This afternoon I stepped off a curb wrong and twisted my ankle. I do this sometimes and usually I fall and my ankle hurts for a bit before I go on my merry way. This time, the husband caught me. As I waited for my ankle to stop throbbing, my vision started to white out, a dull roar developed into a strong ringing in my ears, and my voice sounded muffled to me. My knees were weak. I couldn’t hear any of the street sounds around us and the husband sounded very far away. I was blacking out. I sat down and felt better after a minute or so.
Here’s the question: What is the mechanism behind this kind of black out? I’ve blacked out from low blood pressure before. Is this related? My ankle hurts, but it doesn’t seem like I hurt it enough to have the pain-induced black-out decribed by boxers and navy seals. Those usually go more like “the broken end of my shattered femur popping through my thigh was the last thing I saw before my head exploded with pain and everything went dark.”
So what’s the straight dope, teeming masses? Am I an utter wuss for nearly fainting over a twisted ankle?
If you are then I’m a bigger wuss than you, I nearly passed out (I’m a man, real men don’t faint) from having stitches removed. It wasn’t in any way painful, nor am I squeamish about that sort of thing. And there have been plenty of people who have suffered the same response as a result of having their ears pierced.
Sometimes a combination of stress and striking the wrong nerve (literally) can cause that sort of reaction. Things that aren’t actually painful can cause nausea and fainting. Exactly why that’s the case seems to be a bit of a mystery, but there seems to be some sort of networking with the vagus nerve, which directly depresses the heart. It seems to be some sort of defence mechanism that encourages people to stop moving in response to damage, and sometimes it gets triggered without any damage being done.
It’s related insofar as both are caused by a lack of blood pressure to the brain. Essentially the body stuffs up in response to pain and either shunts all the blood to the extremities or slows the heart action, meaning their isn’t enough blood left to supply the brain. As a result blood pressure drops rapidly and the brain tries to defend itself by making you lie down, very fast.
It’s probably from a sudden rush of catacholamines (the fight or flight response) and endorphins (released in extremely painful or emotional episodes) causing wide swings in blood pressure.
I faint all the time. I’ve fainted in response to intense emotional distress, physical discomfort, being overheated and for no apparent reason at all. My mother is the same way.
Over the years, I’ve learned to recognize the symptoms, and sometimes I can avert it. Sitting down doesn’t help me: I have to lie flat and elevate my feet. (And my mom claims that she has still fainted after laying down.)
Doctors are stumped. A neurologist put me on Zoloft, because, like Blake said, there seems to be some connection with the nervous system. It’s believed by some that the brain floods with chemicals causing the nervous shutdown. The Zoloft is supposed to smooth out the output of chemicals and cut down on those spikes.
However, it doesn’t seem to help with pain-fainting. Just last night, I had to lay on the bathroom floor until I had my urge to faint under control. I had a violent stomach upset, and the pains of the cramps were going to make me pass out unless I laid down immediately.
Anecdotes about what happened to me when I blacked out, or when I fainted, or whatever may be cute, but don’t mistake them for medical advice.
And the question of whether you are a wuss for blacking out depends really on what was going on. There are number of things that can cause blackouts, from simple dizziness to serious brain tumors. You might call your doctor to see what’s your situation, rather than rely on the situation of other people?
The vagus nerve is in charge of your heart rate and sometimes pain or shock can inhibit it too much, causing your heart to briefly stop beating, lowering your BP and causing you to feel dizzy, faint or pass out or in some cases (especially small children) have seizures.
The tendency for this to happen runs in families, so if mum or dad faints when shocked or in pain, chances are the kids will too.
It is NOT something which the person has any control over, isn’t a sign of weakness or a low pain threshold and is best treated by avoiding situations likely to cause it. Trying to make sure the person eats regularly can also help, as shock, pain and excitement (any adrenalin overload) can use up the body’s available sources of sugar, and faints can be made worse by low blood sugar. There actually is science to support a cup of hot sweet tea for shock.
People who pass out for long periods of time after suffering severe trauma are usually passing out from blood loss, brain injury or severe shock due to the extent of their injuries, rather than from the pain itself.
Thanks for the voice of reason, CK. I totally understand where you are comming from. In this case, though, some severe underlying problem is unlikely. I’m 23 and perfectly healthy as of my last chek up in January. If I get inexplicably dizzy without twisting my ankle first, I’ll get to the doc. For now, I’ll go with my own intuition.
