Fainting  
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Definition
  • Fainting (passing out) is when a person loses consciousness for a short amount of time. Usually the person falls to the ground or slumps over
  • Awakens in less than 1 minute.

General

  • Fainting (syncope) is a brief loss of consciousness due to a temporary decrease in blood flow to the brain.
  • There are serious and non-serious causes of syncope.

Findings Suggestive of Serious Cause for Fainting

  • Age over 50 years
  • Known cardiac disease
  • Presence of head or face injury
  • Persisting decreased level of alertness after fainting
  • Fainting occurs during exercise
  • Other symptoms are present: chest pain, difficulty breathing, palpitations, severe headache, internal bleeding

Simple Faints

  • Introduction: Simple faints can occur in healthy individuals due to stress, pain, prolonged standing, or suddenly standing up. It is the most common reason for syncope; perhaps 80% of all fainting occurs in this manner. It is also called vasovagal or vasomotor syncope.
  • Warning Signs (pre-syncope): There are a number of warning signs that occur immediately before a simple faint. These include pallor, dizziness (lightheadedness), feeling cold or warm, blurred vision, nausea or vague stomach discomfort, sweating, feeling cold. These warning symptoms last for 5 to 10 seconds before passing out occurs. Fainting can sometimes be prevented by sitting down, or even better lying down.
  • Symptoms: A brief period of warning symptoms (e.g., dizziness, nausea), followed by unconsciousness, with return to full awareness usually in less than 1 minute; afterwards feeling normal.
  • Expected Course: There is often a feeling of tiredness or mild malaise (e.g, being "washed out") for a period of time after a vasovagal fainting episode.
  • Predisposing Factors: mild dehydration, fasting, hot weather, sleep-deprived, recent illness, pregnancy, change in altitude.
  • Causes: Listed below.

Simple Faints - Causes

  • Prolonged standing in one position prior to fainting (called orthostatic syncope): This is a common cause of simple faints. It commonly occurs at church, graduations, weddings, school assemblies, parades, etc. It is more common if one keeps one's knees “locked” – due to pooling of blood in the legs. Anyone who stands long enough in one position will eventually faint.
  • Standing up suddenly (especially after lying down) prior to fainting (called orthostatic syncope): Usually this just causes brief dizziness.
  • Sudden fearful or disgusting event (emotional pain) prior to fainting (called vasovagal syncope): Examples are any kind of "blood and guts" scenario such as seeing someone vomit, bleed or pass a stool.  Seeing a badly injured person or pet can precipitate syncope.  It can also occur prior to an injection or public performance (e.g., a speech or musical recital).
  • Sudden physical pain prior to fainting (called vasovagal syncope). Examples are receiving an injection (e.g., post immunization syncope), having a sliver or sutures removed, or blood draw for lab tests. The stress of the experience probably has more to do with the syncope than the pain itself.
First Aid:

FIRST AID Advice for Fainting: Lie down with the feet elevated.

When to Call Your Doctor

Call 911 Now (you may need an ambulance) If
  • Still unconscious after 1 minute has passed
  • Difficult to awaken or acting confused
  • Very weak (can't stand)
  • Chest pain
  • Difficulty breathing
  • Lips or face are blue
  • Heart is beating irregularly or very fast (i.e., palpitations)
  • Heart is beating too slowly (i.e., less than 60 beats per minute)
  • Any bleeding (including vomiting blood, blood in stool, or vaginal bleeding)
  • Black bowel movements
  • History of heart problems or congestive heart failure
  • Pregnant or possibly pregnant
  • Any head or face injury
  • Occurred during exercise
Call Your Doctor Now (night or day) If
  • You feel weak or very sick
  • Fainted over 10 minutes ago and still feels weak or dizzy
  • Fainted over 10 minutes ago and still looks pale (pale skin, pallor)
  • Fainted twice in one day
  • Age greater than 50 years
  • Signs of dehydration (e.g., no urine in more than 12 hours, very dry mouth, lightheaded, etc.)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
  • All other individuals who faint and who now feel completely fine (except individuals with known "Simple Faint")
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Simple faint has occurred more than 2 times
Self Care at Home If
  • Simple faint due to stress, pain, prolonged standing, or suddenly standing up and you now feel completely fine, and you don't think you need to be seen
HOME CARE ADVICE FOR SIMPLE FAINT

General Care Advice
  1. Treatment:
    • Lie down with feet elevated for 10 minutes. Reason: simple fainting is due to temporarily decreased blood flow to the brain.
    • Drink some fruit juice, especially if you have missed a meal or have not eaten in over 6 hours.
  2. Expected Course: Most adults with a simple faint are back to normal after lying down for 10 minutes.
  3. Warning Symptoms for Fainting:
    • Fainting usually has early warning symptoms (e.g., dizziness, blurred vision, nausea, feeling cold or warm).
    • If you feel these warning symptoms, immediately lie down to prevent falling down. You only have 5 seconds to act. (Rationale: Almost impossible to faint when laying down).
    • Lying down (even on the floor) is less embarrassing than fainting, no matter where you are.
    • Sitting down (with head between knees) is certainly better than staying standing up, but is less effective than lying down.
  4. Pregnancy test, when in doubt:
    • If there is any possibility of pregnancy, obtain and use a urine pregnancy test from the local drug store.
    • Follow the instructions included in the package.
  5. Call Your Doctor If:
    • You pass out again on the same day
    • You are pregnant
    • You become worse
Simple Faint from Standing Up Suddenly
  1. Reassurance:
    • Standing up suddenly after lying down can cause temporary dizziness in anyone. If you don't sit back down when this happens, fainting can sometimes occur.
    • It is caused by temporary blood pooling in the legs and not enough blood getting to the brain.
    • It is usually not serious and it is preventable.
  2. Prevention:
    • Most fainting can be prevented.
    • When getting out of bed, sit on the edge for a few minutes before standing. If you feel dizzy, sit or lie down.
    • Water and salt are key: If you have this tendency, drink extra fluids every day. Also, add some mildy salty foods (saltine crackers, soup) to your diet.
Simple Faint from Prolonged Standing
  1. Reassurance:
    • Standing for too long in one position is a common cause of fainting.
    • It is caused by temporary blood pooling in the legs and not enough blood getting to the brain.
    • It is usually not serious and it is preventable.
  2. Prevention:
    • If prolonged standing is required, repeatedly contract and relax the leg muscles. This will pump the blood back to the heart.
    • Try to avoid standing in one place for too long with your knees locked.
    • Water and salt are key: If you have this tendency, drink extra fluids every day. Also, add some mildy salty foods (saltine crackers, soup) to your diet.
Simple Faint from Fear - Stress - Pain
  1. Reassurance:
    • Some people faint if they experience a painful, frightening, or emotional event. Examples include getting a shot, having a bloody wound, or seeing someone else bleed.
    • For some people this is a normal reaction to stress and shouldn't cause any lasting effects.
    • It is caused by temporary blood pooling in the legs and not enough blood getting to the brain.
    • It is usually not serious and it is preventable.
  2. Prevention:
    • Preventing fainting from stressful events is not always possible. However, here are some important tips that may help.
    • If you know you are at risk for fainting under certain circumstances (such as a shot in the doctor's office), lie down in advance.
    • Try thinking about something else. Visualize yourself on the beach or with a friend.
    • You can also learn relaxation exercises (relaxing every muscle in the body).

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 10/11/2011

Last Revised: 10/11/2011

Content Set: Adult HouseCalls Symptom Checker

Copyright 2000-2012. Self Care Decisions LLC; LMS, Inc.