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I have a character who engages combat finishing with in-armour duel that pushes her to the limit. After it is over she is so exhausted (and probably dehydrated) that she faints.

Assuming:

  1. she is not severely wounded and there is no underlying health condition, just exhaustation from combat
  2. there are people who can help immediately

Would it be realistic to faint? Would she regain consciousness pretty much instantly (within minute or two)? Or would it take some time?

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    $\begingroup$ Is unconscious a hard constraint? Because it is easier to be still conscious with no or little idea what's going on, or unable to do something about it, than long term unconsciousness. Being unconscious is near unanimously bad for your brain the longer it takes, with possible permanent damage lurking closeby. Also, can the character in this case suffer from heat exhaustion? $\endgroup$
    – Trioxidane
    May 26, 2021 at 12:17
  • $\begingroup$ Is she in full armor with padding under a scorching sun? Is she helped into the shade and cooled down or left like a meat-pie, baking? $\endgroup$ May 26, 2021 at 12:24
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    $\begingroup$ @sphennings, I could possibly ask on medical site, but then it could be more difficult to explain the setting and why call 112 is not an option $\endgroup$
    – Archelaos
    May 26, 2021 at 13:45
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    $\begingroup$ You could just explain it's research for a work of fiction. Writers research everything, everywhere (poisons, drugs, assassination methods, the list goes on and on). $\endgroup$
    – Zeiss Ikon
    May 26, 2021 at 14:09
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    $\begingroup$ Medical sites also tend to explain things as lists of vague possible symptoms which are not very helpful for worldbuilding. I'm always dumbfounded by how little doctors actually understand about how things affect people internally. Like if you ask most doctors what the difference between Vicodin and Percocet is, they will say there is none because they are used to treat the same symptoms, even though one will clearly make you more lethargic and the other will make you more manic... but doctors rarely care about these details; so, they often don't know. $\endgroup$
    – Nosajimiki
    May 26, 2021 at 15:16

9 Answers 9

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Let's first establish the differences between some of the reasons your character might have passed out.

  • Exhaustion: Working hard doesn't really make you lose consciousness on its own, but depending on other factors it can contribute to one of the others reasons you might pass out. A physically fit person who is properly hydrated and not overheated can exercise until there is just nothing left to keep going on and still remain conscious. So saying someone fainted from exhaustion is generally not accurate.
  • Shock: This is your body's natural response to severe trauma, this is where your body restricts blood flow to your extremities to keep you from bleeding out. This can include cutting off blood flow to the brain which can lead to unconsciousness. What you've described could happen from shock, but since your character is unhurt, then this is an unlikely reason to pass out.
  • Asphyxiation: This is what happens when you don't get enough oxygen to your brain for any reason. Because your character won the duel, it is safe to assume that she did not pass out due to lack of oxygen. While a plate armor helmet or generally bad health can restrict breathing enough to cause you to pass out, everything leading up to this would include gradually increasing muscle weakness which would have almost certainly prevented her from winning her fight. Basically, by the time your brain gives up, so have all your other appendages.
  • Heat exhaustion: This is a momentary loss of consciousness that forces your body to stop exerting itself when overheated. Heat exhaustion generally has no long term negative side-effects. This is your body's natural way of protecting itself from overheating, and your most likely culprit. It is a common problem, even for seasoned athletes and heavy laborers. It often comes on quite suddenly rather than wearing down your physical capabilities like asphyxiation would, and does not require something being "wrong" with you like shock would. Heat Exhaustion is an especially a common problem when fighting in plate armor.
  • Heat stroke: This is what happens when you become so overheated that you sustain brain damage. This is a true medical emergency which normally results in permanent neurological damage, coma, and/or death. Based on the context of the OP, I will assume this is not the case.
  • Hyperventilation: This is another distinct possibility. When some athletes work out too hard and then suddenly stop, they are left breathing very hard to catch up to where their blood CO2 levels should be. In some cases, this will overcompensate and over oxygenate the blood causing lightheadedness, numbness, tingling, anxiety, and in severe cases even fainting. This is one of the reasons why athletes are encouraged to do cool-down exercises when thy are done so that they can slowly bring their breathing and heart-rate back to their resting state. This could fit your situation well because it is something that distinctly happens when you STOP exerting yourself. That said, it is not nearly as common as heat-exhaustion, mostly happens to novice athletes or those with underlying conditions when it does happen, and would likely be prevented by the restrictive nature of being in full armor. Just because your helmet, coiter, and breastplate restrict breathing as much as they do, no amount of huffing and puffing would get your blood over saturated. So, I suspect this could only happen if your hero has armor she can easily get off of her after the fight (So might happen in 10th century mail armor, but not 13th century plate armor).

