3.5 — Seizures, Fainting, Diabetic Emergencies and Anaphylaxis

Four situations that look frightening and are usually manageable, and in three of the four the main job of a bystander is to protect the person and wait.

Seizures

What it looks like

The dramatic kind: sudden collapse, stiffening, then rhythmic jerking of the limbs, often with noisy breathing, possible loss of bladder control, and blue lips.

And the quieter kinds, which get missed: staring blankly, unresponsive for seconds, lip-smacking or plucking at clothing, confusion.

What to do

Note the time it started. The single most useful thing you can do, because duration decides whether it is an emergency.

Protect the head. Something soft under it — a folded coat.

Clear the space. Move furniture and hard objects away.

Loosen anything tight around the neck.

And then wait. Most seizures stop on their own within a couple of minutes.

What never to do

Do not restrain them. You cannot stop a seizure by holding somebody down and you can cause injury.

Do not put anything in their mouth. Not a spoon, not your fingers, not a cloth. A person having a seizure cannot swallow their tongue — it is anatomically impossible — and putting something in the mouth causes broken teeth and bitten fingers. This is the single most persistent piece of harmful folk first aid there is.

Do not move them unless they are in danger where they are.

Afterwards

When the jerking stops, put them in the recovery position (3.1).

**They will be confused, exhausted and possibly frightened. This can last minutes to hours.

Stay with them. Speak calmly. Tell them what happened. Do not give food or drink until they are fully alert.

When to call an ambulance

Call if: the seizure lasts more than five minutes; a second one follows immediately; they do not regain consciousness; it is their first seizure; they are injured; they are pregnant; it happened in water; or they have difficulty breathing afterwards.

A person with known epilepsy having a typical short seizure that stops does not necessarily need an ambulance — many people have these regularly and have a plan. Ask them, once they are alert.

Fainting

What it is

A brief loss of consciousness from a temporary drop in blood flow to the brain.

Usually triggered by standing too long, heat, pain, fear, the sight of blood, dehydration, or standing up suddenly.

Almost always benign and almost always resolves within a minute.

What to do

Lay them flat and raise their legs. This is the whole treatment: it restores blood flow to the brain by gravity.

Do not sit them up in a chair. The common instinct, and it works against the mechanism.

Loosen tight clothing, make sure they have air, and keep them lying down for several minutes after they come round — sitting up too fast frequently causes a second faint.

If somebody feels faint

Get them to lie down before they fall. Most fainting injuries are from the fall, not the faint.

Or, sitting, head between the knees.

When it is not just a faint

Call if: they do not come round within a minute; they fainted during exercise or while lying down; there was chest pain, palpitations or breathlessness before it; they hit their head; they are pregnant; or it is happening repeatedly.

Fainting during exertion in particular should always be checked, because it can indicate a cardiac cause.

Diabetic emergencies

Two opposite problems, and the practical rule is what makes this manageable.

Low blood sugar — hypoglycaemia

Comes on fast, over minutes.

Signs: sweating, shaking, pallor, hunger, confusion, irritability or aggression that is out of character, slurred speech, and eventually collapse.

Frequently mistaken for drunkenness, and this mistake has cost lives.

What to do, if they are conscious and can swallow: give sugar. Glucose tablets, sweet juice, sugary soft drink — not diet — or a few teaspoons of sugar.

Then follow with something longer-acting once they improve: a sandwich, biscuits, a banana.

They should improve within about ten to fifteen minutes. If not, repeat once and call for help.

High blood sugar — hyperglycaemia

Comes on slowly, over hours to days.

Signs: extreme thirst, frequent urination, dry skin, drowsiness, breath sometimes smelling sweet or of nail-varnish remover, deep rapid breathing.

This needs medical help.

The rule that makes it simple

If you do not know which it is, and the person is conscious and can swallow: give sugar.

Because low sugar is fast and dangerous and correctable in minutes, and a small amount of extra sugar in somebody who is already high makes very little difference over that timescale.

And if they are unconscious: nothing by mouth. Recovery position, call for help. Some people carry an emergency glucagon injection and a family member usually knows how to use it.

Anaphylaxis

The most time-critical item in this chapter, and the treatment is a single injection.

Recognising it

A severe allergic reaction, usually within minutes of exposure — food, insect sting, medication, latex.

The signs that make it anaphylaxis rather than an ordinary allergic reaction are airway, breathing and circulation:

Swelling of the tongue, lips or throat. A hoarse voice. Difficulty swallowing.

Wheeze, persistent cough, difficulty breathing.

Feeling faint, pale, collapse, a sense of impending doom.

Often with a widespread rash or hives, and sometimes without.

A rash alone is not anaphylaxis. Any breathing or circulation involvement is.

What to do

Adrenaline, immediately. Do not wait to see if it improves — early adrenaline is what changes the outcome, and delay is the main cause of bad outcomes.

With an autoinjector: remove the cap, press it firmly into the outer mid-thigh, hold for the time stated on the device, and it works through clothing.

The standard adult autoinjector delivers 0.3 mg; the paediatric one 0.15 mg for smaller children.

Call an ambulance immediately, every time, even if they improve — reactions can return after an apparent recovery.

Lie them flat with their legs raised. **This matters: sitting or standing a person up during anaphylaxis can cause a sudden and dangerous fall in blood pressure. If they are struggling to breathe, sitting up is acceptable, but they should never be stood up or walked.

A second dose can be given after about five minutes if there is no improvement, and people at risk are usually prescribed two devices for this reason.

And take the used device to hospital with them.

For people who carry one

Two, always, and both in date.

Everybody around you should know where they are and how to use them. Show them. It takes a minute.

And use it early. The most common regret reported after severe reactions is having waited.

What to do with this page

Seizure: time it, protect the head, put nothing in the mouth, wait. Five minutes is the call threshold.

Faint: lay them flat and raise the legs. Do not sit them up.

Diabetes: if unsure and they can swallow, give sugar.

Anaphylaxis: adrenaline into the outer thigh immediately, lie them flat with legs raised, call an ambulance, never stand them up.

And the one to remember above all: nothing in the mouth during a seizure. It is the most common harmful intervention in this chapter and it is done with the best intentions.

Next: 3.6 — drowning, electrocution, heat and cold, where the first rule is about you rather than them.