For clarification, the last time I actually blacked out 3 years ago was definitely related to dehydration. Confirmed it at the doctor afterwards. Getting fluids fixed it.
Update: got x-rays and nothing seems to be broken. Now the waiting and limping game begins.
Another possibility: hyperventilation (i.e., too much oxygen). A very long time ago, I had episodes of dizziness and feeling faint and generally ungood. Also noticed tingling in my toes and fingers. One time I almost blacked out. I was visiting a relative in the hospital; a nurse happened to be in the room and sat me down; I felt nauseous. Nurse wheeled me down to the ER; they checked me over, couldn’t find anything, gave me a shot of something. I did notice that this tended to happen when I got very warm - I was usually wearing a heavy winter coat. Went to private doc who found nothing. Shortly after that, I was reading a Reader’s Digest. There was an article about hyperventilation. As I read it, I realized that this is what was happening with me. Due to stress, anxiety, worry, panic, etc., you breathe faster; you get too much oxygen, you get dizzy and sometimes pass out. Solution: control your breathing. After medical people finally recognized this phenomenon, they’d have the person breathe into a paper bag, but then there’s the chance you’ll get too much carbon dioxide and pass out. You have to recognize the symptoms and control your breathing.
Grrrrr… no post too small. Preview, preview, preview.
"Running from a predator, twisting your ankle, then passing out doesn’t seem a good way too pass along genetic information.
I don’t think every physiological response has to be related to evolution. And if you were running from a pedator and twisted your ankle, wouldn’t your adrenaline kick in and help you keep moving?
I would argue that maybe not every “physiological response has to be related to evolution”, but if it is a shared human condition it should be considered. No?
The only time I’ve nearly fainted was when I was carving a block of wood and the chisel slipped and plunged into my hand, right into the muscle between my thumb and forefinger (everybody cringe!). It didn’t hurt that much really, but the sight of the inside of my hand made me feel shaky, lightheaded and nauseous. Sitting down for a bit made it go away.
As I pointed out above, it seems to be a mechanism to stop you from using damaged organs by forcing you to lie still. People are incredibly stubborn and will override even the most strident pain signals. That’s not good becuse the pain is suposed to stop you from moving and causing further injuries to already damaged tissues. So a secondary system sems to have evolved: if you really are stupid enough to move injured tissue and the damage is too great the pain doesn’t just suggest you stop moving, it forces you to stop moving.
This isn’t a problem when running from predators. Being chased by a predator will initiate a flight-or-fight response. That stimulates the heart and increases blood pressure, IOW it has exactly the opposite effect to the conditions that cause fainting.
Well, consider the effects of the vasovagal response. It reduces heart rate and blood pressure. Which at times, is a good thing to have happen. Especially if you’ve just been severely injured. Elevated heart rate and blood pressure will make you lose blood faster. So the reflex slows this down.
Some individuals just have a bit too strong of a reflex. But apparently not a strong enough negative consequence to select against the vasovagal reflex and remove it from the population.
It also helps if you stop thinking that evolution has a purpose; making us stronger, faster, smarter, and so forth. Survival of the fittest means just that: Whatever fits best in an eco-niche will tend to survive. If slow and stupid helps one survive in that niche, that’s what is selected for.
I bow to your more informed medical position. However, as it relates to evolution; I suggest it is you who stop thinking that evolution has a purpose. My position is exactly that. There is an advantage (re: the OP. Assuming, of course, “the mechanism behind this kind of black out” is biological) , I am merely wondering what the default advantage is. Not debating that there is one.
I would further argue that the “vasovagal response” (which can kill you) is not the same as a twisted ankle.
Maybe I’m not understanding, but running on an injured ankle might surely increase the injury but you might live. Running during heart failure, for example, is another matter.
That’s right and you might also die as a result of the damage done. If the risk of dying as a result of the damage is higher than the risk of dying as a result of not moving then not moving is the preferred option.
In the real world the number of circumstances where a person is not in a flight-or fight situation and yet not running on an injured ankle could result in death are almost non-existent. I’m sure we could come up with some tortured hypthetical situations wher it might be true, but they are not realistic. In contrast the circumstances where people can do serious damage to themsleves by moving injured tissues are almost routine. Quite clearly the greater risk is from movement.