Given the factors at play, I will assume your hero passed out from Heat exhaustion.

Secondly, How long "unconsciousness" lasts can be very misleading in this case since a full loss of consciousness is actually very rare. Rather you go through a series of degraded and recovering states of consciousness. Below is the the general timeline of what these various degrees of consciousness should look like from both the internal and external perspective.

What it is like from a first person perspective

As you start to reach the critical stage of heat exhaustion, the first symptom is that noises begin to sound muffled and more distant. Some kind of white noise like a ringing in your ear or the echo of being under water is also common. Then your vision begins to "slide". This is where your eye stop properly tracking what you are looking at and vision becomes distorted and blurred and it looks like your field of view starts to slide around even though you think you are still looking forward. All of this can happen very quickly or over the course of a 1-2 minutes. In the latter case, it is normally that you feel yourself going into heat exhaustion, but keep pushing yourself anyway.

Time also becomes hard to track, it is hard to say if time feels sped up or slowed down, but it certainly does not feel normal.

Then you blackout. You normally still have some level of conscious awareness of yourself when this happens, but you can no longer see, hear, feel, etc. in any normal capacity or control your body at all. It is like suddenly being in a dark empty room. You are still conscious in the since that you are aware of having a state of being, even though your mind is cut off from your body, it is also common to experience a general sense that you are falling. Once you go down you immediately start to feel better. Vision and hearing start to come back within moments. You still feel overheated and exhausted, but a normal type of overheated and exhausted. People around you will probably look really panicked and insist you stay down, your cognitive abilities will be diminished but it may take what feels like a good 10 seconds or so for your brain to fully grasp that you are even having trouble thinking straight. It will feel like 1-2 minutes before you truly feel normal again, but getting up and moving around may make you dizzy. So while loss of consciousness was very momentary, a full enough recovery to get up and walk away may take 5-10 minutes. It will probably take 20-30 minutes before you feel ready to do any physically demanding tasks again.

What it is like from a third person perspective

From a third person perspective, the affected person usually seems very confused at first. They might look at you like they acknowledge you, but don't understand what you are saying and don't remember what it is they are supposed to be doing. Then loss of body control seems spontaneous. Their whole body goes limp all at once and they fall over. In every case I've seen, the actual loss of consciousness (where they are completely unresponsive) has lasted between about 5-15 seconds. From there they can often open their eyes and start looking around, and maybe mumble some very difficult to understand words. Often it's something to the effect of "I'm fine" even though they clearly are not.

Within 1-2 minutes they should be able to sit up on their own and have a mostly normal conversation, but they can not keep their balance if they try to walk. After about 5-10 minutes they can normally get up and walk around. Although their body seems to be functioning fully at this point they may not seem fully themselves until about that 30 minute mark.

