Introduction
An anxious husband faints at the sight of his wife in labour, a man falls unconscious when his love interest injures herself, and medical students have been known to pass out in the midst of surgeries. We have all witnessed these scenes in movies or heard about them from friends and relatives. Some of us may have even experienced them firsthand.
Blood fear, often known as "haemophobia”, is a commonplace phenomenon that can affect anyone—even a medical student. But what is it exactly about haemophobia that causes a young medical student to lose consciousness and collapse during their first surgery rotation?
Preceding symptoms
If you were exposed to a scene where blood was involved, you might need to be on the lookout for some warning signs, often referred to as a prodrome. These symptoms suggest that you are likely about to experience a fainting attack.
You initially begin to feel dizzy and lightheaded. You may also experience a rapid rush of heat along with sudden, profuse sweating.
One of the most terrifying experiences is having what is known as “tunnel-like vision”, in which your field of vision narrows and you can only see what is directly in front of you. Some people may otherwise experience blurring of vision.
Another unsettling sensation is having palpitations, where it feels as though your heart is hammering against your chest, and that is certainly not a sign to miss. This may be accompanied with feeling nauseous, and people around you may notice that you suddenly look pale.
Furthermore, disturbance in hearing, or more popularly known as ringing in the ears, is a significant warning indication and undeniably a distressing symptom.
Any of these signs can warn you of the fact that you are about to pass out, and so you must be informed of how to manage this attack properly. But first, why do you think this happens?
Why does it happen?
Vasovagal syncope happens when a trigger, such as the sight of blood, causes the portion of your nervous system that controls heart rate and blood pressure to malfunction.
The blood vessels in your legs start to widen, and your pulse rate slows down. Your blood pressure drops as a result of the blood pooling in your legs. The combination of low blood pressure and slow heart rate quickly reduces blood flow to your brain making you faint.
There may not always be a traditional vasovagal syncope trigger. However, typical triggers include:
Prolonged durations of standing
Heat exposure
Having blood drawn and observing blood
Fear of physical harm
Straining to have a bowel movement
What to do?
There is good news for those who suffer from vasovagal syncope; recent studies have found a potential solution. Researchers have explored a number of simple and straightforward manoeuvres which have successfully stopped syncope and presyncopal symptoms in their tracks.
Since the pathophysiology of this condition originates in the peripheral circulation, several actions can be taken to increase peripheral resistance and stop blood pooling. They're known as "physical counter manoeuvres" and include squatting or crossing your legs to tense muscles in your thigh, buttocks and abdomen. The increased peripheral resistance corrects and restores the drop in blood pressure and heart rate during vasovagal attacks stopping the reflex's vicious cycle.
These manoeuvres are most effective when patients are aware of the aforementioned prodromal symptoms that can signal an impending syncopal attack.
Can you prevent it?
“How can I avoid having a fainting attack?” is the thought that must be going through your head right now.
First and foremost, if you saw blood and experienced the pre-fainting auras, doctors advise using the “Applied Tension Technique”.
Applied Tension Technique is a strategy that was developed to help people overcome a fainting attack. It is where you tense your body muscles for 10 to 15 seconds, which constricts the veins in your body (particularly those in your lower limb) and raises your blood pressure, decreasing the chance of fainting. You should hold the tension until you start to feel a warm sensation in the head. After relaxing your body for 20 seconds, repeat the manoeuvre five times until you feel better.
Several psychologists specialise in treatment of vasovagal syncope through practice and exposure therapy. The therapist gradually exposes you to blood over several trials in a form of desensitisation therapy This helps you in overcoming the phobia, often leading to a complete remission from fainting attacks.
Is it dangerous?
Generally, it is almost never life-threatening on its own, as it is just an unnecessary, extreme reflex that your body performs in response to seeing blood. However, fainting itself may pose some risks, such as injuring yourself during the fall and bumping your head. If so, make sure to consult a doctor to determine the extent of the head injury.
You might as well visit a doctor if you rarely pass out to run tests and rule out any underlying heart disorders or more serious issues.
References
R. Hainsworth “Syncope: what is the trigger?” - Heart. 2003 Feb;89(2):123-4. doi: 10.1136/heart.89.2.123. PMID: 12527651. PMCID: PMC1767547.
D. Benditt, John T. Nguyen “Syncope: therapeutic approaches” - J Am Coll Cardiol. 2009 May 12;53(19):1741-51. doi: 10.1016/j.jacc.2008.12.065. PMID: 19422980.
APPLIED TENSION TECHNIQUE: for people who faint at the sight of blood or needles. Anxiety Canada brief article. Retrieved March 10, 2023, from https://www.anxietycanada.com/
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