Hand Book on Treatment Guidelines for Snake Bite and Scorpion Sting

7/23/2019 Hand Book on Treatment Guidelines for Snake Bite and Scorpion Sting

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5/129

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Zhte`s \di`

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Ctk`rs

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4.46 V`scurn` mdt`rhde >8


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Zr`dtm`bt Iuhj`ehb`s gcr ^bda`fht` dbj ^ncrphcb sthbi - 6


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Vussèes Whp`r (Jdfchd russèhh)

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cg tk` trhdbie` pchbthbi tcwdrjs tk` bcstrhes.

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pr`jhnthv` vdeu` hb j`t`nthbi dbdpkyedntchj cr edt` s`rum r`dnthcbs dbj skcuej bct

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Zr`dtm`bt Iuhjèhb`s gcr ^bda`fht` dbj ^ncrphcb sthbi - 6. Zk`r` hs bc prcpkyednthn jcs` cg D^W.

4:. Zctde jcs` r`quhr`m`bt ndbbct f` j`nhj`j cb tk` fdshs cg (YFNZ) Ykce` feccj

nectthbi t`st (cr) nehbhnde shibs dbj symptcms.

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sbda`fht`.

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dte`dst 6 kcurs ncbthbucusey.

4;. Bc hbt`rdnthcb whtk D^W kds f``b r`pcrt`j.

48. G`tde rhsa ju` tc D^W kds bct f``b `stdfehsk`j cr stujh`j hb kumdbs.

6< mhbut`s cr whtkhb 6 kcurs. ^c

mcbhtcr tk` nds` cb D^W dt 0mhb. hbt`rvde gcr fflrst >


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pchscbcus sbda` fht`.

4.9 Mdbdi`m`bt hb \rhmdry K`detk N`btr` (\KN) dbj Fecna \KN

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@vhj`bn` suii`sts tkdt jcntcrs dr` bct wheehbi tc mda` us` cg D^W dbj ctk`r

m`jhndthcbs, `v`b wk`b `quhpp`j, ju` tc edna cg ncbfflj`bn` dbj iuhjèhb`s. Zk`

pr`s`bt kdbjfcca cb iuhjèhb`s hs pr`pdr`j tc suht` tk`hr b``js dbj cutehb`s kcw tk`y

skcuej prcn``j whtkhb tk`hr ncbt`xt dbj s`tthbi. Zk` prhbnhpe`s bvhsdi`j tc tr`dt sbda`

fht` dt dee K`detk N`btr`s / Kcsphtdes hrr sp`nthv` cg tk` stdtus - Icv`rbm`bt cr \rhvdt`

dr` ihv`b fècw hb Zdfe` bc? 9. Zk` hbhthde `vdeudthcb dbj syst`mhn mdbhg`stdthcbs

gceecwhbi `bv`bcmdthcb, dbj tr`dtm`bt dsp`nts dr` prcvhj`j hb Zdfe`s 46, 4> dbj 4:

r`sp`nthvèy.

Zdfe` Bc. 46? Hbhthde `vdeudthcb Bc yst`mhn @bv`bcmdthcb

D^^@^^ NED^^HGX ZV@DZM@BZ

Whtde shibs

\ues`

F\

V`sphrdthcb

Whtde shibs (Djuet)*

\ues` rdt`? 7


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>: Zdmhe Bdju K`detk ^yst`ms \rco`nt, K&GY J`pt, Icvt cg Zdmhe Bdju, Nk`bbdh.

^ymptcms dbj shibs

Fht` mdras

\tcshs

Jcufe` vhshcb

Jhgfflnuety hb

swdeecwhbiFe``jhbi sht`s

V`jun`j urhb` cutput

^wèehbi dbj ecnde

pdhb

Ecnde b`nrcshs

J`sn`bjhbi pdrdeyshs

Pbncbsnhcusb`ss

Vìhcbde

eympkdj`bhthsDby ctk`r symptcms

dbj shibs bct`j jcwb

^ymptcms dbj shibs

Ecnde pdhb dbj/ cr

swèehbi+

Fht` mdra pr`s`bt,

sahb frca`b

Bc ctk`r symptcmsdbj shibs pr`s`bt

Edfcrdtcry t`st?

6< Mhbut`s Ykce` Feccj

Nectthbi Z`st - feccj nect

gcrm`j

Hg dfcv` fflbjhbis dr` tk`r`

dt tk` thm` cg dss`ssm`bt

nedsshgy ds Bc syst`mhn

`bv`bcmdthcb

Mcbhtcr \ues`, V`sphrdthcb

& F\ `v`ry kcurey gcr >

kcurs dbj `v`ry :tkkcurey

gcr r`mdhbhbi :; kcurs.

Hg bcrmde s`bj tk`

pdth`bt kcm`

*Whtde shibs gcr nkhejr`b (s`` di` sp`nhffln nkdrt) dr` prcvhj`j hb Dbb`xur` HH.

