I often see some middle-aged and elderly people go to the doctor with trauma, and when asked the reason, some say: suddenly lost consciousness when standing from a sitting position and fell down beside the seat; some say: when getting up in the morning to go to the toilet to urinate, some fall to the ground for some reason; others say: turned their heads to look behind them and don’t know anything. Such inexplicable collapse on the ground is medically called syncope or fainting. There are many causes of syncope, but most of them are closely related to temporary cerebral ischemia, and the elderly are the most frequent group of syncope. Postural syncope is mostly caused by a sudden drop in blood pressure and is commonly seen in middle-aged and elderly people taking hypertension medication. When a patient suddenly stands up from a lying or sitting position, syncope occurs because the vascular tone is too late to adjust and cerebral ischemia occurs instantly. After fainting, the patient’s brain quickly gets blood supply and wakes up. Experts propose three 3 minutes, that is, do not get up immediately after waking up, lie in bed for another 3 minutes; sit up and sit for another 3 minutes; wait for another 3 minutes with both legs hanging down on the edge of the bed, and then get out of bed and walk around, which can reduce postural syncope. Swallowing syncope refers to syncope that occurs when swallowing food. Patients experience momentary black haze or syncope just after swallowing a mouthful of food, and stop eating for a few seconds or minutes before taking another small bite, and syncope usually no longer occurs. Swallowing syncope is associated with stimulation of the esophageal or gastric vagus nerve by the swallowing action, which causes cardiac rhythm disturbance. Electrocardiographic examination confirms that abnormalities such as atrial fibrillation or supraventricular tachycardia often occur during swallowing, causing a transient decrease in cardiac output, leading to transient cerebral ischemia and syncope. Patients who have had swallowing syncope should chew and swallow slowly when eating, not gobble. Cough syncope refers to syncope that occurs when coughing violently, mostly in elderly people with respiratory diseases. Syncope mostly occurs at the moment of coughing, which is caused by a sudden increase in pressure in the chest cavity during violent coughing, obstruction of venous blood return to the heart, and a sudden drop in blood discharge from the heart, combined with a decrease in carbon dioxide tension in the blood during coughing and an increase in cerebrovascular resistance, resulting in lower cerebral blood flow and syncope. Elderly people with frequent paroxysmal coughs should prevent lung infection, treat lung inflammation, and unblock the airway. Hold a fixed object with your hand when coughing violently to prevent fainting. Urinary syncope occurs mostly during morning urination, and in a few cases it may also occur after non-morning urination or stool. There is no precursor to syncope, and the person suddenly loses consciousness and faints when urination is about to or has finished, and then awakens spontaneously for a short time. Urinary syncope may be related to increased abdominal pressure during urination, rapid bladder contraction after urination, sudden drop in abdominal pressure, and significant decrease in cardiac blood return, resulting in a sudden drop in blood pressure and causing transient cerebral ischemia. To prevent urinary syncope, do not drink more water before going to bed, urinate before going to sleep, and do not hold urine at night when you have to discharge. When urinating, it is best to use a seated urinal, get up slowly after defecation, and stand for a while after getting up before walking. Hypoglycemic syncope refers to a severe hypoglycemic reaction when blood glucose is below 2.8 mmol/L (50 mg/dL). Low blood sugar can cause high sympathetic excitement, sympathetic-adrenaline release, panic, dizziness, hand trembling, cold sweat, pale face, and even fainting, which can often be life-threatening if not rescued. For elderly people with diabetes, they should always take some small food items like candy with them when they go out as a backup. Vascular neurogenic syncope, also called vasovagal syncope, is caused by many factors, such as standing still in place for too long, being in a hot and stuffy environment for a long time, excessive fatigue, excessive hunger, severe pain, excessive mental stimulation, fear, anxiety, etc., which reflexively cause the heart and small blood vessels in the body to dilate, reducing the amount of cardiovascular blood return, sudden drop in blood pressure, and temporary reduction of blood supply to the brain. After the patient falls to the ground, the cerebral blood supply soon improves and the patient’s mind returns to normal. People who are prone to vasovagal syncope should strengthen their physical and volitional exercises and prevent overwork, over-starvation, and overexcitement. Carotid sinus syncope is also called carotid sinus hypersensitivity or carotid sinus syndrome. The syncope is mostly related to the sudden rotation of the head and neck, stimulating or compressing the carotid sinus. This often occurs when turning back, tying a tie too tightly, or shaving the face to compress the neck, which stimulates the carotid sinus and reflexively causes high vagal excitation, resulting in bradycardia or apnea, a drop in blood pressure, and instantaneous ischemia of the brain and syncope. In some people, when the head and neck are turned to one side, only momentary dizziness, vertigo, blurred vision, unsteady gait and a sense of tilting of the body are manifested, but syncope does not occur. Carotid sinus syndrome is seen in patients with carotid sinus hypersensitivity, but also in patients with carotid arteriosclerosis and cervical spine osteophytes. These patients should turn their heads slowly, not tie their ties too tightly, and not wear high-collared clothing.