Under the general concept of “convulsions”, conditions that are manifested by involuntary contractions of skeletal muscles are combined. Despite the fact that convulsive syndrome in most people manifests itself almost identically, it can develop under the influence of various causes and be a symptom of various diseases.
Seizures, causes and initial symptoms of seizures, first emergency medical care for seizures.
Convulsions can occur under the action of several tens of provoking factors. Among them – epilepsy, impaired electrolyte metabolism (for infectious diseases, lack of calcium and magnesium in the body), irritation of the membranes of the brain (meningitis), fever, decreased blood glucose, lack of oxygen, damage to the central nervous system.
) and fever itself: redness of the skin, chills (at the beginning of the stage of raising the body temperature) or a feeling of heat (when the body temperature reached its maximum), weakness, headache, nausea. Convulsions themselves can be of a diverse nature: to be like a large tremor, spreading only through the limbs or the whole body, manifest as transient tension of a particular muscle group, etc..
Sometimes they are accompanied by loss of consciousness. As a rule, they are repeated many times until the body temperature drops, but they can also occur in the form of a single short seizure attack.
Convulsions with meningitis or meningoencephalitis.
It is not difficult to determine the convulsions caused by meningitis or meningoencephalitis if you know about the features of these diseases. There are several signs by the presence of which it is possible to identify irritation of the meninges. A patient with meningitis, for example, has muscles in the back of the neck and neck, which makes him unable to perform a simple test: press his chin to his chest.
If a patient lying on his back tries to bend his head to his chest, then his shoulders are raised along with his head. You can conduct another test. Raise the leg of a lying patient, bending it at a right angle in the knee and hip joint, and then try to bend it only in the knee. When trying to unbend, the person conducting the test will feel resistance – the patient will not be able to straighten the leg due to muscle tension. These tests should be performed for any suspected meningitis..
With meningitis, the following symptoms are noted: an acute respiratory infection preceding the disease, a significant increase in body temperature, a small rash on the skin in the form of hemorrhages, complaints of severe headache, impaired consciousness, lethargy of the patient.
Affective respiratory cramps.
Affective respiratory cramps are easily confused with an epileptic seizure. An important point in the correct determination of the diagnosis is the information that, shortly before the attack, the person suffered some kind of severe stress. By their nature, such convulsions are usually clonic (erratic contraction of various muscle groups) or mixed, i.e. tonic-clonic. During them, as with epilepsy, breathing may be absent and consciousness may be depressed.
However, involuntary urination and bowel movements with such seizures are quite rare, the attack does not go to sleep and there is no clear phase separation, as in epileptics. In addition, if the patient is not alone and there is an opportunity to question his companions, then the fact that there were no such attacks before also speaks in favor of stressful seizures.
If the cause of seizures was a cranial brain injury, then proper pre-medical diagnosis is possible in two cases – if the patient himself reports it or if damage to his head is noticeable – abrasions, hemorrhages. By nature, they can be completely different..
First aid for cramps.
When providing assistance, it must be borne in mind that there are both general measures for convulsions of any origin, and important particulars in which the cause of the condition should be taken into account. If a person has a convulsive attack (this is especially important with severe clonic and tonic-clonic convulsions), you need to act very quickly.
It is dangerous for the patient in several ways: injuries are possible during falling and during seizures (sometimes strong muscle contractions can even cause bone fractures, and falling from a height of one’s own height or hitting one’s head against a solid object can lead to intracranial hemorrhage) and tongue retraction. The latter in some cases even leads to the death of the patient: the tongue blocks the airways and stops the access of oxygen to the lungs.
So, at the beginning of seizures, if a person falls, you must try to grab it and, if possible, lay it on a soft horizontal surface. It does not have to be a bed – you can use a mattress or a blanket on the floor. Often, when an attack occurs on the street or in transport, it is impossible to provide such.
In this case, during a convulsive seizure, you need to isolate the patient from objects that can cause him damage, and try to limit the movements of his body so that there are no severe injuries. Why do you usually have to attract several people to help: muscle contractions are very strong and sharp, and keeping a person alone, if it is not a child, is almost impossible.
In order to prevent oxygen starvation, you need to free your neck and chest from tight clothing and turn your head to the side to prevent the contents of the stomach from getting into the airways. To prevent the tongue from sinking, a spatula should be inserted into the patient’s teeth and, if possible, put pressure on the root of the tongue. You can hold the tongue with a special tool – the language holder.