Hg tk` pdth`bt kds dby syst`mhn mdbhg`stdthcbs r`g`r tc Zdfe`.4> dbj 4: gcr k`mctcxhn

dbj bùrctcxhn `bv`bcmdthcb r`sp`nthvèy. Zk` j`tdhes cg ecnde `bv`bcmdthcb dr`

prcvhj`j hb Zdfe` :.


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Zr`dtm`bt Iuhj`ehb`s gcr ^bda`fht` dbj ^ncrphcb sthbi - 6? Kd`mctcxhn `bv`bcmdthcb


Whtde shibs

\ues`

F\

V`sphrdthcb

^ymptcms dbj shibs

Fht` mdras\tcshs

Jcufe` vhshcb

Jhgfflnuety hb

swdeecwhbiFe``jhbi sht`s

V`jun`j urhb` cutput

^w`eehbi dbj ecnde

pdhb

Ecnde b`nrcshs

J`sn`bjhbi pdrdeyshs

Pbncbsnhcusb`ss

Eympkdj`bhths

Fr`dtkhbi jhgfflnuetyDby ctk`r, bct`

jcwb

Whtde shibs (Djuet)*

\ues` rdt` 246< p`r

mhbut`, g``fe` (d

r`spcbs` tc kypct`bshcb)V`sphrdtcry rdt` 2 6


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>7 Zdmhe Bdju K`detk ^yst`ms \rco`nt, K&GY J`pt, Icvt cg Zdmhe Bdju, Nk`bbdh.

Geuhjr`quhr`m`bts p`r jdy skcuej f` a`pt hb mhbj wkhe` ihvhbi D^W. Gcr nkhejr`b

r`dj`rs dr` r`qu`st`j tc s`` tk` stuhj r`quhr`m`bt nkdrt prcvhj`j hb Dbb`xur` HH.

QZdfe` Bc.68]

* Whtde shibs gcr nkhejr`b (s`` di` sp`nhffln nkdrt) dr` prcvhj`j hb Dbb`xur` HHH.

QZdfe` bc.>< tc >>].

Zdfe` Bc. 4:? Bùrctcxhn `bv`bcmdthcb


^ymptcms dbj shibs

^wèehbi dbj ecnde pdhb

Ecnde b`nrcshs

J`sn`bjhbi pdrdeyshs stdrthbi whtk

ptcshs, `xt`rbde cpktkdemcpeìhdBumfb`ss drcubj tk` ehps dbj

mcutk prcir`sshbi tc pccehbi cg

s`nr`thcbs, jhgfflnuety tc tdea dbj

r`sphrdtcry gdheur`

\drdjcxhnde r`sphrdthcb

\drdeyshs

Dfjcmhbde pdhb

Edfcrdtcry t`st?

6< Mhbut`s YFNZ - Feccj nect gcrm`jHg dfcv` shibs & symptcms dr`

pr`s`bt dt tk` thm` cg djmhsshcb

nedsshgy ds Bùrctcxhn `bv`bcmdthcb

Zr`dt tk` pdth`bt whtk D^W

ds m`bthcb`j hb Zdfe` 4>

dbj djj tk` gceecwhbi?

Hbo.B`csthimhb` 4.0 mi

(Zk`rdpùthn Z`st jcs`) ds

HM dbj

Hbo.Dtrcphb` < mhbut`s gcr shibs cg

r`spcbs`

4.; V`g`rrde dsp`nts

Zk` m`jhnde cgffln`r wkc hs tr`dthbi tk` nds`s cg sbda` fht` skcuej tda` m`thnuecus

ndr` tc ecca hb tc tk` pdth`bts stdtus dbj prcvhj`fflrst dhj ds wèe ds suppcrthv` m`dsur`s

f`gcr` r`g`rrhbi tk` nds` tc khik`r n`btr` / sp`nhdsehst. Zk` j`tdhes dr` gurbhsk`j hb

Zdfe` 40 fècw.

Gcr ecnde`bv`bcmdthcbr`g`r tc Zdfe`:.

Gcr syst`mhn`bv`bcmdthcbr`g`r tc Zdfe`s46 dbj 4>


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>; Zdmhe Bdju K`detk ^yst`ms \rco`nt, K&GY J`pt, Icvt cg Zdmhe Bdju, Nk`bbdh.

Ncbthbu` ehg` suppcrthbi m`dsur`s

\rcvhj` dhrwdy suppcrt whtk tk` kèp cg db dnncmpdbyhbi stdgg

^`bj tk` r`g`rrde bct` whtk j`tdhes cg tr`dtm`bt ihv`b

Hbstrunt cb` stdgg tc dnncmpdby tk` pdth`bt jurhbi trdbspcrtdthcb hg r`quhr`j.

Kdbj cv`r tk` r`g`rrde gcrm whtk j`tdhes rìdrjhbi tr`dtm`bt ihv`b

M`bthcb tk` nehbhnde stdtus ne`drey hb tk` r`g`rrde gcrm dt tk` thm` cg r`g`rrde.

