How Are Fainting Spells Evaluated?
THOMAS CHACKO: The number one
thing that you need to know
if you're having
a life-threatening
anaphylactic-like reaction
is to make sure you have
epinephrine at hand.
That is the one life-saving
emergency treatment.
So that you should make sure you
have available
and be
aware and available and able
to use.
Speed of which you get
the medicine in is probably
priority number one.
The reason why is because you
could have a food
allergic reaction
and the fatalities
occur within minutes.
So you really need to get
the medicine in you
within minutes if it's going
to be a bad one.
So that's why speed is quick.
These anaphylatic reactions,
the bad ones,
happen within minutes,
especially insect stings.
Minutes, not 30 minutes, not
hours, it can occur within five,
10 minutes, or shorter.
Epinephrine works very quickly.
It works within minutes.
You could see the reaction work
within less than five minutes,
maybe even earlier than that.
So that's why epinephrine is
the drug of choice
because it reverses things very
quickly.
Let's say you have been
an anaphylactic reaction
and you don't have treatment,
it can be just hives.
It could be swelling
or angiodema, swelling
of your lips or your tongue.
But it could be as bad as I'm
passing out hypotension, not
enough blood or oxygen
to the brain.
And then, it could be
the fatality or death.
And that's what we're-- those
are the ones that we're really
scared about.
If you have episodes of fainting, your doctor will first want a complete description of the symptoms and events surrounding these episodes. For instance, the doctor may ask:
- Do these episodes come on suddenly or gradually?
- Are you standing, sitting, or lying down when you faint?
- Do you notice any other symptoms?
- How long does the episode last?
- Do you return to normal quickly after fainting, or are you momentarily confused?
Your doctor may attempt to reproduce the symptoms by simulating the situation during which you usually have a fainting episode. For example, if you tend to faint after coughing, you may be asked to bear down forcibly, in order to see if this causes symptoms. You may have your pulse and blood pressure taken lying down and then again after quickly standing, in order to see what changes are provoked by these different positions.
This may be all the evaluation performed in an otherwise healthy child or young adult. But in some cases, your doctor may want to evaluate you further for a heart or brain problem.
The heart evaluation usually starts with an electrocardiogram (ECG), which measures the electrical activity of your heart to look for heart arrhythmias. Other tests, such as an exercise stress test, Holter monitor, or echocardiogram may be needed to rule out other cardiac causes of fainting.
If ECG and other heart tests are normal but your doctor still suspects a heart abnormality, they may order what's called a tilt-table test. A tilt-table test is often used because some people have preliminary symptoms of fainting or actually do faint from having their heads and bodies tilted to about 60 or 70 degrees. Someone may faint during the tilt, due to the rapid drop in blood pressure and/or heart rate. As soon as the person is placed on their back again, blood flow and consciousness are restored.
If your doctor suspects that your fainting is due to a seizure, they may order an electroencephalogram (EEG), which records the activity of your brain waves.
Fainting may also happen when the part of the nervous system that regulates blood pressure and heart rate malfunctions in response to a trigger, such as emotional stress or pain. This type of fainting is more common in younger people.
What Are the Treatments for Fainting?
If you are with someone who faints, there are a number of things you should do. If they are sitting, carefully support them in a bent position, with their head between their knees.
If they are lying down, position them on their back and raise their feet higher than their head. Turn their head to the side, so that their tongue does not accidentally block their breathing and so that any vomit will not cause choking. You may try reviving them by putting a cold, wet washcloth on their face or neck. If they feel cold to the touch, cover them with a blanket.
Once they regain consciousness, do not allow someone who has fainted to get up immediately. Elevate the person's feet. If they were lying down, wait several minutes before asking them to sit up. Ask them to sit for several minutes before standing. Then be prepared to support them in case they faint again when they stand.
If you suffer from episodes of fainting, the type of treatment your doctor offers will depend on the cause of your fainting spells and how often you experience them.
Infrequent non-heart related fainting may not need to be treated.
You may be given certain medications to manage the underlying problem, or if you have an irregular heartbeat you may require a pacemaker.
In certain instances, you may be asked to wear support hose that help keep your blood pressure in balance or to increase your salt intake, which increases blood volume.
