If you are supervising for or caring for an elderly person, one of the most common "emergencies" is vasovagal fainting. It can be very frightening to the caregiver. The co-factor is constipation and dehydration. The problem is the vagus nerve which meanders though the body and passes close to the anal sphincter. It is a very big nerve, the size of your pinky in places. When over-stimulated by straining this drops the heart rate by from 20-40 beats per second. This is the reason many heart-attack victims are found dead on the toilet. It is the reason that the elderly, and in particular the stroke-disabled and feeble, must NEVER be left alone on the toilet. It is a good idea to schedule toilet visits (a) at the same exact time every day and (b) either immediately before meals or an hour afterwards. The reason for the meal interlude is that vomiting and airway compromise after fainting are sometimes a problem. You want a clear tummy. These vasovagal fainting episodes may cause simple woosiness or complete loss of consciousness. Generally the loss of consciousness is not long. Between ten seconds and a minute. The treatment drill is to immediately ease the patient to the floor, feet elevated from seven to ten inches, and a slight pad placed under the shoulder blades. Recovery should be within a minute or two and full recovery after fifteen minutes to an hour. Keep them on the floor and hold their hands or shoulder (providing reassurance) and check for good breathing and a pulse. The pulse will be bradycardic. That is under fifty beats, generally about forty. Don't worry. And don't worry about feces, urine or clearing up until they have completely recovered. The important thing is to stay with them. Not to run to call 911. If there is no regaining consciousness or if there is a breathing problem of the heart stops, of course call 911. Do not put them on the toilet again until they have been well-hydrated. As much fluid as they can take within six hours. Plus a stool softener. Consider using a fleet enema. A big problem is if the patients topples from the toilet. I found that placing interlocking foam squares around the portable toilet will cushion any possible fall. There are great to place around the bed also. They come in ordinary colors and bright ones. They are water resistant. I use them a lot. If they are on a wood or tiled surface use tape that is stick on both sides to secure them to the floor to prevent sliding. They can be assembled in all patterns.
A problem with hired caregivers is that because they have little training they panic and either call 911 or their supervisor (leaving the patient on the floor). An ambulance is then called. The medics gets the callas an unconscious and the drill begins....sigh.
I was with my little one (she was 102 at the time - she is now 108) and I left the apartment to take a walk and get coffee and spend time with the new blond waitress in the restaurant down the block from Germany who spoke little english and looked like Sandra Bullock. Yes dreams that she would take pity on an old man, and teach me all she knew about German massage.
She was with a new aide - a replacement from the agency who spoke no known language.
In any event I get no call on the cell and arrive back at the farm to see an ambulance racing off in the distance. Hmmm. I had sixty-three cents in my pocket. Not enough for a cab, I used the cell and the aide tells me (partly with sign language and mime) that my little one collapsed on the toilet.
Arghhh. A vasovagal fainting episode.
After a mile hike to the hospital I find my little one with four blown veins (all the good she had) while an interns is attempting an arterial blood gas draw! Lots of tubes of blood to cover insurance regulations. They just finished five unnecessary x-rays because they thought "she may have hit her head and had a concussion". She fell on my foam panels. And the aide was not holding her hand but left her alone while she gabbed on her cell-phone to her boyfriend. (I think that was aide eighteen of the thirty-seven I fired) Worse they are talking about a cut-down! The two overweight paramedics are there smiling with their four-cell metal flashlights on their hips and seven patches on each arm certifying expertise in underwater CPR, arctic rescue, scuba-diving, and radiation hazard training. Nobody in the room is holding sweety-pies hand or shoulder. A young doctor is busy entering data in his laptop. And this is in a so-called "top" ER. A doctor is about to administer Haldol to my little one because she is screaming and restless!
At that point I slapped the syringe from his hand and stepped on, and gave him a story about what happens in Sicily to doctors who mistreat elderly women. I disremember the rest of the conversation, but there were various allegations leading me to be removed from the hospital in handcuffs. There was NO Haldol administered. I returned with my attorney (who owed me big because I introduced him to his main squeeze) and who had an office a block away and we engaged in he-said-she said. Meanwhile sweety pie has been admitted because the hospital regs state overlnght stays for loss of consciousness. All over simple fainting. I called in another aide she knew who held her hand while I thought things over. Finally I came back at midnight, told them I was her son (I fibbed but had my fingers cross behind my back so it didn't count), and signed her out against medical advice, and brought her to the park where we held hands under the summer moon and had a hot chocolate party. She was happy and smiling, and we went home, watched cartoons and she had hot chicken soup at three A.M. and went to bed.
And lived happily every after.
Anyways, that's my vasovagal fainting story.
But the foam panels are a worthwhile addition to the accessories necessary to be a good caregiver.
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