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Passing out while standing at attention, posing for a photo, participating in a wedding part, or giving a speech is an often-embarrassing but hardly unusual event. Fainting, swooning, and, in medical terminology, syncope usually don't point to a serious underlying condition.

Sometimes passing out is due to emotional issues, or as the medical profession would describe it, neurocardiogenic syncope ((also referred to as vasovagal syncopeneurally mediated syncope, or reflex syncope). This is the sort of thing that happens to some people when they are getting a shot, or having blood drawn, or watching an autopsy or surgery, or they get sudden, shocking, bad (or even good) news. It can also occur after peeing or pooping. Your sympathetic nervous system send a message to your blood vessels "You could be next!" and tells the blood vessels on the outside of your body not to hold blood. Your parasympathetic nervous system tells your heart "Don't pump so hard!" and it doesn't. You pass out when your brain doesn't get enough oxygen. You may be able to talk yourself into not fainting if you know you are about at risk of it. You don't want to be the person who passes out when Publisher's Clearing House comes to your door with your $10 million check or you have just been awarded Person of the Year.

Another reason people pass out when standing still is hypovolemia. They simply don't have enough fluid in their systems to keep an adequate amount of blood in circulation. You probably have seen people "fall out" on a hot day. Perspiration drains fluid from their bodies. They don't drink enough water with electrolytes to replace that fluid. Their circulation decreases, their blood pressure goes down, and they pass out. 

Sometimes the subclavian artery (under your clavicle, in your chest) "steals" blood from your brain. There are certain arm exercises that will reduce blood flow to the base of your brain if you have a cholesterol plaque or other blockage in your subclavian vessel. 

There are also a variety of much more ominous causes of syncope. Aortic dissection, brain tumors, vascular abnormalities, and psychiatric issues can cause loss of consciousness. But usually the cause is something as simple as locking your knees when standing still.

There are things you can do to prevent syncope:

  • Keep in mind that any disturbance in your vision may mean that loss of consciousness is just a few seconds away.
  • Even if it means you have to "hold it in" because you drank too much water, make sure you drink enough water to avoid dehydration on a hot day.
  • Avoid relaxation techniques that avoid breathing. The longer exhalations you take to calm your nerves also reduce your circulation.
  • Be prepared for emotional shocks. If a friend or informant says "You need to be sitting down before I tell you this," take their advice. If someone does not come back to consciousness in a minute or less after an emotional shock, the cause of the fainting was not the shock.

What can you do once you feel fainting is imminent?

  • Take a few short breaths to increase your oxygen supply. It's important to take short breaths. Long exhalation slows down your heart rate,. which is the opposite of what you need.
  • Relax your knees, but also relax your arms. Soldiers holding a rifle should be taught how to deal with this situation, but it's important to allow blood flow up to your brain by discreetly moving your arms.
  • Relax your knees both vertically and horizontally. If you can "wiggle," you'll get better and faster restoration of circulation.

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