Passing out during ED Observation??

Lots of people do this, so don't let it worry you.

I found out that I get light-headed if I haven't eaten or get overheated. Because of this, I carry easy to eat snacks with me and wear cooler clothing if I think its going to make a difference.

carrie198 said:

I am a first year med student and last night I shadowed an ER doc in the trauma center for the first time and came extremely close to passing out while I was observing an accident victim w/ a massive head wound get stitched back together. I have observed surgeries before with no problem, but last night, my vision got all blurry and then had black spots, I turned white, and got really sweaty and dizzy. Is this common for a MSI, or should I just drop out of med school now? It was definitely and ego-blowing experience and I don't know how to prevent this from happening again. Does anyone have any input?

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Breathe, girl, breathe!!! You were holding your breath. Stick with it, you are fine. Just don't fall in the sterile field when you faint. Better to step out than to fall in.

i have been close to fainting not because it was gross...but because i was standing in one place for a while. try to move your legs or bend your knees to get the blood flowing

A bathroom break with a good splash of cold water to the face has helped me in the past.

As another poster mentioned, don't be afraid to leave the room. There is no shame in recognizing that you aren't feeling great and doing something about it.

Do a search on this topic. There are several threads with some good tips.

Don't feel embarassed at all. It happens to virtually everyone at some point. Check out the 'What makes you squeamish" thread in the EM Residency forum for some funny stories.

yeah, it's happened to me too, and I am not squeamish about blood and guts and gore at all.

i'm still a few months out from being an ms1, but i had a very similar experience when i started shadowing. the first procedure i observed was an LP (not particuarly gruesome, i know) and for some reason it got to me. i had to really focus on my breathing to keep from losing it.

but on the bright side, since then i've seen all sorts of stuff a lot worse and had no problem.

i've heard that pretty much everyone has this happen when they start out.

I was doing an anesthesia elective and my classmate was on Gen Surgery. Anyways she almost passed out in the middle of surgery and ended up passing out on the floor right next to the surgeon. anyhow the words of wisdom are EAT (she didnt eat breakfast), Breathe air is good for you! 3. move your legs and bend your knees (help with venous return(thats why people pass out at weddings)

As an ED nurse I mopped up a couple of med students and gave all the advice you've just read above.
I was pretty surprised when as a MSII during my first open surgery procedure I started getting that little burst of sweat over the brow. I became really distracted and started thinking how will my 6'2" nurse/paramedic self back out of this without making an ass of myself.
Just then the surgeon gave a bark for me to get in and start some retracting. Not a glamorous role, but I was immediately better.

It seems counterintuitive, but being active and concentrating on a job really helps.

If you're on the edge and know that faint-type feeling is inevitable, then breathing and taking a bow-out is the right way to go.

However, the more involved/interested you are in a procedure, the faster that ooky feeling will pass.
That's .02.
F

I think you should drop out. That is the test if you will be a good doctor. It is common knowledge that if you get light headed during MSI year (and only during first year) while in the ED you should just drop out. I would question why you even want to be a doctor to begin with.

NickPapagiorgio said:

I think you should drop out. That is the test if you will be a good doctor. It is common knowledge that if you get light headed during MSI year (and only during first year) while in the ED you should just drop out. I would question why you even want to be a doctor to begin with.

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I concur with the above poster. Quit now while you still can!




j/k I get this quite a bit as an MS3. It almost always has involved being in a warmer room and when I was observing more so than doing anything. Especially bad in the OR with a mask on. I've had to take a knee once to avoid falling into the surgical field. Some may think that's wussy, but I'd rather be known as the guy who took a knee than as the one who ended up with a kidney in his mouth.

Totally cool:

Everyone experiences stuff like that sometimes. I heard of a resident at Baylor faiting right in the middle of surgery. Hit her head on something and then had to get admitted to the hospital's ER to get stitched up. So if someone who does that stuff day in and day out can faint, we all can. I think it is just because it is just not natural for human beings to love seeing blood, the insides of people, etc. But, I think we all get use to it, just like we got use to the smell in Anatomy Lab.

MD'05 said:

Breathe, girl, breathe!!! You were holding your breath. Stick with it, you are fine. Just don't fall in the sterile field when you faint. Better to step out than to fall in.

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so it's the breathing (or lack thereof) that does it?

i almost passed out observing my first pap. i got all dizzy and had to leave the room. needless to say, i was very embarrassed. but, when i actually had to give my first pap, i was fine. i suppose, given the choice i'd much rather pass out as an observer than as the provider.

