fainting during surgery?

[El Nos]

i've heard that most med students will faint sometime during surgery. having fainted once before during 1st year (completely unexpected), this sort of freaks me out... does anyone know why it happens or what you can do to prevent it?

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[Anka]

Unless you're truely squemish, it's usually the standing, lack of sleep, not having eaten since 4 a.m., being dehydrated, etc. all at once. Try wearing TEDs (make sure they are sized properly, remove and put back on between cases), wear Danskos (or another clog that has a slight heel, forcing your knees to bend), stay hydrated (but don't go glugging 3 bottles of water before you scrub, or you'll have another problem). If you feel like you're getting light headed, clench your calves off and on. Try leaning against the table slightly for the entire case. Make sure you don't get hypoglycemic during the case (eat a good, healthy breakfast heavy on the protein). Finally, if you truely feel like you're going to pass out, step BACK so you don't pass out into the field.

Best,
Anka

 

[El Nos]

what are TED's?

 

[Scooby Moo]

what are TED's?

compression stockings

 

[Carm]

Try to avoid entering cases on an empty stomach. Big trouble in the making.

Heat + blood + hunger + tension = trouble

 

[shorrin]

I keep a cliff bar, ibuprophen and zantac close by - nice diet huh? oddly it was the same one I had during the step...

 

[(nicedream)]

But what if you eat before and then have to poo?

 

[Jaded Soul]

i've heard that most med students will faint sometime during surgery. having fainted once before during 1st year (completely unexpected), this sort of freaks me out... does anyone know why it happens or what you can do to prevent it?

"Most" med students don't faint during surgery.

 

[porknbeans]

that's why my nephews doesn't like to eat breakfast..coz they say it will make them want to go poop

 

[Yosh]

I have never seen anyone pass out during surgery...I am sure that it has happened...but it is certainly more the exception than the norm.

 

[Boomer]

But what if you eat before and then have to poo?

Just let it go dude....just let it go....

But, before you do, ask the circulating nurse to put some benzoin on everyone's mask....

 

[femme_fatal]

highly not recommended...try to avoid it. just excuse yourself if you feel 'pre-syncopal'--if you contaminate the sterile field, boy, you are asking for trouble. that being said, if you really do have to faint, and it happens, the sicker you look, the better you will be off. They will understand the 'sick' reason, not the human reaons. Some surgeons forget what it's like to be a student, first time in the OR and see a gush of blood out somebody's artery. So it's 'better' to have a biological, not 'personal' reason for fainting.
I thought being a novice will forgive me all my initial sins--hell no! I got some feedback saying I was behaving in an inappropriate manner, blah blah, need counseling and further mentoring. Imagine if I fainted--probably would have ended up right next to the patient, knowing some of the surgeons.
Also, try not to say 'oops' in the OR.

 

[shorrin]

But what if you eat before and then have to poo?

get a colostomy bag dude.

 

[EJS]

ugh! it happened to me once, more than half way through my surgery rotation and I was on call, evening surgery, no food for over 10 hours. About 30min into it there was just no turning back and I told the attending I was going to half to scrub out.... But, it ended up ok. Only a few days later the surgeon asked me to get him some juice when he was writing orders and feeling like me because he hadn't eaten! So, my advice. Eat, don't get too nervous. And do something like start trying to name all 50 states or all the branches off the carotid when you feel a little lightheaded, gets your mind off the possibility of fainting!!

 

[supercut]

It doen't happen to all students, but it is not uncommon. Most just feel faint but don't acutally pass out.

Almost always it is caused by the factors already mentioned (fatigue, hunger, heat) rather than the procedure being observed. It happened to me a couple of times as a student (on nonbloody procedures)...and I'm now PGY 2 surgery.

Make sure you say something and scrub out if the feeling doesn't pass quickly. It is far more embarrasing (and detremental) to pass out in the field than to say you aren't feeling well and scrub out. Those of us that spend a lot of time in the OR are used to this happening.

 

[vietcongs]

i know an MS3 who was holding the pt's leg during childbirth, the gush of blood and amniotic fluid, smells, and heat caused him to drop the leg and pass out. he ended up being admitted to the same hosp..how embarrassing. good advice given here - eat, stay hydrated, dont forget to breathe.

 

[InductionAgent]

Speaking from personal experience, the two times I felt queasy were due to the combination of being sleep-deprived, undernourished, and what was going on.

The first time was during a circumcision of a nine-year old boy. A surgeon watching the procedure started expressing concern that the one cutting was taking too much off - that concern (which was baseless in the end) and seeing the bleeding unit made me get a bit vagal out of empathy for the boy's situation.

