Interviewer: What should you do if somebody faints? We'll examine that next on The Scope.
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Interviewer: All right. Here's the situation. You're in a social situation, maybe you're at home, maybe you're out and about, and somebody faints, like the traditional they're standing and the next minute they're down on the ground. What should you do? Dr. Troy Madsen is an emergency room physician at University of Utah Health. What should I do?
Dr. Madsen: Well, that's a great question, because fainting can be a really scary thing when you see it happen, and I'm speaking from personal experience here, not just as a physician. But, you know, it wasn't too long ago I was traveling with my wife. We were out eating lunch, and she looked over at me and my face just went blank. The next thing she knows my face falls down, I fall forward, knocked my water over. I'm lying on the table, and she's calling for help. She didn't know what had happened. This is me.
Interviewer: You were the fainter.
Dr. Madsen: I was the fainter.
Interviewer: Wow.
Dr. Madsen: Exactly.
Interviewer: Did you feel it coming on?
Dr. Madsen: I did. I felt it coming on, but then it just came on, and then after that I didn't remember anything. So she lifts me up off the table, and then she says my arm just went up like a bird and started shaking. She thought I was having a seizure. It was pretty dramatic. Finally, they got help there. They called 911, you know, all this drama that I really did not want to have happen. They ended up sending me to the ER, which I absolutely did not want to go to because I work in an ER. Everything checked out fine.
But it's one of these things where, when you see it happen, it's a pretty dramatic thing. I think the best thing you can do obviously is stay calm. It was great she wanted to lift me up, because she said my face was down in the water on the table. But the reason I started shaking like that is if you lift someone up when they've had, say they fainted, the blood is rushed out of their head, that decreases the blood flow to their head, and then they can have what looks like a seizure, which is what I did.
So the best thing you can really do is just help the person to lie down, get them comfortable. They're usually going to come to within about 30 seconds, and then they're not going to know exactly what happened. Typically, then it's going to take some time, maybe the next 30 minutes before they can really get up and start walking around, because they're typically pretty weak at that point. But it tends to be very dramatic like that was, but generally it's not a sign of anything really serious.
Interviewer: Really? That shocks me a little bit.
Dr. Madsen: Yeah. I know it's a little surprising, but you'd be surprised at how often we see people in the ER who have fainted. And if the person is a younger person who's otherwise healthy, typically we'll get an EKG just to make sure their heart is okay. Maybe blood work, but that's usually not necessary. In females, we always just make sure they're not pregnant. Certainly, if you're pregnant and you have issues with that, that could cause you to pass out. And 99.9% of the time everything is absolutely fine, and we just don't find anything wrong.
You can have what's called vasovagal syncope, syncope meaning passing out. Vasovagal just means that your blood vessels dilate. A lot of things can cause that to happen. If you stand up too quickly, decreases the blood flow to your brain. You pass out. It's your body's response to get you flat and get the blood flow back to your brain.
Interviewer: I'm going to push on this.
Dr. Madsen: Okay.
Interviewer: To me, as the average person, I'm like but something had to cause it that can't be right. Something had to have malfunctioned that should be working better than that.
Dr. Madsen: And that's what we think. I mean, you know, in my mind too there was the side of me that's just the emotional aspect like, "Wow, this was crazy. This really, really scares me." But then there's the rational aspect at that time when I passed out, I'm just saying to myself, "Hey, odds are nothing is wrong."
And I think back that day I hadn't been drinking fluids like I should. I'd been a lot of time on my feet. Actually, we were in Washington, D.C., at the Holocaust Museum, very emotional kind of response. So all of those sorts of things can then contribute to cause that response in the blood vessels where they dilate. That blood flow decreases to the brain, and then that's what causes you to pass out.
Interviewer: So it sounds like that we kind of know generally what causes it, but how that comes about we don't really know?
Dr. Madsen: Well, like I said, I mean it could be a combination of things. It's really a response often to, again, maybe there's a dehydration component, maybe there's an anxiety component.
Interviewer: You're saying a lot of maybes. It sounds like for any individual it could be a lot of different components.
Dr. Madsen: It could.
Interviewer: And we really don't have a lot of predictors?
Dr. Madsen: Yeah. That's true. We don't have a lot of predictors. Sometimes we see people in the ER who have multiple episodes, where they pass out lots of times, and they've had multiple tests done and they just can't figure out exactly what's causing this. So they're prescribed salt tablets, things like that to try and keep fluids in their vessels. You know, prescribing lots of fluid intake, things like that.
And I should qualify this too by saying that if you're someone who's older, who has other medical problems like heart failure, or if you had strokes, any kidney problems, things like that, then we probably need to do more testing. And those are the cases where I do get more concern, say someone who's 65 who's had heart problems, we're going to do a lot more tests. We're going to keep him in the ER, probably overnight in the hospital, do an ultrasound of their heart, looking for other possible causes.
Interviewer: But otherwise, healthy individuals, 99.9% of the time it's not.
Dr. Madsen: That's exactly right.
Interviewer: No real reason to go to the ER?
Dr. Madsen: Yeah.
Interviewer: Okay.
Dr. Madsen: And if I had to say, you know, it's 99.9%, one of a thousand cases maybe I've seen someone comes in and then we find something on their EKG, or we see some sort of crazy heart rhythm that they go into, and it's like, "Wow, there's our answer." But the large majority of the time, these things happen and we don't find anything really wrong.
Interviewer: So all in all, fainting not as dramatic as one would think.
Dr. Madsen: That's right. It tends to be very dramatic, like I said, like my experience was a whole lot more drama than I had ever wanted on that trip, but usually things turn out fine.
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