Have you ever felt faint, or actually fainted. I have! Without too much detail (TMI!), I fainted once back in med school, my glasses cut my eyebrow, ER visit to stitch me up, told a professor of anatomy (never consult a guy who treats only cadavers!) who told me to see a cardiologist, who almost laughed me out of his office. Embarrassing!
Today, after exercise, or in the am getting up too quickly, I can still nearly faint. Low blood pressure! In a normal person, a good thing. In others, not so much. So how can you and I prevent actually fainting?
- If possible, lie back down
- If seated, bend over and put your head down
- Do NOT hold your breath.
- If unable to sit or lie down, squat! BP will rise 10 points. Great for a dirty floor, street, or elevator.
- If unable to squat, try tightly squeezing your hands, especially if driving or on a walker. BP rises 10 points with handgrip. You can combine these. And stop the car!
One day, I.W. came in for an emergency room followup. He had been having lunch with a friend, then felt nauseous, and fainted right into his lunch! A true faceplant! His friend called for help, but they were literally next door to More Expensive Hospital on “Pill Hill” in Seattle, so off to the ER. Blood work, urinalysis, EKG, oxygen, IV fluids, and he was told it was because he was dehydrated and should drink more water.
His labs showed a normal BUN and normal urine with normal concentration: Therefore, he was NOT dehydrated, was misdiagnosed, did not need the IV fluid. Why? ERs! Treat first, do everything, then come up with a coding and billing rationale for what you already did. What was his actual diagnosis? Vasovagal syncope: foreign language for this: The gut is innervated by the vagus nerve from mouth to rear end. His nausea, a vagus nerve mediated symptom, depressed his autonomic nervous system and dropped his blood pressure. Had he known the above tricks, he could have put his head down between his knees or laid on the floor of the restaurant, and most likely not have fainted, saving the system a few thousand dollars, an ER visit, a PCP office visit, and a lot of anxiety and confusion.
Don’t faint! Memorize how not to!