One recent day, I was unexpectedly asked if smelling salts were on a list of prescription drugs. I remember walking through a clinic a while back that had smelling salts taped to virtually every flat surface in the clinic. It was impossible to not be within arm’s reach of this “life-saving medicine” at all times.
Smelling salts are not new. They have been around since the Roman times. Pliny, a Roman historian and naturalist, used them.
What the heck is a smelling salt, you might wonder? It is simply a small glass container of ammonia in a cotton bag. You pinch the glass, breaking it, and the ammonia soaks into the bag and fumes are waved around the fainting person’s nose to revive them.
The cotton bag protects the fingers of the reviver, and the nose of the soon-to-be revived, from glass shards.
Why do people faint? Usually because their vagus nerve is stimulated and their heart beat slows too much to remain conscious. The body helpfully collapses on the floor to increase the circulation to the head. A slow heart rate is more effective if it is not pumping uphill. However, since the drop to the floor sometimes breaks bones, it is discouraged.
What makes vagus nerves get excited? Almost anything: fear, anxiety, surprise, strong emotion of any kind, pain, even a little dehydration or a funny heart rhythm.
None of those conditions are best treated by a nose full of ammonia fumes. Smelling salts are the chemical equivalent of a good hard slap across the face – an answer more Hemmingway than medical.
Fainting has nothing to do with attitude, bravery, or mental health. It is not related to your sex, job, or life choices. It is completely out of your control.
These days we are a little more gentile, using a more evolved way of treating those in distress. We try hard to recognize the pale look of someone about to faint. We sit you down where it is an easy option if you mention you have fainted in the past.
Simply laying horizontal and propping up your legs (downhill to the heart) allows gravity to assist. Within seconds you are awake with a flop sweat, a normal condition for vagus nerve-induced fainting. Before the sweat even dries you will feel feisty again.
Science has steadily changed medicine the last 2,000 years. With the computer and Internet the rate of change has become alarming to many patients and doctors.
Procedures, like the use of smelling salts, is so engrained that many medical people still look around, expecting to see them taped to a wall, close at hand. That is just a glance over their shoulder as they are lying you down.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.