By Dr. Tim Shafer, Grace Cottage Family Health
Back in June, during one of those spells of hot sticky weather, I was just finishing a nice meal with coworkers in a restaurant when we were approached by an anxious waitress asking if we were doctors and could help. A few tables away, a middle-aged man was slumped, unconscious, covered in perspiration with occasional snoring respirations, but no pulse when I checked his neck.
“Lie him on the floor and call 911,” I commanded the stunned bystanders, and we soon had him flat on his back with his feet elevated.
As we did this, I heard his wife exclaim, “He was working all day in the hot sun!”
Within moments, I could feel the pulse return to his neck, his eyes fluttered open, he took some deep breaths, and looked around with astonishment.
“What happened? I feel fine. Let me up!” he said.
I kept him flat on his back as I asked a few questions which gave further information as well as time to confirm that he was lucid, articulate, had a steady pulse, was breathing easily and had no noticeable neurologic loss to suggest a stroke. Yes, he was on a blood pressure pill and could name it. Yes, he had worked all day in the hot sun and not had much fluid to drink until he settled into the restaurant and attacked a generous martini. At this point I let him sit up and start drinking ice water.
By the time the ambulance crew had bustled him out the door on the way to the emergency room, he was well recovered and sadly contemplating the lovely dinner he was leaving behind.
Fainting occurs when blood flow to the brain drops below the critical threshold of supplying enough fresh oxygen and glucose to billions of hungry brain cells. We experience a dull, woozy feeling of mental clouding and physical sagging. We get spots or narrowing in our vision, have trouble focusing and speaking. Observers may note that we look pale or even green in color, we sway, stagger, seem confused, thick of speech, or go curiously silent before the mental lights go out. If we faint sitting up, the starving brain cells can even short-circuit, causing generalized seizures, which is particularly frightening to onlookers.
If somebody looks like they are feeling faint or lightheaded, get them lying down! If somebody has already fainted, get them lying down and elevate their legs. This prevents them from falling and hurting themselves, and most importantly, immediately restores blood flow to the brain. If they are experiencing a simple fainting episode, they should promptly recover. If they do not immediately bounce back, call 911, check for pulse and breathing, and if these are not detected, proceed with CPR. Getting them lying down is always the best first step.
Simple fainting spells occur under two common scenarios.
The first is dehydration caused by a combination of inadequate fluid intake and excessive fluid loss. A classic example is excess perspiration loss from working, hiking, biking, running, or other exercise without getting enough fluid and salt replacement. Hot, humid conditions exacerbate perspiration and make heat dissipation more difficult. An overheated brain is in double jeopardy of heat injury as well as inadequate blood supply. But fainting can also occur in a hot auditorium, standing in a long line, at a flea market, or in a church choir where people have not had enough food and drink intake, get overheated and are standing or sitting so long that blood reserves settle to the lower extremities, blood pressure drops, and they swoon. I have grabbed people trying to stagger out of theaters and grocery stores.
Other causes of dehydration include diarrheal illnesses, excessive vomiting, or impairment of access to food and fluid, for instance in a disabled or elderly person. If somebody is on blood pressure or diuretic “water pills” they are even more susceptible to dropping their blood pressure into the fainting range.
The second scenario is called a “vasovagal response” when acute pain, nausea or emotional shock causes the brain to activate the vagus nerve, abruptly dropping heart rate and blood pressure. Think of hitting your fingernail with a hammer, suddenly seeing blood, experiencing something horrible or unexpected, receiving terrible news, getting nasty seasick, coming across a squashed skunk and getting “grossed out.” You get pale, glassy eyed, stomach heaving, limbs go flaccid and down you go. Working in the emergency room, I learned to keep an eye on the rubbernecking family members in case they started looking fishy as their loved one was sewn up. I did not want a second casualty to deal with!
Again, the important lesson, if you see someone in the process of fainting for whatever reason: take command, get the person lying down flat with legs elevated, assess how they respond, send for help, start them hydrating if it can be done safely. You could be the next hero of a restaurant, auditorium, or accident scene.