The other time was during the first autopsy I witnessed during a forensic path rotation. Seeing a freshly-dead person get butchered is a lot different than a cadaver. Everything is so much more lifelike, and profusely bloody. After that I was desensitized, and I didn't have any reactions to subsequent autopsies.

In both situations, I felt sick to my stomach, started sweating, and felt light-headed, but I hung in there, did my best not to hyperventilate, and got past it.

 

[roja]

I got pre-syncopal once.. I was 8 mos pregnant, and classic gas people wanted the or really warm. Patient had a remote h/o 'raynauds' (she didn't have it) but they used it as an excuse to overide the surgeons multiple requests to turn down the temp.


Half way through I felt a little light headed. i just stepped back and sat down.. they cranked the temp way down after that.

 

[leorl]

Yeah, I heard the fainting doesn't usually occur because of queasiness or squeamishness. More due to postural hypotension and other factors you totally can control for.

 

[krisg]

I LOVED my surgery rotation, but I had a few times thrughout the year in which I had to step out. It was never an issue. It happens to lots of people. Some say it's getting used to rebreathing all that CO2 in your mask, some say it's not locking your knees. I can get faint just standing in a line too long--and it's totally random. I never lock my knees, I definitely never wore a t-shirt under my scrubs, and I always had food in my pockets. I'd make it through quintuple bypasses without a sweat, or I'd get faint during a basic lap-chole just shortly into it.

I tried to control for every factor I could going into each case, but sometimes it just happens, and once I'd start getting those pre-syncopal, diaphoretic symptoms, there was no turning back. I imagine I'm more of an exception with respect to those who pass out.

My biggest factor was OR temp. If it was too hot, it was all over but the cryin'. Those OB rooms were the worst.

I think you'll be fine if you keep a stash of food in your pockets and stay hydrated. Don't overdress. Know your symptoms well so you don't try to hold out too long. The most important point, as others have said, is to know when to call it quits.

Surgery is loads of fun! I hope you enjoy it.

good luck,
~kris

 

[lady bug]

Where would they sell compression stockings at?

 

[FutureNavyDOc]

When I was in undergrad, I volunteered in the ER on weekends one summer.
A guy came in with a fish hook embedded in his right temple at about 2PM. I hadn't eaten since breakfast at 6 AM (I was a dumb college student and didn't know any better). By the time the doc was ready to take the hook out it was nearly 3PM. Since it was a barbed hook, she had to puncture the skin with it and clip the barb off before threading it back through.
The pt had thick skin and the Doc was having a hard time getting the hook to poke back through. I stood there with my knees locked while staring straight at the guy's temple as a black dot (the end of the hook) moved around under the skin as the Doc tryed to poke it out. About this time the pt's eye randomly moved laterally then twitched back medially really quick. That was it, I excused myself from the room, took a step back and went down knocking the phone off the wall in the process.
I woke up about a minute later with my favorite ER nurse cradling my head while I laid on the floor. I ended up getting checked into the ER where I was volunteering and had to sit in a bed for a half hour.

Mistakes I now know I made that day:
Locking my knees, staring right at the site being worked on, not eating for 9 hours and having nothing to do but watch.
From that day on anytime I have watched any procedure being done I make sure I have eaten recently, keep my knees bent, move my eyes around every 3-4 seconds to look at something else, and grab a paper towel and roll it around in my hand if I have nothing else to do.

The paper towel gives me something else to think about if I start feeling queasy as well as keeps me moving and doing something. I think that helps me as much as not locking my knees.

All this being said, I won't have my first surgery rotation until next spring, so we'll see how well it goes!

 

[Mr. McDuck]

Oh, man. Keeping your eyes moving and having something to do definitely help. I was assisting on an AV graft the other night at around 9 o'clock after being up since 5 that morning rounding, assisting in surgery, more rounding, seeing consults, etc. I hadn't really had a chance to eat much that day, and while I was sitting there trying to dissect out the artery, there were a few moments when I felt like I was going down--and I've been doing this for a while.

Point is, it happens to the experienced as well as newcomers. Try and do as many things listed in the above post as possible, and you should be fine.

 

[Dr JPH]

Where would they sell compression stockings at?

Most pharmacies carry them or can order them. They arent the most comfortable devices to put on, but after a half hour you forget youre wearing them.

People have mentioned some great tricks...here are mine (I apologize if there are repeats)

1. Never skip breakfast. Few surgeons will scoff at the thought that "the med student went to go grab a muffin" unless he/she is told this while actually scrubbing in. Just make sure you are in the OR in time to help prep the patient. Remember, attendings come in later than you (usually) and have an opportunity to eat before hand.