Nosa said:

so it's the breathing (or lack thereof) that does it?

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Yes. One will focus on the procedure in progress so intently that one will tend to hold his or her breath. Once vision begins to fade, take a couple of deep breaths.

This has happened to me while volunteering in the ER. The first time it happened I was watching a nurse practitioner do some stitches. I remember feeling light headed, and then pretty soon I fainted dead away and had to be carried to a bed in the hallway, where I woke up. (And which I later changed, linens being the main part of my job as a volunteer.) While I was lying there looking like an idiot, some doc walks by, asks how I am and says that he used to know a med student who fainted every time he saw a needle.

The second time it happened was a few weeks ago. I started feeling light headed again, so I made sure to take some deep breaths, not lock my knees, etc. No help! I still knew I was going to faint. So I left the room and sat down. I went back into the room after a few minutes, but to no avail--I had to leave almost right away again. Then I ran into that same doctor, and begged him to tell me whatever became of that poor fainting med student. We got to talking and he sent me home with a bunch of needles to stare at and get used to. He also offered to let me shadow him. Which turns out to be a lot more interesting than changing linens! (Assuming I don't keep fainting. I'm hoping being involved makes things a little easier.)

I have no idea why this happens--I'm not squeamish at all.

There's this thing called "applied tension" where you tense all the muscle groups in your legs/arms to divert blood flow from the periphery to the central arterial circulation, and I've heard it works. I don't know that you can be a dutiful, productive med student (retracting, pap-smearing, etc) while doing this, but I'm pretty sure it has merit cancelling some of the effects of vasovagal syncope.

I tend to get woozy when I stand for a long time observing physicians as well as when the doctor is trying to perform a procedure and is getting resistance. This will sound really corny, but what helps me the most is to breathe yoga-style. Probably because it takes quite a bit of concentration for me: tummy out, lungs full, lungs empty, tummy in. I always get back to normal after a couple of minutes of this, moreso than just deep breathing. Asking questions also helps.

I almost passed out when I was shadowing my mentor (urology) 1st year during a procedure for priapism. The guy had already seen two docs and had priapism for a week from trazodone and it was definitely one of the worst things I've ever seen. You know how when it hurts if you're a guy to even see another one get hit in the groin. Well, this was like a 1000x worse. I had to step out

It's just a reaction...don't worry about it. People faint at the most random stuff that has nothing to do with what you're thinking or feeling or seeing. Remember to eat healthy and sleep well and keep yourself active. Just make sure to not keep doing it otherwise people will question your motivation for medicine.

Oh yeah...one more thing...us slender ladies have a tendency to be anemic or have low blood pressure, even if you're otherwise healthy...

OncHeme2B said:

Oh yeah...one more thing...us slender ladies have a tendency to be anemic or have low blood pressure, even if you're otherwise healthy...

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Huh?

I was sick and spiking fevers up to 103 one night and still went in sick the next day. I was assisting in an orthopedic hand surgery and one of the lights was poorly placed directly onto the back of my neck. I was VERY close to passing out and excused myself and went home for the morning but still took call that night.

The point is that it happens sometimes to many people and isn't anything to be embarassed about. I have seen much worse things and never felt quesy (sp?) before. You will be fine.

TRAMD said:

I was sick and spiking fevers up to 103 one night and still went in sick the next day. I was assisting in an orthopedic hand surgery and one of the lights was poorly placed directly onto the back of my neck. I was VERY close to passing out and excused myself and went home for the morning but still took call that night.

The point is that it happens sometimes to many people and isn't anything to be embarassed about. I have seen much worse things and never felt quesy (sp?) before. You will be fine.

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Man, that's tough. I'm pretty sure I'm a big baby when I get sick, cause whenever I've had fevers like that I've felt "like dying".....

I'm not egotistical enough to think that I REALLY AM sicker than everyone else. But I get concerned, because when I get sick, it's like I'm friggin totally useless. When I DO push through I feel like I'm setting myself even further back in terms of recovery. Not sure if this happens or not, or just my paranoia.

In addition to making sure you eat before you go to work, make sure you stay hydrated as best you can. I had this problem with standing for long periods of time and found that drinking a bottle of water in the mornings seemed to help. Carry a granola bar in your pocket and eat it when you can. And definitely shift weight/move your legs/etc.

Ah yes, I remember the first time I passed out. The examination room was about 5' x 10' and the air conditioning wasn't working. I hadn't eaten all day, it was hot, and stuffy, and the patient had about 8'' of rectal prolapse.

Down I went.