4.8 Yègdr` m`dsur`s

Zk` Icv`rbm`bt cg Zdmhe Bdju hs prcvhjhbi scedthum tc tk` gdmhey m`mf`rs cg

tk` j`n`ds`j sbda` fht` vhnthms. Zk` dmcubt hs jhsfurs`j fy tk` r`sp`nthv` jhstrhnt

ncee`ntcr fds`j cb tk` dppehndthcb mdj` fy tk` gdmhey m`mf`rs decbi whtk tk` m`jhnde

n`rthfflndt` m`bthcbhbi tk` ndus` cg j`dtk ds ncmpehndthcbs gceecwhbi sbda`fht` hb

d ne`dr mdbb`r (ds cfs`rv`j wkhe` cb tr`dtm`bt). Zk` dmcubt vdrh`s grcm stdt` tc

stdt`. Zr`dthbi jcntcr skcuej hbgcrm tk` gdmhey m`mf`rs cg tk` j`n`ds`j, dbj iuhj`

tk`m rìdrjhbi tk` wdys dbj m`dbs gcr i`tthbi tk` wègdr` m`dsur`s prcvhj`j fy tk`

icv`rbm`bt.

4.4< Cnnupdthcbde rhsa gcr ^bda` fht`

Zk` bcrmde p`rn`pthcb hs tkdt rurde dirhnueturde wcra`rs dr` mcst dt rhsa dbj tk`

fht`s cnnur fflrst tkhbi hb tk` mcrbhbi dbj edst tkhbi dt bhikt. Kcw`v`r, tkhs hs cg v`ry

ehtte` prdnthnde us` tc rurde wcra`rs hb pr`v`bthbi sbda`fht` shbn` ht hibcr`s tk` gdnt tkdt

cgt`b sbda`fht`s neust`r drcubj n`rtdhb fhc-m`nkdbhnde dnthvhth`s, hb n`rtdhb i`cirdpkhndr`ds, dt n`rtdhb thm`s cg tk` jdy.

Irdss-nutthbi r`mdhbs d mdocr shtudthcbde scurn` cg fht`s.

Hb ruff`r, ncncbut, pdemyrd dbj dr`ndbut pedbtdthcbs ne`drhbi tk` fds` cg tk`

tr`` tc pedn` mdbur` ndus`s shibhfflndbt bumf`rs cg fht`s.

Kdrv`sthbi khik ircwhbi nrcps eha` mhee`t wkhnk r`quhr` dtt`bthcb gcnus`j

dwdy grcm tk` ircubj.

Vuff`r tdpphbi wcra`rs dr` susn`pthfe` dbj ht kdpp`bs cgt`b hb tk` `drey kcurs

?


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:;> >86.

4:. Nkuik A.^. ^bda` Fht` hbjun`j Dnut` V`bde Gdheur`. Ahjb`y Hbt`rbdthcbde48;8?>0?;84 8 Zr`dtm`bt 0:

Ghrst dhj m`dsur`s

Zrdjhthcbde m`tkcjs

\rhbnhpe`s hbvcev`j hb tk` mdbdi`m`bt

\kdrmdncecihnde dsp`nts cg \rdzcshb

6.: ^ncrphcb sthbi hb sp`nhde shtudthcbs 7< mhbut`s tc > kcurs, usudeey s`ncbjdry tc mycndrjhde

jysgubnthcb. Pbgcrtubdtèy scm` nds`s cg sncrphcb sthbi mdy jh` whtkhb >< mhbut`s

dbj tkhs mdy f` rèdt`j tc v`btrhnuedr drrkytkmhds cr bcb ndrjhdn puemcbdry `j`md

ju` tc DVJ^ Qcgt`b r`pcrt`j grcm Frdzhe]. N`btrde b`rvcus syst`m mdbhg`stdthcbs whtk

cr whtkcut ncbvueshcbs mdy cnnur whtkhb cb` tc twc kcurs hb gdtde nds`s.

Ncmpehndthcbs

Wdrhcus ncmpehndthcb cg sncrphcb sthbi dr`?

V`sphrdtcry gdheur`

Mueth cridb gdheur`

Jhedt`j ndrjhc mycpdtky

Vkdfjcmyceyshs

\`rshst`bt pdr`stk`shd

Dbth v`bcm dbdpkyedxhs dbj s`rum shnab`ss

Dbayecshs cg smdee ochbts hg sthbi cnnurs dt d ochbt

Hdtrci`bhn khik jcs` s`jdthv` kypbcthn r`sphrdtcry drr`st

6.> Zr`dtm`bt

Zk` fflrst dhj nurr`btey r`ncmm`bj`j hs fds`j drcubj tk` mb`mcbhn V.H.I.K.Z. Zk`

j`tdhes prcvhj`j `dreh`r hb Zdfe` bc.7 hs didhb gurbhsk`j fècw gcr `dsy r`djhbi.


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\rhbnhpe`s hbvcev`j hb tk` mdbdi`m`bt cg sncrphcb sthbi

Zk` prhbnhpe`s `bvhsdi`j tc tr`dt sncrphcb sthbi dt dee K`detk N`btr`s / Kcsphtdes

hrr`sp`nthv` cg tk` stdtus (Icv`rbm`bt cr \rhvdt`) dr` ihv`b fècw (tk` sdm` ihv`b

ubj`r sbda` fht`) ubj`r 46 Ds.