In this case, the patient will not be able to fully close the jaw and the tongue will not be bitten, and also will not block the airways. When performing such manipulations often make many mistakes. Firstly, sometimes the time when you need to act is incorrectly determined. Airway management is required as soon as possible from the onset of a seizure.
Of course, sometimes it can be very difficult – in order to overcome the spasm of the jaw muscles, it is necessary to exert great strength. But this must be done in a short time, and not wait for the end of the seizure or at least the relief of cramps – at this point, there may be a lack of breathing for several minutes, which can be fatal. Secondly, when inserting a spatula into the mouth, safety precautions must be observed: the person providing assistance should not put their fingers into the mouth, opening the jaw to the patient – the latter can accidentally close his teeth, which will lead to unnecessary injuries.
The third mistake is to choose an object to hold the jaws open. A spatula and a tongue holder are not always available, only in isolated cases. In extreme situations, the spatula can be replaced with other items. For example, with a metal spoon wrapped in a napkin or cloth to prevent injury to the oral mucosa and damage to the teeth, or a tightly rolled bandage.
You can not use wooden objects or a pen for writing for this purpose: while clenching his teeth, the patient is able to easily bite them. This will not achieve the goal and will lead to injury by sharp fragments of the mucous membrane of the mouth, pharynx, to foreign bodies in the respiratory tract. Finally, the fourth important point is how to insert a spatula (spoon) into the teeth..
A spatula should not be placed between the incisors as is taken in the mouth with a fork while eating or, for example, a cigarette. This does not interfere with the retention of the tongue, in addition, it is easy to damage the bottom of the oral cavity, which will cause severe bleeding. The item must be placed between the molars – as the dog takes the stick when it is carried to the owner. Medication for convulsions cannot be carried out with conventional, widely available drugs.
The necessary medications are easy to find, for example, in the first-aid post if a seizure has occurred at work. As an anticonvulsant, a diazepam solution of 0.3 mg per 1 kg of body weight should be injected into the muscle or vein. With a weak effect, the injection can be repeated after 10-15 minutes. After urgent measures have been taken, all patients who have had a seizure should be hospitalized for a detailed examination and treatment..
Features of first aid for convulsions.
For each condition leading to the development of seizures, there are peculiarities in providing emergency care. In case of an epileptic seizure, in addition to diazepam solution, 10 ml of a 25% solution of magnesium sulfate are injected intravenously or a solution of furosemide in a dose of 60–80 mg into a vein or muscle. With febrile seizures, it is first necessary to ensure a decrease in body temperature.
We must remember that distinguish between the so-called red and white fever. Red fever is less often accompanied by convulsions. The skin with it is pink, the patient has increased perspiration, he complains of pressing. This type of fever is more favorable and requires the following measures: rubbing alcohol, applying cold compresses to areas of the body where large blood vessels are closely located – head, neck, chest. Need to give the patient to drink more fluid.
White fever is a signal that the body is carrying too much stress and can not cope with an increase in temperature. The patient is pale, hands and feet are cool due to spasm of blood vessels. Sweating is minimal, consciousness is often clouded or lost. In this case, the only help will be rubbing the skin with your hands or coarse tissue in order to expand the blood vessels and increase the heat transfer by the body. With white fever, the patient needs emergency medical care.
In order to avoid a recurrence of an attack of febrile seizures before the arrival of doctors, you can use antipyretic drugs. The safest of them, approved for use even by children, is paracetamol, which is given in a dose of 200-500 mg. If, after eliminating the seizure attack, there is a suspicion of their connection with meningitis, this means that a person needs emergency medical care.
An important point when dealing with such patients is that it is necessary not only to provide medical care, but also to protect other people from possible infection. Until the transfer of the patient to the hands of doctors, you must try to isolate the patient. And the person providing assistance must be in a protective mask. Or a 4 ply cotton gauze dressing, especially if all events are held indoors.
Cramps of the calf muscles, even frequently recurring, are not a reason for emergency care. Patients should routinely see a doctor. If convulsions are caused by insufficiency of venous circulation (varicose veins), surgical treatment and / or use of compression stockings and venotonic agents will be prescribed. With convulsions due to calcium deficiency, its deficiency will be filled with calcium-containing drugs.
With affective respiratory cramps, emergency care, in addition to general measures, boils down to taking available sedatives. With convulsions caused by a skull injury, the patient should not be moved independently and given medications. It is not known what kind of damage he has in the brain and how useful this or that intervention will be for him. It is necessary to wait for the doctors to arrive, and in anticipation of them to control the vital functions of the patient – breathing and heartbeat.
Based on the book “Quick help in emergency situations”.