Sudden Illnesses

A sudden illness is a medical condition that abruptly, and often unexpectedly, develops in a patient to the point of becoming severe or even life-threatening. Sudden illnesses can result from an injury, an acute illness/infection, or a chronic medical condition. Despite the different causes and different types, many sudden illnesses present with similar signs and symptoms, including:

  • Sudden, unexplained decrease in level of consciousness (LOC)
  • Dizziness, lightheadedness, or confusion
  • Pale or ashen skin that may be cool and clammy
  • Weak, rapid, or irregular pulse
  • Shallow breathing or breathing difficulty
  • Feeling nauseated or vomiting

When identifying a sudden illness, take care not to equate the immediate complaint with the underlying cause. For example, epilepsy and diabetes should not be considered sudden illnesses, but those medical conditions can lead to sudden illnesses such as status epilepticus (repeated or lengthy seizures) or insulin shock if something goes wrong. As another example, a chronic heart condition (not a sudden illness) can lead to sudden illnesses like heart attack or stroke.

Although you should always find out all you can about the patient’s condition, you do not have to know the exact nature of the sudden illness or underlying cause to provide care. General guidelines for care in virtually any emergency can be defined by the mnemonic PELVIS, which means:

  • Personal protective equipment (PPE) – Always apply appropriate PPE before beginning assessment and care.
  • EMS call – Determine as early as possible if EMS personnel should be called.
  • Life-threatening conditions – Take care of any life-threatening conditions first.
  • Vital signs – Monitor vital signs at all times to determine if a life-threatening condition develops.
  • Injury/illness – Care for any specific injuries or illnesses you find during assessment. In the case of sudden illnesses, you can carry out specific care steps if you can identify the type of sudden illness (as explained on this page).
  • Shock – Always care for shock by:
    • Keeping the patient still and comfortable
    • Stopping any pain or bleeding
    • Maintaining normal body temperature
    • Reassuring the patient

Abdominal Pain

Abdominal pain occurs between the chest and the groin, commonly referred to as the stomach region, the belly, or the gut. When abdominal pain develops without trauma, it can originate from generalized infections as well as any organ in the region, including the stomach, small and large intestines, liver, gallbladder, pancreas, aorta, appendix, kidneys, or spleen. The sudden onset of abdominal pain is called acute abdomen.

Altered Mental Status

Altered mental status is one of the most common sudden illnesses. It is often characterized by a change in LOC, drowsiness, confusion, memory loss, loss of orientation (not cognizant of self, time, or place), and/or disruption of behavior or perception. For a comprehensive list of causes of altered mental status, go to MedicineNet’s Altered Mental Status page.

Syncope (SIN-ko-pee)

Syncope is the loss of consciousness due to insufficient blood flow to the brain. The common name for syncope is fainting. Fainting can be triggered by an emotional shock, pain, heart disease, overexertion, sudden shifts in position (e.g., from lying down to standing up), etc.

Dementia

Dementia is the loss of mental functions such as thinking, memory, and reason that is severe enough to interfere with the patient’s life. Dementia is not a disease itself, but rather a group of signs and symptoms caused by various diseases and conditions. The most common cause of dementia is Alzheimer’s disease, but there are as many as 50 other known causes. Most of these causes are very rare.

In some cases, although the person may appear to have dementia, a severe depression can be causing the symptoms. This is known as pseudodementia (false dementia) and is highly treatable.

Other states of altered mental status

Other states of altered mental status include coma, seizures, shock, unconsciousness due to respiratory or cardiac arrest, etc. Many of these conditions are described in other places in the first aid section of this web site.

Diabetic Emergencies

Diabetes mellitus is one of the leading causes of death and disability in the United States. As of 2011, 25.8 million Americans (8.3% of the population) had diabetes with 1.9 million new cases being diagnosed annually in people 20 years and older. It is estimated that another 7 million people with the disease have not been diagnosed and 79 million are prediabetic. (Click here to see more statistics about diabetes.) Diabetes contributes to a number of other conditions including blindness, kidney disease, heart disease, and stroke.

For more information about diabetes, follow these links:

Forms of diabetes

There are two major types of diabetes: Type 1 (sometimes called insulin-dependent diabetes) and Type 2 (sometimes called adult-onset diabetes).

  • Type 1 diabetes causes the body to produce little or no insulin, the hormone that enables the body to process sugar into energy. Most people with Type 1 diabetes must inject insulin into their bodies daily.
  • Type 2 diabetes is characterized by body cells that do not use insulin effectively, necessitating careful monitoring of diet, exercise, and blood glucose level (BGL).

Some women develop diabetes in the late stages of pregnancy, called gestational diabetes, caused by the hormones released during this time. This form of diabetes usually goes away after the child is born.

Many individuals (79 million Americans) are considered prediabetic. Almost everyone who develops Type 2 diabetes has prediabetes first. Prediabetes is characterized by high BGL, although not high enough to be diagnosed as diabetes. Prediabetes can be treated and reversed, as explained here.

 Types of diabetic emergencies

When a person with diabetes does not manage diet, exercise, and insulin use, an imbalance of glucose and insulin in the body can result. This imbalance can cause one of the following sudden illnesses to occur.

