Medical emergencies & Homoeopathy

Facing the ordeal of critical situation in medical emergencies

(Asian journal of Homoeopathy,  Vol.5 no4(17) Nov 2011- Jan2012)

Key words: Homoeopathy, medical emergency

Introduction:

“No…no I don’t think so….it is not possible because in emergency we need medicine with quick effect. How is it possible with homoeopathic medicine?” this is opinion in the people around US.

Medical emergencies constitute an important part of the medical practice. Correct diagnosis and prompt and Appropriate treatment is essential to save life. Such emergencies not only test the knowledge but also the skill of the medical practitioner. One has to require not only presence of mind but also confidence to tackle the medical emergencies. In Medical emergencies every second counts.  Providing urgent treatment to patients whose medical histories and medications are unknown. Every experience of attending a medical emergency gives courage, experience and knowledge. It is not like taking a long case for one hour and a short or acute case for 20 minutes.

Challenging situation for homoeopath Physician in a medical   emergencies are either to face the emergency or   to escape it due lack of confidence, if he opts later   he will be losing reputation as a Physician, it will also be a black remark on Homoeopathic system, as already there is a misconception that homoeopathic system is only for chronic diseases not for emergencies. Knowledge, attitude and practice are very important for a physician in emergencies. Likewise he has to identify the problem within minutes and plan to give first aid treatment till the patient is shifted to a well established hospital, a patient with severe abdominal pain and vomiting can be food poisoning, can be a case of acute gastritis, it can also be a case of ingestion of any pesticide which require gastric lavage and it is a case of medico legal which he has to report to Police.

The following are important in emergencies .Situation at site of emergency, role of physician, cooperation of the Attendees. For a Private practitioner Situation can be at residence of the patient or physician’s residence or at any public place, for an internee or for a physician who are attached institution   has to face an emergency from already admitted patient or a newly admitted emergency case. In Medical Emergencies there is a fear and anxiety among patients near & dear. Crowd around the patient, making the patient more stressed, and obstructing the smooth working of the emergency services.

There is a lot of difference in types of Emergencies in rural and in urban areas , The types of emergencies in rural areas vary like snake bite, Scorpion bite, accidents, stab injuries  and  suicides with pesticides etc  along with  common  medical   emergencies  like acute abdomen like  renal colic, acute gastritis pain, gastro enteritis , Cardio Vascular Accidents , Myocardial  Infarction  etc. In rural areas supportive staff, transportation, auxiliary medical help is lacking, in very critical conditions. In majority of rural places, referral hospitals are very far, transporting the case to nearby hospital is difficult due to lack of transport facilities during this time we have to attend the case.

Conclusion: Object of this article is to show  that homoeopathic medicines are able to cause quick effect when given in critical situations like various medical emergencies, We Homoeopaths have to take spot decision in selecting the remedy, as, time will not wait for us, before arrival of ambulance what can a homoeopath can do? His motto is to Preserve life, by problem identification and prevent the condition from worsening, by selecting an indicated remedy at earliest. right medicine right time,  we can save not only the life of patient but prevent him from big disability. Our duty not only giving remedy also to do the general management till arrival of ambulance or till his reaches hospital. The vital steps in emergencies are  Clear the airway ,assess if the person is conscious / breathing ,Laying  the person on his back on a hard surface , rising the head level , to open his airway ,Check for breathing sound if not breathing, start mouth-to-mouth breathing. Irrespective of system we practice learning how to perform cardio-pulmonary resuscitation (CPR) is must to saves lives, Combination of rescue breathing & chest compressions  ,done on unconscious patient , persons suffering cardiac arrest and in drowning/ asphyxiation/ trauma cases .^2.

My main objective to write this article is to introduce the value of homoeopathic medicine in emergency cases. It is high time to start a P G course in emergency medicine in Homoeopathy. Even our students do not believe the efficacy of Homoeopathic medicines in various medical or gynaecological emergencies until we show them the cases treated by us.

