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How to manage Emergency Patient ? easy learning

In most of the emergency condition, at first we should try to save the life of patient. The Basic and most important factors to investigate immediately are : Airway, Breathing and Circulation. After maintaining these three vitals further medical procedure are operated in the patient.  Everybody including health professionals should keep the idea of proper management of emergency conditions.

1. Rapid Initial Survey (RIS)

a. Airway maintenance by Cervicalspine control.

b. Breathing and ventilation

c. Circulation (pulses and hemorrhage control)

d. Disability (neurological status)

e. Exposure (complete) and environment (temperature control)

f. restart sequence from beginning if patient deteriorates.

Note : We should always care for signs of shock.

A. AIRWAY  : first priority is to secure airway

• Chance of cervical spine injury in every trauma patient. immobilize with collar.

• Ability to breathe and speak should be assessed.

• ask patient a question; appropriate response indicates patient airway & ability to breathe.

• signs of obstruction are as following :

– agitation, confusion, “universal choking sign”, – respiratory distress, – unable to speak i.e. dysphonia, – adventitious sounds, – cyanosis.

• REASSESS FREQUENTLY (especially if patient status changes).

Airway Management : goals

– permit adequate oxygenation and ventilation

– facilitate ongoing patient management

– give drugs via endotracheal tube (ETT) if IV not available

• Note : start with basic management techniques before progressing to advanced

1. Basic Airway Management

• protect the C-spine

• head-tilt chin lift or jaw thrust (if C-spine injury suspected) to open the airway

• sweep and suction to clear mouth of foreign material

• nasopharyngeal airway

• oropharyngeal airway (not if gag present)

• transtracheal jet ventilation (through cricothyroid membrane) used as last resort, if unable to ventilate after using above techniques

2. Definitive Airway Management

• endotracheal intubation (ETI) with inline stabilization of spine.

– orotracheal ± Rapid Sequence Intubation (RSI).

– nasotracheal - may be better tolerated in conscious patient.

– does not provide 100% protection against aspiration.

– contraindicated with basal skull fracture.

• indications for intubation : – unable to protect airway and inadequate oxygenation via spontaneous ventilation (O₂ saturation < 90% with 100% O₂ or rising pCO₂)

– profound shock.

– anticipate in trauma, overdose, congestive heart failure (CHF), asthma, and

chronic obstructive pulmonary disease (COPD)

– anticipated transfer of critically ill patients surgical airway (if unable to intubate using oral/nasal route)

– needed for chemical paralysis of agitated patients for investigations

– cricothyroidotomy

B. BREATHING :

• LOOK mental status like : anxiety, agitation, colour, chest movement (bilateral or

asymmetrical), respiratory rate/effort, nasal flaring and Loss of consciousness.

• LISTEN sounds of obstruction like: stridor, breath sounds, symmetry of air entry, air escaping

• FEEL flow of air, tracheal shift, chest wall for crepitus, flail segments, sucking chest wounds, subcutaneous emphysema.

Breathing Assessment

• measurement of respiratory function: rate, pulse oximetry, ABG, A-a gradient, peak flow rate.

Management of Breathing

• treatment modalities:

–        nasal prongs,  simple face mask with oxygen reservoir,  CPAP/BiPAP

–        Venturi mask: used to precisely control O₂ delivery.

– Bag-Valve mask and CPAP: to supplement ventilation

C. CIRCULATION

Definition of Shock : inadequate oxygen perfusion to organ and tissues like: brain, kidney & extremities.

Clinical Evaluation :

• rapidly assess for cause of shock and clinical features of hemorrhage.

– early: tachypnea, tachycardia, narrow pulse pressure, reduced urine output, reduced capillary refill, cool extremities and reduced central venous pressure (CVP).

– late: hypotension and altered mental status.

Management of Hemorrhagic Shock

• secure airway and supply O₂

TREAT THE CAUSE OF THE SHOCK!

1. Control external bleeding.
2. Apply direct pressure.
3. Elevate profusely bleeding extremities if no obvious unstable fracture.
4. Consider vascular pressure points (brachial, axillary, femoral).
5. Do not remove impaled objects as they tamponade bleeding.
6. Tourniquet only as last resort.
7. Prompt surgical consultation for active internal bleeding.
8. Infusion of 1-2 L of NS or RL as rapidly as possible.
9. Replace lost blood volume at ratio of 3:1 (maintain intravascular volume)
10. If inadequate response, consider ongoing blood loss e.g. chest, abdomen, pelvis, extremities then operative intervention is required.

