posted 04-07-2005 08:40 AM            

Now I can't say that anymore.

I had a subject feint on me this week - then vomit on my gear. I have the chart recording and video (gross factor is high), I deflated the cuff after about 10 seconds of zero pulse amplitude, while the subject remained seated upright. The subject then collapsed and was not breathing when I immediately came around my desk. I contacted 911 and paramedics were there within 13 minutes. By that time the subject was breathing and conscious, and had vomited multiple times.

Which raises my awareness about the need to keep rubber gloves on hand - and maybe one of the those plastic respiration vents for rescue breathing with PCSOT subjects. Years ago, when I was a counselor working with rock-headed youths in occassional wilderness treatment settings, I was trained in EMT protocols, and further trained in First Responder protocols for trauma patient care in remote or primitive settings.

As this subject initially showed some signs of bradycardia, with eyes open and unresponsive, I initially suspected a seizure. After he regained consciousness I realized it was a parasympathetic syncope response.

I'm must curious how common this might be. I've heard of only one other case of parasympathetic syncope, when a clinical psychologist from DoDPI discussed a case a the APA conference a couple of years ago.

posted 04-07-2005 03:17 PM         

This guy was clearly employing Behavioral Cm #102 and trying to get you to feel sorry for him. (Gotta keep a sense of humor!).

posted 04-07-2005 03:22 PM         

A vasovagal reaction is a reflex of the involuntary nervous system that causes the heart rate to slow down(bradycardia). At the same time, the larger blood vessels in the legs dilate and blood pressure drops due to a reduction in cardiac output. With insufficient blood volume going to the brain, the subject faints.

Situational syncope is synonymous with a vasovagal reaction.

Situational Syncope can be brought on by any stressfull event such as having blood drawn,fear, pain, taking a polygraph or even, getting married!

I have yet to have a subject pass out during an exam but I have heard that is does happen. But think about this:

A "Valsalvo Manuver" is frequently used by emergency room staff to purposely slow a patient's heart rate during certain arythmias including tachacardia. This manuver involves holding ones breath and or, bearing down hard as to cause a bowel movement. Sound familiar???

What may have happened in your case is your subject was trying to employ the old anal pucker counter measure and this, along with the stress of the exam, caused the syncope. What is unusual about your subject is the repeated vomiting. Complaints of nausea prior to fainting are common but the repeated vomiting is not.

Does this help? (Don't ding me on my spelling here guys-I was in a hurry)!

Ted

posted 04-07-2005 04:18 PM            

Thanks. I thought you were LE, are you also EMT?

I have since learned more about this subject.

He is 24 y/o male, and went parasympathetic with cardiac arrest 8 months ago during a DNA blood test ordered by the court (sex offender sample). I was not informed of that, because the team thought it was a "needle phobia"

Anyone want to have fun looking at the charts. I dont' think this forum accepts graphics, but I could post a link.

I am aware of the Valsalvo manuver, but that would be somewhat obvious due to behavioral requirements. Its the same technique, I believe taught to fighter pilots, to prevent feinting in multi-G manuvers. My subject does not stop breathing as his heart shows no (zero) pulse amplitude. Then he stops breathing as he becomes unconscious.

The medical community is somewhat mixed right now on the old physiological description of left ventrical exhaustion, but there does seem to be pooling of blood it the legs. That (pooling) appears neurologically related as blood is normally pumped or massaged back up the legs to the heart by active sympathetic tone (tiny pumping muslces). So there is some suscpicion about a neurologically (emotionallly??) related mechanism of action.

The vomiting (and nausea)are a result of an emotionally (stress-related) driven massive infusion of gluco-corical steriod (cortisal) into the stomach, as part of a sympathetic FFF response, cortisal plays many important functions and is elevated by stress. It stops digestion, allowing the body to devote resources to survival tasks. Cortisal also plays a role in the storage and conversion of blood sugar to fat - which is one reason it is easy for people in high stress jobs (or stress in general) to gain weight. Cortisal also causes nervous stomach (butterflies) and nausea - and vomiting in extreme situations.

As I said previously, paramedics were on site within 13 minutes. By that time, and after vomiting, he was practically begging to complete the polygraph in order to avoid consequences from his supervision and treatment team (I think we've got his attention now.)

The real question is...

how to get the puke out of butyl rubber pneumo tubes... I had removed the pneumo assembly shortly after the subject collapsed, but vomit tends to migrate on its own...

posted 04-08-2005 08:22 AM            

here is a link to a snapshot of the chart segment
http://www.raymondnelson.us/other/vasovagal_syncope.jpg

posted 04-11-2005 08:13 AM            

I took a look at the chart, very interesting. One question I have, due to the segmentation of the chart, is whether or not there were any marked respiratory hyperventilation bouts followed by apnea prior to the subject’s loss of consciousness.

posted 04-11-2005 09:53 AM         

Yes I am LE and yes, I was an EMT. I was the field operations manager for the county's parmedic provider prior to getting into LE.

Take care,

posted 04-11-2005 11:53 AM            

The subjects breathing was fairly regular and normal upto the point of the syncope. No apnea, and no exaggerated or hyperventilation segments, with regular synchrony between the upper and lower pneumo tracings, giving the impression of a general absence of peripheral nervous system (voluntary behavior) activity.

I think the kid (24 years) just doesn't handle stress well, as he had one prior syncope episode (with cardiac arrest) about 8 months earlier - of which I was not informed until after the test (even though I always inquire about health and medication issues). He probably realized he told me enough during the pretest that he would probably loose his deferred judgment.

posted 02-19-2006 07:29 AM         

I opened this thread back up because it just happened to me.

I was going a LE Pre-Employment test and was near the end of the first chart. The 22 year old male examinee began to complain that the cuff was too tight. He then said he couldn't breath, felt like he was going to pass out and wanted to vomit.

He became very pale and sweaty. His symptoms were very real. I discontinued the test immediately and attempted to keep him from passing out by calming him. He never did pass completely out but was very close.

After about 30 minutes, he said he was fine and wanted to continue testing which I declined.

He took another test the following day with another agency and had no similar problems. I tested him again the day after that and again, no similar problems.

Any thoughts?

posted 02-19-2006 08:19 AM            

I think I've seen other situations of dizziness /nausea (outside of polygraph situations) that were nutritiionally prompted. Did your subject eat normally? That shouldn't make too much difference, but it came to mind.

These things really suck when you don't have a plastic ventilator, but it sounds like your subject did not become unconscious. And its always nice not to have to clean puke off the pneumo sensors. (still have some slightly used equipment for sale here.)

I tested my syncope client again, prior to a court proceding, using an alternate in which he laid on the floor with his feet elevated. His doctor also put him on buspar (a beta blocker) as he has had other syncope events and is assumed to have a characteristically low thresholds for that activity.

posted 02-19-2006 08:31 PM            

I would have passed on this test.

posted 02-20-2006 08:47 AM            

The beta-blocker is sometimes uses to manage a condition called VVS - an unusually low threshold for syncope.

I was consulted by both his doctor, attorney, and supervising officer before re-doing the test.

He provided me with a written authorization to use the test data and materials for training purposes.

The laying on the floor procedure is something that I heard from a DoDPI psychologist/polygraph examiner, at the APA conference in I think 2002. That examiner/psychyologist described a similar event with a federal employee, who reportedly became unconscious during two polygraphs, and was tested successfully with his feet elevated.

Dicey, I know.

I met the guy again earlier this month - he failed, and confessed under interrogation.

Its a dirty job, but somebody's got to do it.