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
“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 4th 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 4th 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 8th 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.