SUDDEN COLLAPSE - Full extract
As I was leaving for work one morning I got a frantic call from Mr. Petrovic. His wife had been sick all night with vomiting and diarrhoea and had now collapsed.
She had not complained of chest pain or breathlessness. Mr. Petrovic just heard a crash and found her on the bathroom floor. Within a minute or two she was speaking normally and, aside from a sore forehead, she was apparently okay. I offered to call over straight away.
By the time I arrived, Mrs. Petrovic had come round completely but was still lying under a blanket on the bathroom floor. Her blood pressure was 100/70, much lower than normal. She takes medication for high blood pressure and her usual reading is around 140/90.
She remembered getting up quickly to go to the toilet and then starting to feel woozy as she walked down the hall. By the time she reached the bathroom her vision had gone all blurry. That was all she could recall until she saw her husband leaning over, trying to talk to her.
Aside from the lowish blood pressure and a minor bruise on her forehead, everything else seemed normal. I assumed that she had a fainting turn related to her gastro illness, getting up too quickly and being on medication. She was advised to rest in bed and take particular care when getting up to go to the toilet. Her gastro symptoms cleared and she was feeling much better by the following day.
There is no symptom more dramatic than falling to the ground unconscious. A sudden collapse usually sends bystanders into a blind panic, mainly because most people have no idea what to do.
As a GP I regularly see people who have collapsed. They fall down anywhere. It might be at the surgery, in their home, in the street or at the supermarket. Sometimes it occurs after a heart attack or a stroke, but more often it is due to a simple fainting turn.
Fainting turns are very common. They can occur after a fright or seeing something gruesome, for instance watching your child have stitches. Having a hot shower after vigorous exercise, standing in a hot stuffy room or getting up too quickly out of bed can all cause fainting episodes. Being on blood pressure medication can also make them more likely.
Whatever the cause, it's the same basic mechanism...a fall in blood pressure occurs, not enough blood goes up to the brain, the person starts to feel a bit woozy and then hits the deck...the body's sure-fire way of correcting things. The blood flow to the brain then improves and the person usually comes around wondering what happened. The preceding feeling of faintness and nausea strongly suggests a simple fainting turn.
When someone does feel faint, the best thing to do is lay the person down. This is the time to check the person's breathing and pulse. If the person does not come around straight away, it is best to call an ambulance.
Cardiac arrest If the person is unconscious and there is no pulse to feel, no breathing, or both, you are dealing with a medical emergency. This may occur in association with a heart attack. An ambulance should be called immediately and CPR (cardiopulmonary resuscitation) commenced.
It is not possible to learn CPR by reading a book. It is better to do a St. John's Ambulance first-aid course and be prepared; you never know when this skill will be required. The basics of CPR are ABC: A for airway ( check that there are no dentures or foreign matter blocking the airway at the back of the throat), B for breathing ( mouth to mouth breathing while tilting the jaw forward and pinching the person's nostrils), and C for circulation ( external cardiac massage). CPR must be maintained until the ambulance officers or medical staff take over.
Stroke Most strokes are associated with paralysis down one side of the body, speech difficulties or both. However, some strokes cause sudden collapse with loss of consciousness. Frequently the pulse and breathing appear normal. The person should be laid down on his or her side, the airway checked and an ambulance called immediately.
Epilepsy With some forms of epilepsy the person may fall to the ground and lose consciousness, with or without jerking movements. Move hard objects away to avoid injuries, and avoid putting anything in the person's mouth. If the seizure lasts longer than a few minutes, call for an ambulance. With some seizures there can be breathing problems and oxygen may be required.
There are numerous other causes of sudden collapse, for instance irregularities of heart rhythm, drug and alcohol overdoses, low blood sugar in a person with diabetes, trauma to the head, and some very severe infections.
* Everyone should have a basic idea of what to do if someone suddenly collapses. Find out more by enrolling in a first-aid course.
Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia. Disclaimer
- Last modified: December 11, 2004