 Indications for blood transfusion :

–  Severe hypotension on arrival.

–  Shock persists following crystalloid infusion.

– Rapid bleeding.

–  Transfusion options with packed red blood cells (PRBCs).

– Cross-matched (ideal but takes time).

– Type-specific (provided by most blood banks within 10 min.).

–  Preferred to O-negative uncross-matched blood if both available.

–  O-negative (children and women of child-bearing age).

–  O-positive (everyone else) if no time for cross and match.

–  anticipate complications with massive transfusions.

# Transfusion options with fresh frozen plasma (FFP).

–        Used for clinical evidence of impaired hemostasis.

–        Ongoing hemorrhage and platelet count < 50,000, PT > 1.5 x normal range.

# vasopressors

–        Used if hypotension persists despite appropriate volume resuscitation

–        Dobutamine 2.0-20.0 mcg/kg/min for systolic BP over 100 mmHg

–        Dopamine 2.5-20.0 mcg/kg/min for systolic BP 70 to 100 mmHg

–        Norepinephrine 0.5-30.0 mcg/kg/min for systolic BP < 70 mmHg

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Haridra powder for fast wound healing

Wounds are commonly encountered. Though extremely common, without proper and timely intervention, they may get complicated leading to sepsis, septicaemia and scarring. Wounds are due to various types and intensity of physical injury wherein the skin is torn or punctured or a contusion is formed due to blunt force. Accordingly, a wound is called open when the skin is breached due to injury and closed when there is no tearing or cutting of skin. A wound is considered minor when it is superficial, away from natural orifices, with minor or no bleeding and not caused by a tool or instrument or animal.

Here, the term wound is confined to external and superficial injuries including incised wounds, lacerations, abrasions, puncture wounds, contusions and mild haematoma. If not severe and complicated, wounds can be successfully managed with simple traditional medical care making use of Haridra.

Haridra (Curcuma longa Linn.) :

Haridra is a well established medicinal plant of Indian medicine known for its wound healing properties. Classical medical literature is replete with the uses of turmeric and adequate evidence is available for its antiseptic, anti-inflammatory, anti-bacterial and anti-allergic properties. The earliest reference to turmeric with its indications for skin diseases and wounds is found in Ayurvedic text Charaka Samhita. Use of turmeric is recommended for facilitating wound healing in para-surgical procedures prescribed in Ayurveda such as leech therapy for chronic wounds and Kshara Sutra therapy for piles and fistula. Turmeric is the most common household medicine for first-hand management of injuries and wounds. Its juice, paste, powder, decoction and various formulations are used externally and internally. Haridra is dried rhizome, like that of ginger, of a perennial herb of Zingiberaceae plant family, which is extensively cultivated in all parts of India and harvested between October to April when the lower leaves of the plant turn yellow. The rhizomes are boiled and then dried and the skin peeled off. Turmeric is available in the market both in raw and powder forms. Powdered Haridra is an

essential commodity in Indian homes used as a condiment in almost all sorts of cooking.

Main chemical constituents : Curcuminoids including yellow colouring principal, curcumin, and an essential oil with high content of bisabolane derivatives.

Dosage form : Yellow-coloured fine powder, decoction, and paste.

Therapeutic properties : Haridra has anti-inflammatory, blood purifying, anti-allergic, antibacterial, anti-fungal, anti-protozoal, demulcent and wound-healing properties.

Dose and mode of administration : Haridra may be used simultaneously for washing the wound, application as paste on wound and orally in the following ways and dose schedule:

(1) For oral use the dose of turmeric powder for adults is 2 to 5 grams and for children it is 1 to 2 grams or juice of fresh turmeric in the dose of 10 to 20 millilitres for adults and 5 to 10 ml for children. It is administered twice daily with water

or honey.

(2) Wash the wound twice daily with turmeric decoction.

(3) Apply a thin paste of turmeric over the wound and keep it for 8 to 10 hours and then remove by gently washing the affected part with luke warm water. Alternatively, the wound is dressed with gauze soaked in turmeric decoction or juice or mixture of turmeric and mustard oil or honey. A new dressing should be used after cleansing the wound.