If the homoeopathic colleges are under the shelter of conventional system of medical college, our friends in other systems of medicine don’t have confidence in our system, instead of cooperation they discourage patient to take the homoeopathic treatment in emergencies, and even in their system of medicine scope is less in few emergencies 

Case no 1: Suddenly , I heard door bell ringing continuously, I saw time it  was 3 AM, with great hesitation by wiping my eyes ,  I opened the door, four people with anxious looks were standing , a person was sitting on the floor, bhiya (brother ) please help, then I asked what happened ? Patient was a know face stays in our locality, he told me peshab nai hara (I am not able to pass urine, only with great difficulty I could pass few drops), he was restless, rolling on the floor, please do something.  Pressure was building on me, I told them this is house I cannot do anything here, and one of the lady she shouted at me are you not a doctor? What for you studied medicine? Now time is 3 am how can we take him to hospital , we are all ladies, I told them I will call an ambulance , but for that also they were not prepared as 108 is meant for last stages and  in govt institutions attention will be poor, to complete formalities it takes time. ( in me also anxiety was building up ,my mind says at this movement  that what can I do ? as he is elderly patient I asked him about his problem, he told  he was having urine flow problem,  doctor advised him to get operated. I presumed it could be BPH, I don’t have a catheter to insert nor even if it brought I don’t the experience of inserting it as we don’t do regularly, best way is to give a medicine and send them to a local nursing home,) On examination bladder was full, I gave Aconite 30c 5 DOSES and asked to take every half an hour.. Within 10 minutes of first dose he passed feeble stream of urine, due over anxiety he took even second dose after an hour he could pass normal stream of urine.  He was relieved and I was relived.

Conclusion: in above case of emergency situation was tense, at tenders were reluctant to take the patient to hospital, patients condition they were not able to asses. As physician’s role will be limited, this thing happen in majority of emergencies .In this case mental agony of a patient with urinary retention with full bladder can be understandable. Reasons for selection of Aconite are patient’s anxiety, restlessness.

Case no 2: Patient aged about 51 years obese, male came with heaviness of chest, over anxiety, restless, was brought by his wife, on examination his pulse was 100 pm, BP was unreadable, I advised him to go to cardiac centre as early as possible, he has requested me to give some medicine till he reached hospital, I gave Aconite 30c 5 DOSES and asked to take every half an hour. To fetch ambulance 108, it took nearly 30-40 minutes, he told me he was feeling better, but he went to hospital, he was admitted in ICCU. Case was diagnosed as MI,

Conclusion: In this case as my teacher told me that first think of a worst condition and plan the treatment in this case also mental agony of a patient with restlessness, sub sternal heaviness, was the reasons for selection of Aconite is patient’s anxiety, restlessness.

Case 3 : A boy aged about 4years of age was admitted with high fever , for which he was given conventional type of treatment, fever reduced , after 6 hours he has become drowsy ad finally he became unconscious and admitted in ICU, GCS score was 3, he belongs to a doctors family , who was known to me, doctor spoke to me and said only Manintal drip is been given, chances of survival are bilk , he request me to send the medicine, on the bases of congested face, Pupils dilated, Belladonna 30C, water dose I have sent in drop bottle and advised them to give every half an hour two drops of medicine in mouth by pulling lower lip.  He revered slowly, after 36 hours leg movements were noticed, he regained consciousness after 5 days. After that case was followed by Cal Caria carb 30C

Conclusion: In this case fever followed by coma, on the bases of congested face, Pupils dilated, Belladonna 30C, water dose was given.

Case 4: Patient aged 14 years, male old OPD Bronchial Asthma case, was better for 6months after Homoeopathic treatment, suddenly came to OPD with sever shortness of breath, wheeze, earlier he was on Kali Carb 200C. On examination of the patient Respiration rate was 30 PM, on auscultation bilateral wheeze was heard. He was given Carbo veg 30C, in water , one dose every 15 minutes , two spoons, even after 30 minutes also condition was no better,  Blatta Orientalis Q was add to the prescription , 10 drops in 15 ml warm water to be given every  15 minutes. After 20 minutes respiration rate slowly came down, wheeze was reduced. Within an hour there was betterment in the patient.

Before giving Blatta Orientalis Q we wanted to shift the patient to a hospital either for nebulisation or for oxygen. Giving both   Carbo veg 30C and Blatta Orientalis Q we could avoid hospitalisation

Case 5:Female aged about 27 years ,married, came with agonising pain in lower abdomen, difficult to pass urine, constant urge to pass urine with pain, with few blood streaks in urine , patient was restless, Cantharis 30c , 5 doses were given  asked her to take one dose every half an hourly and  advised her to watch the pain, if she is better by 20%  advised her to stay back in the house and report back after 24 hours  if not advised  her to go to a hospital .She phoned me that  after 4^th dose of  Cantharis she passed multiple stones, pain totally reduced  within 8 hours  ,  which she collected they are shown below visual  .

Conclusion: In this case most probable diagnosis was ureteric calculus Constant urge to pass urine with pain, with few blood streaks, patient was restless. Cantharis 30c, 5 doses were prescribed.

