CASE DETAILS:

• PATIENT PRESENTED WITH COMPLAINTS OF ACUTE ON CHRONIC BREATHLESSNESS WITH HIGH GRADE FEVER SINCE 2 DAYS.

• SPO2-91%

• COUGH WITH EXPECTORATION WITH DIFFICULTY IN BREATHING

• COUGH <EARLY MORNING FROM 4 AM TO 6 AM.

• COUGH WITH DECREASING PAROXYSM.

• WHEEZING PRESENT

• THICK YELLOWISH EASY EXPCTORATION.

• THERMALS-HOT

FEVER TOTALITY-

• CHILLINESS PRESENT ONLY ON CHEST AND ABDOMEN.

• HIGH GRADE CONTINOUS FEVER

• THIRST- REDUCED

O/E-

PULSE-111 bpm

• B.P.-150/90 mmHg

• RR-30/min

• TEMP-102 F(ORAL)

• NO PALLOR,

• NO CYNOSIS,

• NO LYMPHADENOPATHY

• RS EXAMINATION:

• B/L RONCHI AND CREPTS

• BASAL CREPTS PRESENT

• P/A-SOFT,NO G/R

• CVS-NORMAL

• CNS-NORMAL

MENTALS-

• CRYING A LOT,CRYING DURING ILLNESS HAVE ALWAYS BEING PRESENT.

• HOMESICKNESS,WANTS TO GO TO VILLAGE,

• VERY MUCH SENSITIVE TOWARDS EMOTIONS OF FAMILY MEMBERS...

• SAYS SINCE 25-26 YEARS I HAVE NOT SUFFERED THIS MUCH .MY ALL COMPLAINTS ARE AGGRAVATED SINCE FEW MONTHS.

• FEAR OF CHOCKING

• FEAR OF DYING IN TRAIN-SAYS WHAT IF I GET RESPIRATORY DISTRESS IN TRAIN WHILE GOING HOME,

• SAYS I HAVE BECOME VERY EMOTIONAL SINCE ALL THIS COMPLAINTS HAVE STARTED.

• DESPAIR OF RECOVERY.

• PLEADING-SAYS MAKE ME ALRIGHT FOR ABOUT 1 WEEK SO THAT I CAN VISIT MY VILLAGE AND CAN BE WITH MY FAMILY MEMBERS.

INVESTIGATIONS-

22/3/16

Hb-13.6

RBC-4.22 LAKH/CUMM

WBC-21,300/CUMM

LYMPHOCYTES-19

PCV-37.4

PLATELET-4 LAKH 67 THOUSAND

S. CREAT-0.6

NA+ 121

K+ 3.5

CL 96

PS FOR MP- NEGATIVE

URINE ROUTINE-

PUS CELLS-6-8/hpf

EPITHELIAL CELLS-2-4/hpf

REPERTORIAL TOTALITY:

1. DIFFICULTY BREATHING MORNING

2. EXPECTORATION THICK

3. EXPECTORATION COLOUR YELLOW

4. MIND-DESIRES TO GO HOME

5. MIND-FEAR CHOCKING OF

6. MIND-FEAR -DEATH -RESPIRATORY PROBLEMS WITH

7. MIND-DESPAIR OF RECORY

8. MIND WEEPING TENDENCY-TEARFUL MOOD

9. GEN-FOOD AND DRINKS COLD WATER AMELIORATES

REMEDY SELECTION-

PULS 200 1ST DILUTION EVERY 10 MINUTES.PULS 1M 1ST DILUTION EVERY 15 MIN-PULS 1M 5TH DILUTION EVERY 2 HOURS

FOLLOW UPS:

22/3/2016

4 PM



22/3/2016

9 PM



23/3/2016

8 AM





HOLD PULS 1M 1ST DILUTION

START KALI BI 200 1ST DILUTION FOR COUGHING

COSMOS 2 HOURLY

23/3/2016 8PM



24/3/2016

10 AM





PT IS SYMPTOMATICALLY BETTER WITH ALL RESPIRATORY COMPLAINT BUT FEVER REMIANS HIGH.

25/3/2016 10 AM







RESPIRATORY SYMPTOMS 60% BETTER,BREATLESSNESS AND EXPECTORATION REDUCED NO WEAKNESS.PATIENT SAYS HE WANTS TO GO TO VILLAGE AND MEET RELATIVES

FRESH ORDERS-

HOLD PULS 1M 3RD DILUTION-SHIFT THE PATIENT ON PULS 1M 4TH DILUTION 2 HOURLY.OMIT IV FLUIDS

26/3/2016

8:30AM




9PM-PATIENT MUCH BETTER,AFEBRILE THROUGHOUT THE DAY

EXPECTORATION AND BREATHLESSNESS MUCH REDUCED.

