Passing Out: By “passing out” I don’t mean leaving the theater, but instead I mean losing consciousness. The fancy name for this is SYNCOPE. Lay people call it fainting. Doctors call it Vasovagal Syncope, a scenario in which a noxious stimulus, such as the sight of blood, seeing or hearing of a tragic event, or severe pain reflexly overstimulates parts of the nervous system causing a sudden drop in blood pressure and slowing of the heart rate. This results in a shock-like state in which the patient becomes pale, sweaty, lightheaded, sometimes nauseous, and loses consciousness. It’s a scary situation, and it happens all the time. Especially in anxiety-producing situations such as weddings, funerals, church services, or military inspections. I’ve had experience in all those places plus in my office. Not a week went by when someone who had blood drawn, got an injection or had severe pain had a “vagal” spell. We prepared for it. The nurses knew to expect it and asked patients if they were prone to passing out. We kept ammonia ampoules in each room to use if someone was showing signs. Young, old, male, female, it made no difference. It could happen to anyone.
By far the two worst “vagal” spells that occurred were:
- The 60-year-old woman who had blood drawn said she felt ok, checked out at the reception desk, then passed out as she was getting into her car.
- The 22-year-old young man who had vaccinations for the school said he felt ok, and while checking out at the desk, passed out, falling backward striking his head and neck on the bathroom door. I thought there had been an explosion. So did the man sitting on the commode. The impact broke the door off the hinges. WOW! Fortunately, x-rays and a CT scan were negative, and he recovered nicely.
Other interesting scenarios I encountered were:
- The patient who was so prone to syncope we always laid him down to draw his blood.
- The man who passed out in the risers at our church, two rows from the top, during the sermon, who EMT’s carried out of the auditorium on a gurney. I thought he was dying.
- The doctor’s son who passed out cold during his wedding ceremony and despite responding to arousing stimuli passed out a second time, could not stand, and postponed the service.
- My son’s father-in-law’s had a kidney transplant three weeks prior to passing out in church. At least five doctors in his congregation responded. He was severely shocked and was hospitalized for two days.
- One of the bridesmaids during the recessional of a wedding passed out walking up the aisle, blocking the bride and groom from making their exit.
Dr. G’s Opinion: Syncope, vasovagal type, is frightening for lay and medical people alike. One has to make a quick assessment and decision as to whether the patient needs CPR or an ammonia ampoule (smelling salts). Did they faint or is this impending sudden death? Taking into consideration the scenario in which the event occurs helps one decide. Lie the patient down, loosen their clothing, check vital signs, and administer ammonia under the nose. Then watch and wait. They can come around quickly (minutes) or slowly (an hour or more). Treat it as a serious problem and be certain they don’t have an underlying undetected condition. Doctors are expected to have a sixth sense about such situations. If they do have it, it’s acquired because of repeated exposure. There are plenty of opportunities that pop up wherever one goes. I used to carry an ammonia ampoule with me to weddings and funerals because it was occasionally needed. Just like people allergic to bee stings carry an Epi-Pen, you must be prepared.