  • Hyperglycemia/diabetic ketoacidosis/diabetic coma – When the insulin level in the body is too low, the glucose level goes up. Glucose is in the bloodstream, but it cannot be processed into energy without sufficient insulin. When the body attempts to convert fat into energy, waste products are produced and the acidity level of the blood increases, resulting in diabetic ketoacidosis. If this condition is not treated promptly (usually with a dose of insulin), a life-threatening condition called diabetic coma can result.
  • Hypoglycemia/insulin shock –  When the insulin level in the body is too high, the patient has a low BGL. This condition can be caused by taking too much insulin, not eating, over-exercising, or experiencing great emotional stress. If not treated promptly (usually by giving some form of sugar), a life-threatening condition called insulin shock can develop rapidly.

The signs and symptoms of both diabetic emergencies are similar, including:

  • Dizziness, drowsiness, and confusion
  • Feeling and looking ill
  • Irregular breathing
  • Rapid, weak pulse
Assessment/caring for diabetic emergencies

When assessing the patient for any medical emergency, start with the primary assessment and then care for any life-threatening conditions first. For more information about patient assessment, go to assessment of the scene and the patient.

If the patient is conscious and you suspect a medical emergency, the parts of the SAMPLE history most important to touch on are Medications, Pertinent history, Last oral intake, and Events leading up to the emergency. If the patient is alert and oriented, he or she should indicate that they are diabetic and whether they inject insulin or not. He or she should also be able to tell you when he or she last ate and took medicine and what he or she was doing when symptoms began (e.g., exercising, etc.).

Sometimes patients may be confused or drowsy and unable to remember when they took their medicine or had something to eat. Other times, they may know exactly what to do and may ask for your assistance with their medication or something to eat. If the patient is conscious and you suspect a diabetic emergency, give some form of sugar (e.g., a soft drink, orange juice, commercial oral glucose, etc.). If the patient is hypoglycemic, the sugar should improve his or her condition within about 5 minutes. If the patient does not improve, call EMS personnel.

For more care information, follow these links:

 Seizures

A seizure occurs whenever the normal functions of the brain are temporarily disrupted by an injury, an infection, a fever, or any condition causing a decreased oxygen level. Seizures are the result of abnormal electrical activity in the brain that cause temporary involuntary changes in body movement, function, sensation, awareness, and/or behavior.

About 2 in 100 people will have an unprovoked seizure once in their lifetime. However, a solitary seizure doesn’t mean you have epilepsy. At least two unprovoked seizures are required for an epilepsy diagnosis.

Epilepsy is a disorder that results from the surges in electrical signals inside the brain, causing recurring seizures. Seizure symptoms vary. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others have full-fledged convulsions.

Click here for facts and myths about epilepsy and seizures.

Types of seizures

Seizures take many forms. In fact, there are so many different types of seizures that neurologists who specialize in epilepsy are still updating their thinking about how to classify them. In general, all types of seizures can be classified in one of two major groups:

In addition to these major categories, there are a few special cases, including psychogenic seizures, refractory seizures, and breath-holding spells.

The following are YouTube videos showing different seizures:

Types of epilepsy

Categories of epilepsy are defined by a cluster of features that occur together. Whenever a disorder can be identified by a characteristic group of features that occur together, it is called a syndrome. Features that make up a syndrome include the following signs, symptoms, and other characteristics:

  • The type(s) of seizures
  • The age at which seizures begin
  • The cause of the seizures
  • Whether the seizures are inherited
  • The part of the brain involved
  • Factors that provoke seizure episodes
  • The severity and frequency of seizures
  • The pattern of seizure episodes by time of day
  • Patterns on an EEG during and between seizures
  • Other disorders in addition to seizures
  • The prospect for recovery

The following are a few epileptic syndromes:

First aid care for seizures

Providing care for seizures is largely a matter of protecting the patient from further  injury. Many types of seizures cause abrupt loss of awareness and muscular control. During this time, patients may fall to the ground and strike nearby objects with their head, arms, or legs.

To care for a patient having a seizure:

  1. Note the time the seizure begins and ends.
  2. Do not restrain the patient except to keep the patient from further injury. For example, if the seizure occurs in the water, hold the patient from behind so the patient’s airway is above the water. If the seizure occurs at the back of tall bleachers, keep the patient from falling off the bleachers to the ground.
  3. Assess for life-threatening conditions, including unconsciousness, obstructed airway, no breathing, no pulse, long-duration or multiple seizures, etc.
  4. Assess for soft-tissue and musculoskeletal injuries sustained during the fall or convulsive movements.
  5. Remove nearby objects and place a pillow or padding under the patient’s head.
  6. Do not attempt to place anything in the patient’s mouth.
  7. If the patient begins drooling or vomiting during or after the seizure, place the patient on his or her side so that fluids flow out of the mouth.
  8. Offer comfort, reassurance, and privacy as the patient recovers. Stay with the patient until he or she  is fully conscious and aware of the surroundings.

Click the following for:

When to call EMS

The patient will usually recover from a seizure within a few seconds to a few minutes. It may not be necessary to call EMS if the patient has a history of seizures and the seizure episode occurs without injury or complication.

EMS should be called if the patient has an unexpected seizure, is injured as a result of a seizure, or has a seizure with another medical condition. In other words, the seizure:

  • Is unexpected or a “first-time” event
  • Is a long-duration (5 minutes or longer) event or a series of events with no sign of stopping (tonic-clonic status epilepticus)
  • Results from injury or causes injury
  • Occurs to a patient who:
    • Is diabetic
    • Is pregnant
    • Is a child or infant (especially with a high fever)
    • Is an elderly person who could have suffered a stroke

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