Fainted or Feeling Faint? When to Go to the ER

You're standing in a long queue on a hot day, or you get up too fast while fasting, and suddenly you feel hot and sweaty, everything goes blurry, and the next thing you know you're on the floor with people around you. Or maybe you just feel dizzy, as if the world is spinning. Fainting is frightening for the person it happens to and for anyone watching. The good news is that most faints are not dangerous. But a small number are the first warning of a heart or brain problem, and this guide helps you tell the two apart.

What is fainting, and why does it happen?

Fainting (doctors call it syncope) is a brief loss of consciousness that happens when blood flow to the brain drops for a moment. The person falls, and once they are flat on the ground blood returns to the brain, so they usually wake up within about 30 seconds. The most common harmless causes:

• Standing for a long time, especially somewhere crowded or hot.
• Heat, dehydration and not drinking enough.
• Severe pain, fear, strong emotion, or the sight of blood or a needle: this is a vasovagal faint.
• Getting up quickly from sitting or lying: a brief drop in blood pressure called orthostatic (postural) hypotension.
• Fasting or going a long time without eating.
• Alcohol or some medicines, including blood pressure tablets and water tablets.

A simple faint usually comes with warning signs: feeling hot or sweaty, nausea, dizziness, ringing in the ears, or vision greying out from the edges. That warning is a relatively reassuring sign, because it points to a nervous-system reflex rather than a heart problem. A faint that comes out of nowhere, with no warning at all, deserves more attention.

Intense pain and vomiting can trigger a faint too, as we explain in our guide to spicy food symptoms that need the ER.

When is fainting serious?

The key question isn't just "did I faint?" but "what was happening just before?" These are the signs that separate a simple faint from one that needs emergency care:

Call 911 for

• Someone who isn't breathing, can't be woken within a minute, or hasn't fully recovered.
• Fainting during exercise or exertion, or while lying down.
• Chest pain, or palpitations (a pounding, racing or irregular heartbeat) before or after the faint.
• New or unexplained breathlessness.
• Stroke signs: face drooping, arm or leg weakness, slurred speech, trouble speaking or moving.
• A seizure, or shaking and jerking.
• A head injury or another serious injury from the fall.
• Someone with diabetes who isn't responding normally or is unconscious.

Go to the ER now for

• Pregnancy: any faint in pregnancy needs prompt assessment.
• A known heart condition, such as heart failure, a rhythm problem or a pacemaker.
• A family history of sudden death under the age of 40, or an inherited heart condition.
• A faint with no warning at all, especially over the age of 65.
• Hitting your head, even if you seem fine afterwards, especially if you take blood thinners.

Same-day urgent care or check-up

• Your first-ever faint as an adult, even if you have recovered completely.
• Repeated faints, or dizzy spells where you nearly pass out.
• A faint in an older person.
• Someone with diabetes who fainted or had a low sugar episode, even once recovered.
• Fainting or dizziness that started after a new medicine or a dose change.

Home care is usually fine

If a doctor has already diagnosed you with simple faints, and this one happened with your usual trigger (long standing, heat, the sight of blood) and the usual warning, and you came round quickly and are completely back to normal with no injury and none of the warning signs above, rest, fluids and food are usually enough. See your doctor if the pattern changes or the faints become more frequent.

Chest pain with a faint can be a heart attack. Know the heart attack warning signs. If you have high blood pressure or take blood pressure tablets, see our guide to high blood pressure and when to go to the ER, because some blood pressure medicines can cause dizziness on standing.

What should I do if someone faints in front of me?

• Stay calm. Gently shake their shoulders and ask loudly if they are OK.
• If they don't respond, shout for help, gently tilt their head back and lift the chin, and check they are breathing by listening for at least 10 seconds.
• If they aren't breathing normally, call 911 at once and start CPR if you know how.
• If they are breathing, lay them on their back and raise their legs, which helps blood return to the brain.
• If she is pregnant, especially later in pregnancy, it's better to lay her on her side.
• If they are breathing but don't wake up or aren't fully alert, put them in the recovery position (on their side) and call 911.
• Don't give food or drink until they are fully awake and can swallow safely.
• Once they come round, keep them lying down for a few minutes, then let them sit up slowly before standing. Check whether they hurt their head or body in the fall.

If you feel you're about to faint yourself: lie down straight away and raise your legs, or sit with your head between your knees if you can't lie down. Clench your fists, or cross your legs if you're standing, and sip some water once you feel better. Falling from standing is what usually causes injuries, so get yourself to the floor before you fall.