27/3/2016

8:30AM



MUCH BETTER SYMPTOMATICALLY WITH PULS 1M 5TH DILUTION

COUGH-80% BETTER

NO FEVER

EXPECTORATION MUCH REDUCED

GENERAL SENSE OF WELBEING

28/9/16

PT BETTER BUT SEVERE BOUTS OF COUGH AGGRAVATED AT 3AM WITH BREATHLESSNESS(SINGLE EPISODE)

SPO2 94%

NO FEVER THROUGHOUT THE DAY

NO BREATLESSNESS,ITS THERE ONLY WHEN COUGH IS SEVERE

RS EXAMINATION BASAL CREPTS ON RT SIDE

PT DEVELOPED HERPES LABIALIS WITH SLIGHT BLEEDING-

FRESH ORDERS-GIVE SULPHUR 200 4TH DILUTION SINGLE DOSE

CONTINUE PULS 1M 5TH DILUTION 2 HOURLY

29/3/16

CASE DETAILS:

60 YEAR OLD FEMALE HAVING RESPIRATORY COMPLAINTS SINCE A YEAR CAME TO IN PATIENT DEPARTMENT WITH BOUTS OF SEVERE COUGH WITH EXPECTORATION AND BREATHLESSNESS SINCE 2 DAYS.SHE COMPLAINTS OF PAIN IN RIBS AND LOWER BACK WHILE COUGHING AND SHE HOLDS HER CHEST WHILE COUGHING.COUGH WITH EASY EXPECTORATION AND GREENISH YELLOW IN COLOUR

<NIGHT3+,

<COLD3+,

CHEST PAIN >HOT WATER2+,

>AFTER EXPECTORATION3+

ON AUSCULTAION :B/L CREPTS PRESENT ES

PT GIVES HISTORY OF CA BREAST 10 YEARS AGO AND CHEMOTHERAPY TREATMENT.

PHYSICAL GENERALS:

PHYSICAL APPEARANCE:

MODERATE BUILT WITH XANTHELESMAS

APPETITE:DECREASED SINCE 10 YEARS.SAYS THERE IS LOSS OF TASTE SINCE CHEMOTHERAPY

LIKES:COLD THINGS LIKE CURD BUT COULD NOT HAVE THEM AS IT INCREASES COMPLINTS

DISLIKES: NOTHING SPECIFIC

THIRST-1-1.5 LIT/DAY

FOOD/DRINKS AGG/AMEL:CURD,FRIED AND ONION IN FOOD ITEMS INCREASES COUGH

PERSPIRATION:SCANTY O FOREHEAD

SLEEP:DISTURBED DUE TO THOUGHTS,ANXIETY ABOUT FAMILY MEMBERS.

THERMALS:CANNOT TOLERATE HEAT SINCE CHEMOTHERAPY.

MENTAL CHARACTERISTICS:

-AVOIDS GOING OUTSIDE BECAUSE OF COUGH.SHE FEELS THAT WHAT WOULD PEOPLE THINK WHEN SHE CONTINOUSLY COUGHS.

-WANTS COMPANY,MIXES WELL WITH STRANGERS

-SYMPATHETIC AND HELPFUL TO OTHERS

-SAYS I HAVE DONE GOOD FOR PEOPLE,GOD HAVE SAVED HER FROM SO MUCH DISEASES.

-SAYS I HAVE NEVER PLEAD FOR HELP BEFORE ANYBODY.I DO HARDWORK,EXTREME HARDWORK BUT HAVE NEVER ASKED FOR MONEY FROM ANYONE.

-SHE DISCRIBES THAT SHE CANNOT EAT ALONE,GIVES FOOD TO NEEDY...IN HER EXTREME POVERTY ALSO I USED TO SHARE MY FOOD.

-EXTREMELY SYMPATEHTIC AND COMPASSIONATE TOWARDS FEELINGS OF OTHERS...EVEN IF SOMEONE ON ROAD CALLS FOR HELP SHE WILL BE FIRST PERSON TO REACH AND HELP.

-SAYS MY WHOLE LIFE HAS GONE IN STRUGGLE.

-SAYS I EVEN BLESS MY ENEMIES,WILL NEVER TAKE REVENGE FRO ANYBODYEVEN IF SOMEONE HAS DONE BAD,I SAY THAT GOD SHOULD GIVE THEM WISDOM AND BLESS THEM FURTHER,DOES SERVICE FOR MANKIND,WORRIES ABOUT FAMILY.

-12 YEARS AGO,WHEN DIAGNOSED OF CANCER,SHE HAD LOT OF WORRY TREATMENT AND ITS EXPENSES...HAS LOT OF TENSION WETHER SHE WOULD HAVE TO SELL HER HOME INORDER TO MEETTHE EXPENSES.

P/H:CA BREAST 12 YEARS BACK-PARTIAL MASTECTOMY WITH CHEMOTHERAPY DONE

O/E:

PULSE:75/MIN

BP:130/90 mmHg

RR:25/MIN

TEMP:AFEBRILE

RS EXAMINATION:B/L CREPTS

CASE CONCEPTUALISATION:



TOTALITY OF SYMPTOMS:

1)ANXIETY ABOUT FAMILY

2)COUGH EXPECTORATION PROFUSE

3)COUGH <NIGHT >EXPECTORATION

4)CHEST PAIN WITH COUGH >WARM

5)COUGHBREATHLESSNESS

6)MINDSYMPATHETIC,COMPASSIONATE

REMEDY SELECTION:KALI BI 200 1ST DILUTION EVERY 3 HOURS 3 TSP

FOLLOW UP CRITERIA:


FOLLOW UP:

3/10/2016 4 PM



4/10/2015 9 AM

3/10/2016 4 PM