A 55yrs old labourer came with CO pain better by warmth

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Surgery emergency case 2
SURGEONS NOTES
A 55yrs old labourer came with C/O pain better
by warmth swelling of the right foot till mid
leg, after a history of trauma. There was
gangrene of the little toe. The toe had become
blackish, with oozing of watery bloody2,
OFFENSIVE3, yellowish discharge.
He also had fever with chills, with thirst
increased with the complaints
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Surgery emergency case 2
Examination findings
O/E G.C.-fair Temp 101OF Pulse120/min, RR
20/min, BP 120/100 mm of Hg. RS clear P/A
Normal CNS sensation of Right foot till ankle
diminished rest within normal limits
Local examination
Right foot pitting oedema, pus discharge
offensive3, bloody, yellowish. Right little toe
necrosed
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Surgery emergency case 2
INVESTIGATION
Hb- 6.5 Tc- 10,200 N-74, E-04, L-20, M-02
ESR137 HIV Negative Hbs Ag Negative FBS
75 PLBS 221

X Ray foot no osteomyelitis
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Surgery emergency case 2
Diagnosis

• Cellulites of Right foot with gangrene of
  little toe.
• Anemia
• Diabetes Mellitus

• Surgeon's Primary Advise
• Debridment followed by skin graft if wound heals
  
• Amputation

Patient Underwent, Debridement with poor control
of infection with poor wound healing.
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Surgery emergency case 2
OPERATIVE NOTES
Wide Debriment of Right foot right little toe
amputed Multiple incisions, pus pockets removed
O/E- wound pale, whitish look no granulation,
tendon exposed of the flexor aspect A track
formed from dorsum to flexor aspect of the foot
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Surgery emergency case 2
SURGEONS FURTHER LINE OF MANAGEMENT
1) If no healing of wound, then amputation of
foot. 2) If wound heals then will need skin
grafting
After a course of 7 days of Antibiotics the state
of wound same. O/E- wound pale, whitish look no
granulation, tendon exposed of the flexor aspect
Surgeon's advise- refer to homoeopathy with daily
dressing.
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Surgery emergency case 2
BEFORE HOMOEOPATHY
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Surgery emergency case 2
Life Space (Salient Features)

• Patient is youngest son.
• Pet of mother
• Married against his wish, Mothers desire
• OBSTINATE ABOUT HIS DEMANDS .
• Anger if not given money to drink alcohol
• Anger only at home? Fear of quarrels.
• Confused while answering simple questions

Fights like a child Only with wife and
mother Timid in society Fear of being hurt
PHYSICAL GENERAL Perspiration Palms, Soles Cr-
milk3, Tendency to suppuration Tendency to
scars
Talk during sleep Scream during sleep starts
during sleep Chilly patient
Dreams of ghost3. snakes, drowning2
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Surgery emergency case 2
Totality

• Fear of quarrels.
• Anxiety of illness
• Obstinacy
• Starts during sleep
• Screams during sleep
• Talks during sleep
• Dreams ghost3, snakes, drowning2
• Cr- milk3,
• Tendency to suppuration
• Perspiration Palms, Soles
• Chilly patient

Calc. Carb
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Surgery emergency case 2
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10 DAYS AFTER STARTING THE TREATMENT
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3 weeks after treatment
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FOUR WEEKS AFTER TREATMENT
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References for Homoeopathy
TOTALITY? ORIGINAL UNMODIFIED PICTURE WITH ACUTE
TOTALITY

• A/F trauma
• Thirst increased
• Pain gt2 warmth
• Fever with chilliness3
• Discharge yellowish, offensive3 , bloody

Rx. Hep Sulph 200