Hitting your head as you fall can cause a concussion. See our guide to concussion and head injuries in adults for the signs that need the ER.

Dizzy, spinning or off-balance: what's the difference?

"Dizzy" means different things to different people, and describing it precisely helps the doctor a lot:

• Lightheaded or faint: as if you might pass out or fall. Often from a drop in blood pressure, dehydration, heat, low blood sugar or anxiety, and sometimes a heart problem.
• Vertigo: a feeling that you are spinning or the room is spinning around you. Usually from the inner ear, such as labyrinthitis or vertigo set off by moving your head, but it can be a sign of a stroke.
• Off-balance: unsteady on your feet without any spinning. It can come from the ear, nerves or medicines, is common in older people, and raises the risk of falls.

When is dizziness a sign of a stroke?

Sudden vertigo or dizziness with any other neurological sign needs 911 straight away: a drooping face, weakness or numbness in an arm or leg, slurred speech, double vision or sudden loss of vision, sudden trouble walking or balancing, or a sudden severe headache. Don't wait to see if it passes. Learn the stroke symptoms and the FAST test.

Dizziness that won't go away or keeps coming back, or comes with ringing in the ears or hearing loss, should be checked by a doctor, though not usually as an emergency. While you're dizzy: lie down until it passes, get up slowly, drink fluids, and don't drive, climb ladders or use machinery.

Simple faint or something more serious?

This table is a rough guide, not a substitute for an examination:

Low blood sugar in diabetes: what should you do?

Low blood sugar mostly affects people with diabetes who take insulin or certain diabetes tablets, and is rare in people without diabetes. Signs include hunger, shaking, sweating, dizziness, palpitations, tingling lips, irritability, confusion and blurred vision. If it gets severe, it can cause a seizure or loss of consciousness.

• If they are awake and can swallow safely: give fast sugar straight away, such as a small glass of juice or a regular (non-diet) fizzy drink, or glucose tablets. Check their sugar with a meter if you can.
• Once they improve, they should eat something that keeps sugar steady for longer, such as bread, biscuits or their next meal.
• If they are unconscious or can't swallow: put nothing in their mouth. Place them in the recovery position and call 911. If they have a glucagon injection and you know how to use it, give it.
• Even after recovering, a faint from low sugar deserves a same-day review of medicines and doses.

Fainting in the heat and while fasting in Jordan

During Jordan's long summer, people often faint in queues, at weddings and outdoor events, and while working in the sun. Heat widens blood vessels and sweating drains fluid, so blood pressure drops more easily, especially when you stand still for a long time. Drink regularly, find shade, and don't stand for hours without moving.

But be careful: fainting or confusion in the heat may not be a simple faint but heatstroke, which is an emergency. If someone is very hot and confused or doesn't come round quickly, call 911 and start cooling them. Know the heatstroke warning signs in Amman.

In Ramadan, especially when it falls in hot weather, dehydration and low sugar come together, so dizziness on standing up quickly and in the hours before iftar is common. If you feel faint while fasting, sit or lie down straight away. If you don't recover quickly, have diabetes, or actually faint, your health comes first. If you have diabetes or a heart condition, or take blood pressure tablets or water tablets, talk to your doctor before Ramadan about whether fasting is safe for you and how to adjust your medicines. Between iftar and suhoor, spread your fluids out rather than drinking a lot at once.

Urgent care or the ER? What happens when you arrive

If you came round quickly, are completely back to normal and have no warning signs, urgent care sees walk-ins around the clock to look for the cause. With chest pain, palpitations or breathlessness, a faint during exercise or lying down, a head injury, pregnancy or a heart condition, go straight to the emergency department, or call 911, and don't drive yourself.

The doctor starts with questions: what you were doing, whether you had any warning, how long you were out, what people around you saw, your medicines and your family history. Then comes an examination, including your pulse and blood pressure, sometimes measured lying down and then standing, a check of your heart and nervous system, and a look for any injuries. The doctor may order blood tests in the on-site laboratory, for example for sugar, anaemia and salts. UK guidance (NICE) recommends a heart tracing (ECG) for everyone who has blacked out; if you need a test or treatment that isn't available on site, the team will tell you where to go.

Sources

• NHS — Fainting
• NHS — Dizziness
• NICE — Transient Loss of Consciousness ("Blackouts") in Over 16s (CG109)
• NHS — Low Blood Sugar (Hypoglycaemia)
• MedlinePlus — Fainting (Syncope)