Class case:

Mrs narsaiyya yellapa udappa /f /43 / widowed since 9 years. / sells

bananas / braught here by a neighbor / res of golibar slums ,
santacruz [w]. Mumbai.

Physician : Dr Nimish V. Mehta. Case taking 09-08-2022

CASE NO 27/AUG 23

On the 9 t h August, at about 9 a.m. a Kannada lady about 40 years of age

and coming from a law economic strata was rushed to our hospital by
her neighbours in acute respiratory distress. We were taking our
usual round with the Honorary. We saw this lady in a wheel chair
gasping for breath in such a violent way as if her whole body was
jerking with every breath. A passing remark was made that the lady
would probably sink away very fast. At the same time, the Honorary
was approached and asked whether he would accept this case which he
readily agreed.

The patient was wheeled to her bed and orders were given for
immediate 02 administrations and a backrest to be provided. A quick
appreciation of patient’s clinical state was obtained from the
neighbors. She was having an acute exacerbation of Bronchial Asthma.
Simultaneously, the vital parameters – T P R & B P were recorded.
General observations of the patient signs were also looked out for.

Patient was looking very exhausted with perspiration all over,

especially over her forehead where beads of perspiration was visible.

Her temperature was 96 o F (axillary) Respiratory rate was 32/min.

pulse was 108 per min and BP152/94 mm. Hg.

With every gasp, there was spasmodic contraction of the epigastric

region. JVP was not increased. There was minimal edema on the feet.
Another important finding was icy coldness of her legs, much below
the knees. Air entry into her lungs was very much reduced. Rhonchi
could be heard as if the sound was being squeezed through a very
narrow opening suggesting severe spasm of the respiratory passage
Crepitations on left anterior middle zone were present also.
Abdominal examination revealed tenderness all over but more in right
hypochondria.

Selection of a drug could have been done at this junction with the data
available put patient appeared about 10-15% better and comfortable
after oxygen administration, so we ventured to get the acute asthmatic
totality from the patient.
Patient was suffering from asthma since last 4 years. A lot of
allopathic medication had been administered but in vain. Just 2 days
before she was discharged from one of the municipality hospitals. She
developed an acute exacerbation this morning at 4 a.m. after talking to
her milkman. At the present moment, she was complaining of a lot of
pulling pains and crampy feeling in her limbs with serve contraction in
epigastrium. She said such a state also preceded her attack heralding
its onset. On further inquiry she told us that during her last
hospitalization 5-6 days ago she had bleeding per rectum without
stools accompanied by severe cramps in abdomen. At that time she
was better by binding her abdomen tightly with some cloth.

However, at present she had not passed stools for 2 days but had a lot
of gases. She could not think of eating or Drinking anything. Since she
felt that food gets stuck at the pit of her throat bringing on an attack.
She feels only relieved partially when she vomits out everything. She
also complained of bitter taste all along the food passages, which in
her mind would be eleved only if she could expectorate. Her
expectoration would hardly be anything – very scantly and extremely
sticky – difficult to bring it out. She would get chest pain when she
coughs and coughing and talking would bring on her ailment faster.
She generally feels chilly during such with a desire to cover head and
ears. On the other hand during such an attack, if she sits out in her
verandah she feels better. She is comfortable in a position where knee
are bent and she is sitting up and leaning forward with hands on knees
or hands supporting on a wall. Normally her aggravation time is a 2
a.m. onwards.