Case no 6:  A lady aged 55 years had sudden fall after waking up and went into coma. She was brought to city from Jangam. She was taken to local govt hospital and was admitted, case was examined by Neuro physician, they told the attenders that it is a case of CVA, utmost she may survive for 72 hours as the GCS was 3, there is no treatment for this, As patients son was known to me I gave Arnica 30c in water dose asked to repeated every 4^th hourly. After 24 hours BP and pulse was slightly stabilised , Arnica 200c , was given , No response even after 48 hours, 72 hours cut out time given by Neuro physician, was over , as right side is affected  I gave Causticum 200 C, was given and waited for 48 hours , f or me I could not find much improvement, but

Attenders of patient were positive. Absolutely there was zero cooperation from staff; staffs were inadequate emergencies were UN imaginable, only one PG on rotation was present. She died on 8^th day.

Case no 7:  One at 10 pm my own maid servant  aged 75 years had sudden complained of severe headache , followed by vomiting, became drowsy, BP was fluctuating , pulse rate was high , an elderly lady , I thought it could be a CVA, I gave Arnica 30c in water dose  and  shifted  her to a nursing home,  where she went into coma , provisional diagnosis was CVA , she died around 3AM .

In above two cases I could not do much, both cases were diagnosed as Cerebro vascular accidents i.e. cerebral Haemorrhage. 

Case 8 :It 1 pm I was called by aunt urgently, when I reached the scene  from college, my uncle aged about 70 years, was behaving oddly, moving from one end to other end, since half an hour. I could not get any information except he was a diabetic, Hypertensive, I was not having BP apparatus to measure BP, and He was not allowing me to touch. Pulse was 90PM.he was on oral medication for diabetics. Options were many for above case but time is running out, I phoned 108 ambulance, luckily glucometer was there I tested RBS was 45. He was forcible given sugar water and sifted to hospital by 1.30 PM. Even though we are in medical profession we don’t carry emergency kits with us. For him to recover it took 36 hours.

Acknowledgment:  I pay my respect to my teacher Dr K Siva shanker, Former Addl Director, AYUSH Dept for advising us to keep the theme of the conference as homoeopathy-Medical Emergencies. I thank my entire patient who was my source to gain knowledge and experience and permitting to use their data.

Reference:

1)       http://en.wikipedia.org/wiki/Glasgow_Coma_Scale

2)       http://www.medindia.net/patients/Firstaid-cardiopulmonary.htm#ixzz1Ufs4xf5B

Temper tantrums and Homoeopathy

Flip-side of Temper tantrums in daily life - a study

(ASIAN  JOURNAL of Homoeopathy, vol 3,no 2(7) May 2009-july 2009)

Prof Mohan G R *

Abstract:

People say Child rearing is difficult then child-bearing; Temper tantrums are fits of anger that are usually caused by frustrated toddlers. It difficult to consider a child's feelings, Mayo Clinic specialist explains that Temper tantrums are a normal part of growing up. But tantrums are not appropriate behavior. These occur at worst time

for parents. In my study these were seen more in parents who give less time to their kids, it is also found that it is less in unemployed women. Specialist say counseling is the best way to combat tantrums, but tantrums in public places are embarrassing to parents; homoeopathic treatment  gave encouraging results.

Key Words: Temper tantrums, literate, Illiterate, Homoeopathic treatment,

Introduction:

Temper tantrums are disruptive or undesirable behaviors or emotional outbursts displayed in response to unmet needs or desires. They may also refer to an inability to control emotions due to frustration or difficulty expressing a particular need or desire. (1)

Temper tantrums or "acting-out" behaviors are natural during early childhood development. It is natural tendency to assert their independence as they learn they are separate beings from their parents. Many children may not have the vocabulary to adequately express their feelings. According to majority of pediatricians tantrums are normal and it is not due to the bad parenting. Tantrums are not appropriate behavior, some children throw Tantrums and some never do. If the behavior is dealt with incorrectly, the child may learn to use tantrums to manipulate people and to gain attention. (2)

Childhood habits appear in many different forms, such as nail biting or foot tapping, teeth grinding (bruxism) and hair pulling. Habit disorders, now subsumed under the diagnostic term stereotypic movement disorder, consist of repetitive, seemingly driven, and nonfunctional motor behaviors that interfere with normal activities or that result in bodily injury. Fortunately, many childhood habits are benign, they are considered a normal part of development, they do not meet the criteria for a disorder, and they typically remit untreated.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), formerly used the term stereotypy/habit disorder and now uses the term stereotypic movement disorder to designate repetitive habit behaviors that cause impairment to the child.