Indications and uses

(1) External and internal use of turmeric is indicated in acute and chronic wounds with not much damage to the tissues.

(2) Sepsis, allergic reaction, inflammation and skin discoloration around the wound are also manageable with oral use and topical application of turmeric.

Precautions and safety aspects :

(1) Due care must be taken to keep the wound clean and dry. It is advisable to use turmeric decoction for washing the wound.

(2) Frank bleeding and pus discharge from the wound should be attended to properly.

(3) Treatment with turmeric may be stopped if it does not yield beneficial effects in a couple of days.

(4) Being regularly used as a food item, turmeric is considered safe and no toxic or adverse effects are reported of its long-term use. However, its oral use in children and pregnant women should be done under medical supervision. It is safe for the

baby if a nursing mother is taking this medication.

(5) Persons receiving aspirin and warfarin should take turmeric with caution since their combination may cause bleeding.

(6) Side effects with turmeric may occur with use of more than the recommended doses. In that case, it may cause stomach upset

or other gastrointestinal problems such as diarrhoea.

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Ajamoda as Anti-toxin, Anti-oxidant & Joint pain reliever :

Ajamoda(Apium leptophyllum) consists of dried, aromatic fruits of Apium leptophyllum. It is an annual herb cultivated in the central and southern states of India and Nepal.

Ajamoda is a well-known drug for rheumatism, gout, cancer, obesity. It also acts as anti–toxin and anti-oxidant.

Main chemical constituents : Essential oil and fixed oil.

Dosage form : Aromatic, slightly bitter yellowish-brown powder giving a sensation of warmth to the tongue.

Therapeutic properties : Seeds have antiseptic, diuretic, anti-inflammatory, analgesic, anthelmintic, and anti-spasmodic properties.

Dose and mode of administration :

– The dose of the Ajmoda formulation for adults is 1 to 3 grams and for children 125 to 500 mg, two or three times a day, with warm water.

 – For local application as poultice, make a paste of the powdered seeds in warm water and apply on the affected joint.

Indications and uses :

(1) For relief from joint pain in arthritis such as osteoarthritis, rheumatoid arthritis, gouty arthritis, and non-specific arthritis.

(2) It is useful in dyspepsia and colic with or without joint pain, when taken with salt and warm water.

(3) Local application of the paste or poultice of Ajamoda seeds is recommended in painful joint condition.

Precautions and safety aspects

(1) Ajamoda powder should not be used during pregnancy and nursing mothers are advised to take it under medical supervision.

(2) The diuretic action of Ajamoda works by irritating the kidneys and therefore should be used with caution in cases of renal disorder.

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simple Home remedy for Urinary Disorders :

Among urinary disorders there are simple to complex pathology. Here is some simple and effective home remedies which can be used in urinary difficulties. Burning and painful micturation is occure due to the infection in the urinary tract. Which is generally associated with the pain in the urinary tract, fever and weakness. With the related investigation and diagnosis a course of antibiotic is generally taken. Any one of the following easy herbal treatment also helps to relieve urinary symptoms significantly which is easy to prepare and use. These drugs have no side effects and boost up multisystems of our body :

1. Use one teaspoonful (5 gm) of powder of Berginina ligulata or Tribulus terrestris threee times per day with water.
2. One teaspoonful (5ml) of the juice of tinospora cordifolia three times per day with honey is also effective.
3. Take one teaspoonful of the powder of Emblica officinalis or sandal wood (Santalum album) three times per day with water. Santalum album or chandan is a urosoothing agent.

Note : If burning and painful micturation persists, even after the 2 to 3 days after using above formula, you should consult with the medical doctors or Urologist.

Diet and Regimes : Avoid chillies and spicy food. Drink water, lemon juice, fruit juice or buttermilk in sufficient amount.

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History & types of Meditation, Why to contact us for Meditation ?

Origin & history : Thousand and thousand year ago the concept of meditation is originated from eastern society mainly from India, Nepal and Tibet. In the past Meditation was used by great Sages, Yogis to visualize the cosmic radiations, to meet the gods, to get supernatural powers, to visit in the another planets through the micro body, to know the past and future events and finally to get the salvation from the life. Indian scriptures called ''Vedas", “tantras”, "puranas" mentioned meditation techniques 5000 years ago. Hindu meditative techniques are Westernized or spreaded in the United States and Europe in the 1960s.  

