Hypo-perfusion or embolic phenomenon

There is a thing

That happens to some of my patients;

 

The scenario:

 

Sitting quietly, often, after a meal, perhaps breakfast or lunch

And suddenly nothing,

Slippage into unresponsiveness.

 

I don’t say

unconscious

For, that is altogether different.

 

These guys,

Always old,

Grey of hair

And thin of skin.

Are able to maintain an upright posture,

Can stay sitting,

Yet

Nothing.

No response to stimulus.

 

You measure the heart rate,

blood pressure

temperature

saturations,

even, blood sugar;

All reassuringly normal.

 

Bloods, ECG, normal.

 

Chest X-ray, normal.

 

CT, normal.

 

Brain waves will likely have altered,

Although, that is not something we do.

 

And, we are left,

Old person,

Suspended in nothingness;

 

Their

RAS

That is

Reticular Activating System

hanging.

 

Most theories

Discuss

Cerebral autoregulation,

Hypoperfusion,

Embolism

Or

Epilepsy.

 

No one

knows.

 

Modern medicine never works…

 

Cannula, Glasgow Coma Score;

Sternal rub,

Nasty

Finger-nail press,

Skin-flap pinch.

 

Time almost always does the trick;

That,

And staying calm.

 

I suspect some watch me

And think

‘He’s cold… Detached’

 

It’s not that, it is the realisation

That there is nothing you can do to make any difference

In these situations,

Beyond

assurance to

family and friends.

 

Such an exposition of vulnerability;

You can’t even blame the demon

drink

Or

dodgy drugs,

It is how

The human body expresses deterioration.

 

Sands shift

And the

Person falls

And there is no more.

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3 comments

  1. Does this state always end in death? As the persin falls , if you see what I mean.
    It is not a TIA then?
    How long does this state last – is it a variable period of time?
    It seems strange that the person can remain upright ?
    Interesting.

    Like

    • No – mostly people recover and are back to normal within an hour or two, sometimes it lasts a whole day; TIA’s are meant to be something that happens, e.g. a facial, hand, arm or leg weakness that lasts less than a day then goes back to normal – this is something more general that affects consciousness; and, yes, sitting upright. I’ve never seen a person standing, although that might be possible.
      You could describe it as a fugue…

      Liked by 1 person

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