A tantrum is the expression of a child's frustration with the physical, mental or emotional challenges of the moment; Physical challenges are things like hunger and thirst. Mental challenges are related to a child's difficulty learning or performing a specific task. Emotional challenges are more open to speculation. Still, whatever the challenge, frustration with the situation may fuel a child's anger — and erupt in a tantrum. Consider physical or psychological problems that may be contributing to the tantrums (3)

Peak incidence is seen around age 12-18 months, get worse between 2 and 3 years, then decrease rapidly until age 4, in majority children it vanish after words. According to The American Academy of Pediatrics If Tantrums get worse after age 4 these children should be referred to pediatrician (3)

Age of child	Percentage of children who throw temper tantrums
18-24 months	87%
30-36 months	91%
42-48 months	59%

From Potegal & Davidson (2003) (5)

The common presentation of tantrum are Hitting or kicking parents or others Throwing things in a dangerous way and Prolonged screaming or yelling,  disorganized behavior, stiffening limbs, arching backs, falling down, flailing about or running away. . In some cases, a breath-holding spell is a paroxysmal event in which a child stops breathing at end-expiration after crying, typically because of pain or anger. Breath-holding spells: These are common in up to 4-5% of children younger than 8 years. Head banging is the rhythmic hitting of the head against a solid surface. In children who are developmentally normal, it usually lasts less than 15 minutes but can last hours. A high frequency of up to 60-80 hits per minute is common. It can be associated with temper tantrums, tension, or stress. Head banging: This can occur in 3-19% of developmentally normal children younger than 3 years. It is more frequently observed in children with autism or developmental delay and in those living in institutional environments. Head banging  occurs 3 times more often in boys than in girls. Body rocking usually involves a forward and backward rhythmic swaying of the trunk at the hips, generally from a sitting or quadruped position and Bruxism is the forcible gnashing, grinding, clicking, or clenching of teeth, this is observed in 5-30% of children. Most precipitating factors when parents do shopping in the afternoon or when parents are too busy for long hours or when there is too much commotion.

Each episode last for two minutes in one-year-olds, four minutes in two- to three-year-olds And five minutes in four-year-olds. Frequency will be eight times a week for one-year-olds ,nine times a week for two-year-olds ,six times and a week for three-year-olds and five times a week for four-year-olds.

The cause is not clear, majority authors say it is the way to achieve what they want. Majority parents complain that their toddlers are not allowing them to rest in; many parents frequently ask the consultant how long it will take for my toddler to stop having temper tantrum, common answer is use your words instead of your body to mend the toddlers. Rubella vaccines are also known for the bad side effects they cause, including arthritis and central nervous system disorders. The vaccine causes many side effects and the long-term risks are unknown. The vaccine has been associated with meningitis. (6)

While some infants are mild and joyful others are irritable and cry persistently, these are due to  Temperamental differences  present at birth. Child temperaments influence how children behave toward individuals and objects in their environments. These leads to certain emotional and behavioral problems.

Psoric Miasm is fundamental cause and maintaining causes are inattentive parents with busy life, a parent being too harsh with the child, child not feeling loved, the child playing too many video games or watching too much TV. While these can affect a child behavior. Psoric children are very sentimental, affectionate, loving, hypersensitive, hyperactive, and fearless. And love comfort. Anger in Psoric children is sudden, lasting for a short while till the event is over. Revengeful attitude is not seen in these children. They have a lot of intuition and curiosity to know. Psoric individual reacts excessively, He also cries easily, after crying he feels better. Psoric children are very rich in the expressions of his feelings.

Homeopathic remedies can increase well-being on an emotional level; Homeopathic medicines are accepted by children with out any fuss.

Study design:

Total 30 children were studied along with their mothers. Mothers were grouped into three groups like literate working women, illiterate working women and unemployed women. As shown in (table 1). Six Vaccination like (BCG,DPT,OPV,Measles.) are  compulsory in India, MMR,Chicken pox, Hepaties B are mandatory.(6) I have taken the mandatory group in to consideration (table 2). Homoeopathic medicines are given to children according to their presentation and child type. Children and parents were given counseling, Results are studied.

Results:

Composition of  30 cases are as follows, literate working women (17) , illiterate working women (5) and  unemployed women (8), as shown in ( table:1 ).16 children were vaccinated (M) as shown in table (table 2), the intensity of tantrums were as show in table like 14 tantrum cases out of 16 in vaccinated (M) group, 10 tantrum cases out of 14 in non vaccinated (M) group, In Literate working women 17 out of 17 are having tantrums, In Illiterate working women 3 out of 5 are having tantrums and unemployed women 4 out of 8 are having tantrums (table 3) .12 Homoeopathic remedies were given as shown in table 4. Potencies were medium to higher.

