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Tuesday, March 21, 2023

Understanding Fainting in Austere Situations

Fainting (loss of consciousness, passing out) isn’t addressed in any of my off-grid medicine references. Perhaps it’s just so common, so basic, that the physician authors of these texts don’t think about it, like many other topics that have been posted here. However, it’s something I’ve never seen or experienced, and without a little education on the topic I might not know what to do if someone around me were to pass out.

Fainting, this short-term loss of consciousness that lasts only a few seconds to a few minutes, is caused by a sudden decrease in blood flow to the brain. When the fainting episode ends, the person wakes up and returns to normal.

The most common reasons for fainting include:Cardiac—a heart condition affects how much oxygenated blood is pumped to the brainArrhythmias
Heart attack
Pulmonary embolism
Heart failure
Carotid sinus—occurs when the carotid artery, which carries blood to the brain—becomes constricted by a tight collar, by stretching or turning the neck too much (as in shaving), or by a bone in the neck that pinches the artery. This is exactly the spot one aims to hit when trying to escape from an attacker.
Drug use/abuse
Heat stress—exercising, playing, or working too hard in the heat, leading to dehydration
Hypoglycemia—a sudden drop in blood sugars, very common in diabetics
MedicationsACE inhibitors
Calcium-channel blockers
Neurological conditions (rare)
Situational—some movements or bodily functions (peeing, pooping, coughing, sneezing, stretching, vomiting) can cause blood pressure to drop and result in fainting.
Skipping too many meals
Standing up too quicklyEspecially if the blood volume is low due to blood loss or dehydration
Also occurs in individuals with a vitamin B12 deficiency, diabetes, or another condition that affects the peripheral nerves, like Parkinson’s
Vasovagal—a stressful event (sight of blood, emotional stress, physical trauma, pain) initiates what’s known as a vasovagal reaction. The heart slows down, less oxygenated blood is pumped to the brain, blood pressure drops, and the person faints.


If someone faints, immediately check the following:Make sure the airway is clear.
Make sure s/he is breathing.
Make sure the heart is beating.
Look for signs of injury—especially to the head, or a cut that may need attention.
Ascertain the reason the person fainted, if possible, to take the most appropriate corrective measures.
Look for any medical alert jewelry that may indicate a medical condition.
Patients that may have overheated need to be cooled down and hydrated.
Patients that are hypoglycemic may need sugar (honey packets or glucose tablets are great for this).
Make sure there is plenty of circulating air—keep crowds away.

When the patient regains consciousnessMake sure s/he sits or lies down for at least 10-15 minutes. Sitting with the shoulders lowered and head between the knees is a good position.
Check for any other injuries that may warrant medical care.
Offer cold water.

Warning signs indicating the potential for fainting include:Cold and clammy or hot and sweaty
Feelings of being dizzy or lightheaded
Stress and anxiety
Slow pulse
Falling down
Vision changes (“seeing stars”, blacking out, tunnel vision)
Ringing in the ears
Loss of muscle control

Most cases of fainting are not a cause for concern. However, if fainting happens often, a physician should be seen for evaluation.


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