Infant Respiratory Distress – Pediatric Emergency

Preliminary Information: Male child, 10 months

Acute History:

A 10 months old boy was brought to the casualty of the homeopathic hospital around 7 pm with sudden dyspnoea. His parents had traveled almost 60 km in desperation as they were strong believers in homeopathy. The symptoms were:

Complaints started in afternoon with mild cough and fever.  By evening (4 pm ) Dyspnoea started suddenly, with loud audible wheeze.  P/H/O: Similar episode twice where the child had to be admitted for 3-4 days. There was a loud stridor while breathing which suggested tracheomalacia as the possible cause that needed further investigation.

Mother’s observation was that the audible wheeze would subside when child was asleep.

Examination

Category II traige

RS: Loud3, Audible wheeze

Temp: 101 F

Heart rate: 160/min

Respiratory rate: 80/min.

No cyanosis

Supra sternal notching +

Inter costal retraction

Sub costal retraction

Flapping of alae nasi

Chest: Wheezing ++, crepitation +

Stridor +

CVS: S1S2 : Normal

P/A: Liver 2 cm palpable.   Spleen 2 cm palpable

Observation in the ward

Child used to sleep on back with outstretched arms.

According to mother child usually sleeps on sides.

Investigations:

X -Ray:  Straightening of ribs with Hyper inflated lung

Diagnosis:

Hypersensitive Airways disease with tracheomalacia with entrapment emphysema In respiratory distress.

Emergency Analysis and Totality

Respiration whistling – awake when

Dyspnoea > lying on back with outstretched arms

Dyspnoea > Sleep during

Susceptibility assessment

Pace                       :         Moderate to Fast

Pathology                :         Structural reversible

Sensitivity                :         High

Characteristics          :         Present

Correspondence        :         Key note prescription

Dominant miasm       :         Tubercular

Since this was reversible pathology, with characteristics and the diagnosis suggesting hypersensitivity, the susceptibility is high indicating a 1M potency.

This is classified as acute exacerbation of chronic disease, with tubercular miasm being the dominant miasm.

Ancillary measures:

Oxygen

IV fluids for hydration and to maintain electrolyte imbalance

Plan of Emergency Management:

In an emergency, the focus is to control the wheezing to prevent respiratory fatigue and possibility of CCF. Since this was of sudden onset and moving at a fast pace, a higher potency with frequent repetition is needed.

The important aspect is to avoid an aggravation following the remedy when the child was already going into a state of fatigue with an accelerated respiratory rate of 80/min. It was decided to use a 200 potency instead, more frequently as long as its action lasted. This would help to calm down the emergency situation and reduce the respiratory rate gradually.

Prescription: Psorinum 200C 4 doses 4 hrly

When the 200C failed to produce further improvement, Psorinum 1M single dose was given.

Follow Up:

Within 12 Hrs: Audible wheeze better3

RR: 50/ min

Chest: Harsh Breath sounds

Within 24 hrs            No audible wheeze; RR: 36/min

Chest almost clear

Child active and playful

Discussion DC19:

This is a good representation of how a KEYNOTE PRESCRIPTION deals with an emergency. What played an important role here was that the power of accurate observation was converted into a characteristic symptom that indicated the simillimum . Often, in an emergency, an alert homeopath well versed in remedy characteristics and characteristic repertorial rubrics, would be able to find an appropriate remedy very quickly.

Regarding management, the recovery under homeopathic management was quicker, within 24 hours, as compared to 3-4 days in earlier episodes of conventional management.

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Dr. Navin Pawaskar, MD (Hom)
Director, Clinical services,
ML Dhawle Trust and Organizations