Advice For Those Wearing PPE: It’s not only our patients who faint

This article looks at the challenges for fainters having to wear PPE during COVID 19 and offers some advice

PPE offers some protection from COVID 19. This usually consists of an FFP3 mask, a tight-fitting mask with a filter that if worn properly, feels like it impedes breathing, particularly on the in-breath, as if one were breathing in via a long thin tube (imagine breathing through a bubble-tea straw). On a typical shift in ICU, a health care professional may be expected to wear this FFP3 mask together with a full head cap, visor and full gown and gloves. Once donned, the protective equipment usually is worn for the entire shift.  For colleagues with a tendency to faint it can prove a further challenge. This was brought home to one of the Stop Fainting team working a shift in one our ITUs recently.

At 6pm he heard a colleague calling for help from one of the isolation room where she was caring for a ventilated patient.  As he put the necessary PPE cover for her, she told him that she was sweating profusely and feeling very faint. She did not faint but did go home earlier that day. The next day they were on the same shift together and he offered some further insight into her questions about why she may have felt unwell the day before.

“Mary” had been redeployed to ITU; a change she had embraced enthusiastically. However, a combination of new shift hours and fewer trains meant having to leave for work very early in the morning. Too early to have her normal breakfast. Late into a busy shift she was called from her usual role to stop “running” around to cover looking after a patient in a side room. For the first time in a while she found herself standing relatively still by a bedside.  She suddenly noticed feeling prodromal symptoms and called for help.

PPE and the “perfect storm “of fainting triggers

With a visor, FFP3 mask, gown and gloves, it’s clear that healthcare professionals will not be able to drink as usual throughout their shift.  Mary admitted that she had not had much to drink that day and missing breakfast.

Working in warm environments and wrapped in further layers of cloth and plastic, it’s likely to mean that that dehydration will become a common feature of day to day work life. Also, practically, no one wants to spend all that time donning PPE only to have to doff the same for a toilet break because one may have drunk too much. So, the inclination is to keep low on fluids (just in case) before your shift in order to last the shift without having to doff prematurely for that toilet break.

The continuous heat under the gown, inability to drink throughout the shift in addition to the emotional and physical demands of caring and treating patients in novel circumstances and during long shifts increases the tendency to pre-syncope and syncope. The pressure to care for our sick patients may lead to health care professionals soldiering on… but for how long? “Mary’s “symptoms also started as she found herself in a relatively stationary position after she had been moving around

Apart from the exhaustion of a long, dehydrating shift, those with a tendency to vasovagal syncope and low blood pressure states will be more prone to developing worsening in symptoms of pre-syncope and syncope during or after their shifts or during a downtime moment.

So how do you prevent vasovagal syncope during your long Covid-19 shift? Here are a few tips.

  1. Acknowledge that you may have a pre-existing tendency to faint and declare to your shift manager that you may need more frequency breaks to rest and hydrate (and even to take toilet breaks).
  2. Hydrate well prior to your shift, and perhaps take a toilet break immediately before your shift. You should be aiming to consume between 2-3L per day. If you are known to lave low blood pressure, then a salty snack early in the day (or night) is also a good idea.
  3. Continue to perform isometric exercises (clenching calves, quads and buttocks) throughout the day.
  4. Take particular care to avoid standing for long periods, for example during a ward round. There is no shame in sitting in a chair. Consider this a service to your team and your patients, and you want to be in the best shape you can to continue your shift.
  5. Rest well – try to keep a good routine and sleep enough for your needs.
  6. Have a good meal and plenty of fluids, perhaps focussing on water and juice rather than coffee or tea.
  7. Try to minimise (as much as possible) possible triggers such as stressful journeys through better planning. For instance, asking you manager about any travel and accommodation options offered by your Trust or organisation.

Good luck and stay well!  We hope these tips will help you to continue help your patients.

Answers to Questions about Fainting and Covid 19/Coronavirus

In this article the Stop Fainting team answer the most frequently asked questions by our patients about Coronavirus / Covid 19.

Question:  I faint. Am I at a higher risk for the Coronavirus?

Answer:

Having a tendency to faint WITHOUT any other of the health conditions outlined in http://www.nhs.uk advice does not put you in a high risk group.Examples of relevant health conditions include: respiratory conditions such as COPD or cardiac conditions  such as heart failure, ischaemic heart disease or HIGH blood pressure.

Faints involve a drop in blood pressure and or heart rate. The majority of our patients have a tendency to a LOW not high blood pressure.

Question:  I have  been feeling / having more faints. Why?

Answer

There is unlikely to be a single answer to this question.

The first thing to ask yourself is are you following all our usual advice? In recent weeks all our lives have had to change in so many ways – many profound some seemingly minor. All of these changes my have an impact on your daily efforts to stop fainting.  Are you drinking more caffeine because you are at home? Are you missing the water cooler at work? Is your food less salty? Little changes in your routine can impact your hydration efforts.

Similarly, mundane changes in how we now  travel and shop may also have an impact. Social distancing now mean longer times spent in queues. Remember your compression tights and/or isometric manoeuvres when waiting for the checkout.

Finally, Covid 19 has presented us all with numerous stressors. We are all faced with dealing with additional social, economic and psychological hardships. Remember, our stress response plays a key role in coordinating our blood pressure control. For some of us these uncommon  and uncertain times will create further  triggers.

Question: How can I best  help myself and others around me?

Answer:

We ALL have a responsibility to follow the advice on social distancing and infection control. It is vital that we all take care to frequently wash our hands in hot, soapy water for 20 seconds frequently (especially if we have been outside) or use sanitiser gel and avoid touching our face.

As a fainter, it is now vitally important that you do the ‘basics’ of our Stop fainting advice (hydration, and avoiding triggers) well. However, if you do feel faint you must take immediate evasive action (lay down and or raise your legs) to avoid a full loss of consciousness and possible injury.

Some patients have highlighted a reluctance to take action when out because others might think that they are unwell with coronavirus. Your priority to to keep safe. Taking action early will help you to keep safe but also to reassure others that this is ‘normal’ for you and benign. Feel empowered to take control!

Last, but by no means least, it is important to look after our mental  as well and physical wellbeing.  Those at home, use the opportunity to explore meditation, mindfulness and or yoga. Listen to some music or bake – if you can find any flour! Or maybe just limit you consumption to the 24hour news cycle which some can find overwhelming at this time.

For those requiring further support STARS https://www.heartrhythmalliance.org/stars/uk/ offer a valuable telephone and social media platform for people who share your symptoms which you may find helpful.

The Stop Fainting Team hope that you find our resources of help and PLEASE remember:

 

 

 

 

 

Twitter Feed

The Power of Placebo – a Syncope Perspective Fainting on Holiday Part 2: Planning a Faint Free Vacation. Sun, Sightseeing and Syncope: Fainting on Holiday (Part 1) What Can Family and Friends Do? How to stop fainting: Learning your TRIGGERS How Much Do I Need to Drink to stop fainting? Hydrate To Stop Faints What is a Tilt Table Test and why have one? Top tips to help your GP get the right diagnosis Why Do I feel Faint When Cooking? Why Do I Faint After a Shower? “I was just…Why do I faint doing ordinary things? Who can tell me if I faint? 3 Tips On Coping with Fainting by our Psychologist Why do we faint? An Expert opinion from Dr Wieling