2. Keep yourself well hydrated. It is far less annoying to ask to be excused to use the restroom than it is to face-plant into an open abdomen. Many of the long cases have moments when you can take a quick break...rads need to bring in the c-arm, path needs to call back with a report, nurses need to flash something in the autoclave.

3. Never skip lunch. See #1.

4. Stretch before going into the OR. OK, I know it sounds stupid, but trust me on this one. Proper posture and stretching will help limber you up and allow you to stand more comfortably and avoid NavyDOcs scenario of locking the knees.

5. Don't get into awkward positions in the OR. If you need a stool (or 2), ask for it. If you cant see the field without craning your neck into ungodly positions, then dont look at the field...hopefully youre not first assist in this case!


One attending once told me the medical students who passed out in the OR would make great surgeons...because they wouldnt make the same mistake twice.

 

[Bertelman]

Where would they sell compression stockings at?

I would agree with all the suggestions thus far, but I'm not so sure the compression stockings are neccessary. Seriously, unless you have some clinically significant venous insufficiency, all you have to do is lift one leg at a time every 5-10 minutes, just flex your leg. If you insist on leaving both legs on the floor, just squeeze your muscles every few minutes.

We were all born with compression stockings- the muscles of the leg. Besides, those things cost like $50+.

 

[nabeya]

I never fainted or came close to it. Another student that was with me on that rotation fainted once and collapsed on the floor luckily missing the mayo table and not contaminating anything.

The only issue I have had with scrubbing into general surgeries and c-sections is the heat. Wearing all that attire, I'd nearly sweat like crazy during every procedure. Once so bad that I had to scrub out or else it was about to drip off my face and onto the patient contaminating the sterilie field.

In order for it to be comfortable in the OR, it's gotta be at least 68 on the thermostat for me not to sweat.

Anybody else have the heat issue in the OR? Thats one reason why I can't ever be a surgeon, I can't stand to be hot.

 

[inliner42]

First time i ever scrubbed in (Second assistant), after workin for 9 or 10 straight hours in the surgical er (in greece er is divided in im er, surg er, etc,) having sutured almost everything in the world (yes i was a crapy MSII-msII in greece is something like ms1 in a 4 year med school) and haven't eaten anything since lunch (and it was a really light lunch), i almost fainted on an appendicetomy in 2 in the morning. I was sweating as hell, felt light-headed and felt my ears doing some strange things and started turning white. Luckily a nurse saw me and the attending orderd me to scrub out. And it was not my first time in the OR. I have observed a lot of cases, near the gas resident but watching the field, since i was a teen cause my mother is an anaesthisiologist in the same hospital.

So the clue is eat eat eat and stay hydrated.

 

[kate_g]

Yeah, I heard the fainting doesn't usually occur because of queasiness or squeamishness. More due to postural hypotension and other factors you totally can control for.

One other thing nobody has mentioned... If you find yourself getting lightheaded (or get the vasovagal "cold sweat") frequently - say twice or more in a couple months - go have your iron levels checked. 'Specially us menstrual-age gals have a tendency to get a simple iron deficiency anemia that never gets quite bad enough to notice during "normal" daily life. But add in all of the above - heat, dehydration, hypoglycemia, postural issues - and you're on the floor. I had two near-syncopal episodes a month or two apart, during surgeries I'd done a zillion times, nothing unexpectedly gross or whatever, and then another a few weeks later, a couple hours after giving blood (NOTE: I passed their little blood-drop test, so you've really got to get the lab test where they check ferritin). After diagnosis (and doc's orders to take iron supplements until my numbers improved, and then a daily women's multivitamin thereafter), I thought back and realized that I used to get the same symptoms fairly often during menstruation in high school and college, during which time I ate hardly any meat. Probably been slightly anemic most of my life and never knew it...

(Further note: Y'all probably already know this but even though they're OTC iron supplements can cause nasty side effects, and you need to take vitamin C and calcium at the same time, so wait for a doctor to suggest it. Also, unless you're a hockey player or something, guys don't generally lose as much blood as girls and are thus more susceptible to iron *poisoning*, so be careful with self-diagnosis here.)

 

[caroladybelle]

Try to avoid entering cases on an empty stomach. Big trouble in the making.

Heat + blood + hunger + tension = trouble

After years of being in the OR, I fainted while assisting during a circumcision. I had been on duty in the nursery (kept very warm), and had been on for 9 hours without eating.

