Chapter Fifteen UNCONSIOUSNESS and SUDDEN ILLNESSES

Key terms Diabetes Mellitus (DM) : is a defect in the regulation of blood sugar level. Diabetic emergency: A situation in which a person becomes ill because of abnormal blood sugar (increase or decrease) Hyperglycemia: increase in blood sugar Hypoglycemia: decrease in blood sugar Epilepsy : is a condition that is characterized by recurrent episodes of seizures because of disturbance of electrical activity of the brain. Seizure : Epileptic attack Fainting : very short loss of consciousness, which occurs Febrile convulsions in young children (1- 4 years)

Fainting (Nervous shock)( Syncope) Fainting is partial or complete loss of consciousness due to Temporary reduction of blood flow to brain Fainting is not a disease, but can be a symptom of a wide range of conditions and diseases Causes of Fainting Fainting may occur while you are: During urinating, During having a bowel movement (especially if straining), During coughing very hard,

Due to standing in one place too long. Fear, Severe pain, or Emotional distress. drop in blood pressure can cause you to faint (suddenly due to bleeding or severely dehydrated) Stand up very suddenly from a lying position. Exhaustion and Long time standing Lack of food Alcohol, cocaine and marijuana can also cause fainting Seizures Certain medications may lead to fainting by causing a drop in blood pressure or for another reason. (such as drugs used for anxiety, high blood pressure, nasal congestion, and allergies.) Breathing too fast (called hyperventilating) . Pregnant women or elderly more likely to faint when suddenly changing their positions, such as moving from sitting or lying to standing up

It may also happen after long periods of physical inactivity, especially in warm conditions and/or where the body is in an upright position, where blood can tend to pool in the lower part of the body Less common but more serious reasons for fainting include heart disease (such as abnormal heart rhythm or heart attack) and stroke. These conditions are more likely in persons over age 65 and less likely in those younger than 40

Signals of fainting Week feeling Feeling of headed or dizzy Pale skin ) ( Moist cool skin Nausea ( ) Numbness in the fingers and toes (sometimes)

Slow pulse First aid of fainting

Usually the victim resolves by itself Keep airway open Monitoring of vital signs Lower the victim on the ground for 10-15 minutes Elevate the victim legs Loosen his tight clothes Dont give him water or food Dont splash water on the victim face

Call your local emergency number (usually101) if the person who fainted: Fell from a height, especially if injured or bleeding. Does not regain consciousness quickly (within a couple of minutes). Is pregnant or over 50 years old. Has diabetes. (Check medical identification bracelets.) Feels chest pain, pressure, or discomfort; pounding or irregular heartbeat; or has loss of speech, visual disturbances, or inability to move one or more limbs. Has convulsions Tongue trauma Loss of bowel control Diabetic Emergency Diabetic Emergency Introduction:

Body cells need sugar as a source of energy. Insulin, a hormone produced in the pancreas, takes sugar into the cells. Diabetes mellitus (DM) : is a defect in the regulation of blood sugar level. It is the condition in which the body does not produce enough insulin. The main signals are thirst and increase frequency and quantity of urine. There are two major types of DM:

1. Insulin-dependent diabetes (type 1): occurs when body produces little or no insulin (Juvenile diabetes- in children). This type have to inject insulin.

2. Noninsulin- dependent diabetes (type 2): occurs when the body produces insulin but not sufficient quantity for the body needs (adult diabetes). There are 2 major types of diabetic emergencies 1. Diabetic coma (Hyperglycemia ) 2. Insulin Shock (Hypoglycemia ) 1. Diabetic coma (Hyper glycemia ) Gradual development

Signals of diabetic coma

Air hunger and deep breathing Thirst : due to loss of fluids because of excessive urination. May be fever Acetone odor

Drowsiness Fast pulse 2. Insulin Shock ) (Hypoglycemia Developed rapidly

Signals of Insulin shock Rapid weak pulse Shallow fast breathing Vision difficulties Dizziness Sweating Headache Numb hands and feet Hunger feeling First aid for diabetic emergencies

Practical

Do a primary survey Do a secondary survey Ask if the victim is diabetic patient If the victim conscious ask him : -

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Epilepsy Epilepsy Seizures When injury, diseases, fever, or infection disrupts the normal functions of the brain, the electrical activity of the brain becomes irregular. This can cause a loss of body control known as a seizure

Epilepsy : is a condition that is characterized by recurrent episodes of seizures because of disturbance of electrical activity of the brain.

