Deborah Howell (Host): Well, we've all probably done it at least once in our lives, so let's talk about fainting. What happens when someone faints, and how should we respond? Dr. Garrett Luettgen , Luettgen an Emergency Medicine Physician at Pullman Regional Hospital's Emergency Department, is with us today, and he's here to break down what happens when someone faints, what you should do to help, and when to seek medical attention.

Welcome, Dr. Luettgen.

Garrett Luettgen, MD: Thank you so much for having me. I'm happy to be here.

Host: Pleasure is all ours. So what really happens when someone faints?

Garrett Luettgen, MD: That's a very excellent question. What they experience is a temporary loss of consciousness that is caused by insufficient oxygen delivery to the brain, which most often results in a loss of their postural tone, where they would go from typically a standing position to either a sitting or lying on the ground position.

This most commonly occurs from what's called a vasovagal response, where the part of the nervous system that regulates blood pressure and heart rate, malfunctions in response to some kind of a trigger, whether that's pain, emotional stress, or some type of environmental trigger. In terms of fainting, or what we typically refer to in the medical community as syncope, which is the loss of consciousness, the overall broad categories of that would be vasovagal, which is the most common, but it can also include both cardiac, and neurologic causes, as well as something like postural hypotension, where you experience a sudden severe loss of blood pressure when you go from a sitting to standing position.

And then there are also some situational episodes, that can contribute to it as well.

Host: That's interesting, we're a very tall family and my father was also an emergency medical physician and he said, you know, don't stand up too fast because we're tall and you know, you're going to see those stars.

Garrett Luettgen, MD: Yeah, and in terms of seeing the stars that you mentioned, oftentimes these episodes can be preceded by numerous amount of symptoms, including dizziness, blurred vision, feeling weak, looking pale, having rapid breathing, or sometimes nausea. You can also include things like headache, feeling unsteady, or seeing those spots in your vision that you talked about. And other concerning symptoms can also include things like chest pain or shortness of breath.

Host: Got it. are there any conditions or health issues that increase the likelihood or frequency of someone fainting?

Garrett Luettgen, MD: Yes, there are I would say numerous medical conditions that can contribute. Diabetes would be one. What's known as ischemic heart disease or heart disease that is related to disease of the coronary arteries is another. Disease of the heart valves, whether that tends to have the valves become too sticky, or difficult to pump blood through, or whether the valves become leaky over time can put you at risk. And certainly diseases of heart rhythms where people either experience very fast heart rates or very low heart rates, both which can contribute to that lack of blood flow to the brain.

Older patients do tend to be on multiple medications and oftentimes either the medications themselves can contribute to these episodes or the interactions of these medications can contribute to these episodes as well. And then one other one that I did want to mention that's become a little bit more common recently, especially in the setting of long COVID, would be postural orthostatic tachycardia syndrome, or POTS syndrome is another one that can contribute.

Host: Okay. And how long does a fainting episode normally last?

Garrett Luettgen, MD: It certainly can vary in all conditions and episodes. What the most common timing of it that people would experience would be something along the lines of seconds to under a minute. Now when somebody is minimally conscious and not responding appropriately, those seconds can certainly seem more like an eternity.

But they often do last less than one minute and anything lasting greater than one minute, I would say would be something that would be a little bit more of something to be concerned about, and a little bit more atypical.

Host: Sure. A lot of people really, really hate needles and they go to the doctor and they see the needle and they, they faint.

Garrett Luettgen, MD: Yep. That's a very common one. And, and that, would kind of fall into the category of what we call situational syncope, or episodes of fainting that are brought on by either, triggers or stresses, or some kind of a provocated event where something going on around you contributes to that one. But that is one that is very common for people to experience.

Host: Now, do you need to seek medical attention after fainting and do you need to go to the emergency room?

Garrett Luettgen, MD: Another excellent question and the answer, of course, as a lot of things are, is that it really depends. Those situations you talked about where people faint after they either see a needle or see blood, those tend to be much more benign and are not necessarily reasons that people need to seek immediate medical attention.

Those episodes typically are kind of self limited, and patients who experience those types of episodes often go on to have multiple episodes. And so if people have had similar episodes previously, and it seemed to be kind of brought about in the same sort of circumstance, that wouldn't necessarily be a reason that somebody would need to seek immediate medical attention.

When we think about reasons to come, you know, see me in the emergency department or to seek some sort of medical attention, that's when we would think about something like that prolonged loss of consciousness that I mentioned. Older patients especially tend to be at higher risk for having some of the more serious and concerning causes of their episode of fainting.

Anything that is exertional or exercise related, especially when you think about some of like the younger athletes who in the middle of some sort of athletic event have a sudden and very unprovoked episode of passing out, that would absolutely be a reason to seek medical attention. And typically what I tell people is that anything that's preceded by some sort of irregularity of your heart or palpitations or the feeling of your heart beating irregularly to you would be something that I would recommend.

And then one other broad category to think of is that anybody with a family history of either recurrent episodes of passing out or sudden unexplained deaths at young ages would definitely be a reason to get checked out.

Host: And what about dehydration?

Garrett Luettgen, MD: That absolutely is a very common cause and something that is kind of a little bit of an individual process. But if you feel like you are dehydrated and you've kind of felt lightheaded and weak prior to the episode, the immediate recommendation would be to try to get some fluids on board and see if that improves how you're feeling.

