Convulsions - First-Aid Measures

Convulsions, or to use a common, although distinctly un-medical term, "fits", often result in well-meaning bystanders doing more damage than good owing to erroneous and outdated beliefs. Let us clear these misconceptions and watch out for the correct first-aid measures to be taken.

Convulsions may have several causes, such as idiopathic (cause unknown) epilepsy; brain damage resulting in mental abnormality; a hit or an injury to the head, resulting in epilepsy at a later stage; tumours; kidney or liver failure; an over-indulgence in alcohol and narcotics or their withdrawal in chronic cases; and the abrupt withdrawal of epileptic drugs.

A convulsion has four distinct phases:

1. Aura: the patient receives warning of an oncoming attack. This may be in the form of an abortive attack characterised by jerks or certain sensations - including, sometimes, pain - which, from past experience, he can recognize as warning signals.
2. Tonic: The limbs stiffen, the jaw is clenched tightly shut, the patient may also foam and drool at the mouth.
3. Tonic-clonic: This is probably the most easily recognizable phase, characterized by shaking or jerking motions of the body. They may be localized in one area or may occur all over the body. The patient may lose control of his bowels and his bladder, resulting in his passing stools and urine uncontrollably.
4. Postictal: This is like the aftermath of a storm. The patient remains drowsy and unsure of himself. He may be in a semi-conscious or even unconscious state for some time.

WHAT TO DO:

• The first step is to take the patient away from immediate danger to himself such as sharp or hard objects; busy thoroughfares; the exits of running buses or trains; a balcony or swimming pool edge.
• Get him to lie down, placing his head to one side in order to prevent vomitus from entering the lungs (this could cause aspiration pneumonia).
• If possible, put a folded handkerchief in his mouth between his front teeth, to prevent him from biting his tongue. But, on no account should you put your finger or any hard object into his mouth. With the unnatural force of the convulsion, he could bite off something like a stick and choke on it.
• Loosen clothing so as to facilitate breathing (this may not be possible if an attack has already begun).
• Give him ample space.

• Restrain the patient, as he may cause you bodily harm. Let the attack tide over in its own time.
• Feed or attempt to pour water into the patient's mouth (a common mistake, especially when dealing with babies - water is considered the universal reliever for most medical emergencies!)
• Attempt the "onion in the mouth" or the "sleepers" routine. (if the patient recovers in a few minutes, you may feel these traditional methods have 'worked', whereas the fact is just that the convulsions has worked itself out).

When several attacks occur in a row, immediately summon medical help as an anti-convulsion injection and other treatment will be called for.

After the seizure:

• Get the patient to lie down if he is not doing so already.
• Usually the patient feels sleepy (the fourth phase). If so, let him drowse off.
• Keep his head well on one side as suggested before.
• Only after the patient has returned to normal should he be given anything to eat or drink.

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