An epileptic seizure ( often called a fit and sometimes an attack, turn or blackout) happens when ordinary brain activity is suddenly disrupted. The seizures described here are epileptic and arise from the brain. Epileptic seizures can take many forms, Any of some of the brain functions (personality, mood, memory, sensation, movement or consciousness) may be temporarily disturbed during the course of a seizure. Some very young children have convulsions when there is a sudden rise in their body temperature and this is called a 'febrile convulsion'. Epilepsy is currently defined as a tendency to have recurrent seizures (sometimes called fits). A seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary disruption in the normal message passing between brain cells. This disruption results in the brains messages becoming halted or mixed up. The brain is responsible for all the functions of your body, so what you experience during a seizure will depend on where in your brain the epileptic activity begins and how widely and rapidly it spreads. For this reason, there are many different types of seizure and each person will experience epilepsy in a way that is unique to them. What causes epilepsy? Sometimes the reason epilepsy develops is clear.

Brain damage caused by a difficult birth; a severe blow to the head; a stroke which starves the brain of oxygen; Infection of the brain such as meningitis.

Brain tumor. Epilepsy with a known cause is called symptomatic epilepsy. For most people - six out of ten, in fact - there is no known cause and this is called idiopathic epilepsy Some Types of seizures

Generalized seizures: In these seizures the whole of the brain is involved and consciousness is lost. They often occur with no warning and the person will have no memory of the event. Partial seizures : During partial seizures the disturbance in brain activity begins in or involves one part of the brain. These seizures are sometimes known as 'focal' seizures Seizures

A seizure is the result of a sudden burst of excess electrical activity in the brain. This causes the brain's messages to become temporarily halted or mixed up. The type of seizure a person has depends on the area of the brain where this activity occurs. The old word for a seizure is 'fit'. Epilepsy Action prefers the word seizure because in today's language, 'having a fit' usually means getting really angry, which of course has nothing to do with epilepsy.

There are around 40 different types of seizure, ranging from brief absent moments, to episodes of losing consciousness, falling to the floor and convulsing. Because there are so many different seizure types and symptoms, epilepsy can be a difficult condition to diagnose. It is also possible for some people to be misdiagnosed with epilepsy, because there are a number of other conditions which can cause episodes or attacks that look like an epileptic seizure. Examples of these can include vertigo, faints and heart disturbances. It is important for doctors to know what type of seizure a person has, so they can decide on the most suitable course of treatment. This is why it is so helpful to keep a diary and even take a video recording, when someone has a seizure. It is rare that someone has a seizure in the doctor's consultation room, so it is helpful to be able to provide as much detail as possible. How can seizures be described?

There are many different types of seizures. Not all of them involve convulsions. When naming seizures, it is important to use terms, which describe what is happening during the seizure, and to avoid terms such as 'mild' or major, which do not describe the event. A person with epilepsy can experience more than one type of seizure. The frequency, length and pattern of seizures tend to be fairly constant for each person, although it may change in the longer

term. If a person becomes aware of any changes to their seizures it may be helpful to have a review of their epilepsy and its treatment.

Signals of seizure

Aura is unusual sensation or feeling such as a visual hallucination, a strange sound, taste, or smell, or an urgent need to get safety) Then the attack starts (usually 5 minutes at the most) The victim falls on ground. Then uncontrolled muscular contractions (convulsions) occur for several minutes. The muscles stiffen then relax then begin jerking movements . Forth or bubbles may appear around the mouth

Finally the seizure stop and the victim sleep deeply. The victim will regain consciousness but may become dizzy and confused. Status Epilepticus

Most seizures last for the same amount of time for each person and usually stop of their own accord.

However, in some circumstances seizures are not self-limiting and do not stop, or one seizure occurs after another with no recovery period in between. This situation is known as status epilepticus. This can occur in any type of seizure, however it is a medical emergency requiring medical intervention if it occurs with a tonic-clonic seizure.

An ambulance should be called if the seizure lasts for 2-3 minutes longer than normal, or if it lasts for more than 5 minutes and the usual duration of a seizure is not known. First aid of seizure During the fit : Dont try to stop the seizure Dont hold or restrain the victim

Keep the airway open Move away nearby objects Protect his head by placing a thin cushion Loosen any tight clothing around the neck (carefully)

If there is a fluid (saliva, blood, vomit) in his moth, position his head on one side so that the fluid drains from the mouth. Dont place any objects between his teeth

First aid of seizure When the seizure is over :

He will be drowsy and disoriented. So do a secondary survey, checking to see if he was injured during the seizure. Stay with the victim until you are sure he is completely recovered and is able to get home. Turn the victim into the recovery position

Call EMS if The seizure lasts for few minutes The victim has repeated seizures The victim appears to be injured The victim is diabetic The victim is pregnant The victim is an infant or child The seizure takes place in water The victim fails to regain consciousness after the seizure