Atyayika Chikitsa evam Tivra Chikitsa आत्ययिक चिकित्सा

Emergency medicine and intensive care · Third (Final) Professional (Tritiya Varsha) · AyUG-AC

Papers

• Paper I — Atyayika Chikitsa

Units in this subject

Study notes

Emergency medicine, a separate NCISM subject in the final year. Its real content is judgement: recognising which presentations are emergencies, stabilising what can be stabilised, and knowing without hesitation what must be referred rather than treated.

Recognising an emergency

• Airway, breathing, circulation, disability, exposure — in that order, every time.
• Red flags that mean referral now: altered consciousness, chest pain, breathlessness at rest, sudden severe headache, sudden visual loss, bleeding that does not stop, a rigid abdomen, a seizure that does not end.
• Sadyah pranahara marma injury is the classical counterpart and is worth naming alongside.
• The commonest failure in practice is not a wrong treatment but a delayed referral.

Life support

• Basic life support: chest compressions at 100–120 a minute, minimising interruption; early defibrillation where available.
• Recovery position; choking and its management in adults and children.
• Recognition of cardiac arrest — unresponsive and not breathing normally.
• Every practitioner should be able to do this without reference to a book.

Shock and haemorrhage

• Types: hypovolaemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), obstructive.
• Recognition: tachycardia, hypotension, cold clammy skin, poor capillary refill, reduced urine output, confusion.
• External haemorrhage: direct pressure first. Sushruta's four methods — sandhana, skandana, pachana, dahana — are the classical parallel.
• Anaphylaxis is the one every practitioner must recognise instantly, because minutes decide it.

Poisoning and snakebite

• Snakebite: immobilise, keep the limb below heart level, transport. Do NOT incise, suck, apply a tight tourniquet, or try to catch the snake. Antivenom is the treatment.
• The Agada Tantra plant poisons are emergencies: aconitine (perioral tingling then arrhythmia), colchicine (delayed, no antidote), abrin, oleandrin, camphor in a child.
• Do not induce vomiting after a corrosive.
• Delay for a herbal remedy is what kills people in these presentations, and that must be said plainly.

Other emergencies

• Cardiac: chest pain, arrhythmia, acute failure. Respiratory: acute severe asthma, pneumothorax.
• Neurological: stroke — recognised by face, arm, speech and time — seizure, head injury.
• Obstetric: antepartum and postpartum haemorrhage, eclampsia, obstructed labour.
• Paediatric: dehydration, febrile convulsion, the danger signs of neonatal sepsis.
• Burns and trauma: rule of nines, and the immediate priorities.

Referral, transport and documentation

• Stabilise, then transfer — and start the transfer early rather than after stabilising fully.
• What must be recorded: time of onset, findings, what was given, what was not, and the reason for referral.
• Consent in an emergency, and what to do when the patient cannot give it.
• Medico-legal cases must be reported; this ties directly to Vyavahara Ayurveda.

Where the texts disagree

• Classical emergency measures and modern ones differ sharply in snake bite: incision and suction are described in Sushruta and are now considered harmful.
• The classical arishta lakshana describe impending death; they are not a modern prognostic scale and should not be presented as one.

Commonly confused

• Murchha, Bhrama and Sanyasa - a graded series, not synonyms.
• Urdhwaga, Adhoga and Ubhayaga raktapitta - and the treatment runs opposite to the direction.

Practise it, and prove it