Fainted? Stay flat!

     I have had several personal fainting episodes in my life, some quite silly.  For example, there was the time in high school biology class:  I was to get a drop of blood from my fingertip to look at blood cells under the microscope.  I guess I was nervous, because when I poked myself with the lancet, no blood came (being nervous will cause a reflex wherein blood is kept out of your extremities).  I thought that was weird, so I poked myself again.  Still no blood.  I poked a third time.  Now I began to get woozy, my vision got spotty, and I got clammy and had to put my head down.  Stabbing yourself again and again is not a natural thing to do to yourself, and my brain gave up and put me down. 

    Even sillier was the time in medical school after I had been up all night in the hospital.  The next morning they had a blood drive in the cafeteria.  I did my part, gave up a pint, and then leapt up and headed for the free cookies and juice.  Funny, I thought as I reached for an oreo, I can’t see.  My vision had blacked out so fast that I did not realize what was happening until people were helping me into a chair like I was a sack of potatoes.  The combination of fatigue, blood loss, and jumping up made it extra hard for my body to pump blood into my head, and down I went.

     Teenagers, like I was then, faint easily.  First, they have healthy, squishy blood vessels in their legs, unlike we older folks whose vessels have stiffened with age.  This helps blood pool in the legs, away from the head.  Then when a teenager stands up quickly, or stands still for a long time, enough blood stays below that it can’t get up to the brain fast, and the teen passes out.  Teenagers get this even more easily when they don’t drink enough fluids or eat regularly, adding slight dehydration and low blood sugar to the mix.  Finally, being ill with a virus or other infection slows your body’s response time to stresses like being on your feet, and out you go.

     Fainting is not an emergency.  Fainting is not a seizure. Unlike a seizing patient, the fainter will typically wake up quickly if allowed to lie flat, or at least in a chair with the head below the knees.  Having the head down helps the body get blood back to the brain and wake it up quickly.  Then keep the person down for five minutes, and then sit up and stand up slowly, in stages.  The body needs time to compensate and recover.  I have had kids come in with fainting episodes lasting on and off for fifteen minutes because bystanders stood them up too fast and tried to get them walking around.

     When do we worry about fainting episodes?  When the patient does not wake up within five minutes.  That may indicate a seizure.  Also, if the patient faints while exercising, when the legs muscles are squeezing blood out as fast as it comes in, that is a sign that the problem may be with the heart’s ability to pump.  Finally, multiple fainting episodes in a week may be because of a more serious problem.

     But for one fainting episode, don’t panic!  Lay the patient flat, and leave them there.  If they wake up in half a minute, no problem.  Keep them down, sit them up later, give them something to drink, and give them plenty of chance to rest.  Then they may have their own silly story to tell.

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