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Fainting, Diabetes Emergency and Convulsions
First aid in cases of collapse

Imagine that you are standing in line at the bank and the person ahead of you collapses. You don’t know the person and have no idea what medical problems there might be. Is it a fainting spell, or something more serious such as a diabetic emergency, a seizure or a convulsion?

These conditions often appear similar but they are not treated in the same way. If you understand the differences, you will know the first aid to use until medical help arrives. In all cases your first action should be to check for a medic alert device, usually worn at the neck or wrist, that will assist you in quickly identifying the problem.

Fainting

Fainting (syncope) is a temporary loss of consciousness due to insufficient oxygen reaching the brain. It often results from a slowing of the heartbeat and a fall in blood pressure which reduce blood flow to the brain. Sweating, dizziness, nausea, dimmed vision, ringing in the ears and weakness usually precede fainting spells. These attacks are often caused by pain, shock, stress, fear or by being in a stuffy atmosphere with little oxygen.

Fainting may also occur when a person stands still for a long time or suddenly stands up. This is a result of pooling in the legs (postural hypotension) and a resultant drop in blood pressure. This type of fainting is common in the elderly and in those suffering from diabetes mellitus or taking certain medications. On occasion, fainting episodes may also be associated with temporary speaking difficulty or weakness in the limbs.

Diabetic Emergency

There are two kinds of diabetic emergency - insulin shock (low blood glucose, hypoglycemia) and diabetic coma (high blood glucose, hyperglycemia). The signs and symptoms of each are listed in the table below, along with the possible cause. For someone giving first aid, it is not important to know the type of diabetic emergency - the first aid is the same. What is important is that you recognize the person’s condition as an emergency and get medical help quickly.

First Aid for Fainting, Diabetic Emergencies, Seizures & Convulsions

First aid for diabetic emergencies

1. If the person is unable to respond, follow these steps.

• Call for medical help immediately.
• Place the person in the recovery position (see diagram) and monitor closely until medical help takes over.
• Check for a medical alert device that will give you more information about the person’s condition.
• Stay with the person and give any obvious help needed.

2. If the person is conscious, ask what is wrong. You may get an answer or the person may be confused.

• Send for medical help.
• If the person can speak or if you can tell by the signs and symptoms, help with what is needed - sugar or prescribed medication.
• If the person is confused about what is needed, give something sweet to eat or drink. A drink sweetened with 30 ml (2 tbsp) of sugar may help and if it doesn’t it won’t make the person any worse.
• Place a person who is conscious but weak in the most comfortable position, which may be the shock position (lying on back with feet elevated).
• Stay with the person and give any obvious help needed.

Seizures and Convulsions

A seizure is caused by abnormal electrical activity in the brain which takes the form of abnormal, uncontrollable muscle contractions called a convulsion. In a generalized seizure, the whole brain is affected -- the person loses consciousness and may have convulsions. In a partial seizure, only part of the brain is affected. The person may experience a tingling or twitching in a part of the body. Epilepsy is a disorder of the central nervous system characterized by recurrent seizures. Many people with a seizure disorder take medication to control the condition. Other causes of seizures include:

• head injury
• brain infection
• a high fever in infants and children
• uncontrolled diabetes (especially low blood sugar)
• stroke
• drug overdose

With epilepsy, the person may sense a seizure is about to occur because of a brief sensation called an aura. The aura may be imagined sound, smell or feeling of movement sensed just before the seizure. A convulsion can come on very suddenly but seldom lasts longer than three minutes. After the seizure, a person may not remember what happened and appear dazed, confused, exhausted and sleepy.

Signs and symptoms of a generalized convulsion

• sudden cry, stiffening of the body and loss of consciousness causing the person to fall
• noisy breathing and frothy saliva at the mouth
• jerking of the body
• breathing may stop or be irregular for a minute -- the person may turn blue
• loss of bladder and bowel control

A typical generalized seizure has two phases:

The “tonic” phase - a sudden loss of consciousness causing the person to fall. The body becomes rigid for up to a minute during which the face and neck may turn bluish.

The “clonic” phase - jerking movements of the body most noticeable in the limbs, breathing is noisy, frothy saliva may appear around the mouth and the teeth may grind.

When the seizure is over, the muscles gradually relax and the person regains consciousness.

First aid for a seizure

• Make the area safe - clear away hard or sharp objects that could cause injury.
• Clear away onlookers to ensure the person’s privacy.

During convulsions:

• Don’t restrict the person’s movements. Offer gentle guidance, if necessary, to protect from injury.
• Loosen tight clothing, especially around the neck.
• Place something soft under the head.
• Do not try to put anything in the mouth, between the teeth or try to hold the tongue.

After convulsions:

• Check how responsive the person is. Place an unconscious person in the recovery position (Diagram B) - wipe away any fluids from the mouth and nose. If the person was injured during the seizure (although it is rare, injury is possible)
• give first aid for the injuries.
• Stay with the person and give any obvious help needed. Make sure breathing is normal. Keep the person warm and allow a chance to rest (may need up to an hour). Do not give any liquids during or immediately after a seizure
• Call for medical help unless you know the person is epileptic and are familiar with the medical history.

Watching a person have a convulsion can be a frightening experience. If you have a knowledge of the basic first aid needed, you will not feel helpless, wondering what to do. At the same time, you will be able to offer help and comfort to the person.

The advice given in this article cannot, nor is it intended to, replace the first aid skills that can only be learned in an approved first aid course. Readers are encouraged to take a first aid course from their local St. John Ambulance Branch or other recognized organization.