convulsions Code to eclampsia in pregnancy (O 15. 0). • Example 61: • I (a) Aneurysm of aorta • (b) Syphilis • Code to syphilitic aneurysm of aorta (A 52. 0). The conditions are stated in the correct causal relationship. • Example 62: • I (a) Pericarditis • (b) Uraemia and pneumonia • Code to uraemic pericarditis (N 18. 5). Uraemia, selected by Rule l (see Example 14), modifies the pericarditis.
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