Types/Methods of meditation :

1. Transcendental meditation 2.Tantric meditation 3. Kundalini  4. Mudra Meditation 5. Tratak 6.Mantra Meditation 7. Kryayoga meditation 8. Patanjal Dhyana 9. Yoga nidra, Nyas 10. Reiki meditation 11.Vipashyana 12. Preksha Dhyana 13.Jain Dhyana 14.Nabhi Dhyana, 15. Swapna Dhyana, 16. Nidra Dhyana 17. Smriti Upasthan  18. Atit Dhyana (past) 19. Bhavidhyana (future) 20. Adarshdhyana (mirror)   21. Your own system.

Why to Contact us for Meditation ?

Normal meditation techniques can be found easily in websites but for the higher level meditations, to get tremendous amount of peace, satisfaction you must connected with a powerful meditation teacher. That type of teacher who can connect you in spiritual world, who can activate your inner spiritual channels so you can visualize gods, you can make journey of astral travel, you can feel and see the other planets, You can see your past life as well as future life. These facts are generally incredible and can't be proved in science lab. Only the feelings and experiences got by the Yogis, Spiritual master and meditation practitioners are the proof the facts. To get that type of authorised and very secret meditation techniques you can contact us. We will provide you a good channel to the spiritual power and spiritual world. Contact  us : stbdr63@gmail.com

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Get rid of Gout (Vatrakta) : Diagnosis, Treatment & Tips.

Brief introduction to Gout  :  Gout is known as VataRakta in Ayurveda. Nowadays its treatment is much effectivly done by Ayurveda medicine.   Charak Samhita, Ashtang Hridaya & Madhav Nidan elaborated VataRakta in great details.     Gout is a painful and strong disabling rheumatic disease. It is a main forms of arthritis. 5% arthritis patients are gouty. In the U.S. it around 840 out of every 100,000 people. Historical records for gout have been found dating back over 2000 years. Gout was first described by Hippocrates, High levels uric acid in the blood is the main feature of Gout. If the kidneys are unable to eliminate uric acid efficiently from our body, blood uric acid levels will increase. A hardened form of uric acid e.g. sodium urate may then be deposited around joints.

– Gout may be confused from the symptoms of the diseases like : Pseudogout, Rheumatoid arthritis, Psoriatic arthritis, Infection etc. A proper diagnosis is essential.

Diagnostic Procedures Methods & Techniques :

Physical examination and review of medical history : Family medical history and a physical examination helps to diagnose the disease. The presence of tophi below the skin and red shiny skin above the affected area can indicate gout. However a more detail medical examination is required to distinguish from the other conditions listed above.

Blood test : It is used to measure levels of uric acid in the blood. This is not a reliable method. During gout attack blood uric acid levels may lie within the normal range. Also, high uric acid levels don't always indicate the presence of gout.

X-rays : X-rays can be taken to show tophi crystals around the joints and under the skin. However, X-rays of affected joints often show the joints to be normal so may not help in the diagnosis.

Arthrocentesis : It is a more reliable method. Using a syringe and needle a synovial fluid sample is taken from an affected joint. The synovial fluid is analysed under a microscope. The presence of monosodium urate (MSU) crystals in the fluid indicates the presence of gout.
Treatment of Gout in to Ayurveda : 
Common Herbal Drugs for Gout : Guggul : Sinhnad, Gokhshuradi, Kaishor Mahayograj (Sharngdhar Sanhita), Yograj, Panch Tikta Ghirta.

Bhasma : Shrung (Ras Tarangini), Shankha (Siddha Yog Sangraha), Praval (Ayurved Saar Sangraha), Swarna Makshik (Rasendra Saar Sangraha).

Arishtha/Asava : Dashmularishtha, Chandanasava, Maha Manjishthadyarishtha (Siddha Yog Snagrah)

Rasa Kalpa/Vati/ Mandur : Samshamni, Gandhak Rasayan (Ayurved Prakash), Punarnavadi Mandur (Ayurved Saar Sangraha)

Herbs : Lahsun (Garlic), Guggul (Commiphora mukul), Sallaki (Boswelia sarrata)

Ayurvedic Suppliments : Kaishore Gugglu, Guduchyadi taila, Panchtikta ghrita, Balarista.

