|
Emergency First -Aid
"It would seem that for most of us life comes in phases. ... These are common to all, but there are also
phases peculiar to each of us. I am now looking back over the period when I was actively engaged in the work of the Hospital
and the teaching carried on there. Thinking of my early days and the difficulties then confronting me I wondered if in any
way I could help those starting out on the same road. As a result, I am tempted to offer you this paper on some of the emergencies
confronting the beginner in homeopathic general practice.
I think emergencies are one of one's greatest difficulties when
beginning to practise Homoeopathy. In an acute emergency one has to do something immediately; we cannot spend time hunting
for a drug.
All these emergency cases fall roughly into two main groups - the patient who is dying, and the patient who
is in great pain. You sometimes get the two combined. There is a third problem - Is the case medical or surgical ? - and that
is always at the back of one's mind. Here it is your general medical skill that comes in; in the other two types it is a question
of homoeopathic knowledge. So it is the dangerous case and the case of acute pain that I want to consider here.
In the
first instance you will find that the matching of
acute pain is much the more difficult; the cases of acute danger are
much easier to tackle. The dangerous cases usually resolve themselves into a question of cardiac failure in one form or another,
I think from the homeopathic standpoint one can tackle these cases of incipient cardiac failure very satisfactorily.The simplest
way to group the dangerous cases from a drug point of view is to look on them under three headings:
1. The cases with
acute cardiac failure
2. The case in which there is a gradual cardiac failure with a tendency to dilation and
3.
The case of acute cardiac attack of the anginous type.
Acute Cardiac Failure
For the acute cardiac failures
,I think you will find that most of your cases require one of four drugs,: Arsenic, Antimony tart, Carbo veg., and Oxalic
acid. There are various points about these individual drugs which help you in your selection, and you will find that very
soon you begin to select your drug almost as quickly as you spot your pathological condition, and by the time you have overhauled
your patient you know what to give.
In the Arsenic case, you have the typical Arsenic mental distress, with extreme fear,
extreme anxiety, mental and physical restlessness, and with a constant thirst, a desire for small sips of ice-cold water.
So far as the actual local symptoms are concerned the main complaint is of a feeling of extreme cardiac pressure, a sensation
of great weight on, or constriction of, the chest, as if the patient cannot get enough breath in, and a fear that he is just
going to die.
The patients as a rule are cold, they feel cold, but they may complain of some burning pain in the chest.
In appearance they always look extremely anxious and are grey, their lips rather pale, may be a little cyanotic, and they
give you the impression of being very dangerously ill. They often have a peculiar pinched, wrinkled, grey appearance.
As
a rule in these cases you will get the history that the attack has developed quite suddenly, and the response to Arsenic should
be equally quick. If you do not get a response to Arsenic within a quarter of an hour the patient is not an Arsenic one. The
first response that you ought to get is a diminution of the patient's mental anxiety and extreme fear; the restlessness beginning
to subside, and he begins to feel a little warmer.
In these cases my experience has been that you are wise to administer
the highest potency of Arsenic you have with you, and as I now carry all remedies up to the cm. I always give cms. of Arsenic.
But whatever potency you have with you, use the highest, because this is the kind of case that will die very rapidly and you
gain more by giving whatever potency you have than by wasting time going home to get a higher one. The Arsenic seems to act
very much like a temporary cardiac stimulant, and I find that in the majority of these cases you have to repeat the dose,
certainly to begin with, about every 15 minutes.
The next thing is that very often one sees a case of that sort which
responds perfectly well, the patient is better, everyone feels he is getting over it, and then in three, or four, or
six hours the symptoms begin to come back, the patient no longer responds to Arsenic, collapses and dies. That was my experience
at one time. Then it began to dawn on me that I had given another drug during the reactive period I could have carried these
cases on. I found that when this was done the patients did not get the secondary collapse and were thus saved. To achieve
this result, you have to give your secondary drug within four to six hours of the primary collapse while the patient is still
responding to the Arsenic, otherwise you are in great danger of having a secondary collapse which you cannot combat. So remember
that this is one of the very few instances in which one appears to ride right across the dictum that so long as the patient
is improving one carries on with the same drug. In these acute cases if you have set up a reaction at all you have got
to take advantage of it, otherwise patient will sink again.