Host: And perhaps electrolytes?

Garrett Luettgen, MD: Electrolytes would also be another excellent thing. And that's something that again is a little bit individualized, to each person. But if you are feeling lightheaded and weak, getting some fluids with some electrolyte containing material is always indicated.

Host: Okay, great. Now, Dr. Luettgen, if you're with someone and they do faint, what actions should you take?

Garrett Luettgen, MD: The first thing would be to try to identify that somebody may faint or pass out. If you're with somebody and they're starting to complain of feeling faint or lightheaded, I would try to help them to the ground as much as you possibly can, if you're able to do that. The goal there is to try to limit any additional injuries that may occur in that same circumstance.

So try to help them to the ground, and if you can, try to get them to lie flat on their back, if they're physically able to do that. Once you've done that, if you're able to prop their feet up about a foot above the level of their heart, that may help some blood from the legs kind of passively return to the heart and might help their blood pressure get a little bit better. Once they're feeling improved, if you can get them to sit up and then place their head between their knees and keep them in that seated position, if they're awake and talking for about 10 to 15 minutes, and if they're able to drink fluids and they're not vomiting, go ahead and offer them something to drink.

And that's where those electrolytes that you mentioned, can come into play, try to get some electrolytes in at that point. If there's anything concerning about it, either they have the concerning symptoms that we talked about, or if they're have a prolonged loss of consciousness or not breathing, then absolutely that's the time when you need to call 911 and get EMS involved.

Host: So once again, just to recap, elevate the feet, not the head. And then get them to sit up and put their head between their knees, if possible.

Garrett Luettgen, MD: After a period of time when you've had their legs elevated above their heart and they're starting to feel improved.

Host: You know, when I was little and we went skiing, invariably at the top of the mountain, and I was about six years old, I looked like I was going to faint. And my parents always rushed to get me a donut. Good idea or not so much? Are there better ways to prevent fainting?

Garrett Luettgen, MD: I think that's an excellent idea from a child's perspective if you happen to like donuts.

Host: Yeah, definitely.

Garrett Luettgen, MD: That's, that's certainly one option and donuts may be a good option for patients with diabetes, who may be suffering from a low blood sugar episode. Those simple carbohydrates and simple sugars can raise your blood sugar fairly quickly, and are fairly easy to digest.

Other ways that you can try to prevent fainting, as you mentioned, the hydration, dehydration is very common, so trying to stay well hydrated. Some people may want to eat more small frequent meals, and then everybody should review their nutrition to try to ensure that they're taking in the right amount of sodium, potassium, and magnesium.

Reviewing medications with your prescriber and understanding if they put you at risk for these episodes is also important. And then people with the recurrent episodes of it, they should kind of be aware of the triggers that may contribute to this and try to modify them if they're able to.

Host: Right. Back to the donut, is there a better something? I mean, a lot of times people bring orange juice to the person. What would you, as a physician, suggest?

Garrett Luettgen, MD: It a little bit depends on the circumstances of it. Orange juice is an excellent option in patients with diabetes. Any fluid to somebody that's dehydrated, whether that's pure water or something like Gatorade or Pedialyte, all of those would be acceptable options as well. But the low blood sugar specific to the patients with diabetes; the orange juice would be an excellent option, or even something as simple as cake frosting, which would be about the quickest way that they could immediately raise their

blood sugar.

Host: All right, I want to make sure that I understand. You spoke to this earlier. I want to know the difference between syncope and fainting.

Garrett Luettgen, MD: There's not necessarily a definitive difference between the two. Fainting is typically the term that is used more by lay people to talk about episodes of this occurrence, whereas syncope is the medical term that we apply to it. Fainting has been a common phenomenon for centuries, and over hundreds of years in the medical literature, they referred to it by the Latin term of lipothymia, which means to leave the mind.

But I think that syncope and fainting, can be thought of as kind of equivalent terms, one used more medically and one used more by lay people.

Host: Okay. Got it. Anything else you'd like to add to our conversation?

Garrett Luettgen, MD: This is not necessarily just specific to syncope, but I always encourage everybody to learn and know how to do CPR. If you see somebody who goes into cardiac arrest, performing immediate bystander CPR is the best thing you can do to help try to improve that person's chance of survival. According to the American Heart Association, you can even double or triple their likelihood of survival by starting early bystander CPR.

And both the American Heart Association and the Red Cross have excellent resources from something as full as a bystander CPR course, or even a 90 second hands only option for CPR, where some people are a little bit leery about doing mouth to mouth breathing, but doing the hands only CPR is a perfectly acceptable form of bystander CPR, and I would encourage everybody to understand how to do that properly.

Host: Solid point and critical information. Dr. Luettgen, thank you so much for being on the podcast today to bring us up to speed on what to do when it comes to fainting. We appreciate it.

Garrett Luettgen, MD: You're very welcome. It was a pleasure to be here.

Host: And you can learn more about this subject, providers, and services at PullmanRegional.org for more information about emergency medicine services.

This has been the Health Podcast from Pullman Regional. I'm your host, Deborah Howell. Thanks for listening and have yourself a terrific day.