Anecdotally Speaking

A patient passed out in my lab in the office the other day. This happens frequently. A reflex can be triggered in most people in the right circumstances called the vaso-vagal reflex. Pain and fear are common triggers, as are emotional stimuli, and getting blood tests taken in the doctors office, on top of feeling ill, is all it takes in many cases.

The vaso-vagal reflex includes a slowing of the heart rate, a dropping of the blood pressure, a feeling of nausea and lightheadedness. The victim will appear pale, break out in a cold sweat, and if they do not lie down, they will loose consciousness. This would be the famous "swoon" or fainting. The loss of consciousness is very brief as long as the person is allowed to lay flat. Laying flat allows blood to flow to the brain and the episode then resolves.

I happen by the lab as my patient was getting the last tube of blood filled. I cracked a little joke to ease the tension a bit and noticed he was loosing his focus. In fact, he was beginning to get a blank stare. Was the joke that bad? No, this was very definitely a blank stare moving into a rolling of the eyes kind of thing. As I called him by his name, I noticed he did indeed look very pale. When he did not answer me, I was certain he was checking out on us.

For many people their first reaction when this is coming on is to get someone up and move them to a room where they can lie down and recover. The patient says, "Oooo, I feel sick!" Then the nurse says, "Come on then, let's get you up and move you over to this room over here so you can lay down." But what happens then is that the patients tend to pass out while they are standing up instead of while they are sitting down. This is not good because it is hard to catch people when they are crashing to the ground from a standing position. Moreover, their heads are then traveling at a higher velocity when they encounter the ground and more damage to the head can occur. We want to avoid this unpleasant outcome.

So, for the sake of the gourd, this is what we do, as undignified as it may seem. "Oooo, I feel sick!" "Come on then, let's have you just slide down off of this chair and lay on the floor for a while." So, that is what we did with my patient. He is a big guy. But with four of us we very carefully and skillfully slide him onto the floor, laid him out, gently placed a pillow under his head, and when he started coming around his first words were, "How did I get down here?"

I am telling this story because I was tickled to death at how this all worked out. You see, we recently moved in to a new clinic that we designed for ourselves from scratch. In the "old" clinic, this patient would now be sprawled out in the middle of the entire lab, which was too small anyway. All operations would have ceased, people would be stepping over him, it was even more embarrassing because he would be out in the middle of everything.

So, I designed the "new" blood draw area with this particular problem in mind. In my minds eye I had imagined how a patient would be handled if they passed out, how we would lay them down, make them comfortable, how we would have plenty of space for what we needed. And it would be relatively discreet. And here it was in real life working out just as I imagined it would. It was great.

The patient recovered fine. He had a glass of water and rested a little while. Then went home. Hopefully that experience will never happen to him again. Next time we need blood from him we will do it with him lying down on a table. No chances.

Just outside the door opening into the blood draw area of the lab are a few chairs for patients to wait their turn to have their blood tests taken. I noticed another one of my patients had been waiting quietly while this passing out thing was going on. When it was all over and it was his turn, I sat down next to him, put my hand on his shoulder and said, "OK, now it's your turn." He looked at me with what I was sure was second thoughts.