The drugs which as a rule I have found in these Arsenic cases
go on to the reactive stage, are Phosphorus or Sulphur, but that is by no means constant. You can quite see that grey; pinched,
anxious Arsenic patient responding, getting a little warmer, less pinched and drawn, not so anxious or restless, with
a little more colour, and becoming a typical Phosphorous type. Equally you can see them going to the other extreme, where
they are too hot, with irregular waves of heat and cold, rather tending to push the blankets off, still with air hunger and
going on to Sulphur.
These are the two commonest drugs you will need, but whatever the response is you ought to be able
to follow up immediately you get the action well under way.
The Antimony tart. patients have very much the same sort of
condition, but mentally they are quite different. In Antimony tart. there is a more definite tendency towards cyanosis than
in Arsenic, you never see a patient needing Antimony tart, without very definite cyanotic signs in the finger nails, often
extending over the whole of the hands, and the feet may be involved as well.
We do not get the same degree of mental anxiety
in Antimony tart, as in Arsenic. The patients are more down and out, much more hopeless and depressed. They are never quite
so restless nor so pale. Again, there is none of the thirst you meet with in Arsenic, in fact anything to drink seems to increase
the feeling of distress.
Another contrast is that the Antimony tart, patient is very much aggravated by heat, and especially
by any stuffiness in the atmosphere. But there is one point to remember here as a contrast between Antimony tart, and Carbo
veg.: the Antimony tart, patients do not like a stream of air circulating round them; they want the room fresh, but they like
it still.
In most Antimony tart. patients there, is a very early tendency to oedema of the lower extremities. Another
point which helps in your Antimony tart. diagnosis is that practically all these patients have a very thickly coated
tongue - it is a thick white coat- and a rather sticky, uncomfortable mouth.They have a feeling of fullness in the chest much
more than the sensation of acute pressure found in Arsenic. And you are likely to find pretty generalised, diffuse rales in
the lower parts of the chest on both sides.
In contrast to Arsenic, the collapse is similar to that after a pneumonic
crisis, and if the patient responds to Antimony tart. it will carry him through. You do not have to be on your guard to find
the follow-up drug as you have to be in an Arsenic case.
The Carbo veg. case gives the classical picture of the patient
with all the symptoms of collapse. They have the cold sweaty skin, are mentally dull, rather foggy in their out look
with not a very clear idea of where they are or what is going to happen to them. There is intense air hunger, and in spite
of their cold, clammy extremities, they want the air blowing on them; they cannot bear the bedclothes around the neck and
they do definitely benefit from the exhibition of oxygen. They are very much paler than the Antimony tart. patients, the lips
tend to be pale rather than cyanotic, and there is none of the underlying blueness one associates with Antimony tart.
The
next point is that they always have a feeling of great distension, not so much in the chest as in the upper abdomen, and the
cardiac distress is always associated with a good deal of flatulence. Like the Antimony tart. patients, any attempt to eat
or drink tends to increase the distress, and they have none of the Arsenic thirst.
Another apparent contradiction you
come across in Carbo veg. is that, in spite of the desire to be uncovered and the intolerance of the blankets around the upper
part of the neck or chest, these patients complain of icy-cold extremities, as if the legs were just lumps of lead, and they
cannot get them warm at all. I think in Carbo veg. you have to be careful as to how long you are going to keep up your drug
administration when you get the patient responding - sweating less, the surface becoming warmer, and the distress less acute.
You are wise then to be thinking of a second drug, because some Carbo veg. patients do relapse although many of them make
quite a straight recovery on that remedy. You do have to be careful. If you find the patient has responded up to a point on
Carbo veg. do not imagine that a higher potency of Carbo veg. is necessarily going to carry on the improvement. As a rule
it does not, and it is much better to look round for a fresh drug to keep up the reaction. In the majority of these cases
the drug that follows best has been Sulphur, although Kali carb. should always be considered.
|
