CONVULSIONS
Convulsions, or seizures, are a startling and often frightening phenomenon. They are characterized by severe muscle spasms or muscle rigidity of an uncontrolled nature. Convulsive episodes occur in 1 to 2 percent of the general population.
Although epilepsy is the most widely known form of seizure activity, there are numerous causes that are classified as either central nervous system (CNS) or non-CNS in origin. It is especially important to determine the cause in patients who have no previous history of seizure activity. This may require an extensive medical workup in the hospital. Since epilepsy is the most widely known, this section will highlight epileptic seizure disorders.
Epilepsy, also known as seizures or fits, is a condition characterized by an abnormal focus of activity in the brain that produces severe motor responses or changes in consciousness. It may result from head trauma, scarred brain tissue, brain tumors, cerebral arterial occlusion, fever, or a number of other factors. Fortunately, it can often be controlled by medications.
Grand mal seizure is the more serious type of epilepsy. It may be, but is not always preceded by an aura that its victim soon comes to recognize, allowing time to lie down and prepare for the onset of the seizure. A burst of nerve impulses from the brain causes unconsciousness and generalized muscular contractions, often with loss of bladder and bowel control. The primary dangers are tongue biting and injuries resulting from falls. A period of sleep or mental confusion follows. When full consciousness returns, the victim will have little or no recollection of the attack.
Petit mal seizure is of short duration and is characterized by an altered state of awareness or partial loss of consciousness and localized muscular contractions. There is no warning and little or no memory of the attack after it is over.
Although first aid treatment consists of protecting the victim from self injury and placing a padded bite stick between the jaws to prevent tongue biting, additional methods of control may be employed under a medical officer’s supervision. In all cases, be prepared to provide suction since the risk of aspiration is significant.
Medications Unless hypoglycemia can be ruled out, an intravenous infusion of 50cc of a 50 percent dextrose solution in water may be used. For immediate control of severe convulsions, Diazepam (Valium) may be used, administered 5 to 10 mg intravenously at 5 mg/min. Watch for respiratory depression and hypotension. Diphenylhydantoin (Dilantin) can also be used, but it takes approximately 20 minutes to achieve therapeutic levels. Administration is 50 mg/min up to the 1000 mg maximum dose. Phenobarbital is an alternate to Diphenylhydantoin but is not preferred due to its hypnotic effects. Dosage is 150 to 250 mg intravenously at 25 mg/min. This may be repeated in 15 minutes up to a maximum dosage of 400 mg in the first 2 hours.
DROWNING
Drowning is a suffocating condition in a water environment. Water seldom enters the lungs in appreciable quantities because, upon contact with fluid, laryngeal spasms occur which seals the airway from the mouth and nose passages. To avoid serious damage from the resulting hypoxia, quickly bring the victim to the surface and start artificial ventilation, even before the victim is pulled to shore. Do not interrupt artificial ventilation until the rescuer and victim are on dry ground, then quickly administer an abdominal thrust to empty the lungs and immediately restart the ventilation until spontaneous breathing returns. Oxygen enrichment is desirable if a mask is available.
Remember that an apparently lifeless person who has been immersed in cold water for a long period may be revived if artificial ventilation is started immediately.
PSYCHIATRIC EMERGENCIES
A psychiatric emergency is defined as a sudden onset of behavioral or emotional responses that, if not responded to, will result in a lifethreatening situation. Probably the most common psychiatric emergency is the suicide attempt. This may range from verbal threats and suicide gestures to successful suicide. Always assume that a suicide threat is real; do not leave the patient alone. In all cases, the prime consideration is to keep patients from inflicting harm to themselves and getting them under the care of a trained psychiatric professional. In the case of gestures or attempts, treat self-inflicted wounds as any other wound. In the case of ingested substances, do not induce vomiting in the patient who is not awake and alert. For specific treatment of ingested substances, refer to the section on poisons.
There are numerous other psychiatric conditions that would require volumes to expound