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    $\begingroup$ can confirm on not being able to see, I know people who see everything ''white'' as if there was too much light, but when it happened to me everything went completely dark, but I was still conscious.... conscious and blinded. $\endgroup$
    – user85816
    May 26, 2021 at 14:54
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    $\begingroup$ Wow, awesome answer, Thanks! $\endgroup$
    – Archelaos
    May 26, 2021 at 14:59
  • $\begingroup$ @furtyfur Good point on the white out. I've heard of people people reporting that from going into shock from trauma, but not associated with heat exhaustion. Can you confirm that those people were actually passing out from heat exhaustion? $\endgroup$
    – Nosajimiki
    May 26, 2021 at 15:03
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    $\begingroup$ Your first person "what it is like" is on spot. Every single time I fainted one of the first symptoms was always alterations in hearing, usually not sounding like underwater, but simply as distant, sometime with a ringing in the ears, followed by the vision blurring and time seeming to slow down, and finally the blackout, although I have managed to avoid the last part at times by trying my best to stay conscious immediately after noticing the hearing symptom, such as singing repeatedly the lyrics of a song I knew well. $\endgroup$ May 26, 2021 at 15:07
  • $\begingroup$ @Nosajimiki one of my exes, her father told me he used to run outside all the time but bought a treadmill cause he started passing out quite often, might be a condition but he didn't knew what it was. $\endgroup$
    – user85816
    May 26, 2021 at 15:11
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If a person loses consciousness due to overheating or dehydration (heat exhaustion or heat stroke), it's a medical emergency; there's a possibility she'll die without being externally cooled and getting fluids -- and she could choke to death or drown if someone tries to administer fluids by mouth while she's unconscious.

Heat exhaustion need not proceed to loss of consciousness to be serious, but if she's conscious, it's probably possible for her to cooperate enough to at least get her armor and padding off, at which point dampening exposed skin and remaining clothing with cool water will start the process of safely cooling her. There are well documented procedures to follow to prevent and treat heat exhaustion (where I work, we get a reminder of this in our safety newsletters about this time every year); they all revolve around hydration and avoiding excessive exertion in excessive heat.

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    $\begingroup$ If your goal is to "skip ahead" a few hours until after the duel ends, then heat stroke is the way to go. The character becomes confused and disoriented, and we get a very jumbled description of the treatment, and then we skip ahead in time to when she has recovered. $\endgroup$
    – Daron
    May 26, 2021 at 14:59
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    $\begingroup$ After fighting under a hot sun, stumbling into the shade and trying to loosen/remove armour before collapsing would seem reasonable. IME heat-exhausted but conscious people are listless and floppy, so they'd be able to neither resist nor cooperate in undressing except passively. That would be enough if there's a squire/second/friend to help with the armour, as may be needed anyway $\endgroup$
    – Chris H
    May 28, 2021 at 8:10
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Fainting usually happens when blood flow to the brain isn't adequate for a short period, this can happen due to extreme heat, dehydration, exhaustion or even due to illness. Your character is wearing armor, exhausted and possibly dehydrated so she can easily check out 3 of those, 4 if she was already a bit sick before combat. If she's not actually dehydrated and the main cause was a mix of mostly the heat and exhaustion from the battle, then if my personal experience is anything to go by she shouldn't stay out for too long (probably from a couple seconds to not much more than a minute), and the best to do is put her leaned down in the shade and remove excessive gear to help dissipate the heat. Also if possible don't let her fall on the floor and hit her head, or she might experience convulsive syncope (fainting followed by a certain amount of jerking, can be mistaken with a seizure. The individual regains consciousness shortly after and usually fully recovers without problems, I can tell you it's not an enjoyable experience, but it can happen without any noticeable damage to the brain) or something worse if she does hit her head or neck on something.

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    $\begingroup$ On the plus side, if she is in full armor (whatever that means for the setting), then she should be wearing a helmet. Depending on the time period of the setting, her armor could be VERY good at preventing injuries from the fall. $\endgroup$
    – Nosajimiki
    May 26, 2021 at 19:59
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Don't underestimate severe exhaustion (like several days/months without or with really minimal sleep). The person might be able to function for a short while in a high-pressure situation, but the result will be he will just fall asleep at the first sign of ending.

I have a very heavy case of sleep apnea, which causes me to choke when I sleep (treated with a pump that forces air to my mouth/nose and keeps my breathing tubes inflated with overpressure called CPAP) and one of the other reasons you can pass out is simple extreme exhaustion.

