Prevent Vasovagal Syncope
Everyone hates a vasovagal episode. The front desk staff watches as a client who came in for a routine immunization hits the ground for no apparent reason. The clinician in the middle of an IUD placement hears the client’s voice trail off and in the eerie silence jumps up in time to see the client’s eyes rolling back. As scary as these episodes are for the office staff and as badly as they impact the day’s schedule, the client is the person who suffers; who, without warning, feels horribly sweaty, nauseated, feels an urgent need to go to the bathroom, and then blacks out. If we are lucky, the client is lying down and doesn’t get a blow to the head or break a bone. If you recognize the signs and symptoms of a vasovagal, you can almost always stop it and prevent loss of consciousness.
Best practice: give your clients anticipatory guidance so they can prevent their own vasovagal reactions!
Vasovagal reactions are common, scary, and preventable. Tensing the muscles of the arms, hands, feet, and legs can instantly stop a vasovagal reaction and prevent fainting.
Pathophysiology of a Vasovagal Reaction
A vasovagal reaction is a reflex—like a “knee jerk” or a Babinski reflex. It begins with pooling of blood in the extremities which decreases peripheral vascular resistance, causing a sudden drop in blood returning to the heart. This triggers a reflex bradycardia—an abnormally slow heart beat—along with a drop in blood pressure. This combination leads to reduced blood flow to the brain and syncope. If, at any point in the reflex, the drop in peripheral vascular resistance is reversed by contracting the muscles in the extremities, the reflex will stop.
1 Simple Step: Stop the Vasovagal Reaction!
Isometric contraction of the muscles of the hands, arms, hands, feet, and legs can immediately stop the vasovagal reaction in its tracks and prevent fainting. This is because, contracting the peripheral muscles pushes blood back into the center of the body which interrupts the reflex and stops it from progressing to loss of consciousness.
When your clients are about to undergo medical care that may trigger a vasovagal, give them a heads up so they have control, and if necessary they can stop the reaction themselves. For example, you can say:
“Sometimes people having this done begin to feel dizzy and they can even faint. If that happens to you it doesn’t mean anything is seriously wrong, but it can be very scary. If you start to feel lightheaded or sick to your stomach or sweaty or…. if you feel weird in any way, it’s probably a sign that you’re about to pass out. You can prevent that from happening by intensely griping the muscles in your hands, arms, feet, and legs. There is no need to move your arms or legs—just tense the muscles in place. Do you want to go ahead and practice doing that now? Yes, perfect, and now that you’re tightly tensing the muscles in your hands, arms, feet, and legs, release your belly muscles and the muscles of your bottom, and your chest.”
Know the Common Triggers
Some common events in patient care that can trigger vasovagal reactions:
• Invasive procedures like cervical or uterine biopsies or placement of an IUD
• Pap tests or other cervical swabbing
• Blood draws
• “Fainting at the sight of blood”
• Injections (immunizations)
• Watching a loved one have a procedure
• Patient's Victorian-era corset is too tight
Be Alert for Pre-Syncopal Signs or Symptoms Before a Trigger
Maintaining communication with your client before and during these types of triggering procedures can help you to notice signs or hear from the client if there are any symptoms of vasovagal.
• Lightheadedness, dizziness
• Ringing in the ears
• Blurred or reduced vision (spots, dark, grey tone, or tunnel-vision)
• Fatigue, restlessness
• Sudden sensation of feeling hot or cold
• Sudden feeling of need to urinate or defecate
• Face looks pale or green or grey
• Dilated pupils
Is Your Client a Fainter?
Vasovagal reactions occur more frequently in people who have had one before. So, you can ask your clients if they have ever fainted or passed out at the sight of blood or when having an injection or procedure. If they say “yes,” let them know that they can prevent it from happening again by contracting the muscles in the extremities as soon as they notice it starting.
It is also helpful if they:
Drink plenty of water before coming in
Eat before coming in
Cross their legs and tense the muscles in the contralateral hand and arm before a blood draw or an injection.
Be Alert for Signs of an Impending Vasovagal Response
If you haven’t talked with your client about how to prevent a vasovagal reaction beforehand, watch for signs and symptoms of a vasovagal. If someone starts to show signs or have symptoms, touch the extremity closest to you and say: “Tense these muscles very, very tightly. Grip all the muscles in your arms, hands, legs and feet. Release the muscles in your belly, your buttocks, and your chest. Keep squeezing your muscles really hard.” When you sense the client needs a break after 30 seconds or so: “OK, go ahead and relax. How do you feel?” You can continue to do this for as long as it is necessary, but often only once or twice is enough.
Debriefing with your client can help to reassure them that this is a common reaction. “You were having a reaction that is common for people having this done. If you start to feel weird again, just grip your muscles again and that will stop it.”