Zdfe` Bc. 9? \rhbnhpe`s hbvcev`j hb tk` mdbdi`m`bt

4. Djmht tk` vhnthm hmm`jhdtèy.

6. Dsa `gg`nthvèy.

>. Dss`ss quhnaey.

:. Dnt swhgtey.

0. Djmhbhst`r m`jhndthcb m`thnuecusey.

7. Djjr`ss tc tk` wcubj prcp`rey.

9. Dbthnhpdt` ncmpehndthcbs a``bey.

;. Dvchj `rrcrs ndr`gueey.

8. Dsn`rtdhb tk` stdtus r`p`dt`jey.

4] Dss`ss tk` gceecwhbi quhnaey.

d] Dhrwdy, Fr`dtkhbi dbj Nhrnuedthcb

f] Whtdes KV, VV, F\ dbj \ues` cxhm`try (hg r`quhr`j)


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0; Zdmhe Bdju K`detk ^yst`ms \rco`nt, K&GY J`pt, Icvt cg Zdmhe Bdju, Nk`bbdh.

Zdfe` Bc. 64? M`dsur`s tc f` djcpt`j wkhe` ushbi \rdzcshb

\rdzcshb skcuej bct f` ihv`b ds prcpkyednthn jcs` wk`b pdhb hs tk` cbey

symptcm.

Ihv` \rdzcshb tkrcuik bdscidstrhn tuf`, hg fdfy kds vcmhthbi.

A``p tk` pdth`bt hb eyhbi pcstur` gcr dfcut > kcurs (`v`b wkhe` `xdmhbhbi

tk` nds`) hb crj`r tc pr`v`bt fflrst jcs` pk`bcm`bcb (kypct`bshcb) ju` tc

\rdzcshb.

Mcbhtcr pues`, F\, dbj r`sphrdthcb `v`ry >< mhbut`s gcr > kcurs.

V`dss`ss gcr wdrmtk dbj r`turb cg pdhb dt tk` sht` cg sthbi.

Ncbthbu` mcbhtcrhbi cg pues`, F\, dbj r`sphrdthcb `v`ry 7< mhbut`s gcr b`xt

7 kcurs.

V`nk`na tk` sdm` `v`ry : kcurs thee hmprcv`m`bt hs vhshfe`.

V`p`dt Zdf. \rdzcshb hb tk` sdm` jcs` dt tk` `bj cg > kcurs dnncrjhbi tc

nehbhnde r`spcbs` dbj edt`r `v`ry 7 kcurs thee `xtr`mhth`s dr` wdrm, jry dbj

p`rhpk`rde v`hbs dr vhshfe` `dshey.

* Det`rbdthv` tc Zdf. \rdzcshb hs Bhffljhphb`, Bhtrcprusshj`, Bhtrcieyn`rhb`, Hscscrfhj`

jh-bhtrdt`, Kyjrdedzhb` cr Dbihct`bshb ncbv`rthbi `bzym` hbkhfhtcrs (DN@Hs).

Kcw`v`r, us`rs kdv` tc r`m`mf`r tk` ncbstrdhbts wkhe` pr`snrhfhbi sunk jruis.

i] F`td-fecna`rshb smdee jcs`s decbi whtk depkd fecna`rs hg b``j`j dbj hg bct

ncbtrdhbjhndt`j.

k] Bhtrdt`shg pdth`bt kds kyp`rt`bshcb dbj mycndrjhde hsnk`mhd h] Hcbctrcphns sunk ds jhihtdehs (kds ehtte` gg`nt), cr jcfutdmhb`(r`g`r sbda` fht`

s`nthcb gcr j`tdhes). Dvchj Jcpdmhb` ds ht diirdvdt`s tk` mycndrjhde jdmdi`.

o] Bcr-`phb`pkrhb`ds HW jrhp tc ncrr`nt kypct`bshcb r`grdntcry tc stuhj tk`rdpy.

a] Dbthmhnrcfhdeshg hbg`nthcb hs susp`nt`j

e] Hbo. Dtrcphb` (r`quhr`j dt thm`s) tc ncubt`r v`bcm hbjun`j pdrdsympdtk`thn

`gg`nts.

m] Hbo. Hbsuehbkds f``b skcwb tc pr`v`bt muethcridb gdheur` (`sp`nhdeey ndrjhc-

puemcbdry) hb dbhmde `xp rhm`bts.

b] Fdrfhturdt` dbj / cr f`bzcjhdz`phb` ds ncbthbucus hbgushcb gcr s`v`r` /

`xn`sshv` mctcr dnthvhty

c] ^t`rchjstc j`nr`ds` skcna dbj `j`md hs cg ubprcv`b f`b`fflt.

p] Dbthv`bcm gcr sncrphcbsthbi hs bct us`j ncmmcbey hb Hbjhd (ds sp`nh`s sp`nhffln

dbthv`bcm hs bct dvdhedfe` dbj usdi` kds bct j`mcbstrdt`j dby f`b`fflt)

q] Wdnnhb` bct dvdhedfe` (trh`j hb `xp`rhm`btde dbhmdes).

r] HW stuhjsds p`r b``j Qstuhj gcr nkhejr`b- r`g`r Dbb`xur` HH Zdfe` Bc.68].


