Contenu connexe


Damsam Case ppt.pptx

  2. A 34 year female patient came to our OPD with complaints of the alleged bite (unknown ) on 02/09/2021 which happens 8 days back. Site : Medial aspect of left arm just above elbow C/0 • Bite mark which is ulcerated. • Greenish discoloration over bite site with black spot . • Reddish painful swelling over surrounding area. O/E She was conscious , oriented and afebrile.
  3. History of bite • According to the patient, bite may occurred on 23rd August while she was handling with some creepers on her garden. She also was busy with cleaning her house on the same day. • She felt an itchy sensation over whole body but ignored. • They have seen a green snake around their house before, as well as centipedes inside house. • Next day she saw two bite marks on medial aspect of left arm above elbow which became a small pinpoint water filled bubble on 2nd day. • On 4th day her whole upper arm became oedematous with severe pain and one bite mark seems a purplish colour with reddish surrounding area and the bubble bursts out , while the other mark remains the same.
  4. • Went to nearby allopathic hospital, they initially doubted as snake bite, given medications and advised 3 days dressing. • By then swelling and pain of whole upper arm reduced considerably but persists over surrounding area of bite mark. • Next day she came to our OPD for further management , the area appears slightly necrosed , bite mark seems a black colour with erythema and swelling. No k/h/o DM, HTN, DLP, Thyroid disorders
  5. Treatment history of present illness Took allopathic medications Mg Sulphate – ointment for wound dressing for 3 days T. Chymotrypsine – 1-1-1 A/F • Took blood tests and was normal ( alleged, reports not available )
  6. Personal history • Mixed diet with good appetite • Bowel regular and micturition is within normal limits • Sleep good • Addictions, Habits nil • Allergic towards analgesics and most of wound healing medications, identified followed delivery. • Mode of work : 10-5pm office work • Exercise poor
  7. General examination • Temperature : 36.3⁰ C • Pulse rate : 76 / min , right radial, volume full • Body weight-75 kg Systemic examination All others are found to be normal
  8. INSPECTION • A single small ulcer present on medial aspect of left upper arm 10cm above elbow. • Margin – Irregular , rounded nearly .5 cm diameter • Edge – Raised and beaded edge • Floor –Slough present • Base –Underlying soft tissue • Skin around ulcer is hyper pigmented. • Started slight necrosis PALPATION Tenderness : present , grade 1 Warmth absent
  9. DASHAVIDHA PAREEKSHA Dushyam : Dosham - Vatam, Pittam , kapham Dhatu -Raktam Desham : Deham - Vama Bahu : Bhumi - Jangala sadaranam Balam : Rogam - Madhyamam Rogi - Madhyamam Kalam : Ritu - Varsham Vyadhyavastha- Navam
  10. Analam : Samam Prakruthi : Vatakaphajam Vaya : Madhyamam Satwam : Madhyamam Satmyam : Shadrasa satmyam Aharam : Jarana shakti- Madhyamam Abyavaharana shakti- Madhyamam
  11. ASHTASTHANA PAREEKSHA • Nadi - Sadaranam • Mutram - Anavilam • Malam - Susamhatam • Jihwa - Anupalepatwam • Shabdam - Spashtam • Sparsham - Anushna sheetam • Drik - Anavilam • Akriti - Madyamam
  12. Laboratory investigations Done on 28/08/2021 Reports not available Alleged normal
  13. • Visha bheda- Jangama Jangama Vishabhedam a. Place of bite : At her house b. Time of bite : Afternoon c. Time elapsed between time of bite and arrival : 8 days d. Part of body affected : Medial aspect of left arm above elbow e. Nature of bite : 2 bite marks present initially, one became ulcerated later with slight necrosis. Erythematous swelling present on surrounding area.
  14. Signs and symptoms a. Samanya lakshana : Ruk, Todam, Ragam, Pakam, Sopham b. Vega lakshana : Not found c. Anubandha upadrava : Kotham, Vranam d. Rishta lakshana : Nil
  15. VISHA SAMPRAPTI Here the nidana is Aganthuja , therefore we can assume a raktadushti from it ( Ref : Aganthuja jwaram – Tatra abhighajate vato prayam raktam pradhooshayan Cha.Chi 1st chapter ) also the guna of visha causing this bite also cause sthanika doshadushti and raktadushti , thus manifesting the symptoms. The guna may affected are Theeksha (prayeena avara) Ushna, ------- ----Pitta kopa, Ushna Sookshma guna -------Raktakopa, Rooksha guna -------Vatakopha.
  16. DOSHA AND VIKRUTA LAKSHANA : Vatam - Ruk, Todam, Syava varnatha Pittam - Raga, Paka, Kotha Kapham - Sopha DOOSHYA AND VIKRUTHA LAKSHANA : Raktam - Pidaka SROTAS AND VIKRUTHA LASKHANA Raktavaha srotas - Pidaka
  17. VYADHI ADHISHTANAM - Twak VYADHI MARGAM - Bahyam DIAGNOSIS a) Provisional : Keeta visham b) Differential : Sarpa visham : As the patient didn’t see the snake and the vega lakshanas were not found c) Actual : Satapati damsam : The symptoms presented by the patient was pain, swelling and redness, as she didn’t notice any insect , from the clinical presentation we assumed it as a centipede bite.
  18. Treatment : Chaturvimshati upakrama Shamana chikitsa - Oushadam, Lepa
  19. Details of treatment : DATE OBSERVATION MEDICINE 02/09/2021 13/09/2021 Erythematous painful swelling on medial aspect of upperarm just above elbow Bite mark slightly necrosed with a blackish spot at centre Swelling reduces , wound not healed fully, greenish discoloration subsided •Patoladigana kashayam-90ml-bd-6am, 6pm-before food •T. Vilwadi 1-0-1 with kashayam •Sigrupunarnavadi lepam – for external application and dhara •Continue kashayam and gulika •Triphala kashayam –kshalanam •Jathyadi ghritham – External application
  20. Pathya : Ahara - laghu ahara preferably peya for few days, mudga yoosham, mudgam, saindavam . Vihara - visramam Apathya Ahara : Dadhi, guda, payas, tilam, masham, katu amla and lavana ahara, abisyandhi ahara, matsyam,mamsam Vihara : Divaswapnam
  21. Adviceondischarge • Mahatiktaka ghritham - 10 g bd for 5 days • After that virechanam with Avipathy choornam 20g with honey For sheshadoshasamanam • T. Dooshivishaari 1 tds for 2 weeks

Notes de l'éditeur

  1. 4th day pain type
  2. Chymotrypsin – in the treatment of pain relief and swelling
  3. Paracetamol family, diclofenac…..
  4. Patient says it is tender