Lifestyle : The patient should not perform any fast paced exercise. Patient should not sit idle either. Exposure to cold wind and rain, and cold-water bath are strictly contra-indicated. Oil massage is beneficial

Diet : Freshly harvested rice and wheat should not be given to the patient. Old rice, wheat, moong dal, garlic, onion, bitter gourd, papaya and green banana can be taken by the patient. High fibre diet is the best diet for this disease. Butter, Milk and high protein diet will be avoided , and any other sour articles of food, heavy food articles and fried things are prohibited

Yoga : Sukshma Vyayama, Forward bending, Lotus pose.

Extra tips and procedures :

Protect yourself from aggravation of vata (about vata please search in net).

• The blood of the patient of Vata Rakta (gout) should be let out, in small quantities, at many times after oleation therapy. If pain, redness, pricking pain and burning sensation are present, blood should be got sucked by jalauka i.e. medicated leeches.
• Eranda taila should be consumed mixed with milk to produce purgations in the patient who has great increase of dosha; after it gets digested (and after purgations) he should eat boiled rice along with milk.
• Cold application are beneficial In gout, when there is predominance of pitta and rakta, plosha or blisters & blebs, osha or localised burning sensation, pain, redness, sweating and avadarana or laceration and abrasion will develop by heat or by warm applications.
• If tingling sensation, itching, pain and burning sensation are present srnga-alabu i.e. sucking horn or gourd is used.
• When the disease/lesion is found spreading from place to place, either pracchana  or scratching the skin or siravyadha (venesection) is recommended.
• Blood should not be let out when there is debility of the body, dryness and predominance of vata; vata getting aggravated (increased) by loss of blood from blood-letting. Which may produces profound swelling, stiffness, tremors, diseases of tendons, and veins, debility and many other disorders of vata origin.
• Purgation therapy should be given after proper oleation therapy. Purgative drugs mixed with fats e.g. medicated ghee/oil.
• In gout having predominance of vata, the patient should be made to drink old ghee. Ghrta prepared with decoction of Draksha and Madhuka, added with Sitopala or sugar candy should be consumed; or milk boiled with addition of fresh juice of Guduchi; or drink the mixture of taila (oil), milk and sarkara or sugar boiled together.
• In Vatarakta caused by pitta, decoction of vari, tikta, patola, triphala and amrta should be consumed. Also ghee or milk boiled with drugs of sweet and bitter tastes should be consumed. 
• Basti (enema therapy) is the best treatment of vatarakta especially for those who have pain in the rectum, flanks, thighs, joints, bones and abdomen.
• When kapha is predominant, the decoction of musta, dhatri and haridra or of triphala or of guduchi, whichever is suitable, should be consumed mixed with honey
• After administering the appropriate sneha or fat to drink, he should be given mild vamana emetic drugs and then rukshana i.e. therapy creating dryness inside.
• Decoction of kokilaksha consumed followed by partaking its leaves only as food, cures gout just like the practice of compassion cures anger.
• Medicated oil prepared with madhu ucchista i.e. bee's vax, manjishta, sarjarasa and sariva-known as pinda taila-used for abhyanga (anointing and massage) relieves the pain of vatrakta.
• The Uttana kind of vatrakta (gout) should be treated with lepana (application of pastes), abhyanga (anointing with fats) parisheka (pouring liquids on the body) and avagaha (immersing the body in liquids), the gambhira kind of gout by vireka
• (Purgation), Asthapana (decoction enema) and snehapana (drinking of fats). · When vata and kapha are predominant, warm applications of pastes etc. are beneficial; if cold applications are made, burning sensation, swelling, pain and itching will increase, due to rigidity (caused by cold).

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Lavanga oil for toothache

Toothache is a commonly encountered problem. Any inflammatory condition affecting the gums and tooth pulp gives rise to pain. Enamel of tooth is insensitive to pain, toothache occurs only when the enamel is eroded. In most cases toothaches are caused by problems in the teeth or gums, such as cavities, gum disease, the emergence of wisdom teeth, a cracked tooth, infected or inflamed dental pulp, jaw disease or exposed tooth root. After having one or more teeth extracted, a condition known as dry socket can develop, leading to extreme pain. The severity of a toothache can range from mild discomfort to excruciating pain, which can be chronic or sporadic. This pain can often be aggravated by chewing or by hot or cold temperatures. Severe pain may be considered a dental emergency.