I came to with them checking my blood sugar...it was 25...and several swipes with ammonia inhalents.

To my credit, I managed to put down the baby and back away from the sterile field, prior to falling.

 

[DOAnestMan]

I have worked as a OR Tech for about 6 years and in addition have significant VDS. As someone who has frequently passed out in surgery, it is ALWAYS preferable to excuse oneself than to pass out on the field. Heat is often a factor, particularly when you are standing still holding a retractor for a long time. Ask for a stool when necessary. Try to walk in place. Don't hesitate to excuse yourself if you need to.

 

[Pinki]

I was newly pregnant during my surgery clerkship and very vulnerable to the heat, hypoglycemia and hypotension that comes with the territory of being a medical student AND gravid.

An attending told me to befriend the circulating OR nurse and ask her to rip open an alchohol prep wipe if I was feeling faint and to take a few deep sniffs through my mask. Probably placebo effect, but I swear it worked, I would snap right out of my tunneling dizziness and be ready to go. Luckily for me, I guess huffing alcohol prep wipes a few times a week isn't teratogenic - my kid turned out fine.

The hard part was finding a friendly circulating nurse to help out - but that's been beat to death in previous threads, eh?

 

[beansandchips]

I only WISH I could have fainted during surgery. I was once 8 hours without food, about 4 gallons of piss in my bladder and bored to tears. I had already been yelled at for contaminating myself (purposefully,) the day before (to get out of the OR for a minute) and was toying with faking a faint. I decided to go for the 'knee buckle' as opposed to the classic '1920s swoon' and did like 4 of them, but noone paid any attention to me at all.

GOD I hated my surgery rotation.

 

[SurgeryChef]

So I get that it's OK for a med student to excuse him/herself if feeling faint. But does this happen to residents too? And what about attendings? I've never seen a resident ask to step out. Is this because they are actually DOING the case and don't have time to feel faint, or do you just become desensitized by that point?

 

[Catalystik]

I also had a tendency toward vasovagal symptoms with prolonged standing. I found that eating more salt, along with increased fluids, helped keep my BP up (it was on the low side even without symptoms). A secondary benefit: the urge to void is delayed.

 

[Bertelman]

So I get that it's OK for a med student to excuse him/herself if feeling faint. But does this happen to residents too? And what about attendings? I've never seen a resident ask to step out. Is this because they are actually DOING the case and don't have time to feel faint, or do you just become desensitized by that point?

I saw a resident step away during a C-section, maybe 2-3 times during the case. I didn't get the whole story (didn't really care), but I think she may have had a head cold or something. She ended up breaking scrub, and the attending and intern finished the case. I helped close, so it worked out for me

 

[imalwayshungry]

Speaking from personal experience, the two times I felt queasy were due to the combination of being sleep-deprived, undernourished, and what was going on.

The first time was during a circumcision of a nine-year old boy. A surgeon watching the procedure started expressing concern that the one cutting was taking too much off - that concern (which was baseless in the end) and seeing the bleeding unit made me get a bit vagal out of empathy for the boy's situation.

The other time was during the first autopsy I witnessed during a forensic path rotation. Seeing a freshly-dead person get butchered is a lot different than a cadaver. Everything is so much more lifelike, and profusely bloody. After that I was desensitized, and I didn't have any reactions to subsequent autopsies.

In both situations, I felt sick to my stomach, started sweating, and felt light-headed, but I hung in there, did my best not to hyperventilate, and got past it.

It's funny, I also got all vasovagal while watching a circumcision! An amputation of a necrotic foot, open heart surgery, any belly procedures - that's fine, but a circumcision will get me every time especially when they strap them down into the "circumstraint"! and the baby's crying and getting all red in the face - i was like, um i gotta go get some water...

i've also heard stories of these big tough guys passing out during vein strippings because they think the veins look like worms

 

[Blue Frog]

Just to add my 2 cents...Most students do not faint. I was very concerned b/c I tend to get light headed after standing a while, especially 2nd year, and lost visions several times...I also have had other issues with standing (back and foot problems) I even went out and got compressions stockings. However, on surgery I never had any issues with fainiting (or any of my other issues). I found that as you are retracting and seeing cool stuff, your blood is pumping and you're moving a bit which eliminates low BP issues and back soreness. (People who faint for vasovagal reasons I suppose is another story) The only problem I had was falling asleep. In that case the more the surgeon yells, the better. I worked with one surgeon (not a yeller, and didn't require retraction) who often looked at me funny when it seemed like i had "ants in my pants"...but it was actually me trying to stay awake. I'm sure I looked pretty ridiculous...but hey, its better than collapsing onto the field.