DISSCUSSION: 

Children in literate working women  group,17 out of 17  were having tantrums,  (out of 17  cases of tantrum 12 were sever type 5 were mild type), this could be due to time spent with children was very less, as most of the parents working for 8-10 hours a day, in the available time child either gets up late and most of the children are at Crèches . Children in Illiterate working women 3 out of 5 are having tantrums, (out of 3  cases of tantrum 1 was sever type 2 were mild type) time spent with children was more as working hours were less in two shifts. Children were feed personally as time was at their disposal. This is not a practice with Literate working women. Majority of their children are kept in child care centers (Crèches) or with  maid servants and aged family members. Children in unemployed women 4 out of 8 are having tantrums, (out of 4 cases of tantrum 1 was sever type 3 were mild type).The one sever type tantrum child was born as Intra Uterine Growth retardation. (Table 3). Severity in vaccinated and UN vaccinated children are same as shown in( table 2), 14 out of 16 vaccinated children were having tantrums. 10 out of 14 unvaccinated children were having tantrums.

 CHAMOMILLA

The chief guiding symptoms belong to the mental and emotional group, Peevishness, ill-humor, anger with rage, violence and heat. Cannot bear to be looked at. Impatience, Children want to be carried and petted. Child wants many things which he refuses again. Piteous moaning because he cannot have what he wants. Ugly behavior, cross and uncivil, quarrelsome. Averse to being spoken to touched or being looked at. This remedy helped in majority of cases.

ARSENICUM ALBUM was indicated in children with allergic background, with nervous constitution, anxiety, restless children, and children better from company. Used Thuja as a complimentary remedy after Ars Alb and in bad effects of vaccination Thuja was the first prescription.

CINA

Child is very cross; does not want to be touched, or crossed, or carried.

Desires many things, but rejects everything offered. An irritability of temper, variable appetite, grinding of teeth, and even convulsions, with screams and violent jerking of the hands and feet, are all within its range of action. Wants to be rocked. Extreme sensitiveness of mind and body: offended by the slightest thing, peevish and obstinate, aversion to be caressed. Causations are Worms.

TUBERCULINUM.

Obstinate children Dissatisfied and restless, always wants a change. Desire to travel,

Does not want to remain in one place long. Wants to do something different or

Even to find a new doctor, weary of life. Reckless. Depressed, melancholy, hopeless. Anxious. Whines and complaints with very little ailment. Contradictory behavior, changing moods. Fear of animals of dogs. Averse to cats. Fits of violent temper, wants to fight, and throws anything at anyone even without a cause. Desire to use foul language, curse and swear. Sensitive to music. Every trifle irritates, worse awakening. Aversion to mental work. Confusion everything in the room seems strange.

CARCINOSIN

Carcinosin has constant changing symptoms. Can be used as an intercurrent

Remedy. Contradictory and alternating states. At night wide awake with

Insomnia. Child's development is arrested. Dwarfishness. Malformations, mongolism. Discharges, acrid, thick.

Nux-vomica

Nux-vomica. Is especially suited to Very particular, zealous persons inclined to get angry and excited or of a spiteful, malicious disposition, Nux-vomica. Is especially adapted to digestive disturbances, Nux-vomica. Patients are easily chilled, avoid open air.

Back trace was done by taking the past history of mothers regarding their family life style and vaccination history. This was possible only with 20 mothers, as other one third groups were not aware of past. According to them the percentage of tantrums was very less because parental attachment was more, time spent was more as majority mothers were unemployed. Percentage of working women in India during last fifty years is rising gradually.

Managing the tantrums in above said groups are varying, illiterate working group and unemployed group spend more time with kids; take the tantrums in a positive way. Where as in Literate working group who are actively involved in occupation are getting frustrated with tantrum, either beating them or landing with some health problems. Majority of authors say tantrums are temporary, it is the emotional expression of toddlers, and this explanation is not working out with working parents who are sparing less time with the toddlers. Still a deep study is required with the cooperation of other faculties.

PREVENTION

Be aware of your child's temperament and respect his or her uniqueness without comparing him or her to others or trying to change your child's basic temperament

Listen to the child's points of view and encourage teamwork on generating solutions

Respect opinions but remain firm on important limits. Be a good role model because children learn by imitation. Enjoy the dance. (7)