Treatment by Lavanga (Syzygium aromaticum Linn.) : Lavanga is the dried flower bud of Syzygium aromaticum, a tree cultivated in many parts of the world and also to a considerable extent in South India.

Composition : Lavanga oil is extracted from the buds of clove.

Main chemical constituents : Eugenol, eugenol acetate and caryophyllene

Method of preparation : Clove oil is usually available in grocery and medical shops. It is prepared by water distillation of clove buds containing the desired percentage of eugenol.

Dosage form : Clove oil has a warm, strong, spicy smell and the oil is colourless to pale yellow with a medium to watery viscosity.

Therapeutic properties : Clove oil is analgesic, anaesthetic, antiseptic, refrigerant, digestive, carminative, stomachic, anti-spasmodic and rubefacient.

Dose and mode of use : (1) Cotton swab soaked in clove oil should be kept on the affected tooth without touching the gums.

(2) Clove oil-soaked tissue paper can also be applied directly to the affected site of the tooth. It may be used 2 to 3 times a day.

(3) Gargles with one to two drops of clove oil in a cup of warm water are useful as a mouth wash for toothache and gum

problems.

Indications and uses : Clove oil is useful in toothache, halitosis, cephalalgia, dental caries, and painful condition after tooth extraction.

Precautions and safety aspects : 

(1) Clove oil is irritant and pungent. Therefore, it is advised to prevent the oil from touching the tongue and gums.

(2) If topical application of clove oil fails to relieve the pain, take dental consultation.

(3) Clove oil application in deep dental cavities should be done carefully.

(4) Clove is toxic, its oral use in large amounts (i.e. more than 3.7 g/kg body weight) may be life threatening.

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Haridra powder paste for sprain, Allergy and blood purification

The stretch or tear of soft tissues around a joint such as ligament is known as sprain. Common symptoms and signs of sprain include pain, swelling, bruising, instability and loss of function. One or more ligaments can be injured at the same time. The severity of the pain will depend on the extent of injury, i.e. whether a tear is partial or complete and the number of ligaments involved. A sprain can result from a fall, a sudden twist, or a blow to the body that forces a joint out of its normal position. This results in an overstretching or tear of the ligaments supporting that joint. Typically, sprains occur when people fall and land on an outstretched arm, land on the side of their foot, or twist a knee.

Haridra powder cure it :

Haridra powder mentioned in Ayurvedic classics. it is a simple ormulation which is effective when taken internally as well as applied locally. Haridra is a dried rhizome of a plant that grows to 2 to 3 feet in height with funnel-shaped yellow flowers. Haridra or turmeric powder is bright yellow in colour. Haridra powder made from rhizomes is used orally as well as for local application.

Chemical constituents : Curcuminoids including yellow colouring principal – curcumn, and an essential oil with high content of bisabolane derivatives.

Therapeutic properties : Tumeric powder has anti-bacterial, insecticidal, anti-inflammatory, and anti-arthritic properties.

Indications and uses : (1) Sprain, inflammatory conditions of joints and burns are the main indications for local application of Haridra paste. Haridra powder is used internally for blood purification, skin blemishes and allergic conditions.

Dose and mode of administration : (1) For oral use, the dose of turmeric powder for adults is 2 to 5 grams and for children it is 1 to 2 grams. The dose of fresh turmeric juice is 10 to 20 millilitres in adults and 5 to 10 millilitres in children. Normally two doses a day should be taken with water or mixed with honey. A paste made from rhizomes, mixed with lime and (2) salt, is applied to the sprained area and removed when it gets dried.

Precautions and safety aspects

(1) Turmeric being regularly used as a food item is considered safe and no adverse effects are reported of its long-term use. However, its oral use in children and pregnant women should be done under medical supervision. Turmeric or its alcoholic extract administered respectively in the dose of 2.5 grams per kilogram body weight and 300 milligrams per kilogram body weight on different species of animals proved non-toxic. It is safe for the baby if a nursing mother is taking this medicine.

(2) Turmeric’s side effects may occur with the use of more than the recommended doses. In that case, it may cause stomach upset or other gastrointestinal problems like diarrhoea.

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