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 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.
Reference:
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