CONVULSIONS Make sure the patient has a good airway. This may stop them.
If improving his airway fails, give him diazepam (A 2-4) intravenously for its immediate effect. Follow this with phenytoin sodium (’Epanutin’), first 250 mg intramuscularly, and then 50 mg, 6 hourly by mouth or tube. Phenytoin causes very little depression of consciousness, so it will not mask the signs of clot compression.
If these fail to stop convulsions, give him paraldehyde into the outer side of his thigh. Give infants under 6 months 1 to 2 ml, older children 2 to 4 ml, adults 7 to 10 ml.
If even these methods fail, give the patient 10% paraldehyde in 0.9% saline (50 ml in 500 ml of saline) by Intravenous drip slowly, as necessary. You can supplement this with phenytoin sodium 250 mg intramuscualrly, or by slow intravenous injection.
Sedate the patient with phenobarbitone for a month after discharge. You may need to sedate him permanently. Reduce the dose gradually. Never halve it at any one time, instead, cut it by a quarter. The difference between a half and a quarter of a tablet may be critical.
Alternatively, maintain him on phenytoin to control convulsions.