Just before I signed myself into a sleep laboratory/clinic to get treated I slept about 30 minutes a night in 30-second intervals for 8 - 12 hours (the rest I was unconsciously choking).

In the end I was literally passing out every time I just stopped to sit or stand. I couldn't do anything, couldn't think properly and kept passing out. If there was nothing pressing or after doing anything strenuous and registering the need for alertness was over, I just passed out.

The onset was usually preceded by all of the sounds slowly muting - like coming from far away or another room, my eyes closing on itself and becoming so extremely heavy and I just retreated to my inner world and my thoughts slowed down to a trickle, only for a sudden jarring sensation as everything becomes back into focus and you realize that you were sleeping and don't know how much time passed or what happened.

My oxygen levels got as low as 62% during the night (the doctor at the clinic was really surprised I was even conscious)

I couldn't think, couldn't concentrate (I was like a goldfish, constantly forgetting what I was doing or needed to do).

The first time I got the CPAP (it was just a loaner from the doctor to see if it would work for me) I cried after I woke up. I slept 14 hours and only choked about 6 times in an hour instead of every 30 seconds.

Only after I got some real sleep I was able to realize my own situation again. I stopped cleaning my home, stopped cooking, or going shopping since I couldn't remember what I needed to buy. I was barely able to get dinner from fast-food restaurants since it was all I could do to order, pay and get it home to eat and then pass out in a chair. I was sometimes able to fill a washing machine and clean some clothes. I was just too exhausted to do anything, really.

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When I broke my legs I passed out from the pain for like a few seconds to 3 minutes... but it happened multiple times (within a few hours), I also once run to almost exhaustion and collapsed on the streets and it took about 2 hours for the dizziness and nausea to pass. I learned that when doing cardio you only feel tired after you stop out of boredom, so one might run or fight to exhaustion without even realizing it, because I felt incredibly good while running and the exact moment I stopped I dropped on the ground struggling to breathe, I also felt the blood leaving my brain but that might just of been a strange sensation. Maybe the hype and adrenaline of fighting is similar to the hormones one gets when doing cardio.

I have never fought but combat should be a mixture of pain and tiredness so it may help.

But I think heat is the most dangerous thing, broken bones and bruises can kill with thrombosis but the chance of survival is high enough, exhaustion also isn't too dangerous.

Probably it depends on the type of armor, plate armor on a sunny day in a continental climate might be a big deal.

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I'd like to add another possible cause that fits your scenario and gives a longer and more flexible window: Hypoglycemia (low blood sugar). As I diabetic, I am familiar with this condition as treating the high blood sugar caused by diabetes can often cause this as a side effect.

In my experience, the effects of this are varied, and can cause a blackout. Usually the effect is tiredness and confusion, but still a level of consciousness, but there has been at least one time where I did eventually blackout. Thankfully I woke up later, about a half hour later. I think I didn't just blackout, I also fell asleep. I vaguely remember walking around not knowing what was happening for a few minutes, and then nothing until I woke up on a bench. Apparently I had had enough consciousness to lie down, but not any more.

It seems possible that Exercise-induced hyperinsulinemic hypoglycemia could be a possibility, especially if your character had not had a particularly nutritious diet recently. If a savvy medic recognized the condition, they could treat it easily with just some fruit juice, but if left untreated it could take a while to recover from, but probably not more than a few hours.

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I have seen this happen. (technically, it wasn't combat)

When I was in college, I lived in house with a large number of housemates. One afternoon, several of us were watching TV in the living room and one of our housemates staggered into the house, wobbled a little, and collapsed.

Luckily, we had a few medical school students in the house (the university has a world-renowned medical school), so they did their thing, but after a minute or two, they said she was still unresponsive (their word, so presumably in the medical sense) and we needed to get her to the ER. I helped transport her there and stayed until her boyfriend could arrive and take over, so I can tell you what I saw.