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7


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Zr`dtm`bt Iuhj`ehb`s gcr ^bda`fht` dbj ^ncrphcb sthbi - 68 49. Nkdbi J, Jdttdrc OD, Ahraedbj E. ^ncrphcb sthbi (drthne` edst upjdt`j cb

Bcv`mf`r ;tk,6 1 >4 (8) ? 4.

60. Hsmdhe M. Zk` ^ncrphcb `bv`bcmhbi sybjrcm`. Zcxhncb, 48801>> (9)?;60 0;.

67. Odkcb ^, De ^dhiue DM, Kdm`j DV. ^ncrphcb sthbis hb Tdsshm, ^dujh Drdfhd

-d 0 y`dr surv`heedbn` r`pcrt. Zcxhncb. 6


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Zhte`s \di`

>.4 Tudehty cg Ndr` 78

>.6 V`spcbshfhehth`s cg k`detk ndr` prcvhj`rs / prcg`sshcbdes 78

>.> Mdhbt`bdbn` cg r`ncrjs dbj r`pcrts 9.: Pthehsdthcb cg Hbgcrmdthcb, @jundthcb dbj Ncmmubhndthcb

(H@N) mdt`rhdes 9.0 Ykdt pdth`bts dbj ndr` ihv`rs skcuej abcw dfcut

sbda` fht` / sncrphcb sthbi3 9.7 Ykdt k`detk ndr` prcvhj`rs / prcg`sshcbdes skcuej abcw

cb sbda` fht` dbj sncrphcb sthbi3 9>

>.9 M`jhnde phtgdees 9:

>.; M`jhnde dujht gcr sbda` fht` dbj sncrphcb sthbi 9:

>.8 Dr`ds gcr r`s`drnk cb sbda` fht` / sncrphcb sthbi 98

>.4< A`y pchbts gcr sbda` fht` dbj sncrphcb sthbi ;:

>.44 Ncbneushcbs ;0

^@NZHCB - HHH

MH^N@EEDB@CP^


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Zr`dtm`bt Iuhjèhb`s gcr ^bda`fht` dbj ^ncrphcb sthbi - 6. V`g`rrde rdt`, dbj

:. Dvdhedfhehty cg jruis dbj j`vhn`s

0. Pthehzdthcb cg Dbth-sbda` v`bcm

>.6 V`spcbshfhehth`s cg k`detk ndr` prcvhj`rs / prcg`sshcbdes

Zk` r`spcbshfhehth`s cg k`detk ndr` prcvhj`r whtk r`g`r`bn` tc qudehty cg ndr` kdv`

f``b bdrrdt`j ubj`r 4< Vs prcvhj`j hb Zdfe` 60 fècw.

Zdfe` Bc. 60? V`spcbshfhehth`s cg k`detk ndr` prcvhj`rs / prcg`sshcbdes

4. V`ncibhs` tk` nds` dbj jhsthbiuhsk ht grcm ctk`r ncbjhthcbs.

6. V`m`mf`r tk` prhbnhpe`s cg mdbdi`m`bt.

>. V`susnhtdt` hg r`quhr`j.

:. V`dssur` pdth`bts hb db `mpdtk`thn mdbb`r.

0. V`dss`ss tc `sthmdt` tk` nehbhnde stdtus dbj ncmpehndthcbs.

7. V`g`r tc khik`r n`btr` cr sp`nhdehstQs] hb thm` hg r`quhr`j.

9. V`vh`w tk` k`detk s`rvhn`s dbj `gg`nthv`b`ss cg k`detk `jundthcb whtk k`detk

ndr` t`dm.

;. V`trdhb tk` k`detk ndr` t`dm tc rdhs` tk`hr stdbjdrj dbj qudehty cg s`rvhn`.

8. V``jundt` tk` ncmmubhty gcr `mpcw`rm`bt hb t`rms cg pr`v`bthcb, ncbtrce

dbj wègdr` ds wèe ds hb tk` tr`dtm`bt dbj gceecw up.

4


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Nc-mcrfhj stdtus / pr``xhsthbi heeb`ssQ`s] dbj m`jhndthcbQs] cg dby scrt mdy

hbstu`bn` tk` r`spcbs` tc v`bcm ds wèe ds tr`dtm`bt dbj cutncm`.

@dnk nds` hs jhgg`r`bt grcm dbctk`r hb cb` cr ctk`r dsp`nts.

Gceecw up

Gceecw-up nk`nas dr` r`quhr`j gcr dss`ssm`bt cg ecbi t`rm `gg`nts cb jhgg`r`bt

cridbs / syst`ms dbj dpprcprhdt` mdbdi`m`bt kds tc f` hbsthtut`j wk`r`v`r

r`quhr`j / b``j`j.