She had no issues breathing, but wouldn't respond to stimuli. Her eyes were open, but the lids were droopy and the eyes themselves were unfocused and swimming and wouldn't track an object. She didn't respond at all to her name, loud noises, shaking her hand, anything.

The medical students declared her safe to move, so we picked her up between two of us and she was completely limp. Someone had to hold her head to keep it from lolling because it was also completely limp. We were able to get her into a car and down to the ER. It had been about 10 minutes since she collapsed.

Maneuvering her into a wheelchair at the ER, her eyes were starting to track and she moaned a couple of times. The nurses got her into a bed and her boyfriend got there about 10 minutes later. She gave him the slightest smile when he arrived, so at that point she was at least starting to recognize people. I left at that point and we found out from her boyfriend later that she got a glucose drip and perked up within a half hour or so. The hospital wouldn't discharge her for a couple hours after that, just in case.

It turns out she was a dancer and we found out afterward from her boyfriend that she had been training for her MFA recital about 12-14 hours a day for the last two weeks straight. He said he had been telling her to eat more and sleep more, but she refused.

This only gives you one data point, but 1. there was no wound or underlying health condition (except for maybe a little undernourished and short on sleep) and 2. there were people who could help immediately. The final timeline was unresponsive for 10-15 minutes, minimally responsive for another 10-15 minutes, fully responsive after another 30 minutes on a glucose IV.

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  • $\begingroup$ How does the last paragraph not exactly explain how it applies? "Would it be realistic to faint?": yes. "Would she regain consciousness pretty much instantly (within minute or two)?": no. "Or would it take some time?": between 10 minutes and an hour with sufficient nourishment, depending on how conscious. The question doesn't ask for causes or attribution of time to those causes. $\endgroup$ May 29, 2021 at 15:10
  • $\begingroup$ Fair enough, comment withdrawn. $\endgroup$ May 29, 2021 at 16:28
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Vagal (Vasovagal) Response

Depending on what effect you want to achieve, after an intensive effort people can get a vagal response that can make people faint just for a few seconds maximum. Most of the time you'll just fall to the ground due to your legs feeling really weak.

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As long as you want

There are a number of conditions that could cause someone to faint. Maybe your character is simply exhausted and takes a short cat nap. On the other extreme, your character could have heat stroke, which is a serious medical condition that sometimes proves fatal. Here's a good overview of heat stroke. How long could someone be unconscious from heat stroke? This case study highlights a patient who lapsed into a coma: "The patient regained consciousness and was discharged from our intensive care unit after 16 days."

So you can use real world science to justify any length of unconciousness.

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  • $\begingroup$ Slipping into a short nap is one of the things I considered - just I do not know probable is that. $\endgroup$
    – Archelaos
    May 26, 2021 at 14:33
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    $\begingroup$ Physical exhaustion generally won't bring on uncontrollable sleep -- that comes from extreme sleep deprivation. Inability to stand, lift arms (or a weapon), yes, very easily so, but not actual sleep. $\endgroup$
    – Zeiss Ikon
    May 26, 2021 at 14:46
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    $\begingroup$ 16 days is probably a bit beyond feasible for a medieval setting - a coma is survivable now because we can hook people up on an IV drip (and possibly a respirator) to keep them nourished while they are unable to eat or drink (or possibly even breathe) on their own. Without modern medical techniques, the patient would likely die of hunger and thirst (and possibly hypoxia) before recovering from such a severe coma. If you want it to last that long, you might want to add fleeting moments of semi-consciousness every few days where they can eat or drink - that can and does happen. $\endgroup$ May 26, 2021 at 20:51
  • $\begingroup$ @ZeissIkon Yup, I have sleep apnea (extremely heavy), and before I realized I got to a state where I progressively couldn't sleep properly for years (snowballing and piling up in the last months before I tried treatment). I could barely function. In a high-pressure situation I could whip myself up for a few minutes to alertness, but afterwards I just crashed and passed out to a choking sleep. $\endgroup$
    – mishan
    May 27, 2021 at 14:05

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