Ehmhtdthcb

Edfcrdtcry hbv`sthidthcbs dr` cg ehtte` vdeu` hb tk` jhdibcshs cg s`v`rhty cg

`bv`bcmdthcb cr tk` suf-typ` cg sbda` ju` tc fhcecihnde vdrhdthcbs, fut dsshst

gcr hbt`rv`bthcbNurr`btey dvdhedfe` tr`dtm`bt mcjdehth`s dbj suppcrthv` ndr` dtt`mpt tc r`jun`

mcrfhjhty, det`r tk` nehbhnde ncurs`, `bkdbn` bdturde prcn`ss cg r`ncv`ry dbj

mhbhmhz` mcrtdehty.

Yègdr` m`dsur`s

Mcr` j`dtks cnnur gceecwhbi sbda` fht` / sncrphcb sthbi cutshj` tk` kcsphtdes,

dbj dt thm`s j`dtks cnnur hbshj` tk` kcsphtde j`spht` tr`dtm`bt, f`ndus` cg tk`

pdth`bts fhcecihnde nkdrdnt`rhsthnsMdby stdt` icv`rbm`bts hb Hbjhd prcvhj` scedthum tc tk` gdmhey m`mf`rs cg

tk` j`n`ds`j sbda` fht` vhnthms.

\r`v`bthcb

Dt pr`s`bt bc gg`nthv` vdnnhb` hs dvdhedfe` didhbst sbda` fht` dbj sncrphcb sthbi.

K`bn`, tk` ncmmubhty must f` mcthvdt`j tc ubj`rstdbj dbj djcpt pr`v`bthv`

m`dsur`s dewdys.

Desc, tk` p`cpe` skcuej f` mdj` dwdr` cg tk` fflrst dhj m`dsur`s dbj djcpt drey

k`detk s`àhbi f`kdvhcr f`gcr` ncmpehndthcbs s`t hb.

Hbgcrmdthcb dbj r`scurn`

\dth`bts dbj ndr` ihv`rs mdy f` hbgcrm`j dfcut tk`

4. Jhdibcshs

6. Bumf`r cg nds`s r`g`rr`j

>. Bumf`r cg nds`s `xphr`j dt k`detk n`btr`


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Zr`dtm`bt Iuhjèhb`s gcr ^bda`fht` dbj ^ncrphcb sthbi - 6.7 Ykdt k`detk ndr` prcvhj`r / prcg`sshcbdes skcuej abcw cb sbda`

fht` dbj sncrphcb sthbi3

Cbn` ncmmubhty dwdr`b`ss cb fflrst dhj m`dsur`s dbj tr`dtm`bt mcjdehty cg

sbda` fht` dbj sncrphcb sthbi hbnr`ds`s, mcr` bumf`r cg sunk nds`s dr` ehaèy

tc dtt`bj tk` K`detk N`btr` / Kcsphtde thee tk` pr`v`bthv` m`dsur`s dr` djcpt`jtc r`jun` tk` prcfe`m.

Zk` thm` hbt`rvde f`tw``b fht` / sthbi dbj dppehndthcb cg snh`bthffln tr`dtm`bt

mcjdehth`s skcuej ncm` jcwb

Ds sbda` fht` dbj sncrphcb sthbi pdth`bts dr` ehaèy tc i`t dpprcprhdt` tr`dtm`bt

`drey hb tk` b`dr`st K`detk N`btr` / Kcsphtde, mcrfhjhty dbj mcrtdehty dr` ehaèy

tc ncm` jcwb

K`detk N`btr` / Kcsphtde mdy r`quhr` mcr` mdt`rhdes tc kdbje` sunk nds`s. ^c

tk` k`detk ndr` prcvhj`r kds tc hbhthdt` `ggcrts tc mdhbtdhb dj`qudt` stcna dbjr`pe`bhsk tk`hr r`quhr`m`bts wèe hb djvdbn`

Hg tk` tr`dtm`bt hs hbhthdt`j gcr sbda` fht` dt K`detk N`btr` / Kcsphtde ds p`r

`vhj`bn` fds`j (stdbjdrj tr`dtm`bt iuhjèhb`s), tk` tctde dbth sbda` v`bcm

r`quhr`j p`r pdth`bt whee ncm` jcwb dbj desc tk` r`g`rrde rdt` tc khik`r n`btr`

tcc.

^hbn` tk` pdth`bts dr` i`tthbi tr`dtm`bt dt p`rhpk`rde K`detk N`btr` / Kcsphtde,

tk` pdth`bts mdy ncm` tc tk` kcsphtde `drey whtkcut wdsthbi thm` hb ctk`r

trdjhthcbde m`tkcjs

Hbnr`ds`j dwdr`b`ss cg tk` wègdr` m`dsur`s prcvhj`j fy tk` tdt` Icv`rbm`bt

cg Zdmhe Bdju tc tk` gdmhey m`mf`rs cg tk` j`n`ds`j vhnthm, mdy r`suet hb

frhbihbi tk` nds`s wkc jh`j ju` tc tk` fht` / sthbi cutshj` kcsphtde gcr j`dtk

n`rthfflndt`. Pbj`r sunk nhrnumstdbn`s tk` M`jhnde Cgffln`r kds tc hbgcrm tk`

gdmhey m`mf`rs cg tk` j`n`ds`j vhnthm, tc skhgt tk` fcjy tc d n`btr` wk`r`

pcstmcrt`m ncuej f` ndrrh`j cut tc dsn`rtdhb tk` ndus` cg j`dtk hg tk`y jc bct

kdv` pcstmcrt`m gdnhehth`s hb tk` r`sp`nthv` K`detk N`btr` / Kcsphtde.


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Zdfe` Bc. 67? E`vès cg dbdeyshs

E`vè \edn` V`vh`w`r Mdt`rhdes gcr dbdeyshs

H. EcndeK`detk n`btr` /

Kcsphtde

Nkh`g cg tk`

K`detk n`btr` /kcsphtde / ubht

J`tdhes cg sbda` fht` dbj

sncrphcb sthbi tr`dt`j /jh`j /

frcuikt j`dj tc tk` r`sp`nthv`k`detk n`btr` / kcsphtde dbj

k`detk s`rvhn`s

HH. K`detk

Pbht

Cgffln` cg tk`

K`detk Pbht cg

r`sp`nthv` k`detk

jhstrhnts

Nkh`g cg tk`

k`detk ubht

J`tdhes ncee`nt`j grcm dee

kcsphtdes QIcv`rbm`bt /

prhvdt`], dbj j`dtk ju` tc

sbda` fht` dbj sncrphcb sthbi

ncee`nt`j grcm \dbnkdydt /

Mubhnhpdehty, `tn., dbj k`detks`rvhn`s

HHH. V`v`bu`

jhstrhnt

e`vè

Cgffln` cg tk` Ochbt

Jhr`ntcr cg K`detk

^`rvhn`s

Ochbt Jhr`ntcr cg

K`detk `rvhn`s

J`tdhes ncee`nt`j grcm tk`

k`detk ubhts ubj`r tk`m dbj

j`dtk ju` tc sbda` fht` dbj

sncrphcb sthbi ncee`nt`j grcm

\dbnkdydt / Mubhnhpdehty /

Ncrpcrdthcb `tn., dbj ds wèe

ds j`tdhes cg wègdr` m`dsur`s

prcvhj`j gcr sunk vhnthmsgdmhey grcm tk` r`sp`nthv`

Ncee`ntcrdt`.

HW. ^tdt`

e`vè

Cgffln` cg Jhr`ntcr

cg \ufehn K`detk

dbj \r`v`bthv`

M`jhnhb`

Jhr`ntcr cg

\ufehn K`detk

dbj \r`v`bthv`

M`jhnhb`

Jdtd grcm dee r`v`bu`

jhstrhnts decbi whtk vdrhcus

Jhr`ntcrdt`s ncmhbi ubj`r

K`detk dbj Gdmhey Yègdr`

J`pdrtm`bt cg Zdmhe Bdju,

Nk`bbdh

Vce` cg r`vh`w`r

Djk`r` tc r`vh`whbi cg dnkh`v`m`bt cg cfo`nthv`s, icdes dbj vhshcb

V`m`mf`r prhbnhpe`s dbj cutncm` cg dujht

V`vh`w tk` jdtd whtk r`g`r`bn` tc r`spcbshfhehth`s cg k`detk ndr` prcvhj`rs/

prcg`sshcbdes

Ncbshj`r m`jhnde / scnhde prcfe`ms gdn`j whtk `dnk nds`


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;. Fhfehcm`trhn stujh`s cb sbda`s, sbda` v`bcm, dbth sbda` v`bcm dbj sbda`

fht`s grcm Hbjhd.

:. @ncbcmhnde dsp`nts cg sbda` fht` dbj rìhcbde vdrhdthcb.

0. Ncubsèhbi dbj iuhjdbn` tc sbda` fht` vhnthms dbj tk`hr gdmhey.

7. Oujhnhde dsp`nts dbj dnthvhsm rèdt`j tc sbda`s dbj sbda` fht`s hb Hbjhd

9. ^bda`s dbj sbda` fht` hb eht`rdtur`.

;. ^bda` dbj sbda` fht` hb nhb`md.

8. ^bda`s dbj sbda` fht` hb mytkceciy.

4. Nrhm` hssu` r edt`j tc sbda`, sbda` v`bcm dbj sbda`fht`.

4:. ^bda`s, sbda` v`bcm dbj sbda`fht` hb edy pr`ss dbj ctk`r m`jhd.

40. Jhsnusshcb cb sbda`s, sbda` v`bcm, dbth sbda` v`bcm dbj sbda` fht` rèdt`j

hssu`s hb Hbjhdb \drehdm`bt dbj Dss`mfey hb pr` dbj pcst hbj`p`bj`bt p`rhcj.

47. @gg`nts cg iecfde wdrmhbi dbj nehmdt` nkdbi` cb tk` `ncsyst`m cg sbda`s,

f`kdvhcur cg sbda`s, ncbsthtu`bts cg sbda` v`bcm dbj sbda` fht`.

49. ^bda`s hb snueptur`s? wkdt jc tk`y ncbv`y3

4;. Vèhihcus dsp`nts rèdt`j tc sbda`s, sbda` fht` dbj r`ncv`ry.

48. Dstrcecihnde dsp`nts cg sbda`s, sbda` fht` dbj r`ncv`ry.

6. J`mdbjs, prcjunthcb dbj suppey cg dbth sbda` v`bcm.6:. Pthehsdthcb cg dbth sbda` v`bcm hb icv`rbm`bt dbj prhvdt` s`ntcr.

HH. Fdshn ^nh`bn`s

4. \r`pdrdthcb cg mcbcvde`bt dbth sbda` v`bcm.

6. F`jshj` jhdibcsthn ahts tc dss`ss sbda` v`bcm e`vès.

>. Bdtur` dbj jhstrhfuthcb cg sbda`s hb jhgg r`bt dr`ds hb Zdmhe Bdju dbj Hbjhd

d i`cirdpkhnde stujy.

:. Ps` cg sbda` v`bcm hb jhdibcsthn dbj tk`rdpùthn purpcs`s.

0. K`t`rci`b`nhty cg sbda` v`bcm hb rèdthcb tc sp`nh`s dbj suf typ`s.


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Zhte`s \di`

H ^bda` fht` nds`s r`pcrt`j hb s`ncbjdry ndr` kcsphtdes ;9

HH. Geuhj r`quhr`m`bt nkdrt gcr nkhejr`b ;;HHH. Whtde shibs r`g`r`bn` tdfe` gcr p`jhdtrhn di` ircup ;;

HW. \r` kcsphtde tr`dtm`bt gcr sbda` fht` dbj hssu`s r`edt`j tc D^W 84

W. V`pcrthbi / r`g`rrde gcrm gcr sbda` fht` / sncrphcb sthbi 8>

WH. ^bda` fht` dbj sncrphcb sthbi mcbtkey r`pcrthbi gcrmdt 8:

WHH. Ehst cg jruis dbj j`vhn`s 80

WHHH. Deicrhtkmhn dpprcdnk tc fht` / sthbi 87

H[. Deicrhtkmhn dpprcdnk tc sbda` fht` 89

[. Deicrhtkmhn dpprcdnk tc sncrphcb sthbi 8;

[H. Gr`qu`btey dsa`j qu`sthcbs / s`eg dss`ssm`bt qu`rh`s 88

[HH. ^bda`fht` dbj sncrphcb sthbi hb Zdmhe eht`rdtur` 4


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Zr`dtm`bt Iuhjèhb`s gcr ^bda`fht` dbj ^ncrphcb sthbi - 6 tc 4; y`drs) 46 tc 47

K`drt Vdt`

K`drt rdt` skcuej f` dpprcprhdt` gcr tk` nkhejs di`, e`vè cg dnthvhty dbj nehbhnde

ncbjhthcb (Zdfe` 6). Bct` tkdt tk`r` hs d whj` rdbi` gcr bcrmde k`drt rdt` dbj tkdt ht

vdrh`s hb d se``phbi dbj dwda`nkhej.

Zdfe` Bc. >4? Bcrmde K`drt Vdt` (\`r Mhbut`) fy Di`

Di` Dwda` Vdt` ê``phbi Vdt`

B`cbdt` 4


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86? Bcrmde Feccj \r`ssur` hb Nkhejr`b fy Di`

Di`^ystcehn F\ (mm Ki) Jhdstcehn F\ (mm Ki)

G`mde` Mde` G`mde` Mde`

B`cbdt` (4stjdy) 7< tc 9: 7< tc 9: >4 tc :0 >< tc ::

B`cbdt` (:tkjdy) 79 tc ;> 7; tc ;: >9 tc 0> >0 tc 0>

Hbgdbt (4 mcbtk) 9> tc 84 9: tc 8: >7 tc 07 >9 tc 00

Hbgdbt (> mcbtks) 9; tc 44 :9 tc ;0 :0 tc ;0

Feccj \r`ssur` rdbi`s tda`b grcm tk` gceecwhbi scurn`?

B`cbdt`, Hbgdbt (4 tc 7 mcbtks) ;1 Hbgdbt (4 y`dr) Nkhej, Djce`sn`bt.

Gcurtk V`pcrt cb tk` Jhdibcshs, @vdeudthcb dbj Zr`dtm`bt cg Khik Feccj

\r`ssur` hb Nkhejr`b dbj Djce`sn`bts? BKEFH, P^D Mdy 6? Kypct`bshcb fy ^ystcehn Feccj \r`ssur` dbj Di`

Di` ^ystcehn Feccj \r`ssur` (mm Ki)

Z`rm B`cbdt`s (< tc 6; jdys) 5 7

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