My reccommendation is wait until your rotation to see how you feel. If its a problem, deal with it then...most likely it won't be.

 

[lp=md]

i once fainted in the OR during a c-section. i tried hard to stick it out but it was like fighting a losing battle... all the sudden i knew i had to get out of there and i was scared. i started to walk away from the field and 3 nurses came charging at me from all sides. they kept me from falling and i am still grateful.
I had seen many c-sections before that so I felt very embarrassed and confused. But later I found out that the air conditioning was "broken" and that another med student passed out the same day in the same OR.
if this happens to you just take a breather, let the nurses take care of you (they will) and take it easy for a bit. then get back to work when you're ready...

 

[starla]

Today i scrubbed in a coronary bypass, i had eaten well, slept well, was well hydrated, and it was an extremely interesting, entertainig procedure. It was hot, I felt nauseus, light headed, had cold sweat after the third hour, tried to think about something else, moved my legs, but nothing worked, i tried to excuse myself before i collapsed into the sterile field but i just blacked out, couldnt see a damn thing and i had to stay still while the nurse helped me get out, fortunately i didn't fall down. It was the most embarassing experience ever!
I'm really freaked out it will happen again, as i cant find a reason why this happened!

 

[caroladybelle]

Are you female, and if so could you possibly be pregnant?

(Notorious issue with OR/scrub nurses)

 

[alimarie81]

i know an MS3 who was holding the pt's leg during childbirth, the gush of blood and amniotic fluid, smells, and heat caused him to drop the leg and pass out. he ended up being admitted to the same hosp..how embarrassing. good advice given here - eat, stay hydrated, dont forget to breathe.

I nearly passed out last week after the placental delivery and sewing up the perineal region. It wasn't the blood or smell, i think it was the god awfully hot lights blazing into the field, not enough hydration, and leaning over the field at an odd angle. I said I needed to step back for a moment- would much rather sit down for a minute and get some water than to drop face first into a bloody perineum and make a fool of myself!

 

[Hard24Get]

I nearly passed out last week after the placental delivery and sewing up the perineal region. It wasn't the blood or smell, i think it was the god awfully hot lights blazing into the field, not enough hydration, and leaning over the field at an odd angle. I said I needed to step back for a moment- would much rather sit down for a minute and get some water than to drop face first into a bloody perineum and make a fool of myself!

Tee hee, I hadn't eaten the other day in the OR and suddenly got a hot flush. I mentioned it, debating whether or not to point out that I may faint, and as soon as I said, "I feel hot", the attending told the circulating nurse to "grab the student", which she quickly did. It was really dramatic and embarassing but everyone was nice about it. Had no idea I would one day join the statistics, but it hasn't happened since (I eat BIG breakfasts now!). The anesthesiologist felt that women with low bp are more susceptible.

 

[deleted29780]

Try to avoid entering cases on an empty stomach. Big trouble in the making.

Heat + blood + hunger + tension = trouble

well said, well said. experienced it a couple of times. dehydration, low blood glucose - these two am sure of in my case. wasn't tensed up at all on all those circumstances i almost fainted. But tension indeed plays a role too.
heat, oh heat - causes mild to moderate dehydration. 500ml of water should help preop.

 

[krasnayana]

I shadowed ED residents and was fine when observing patients w/ GSW or serious injuries. I've had blood drawn from me before and was fine. Don't have a needle / blood issue.

Then I went to my vet and saw him draw blood from my cat. I walked out of the room and dropped to the floor.

Go figure

 

[specialkay]

Fainting during surgery is common and the attending on my surgery rotation was cool about me stepping out last week during a lap chole the morning I got my period. I also felt a vaso-vagal episode coming on during a c-section at four am when I had a mild stomach flu.

Factors that have been mentioned in this thread that I agree with -

#1 - Hot OR or using a plastic-y vs. a paper gown.
#2 - Not having eaten.
#3 - getting your period
#4 - sleep deprivation
#5 - staying in one position

Ways to avoid this -

Sleep as much as you can on that rotation. This past month on surgery I went to bed at nine pm every night, whether or not I was on service. I haven't gone to bed that early since I was eight, but it made a huge difference when I was sleep-deprived.

Make sure you eat as much as you can, even if it means drinking a cup of coffee and eating those graham crackers in the recovery room in between cases. Try to skeeve food from the doctors lounge, esp bananas. I also found having hard candy in my pockets allowed me to keep my glucose up.

Pull a paper gown for yourself instead of those reuseable plastic-y gowns that get so much hotter.

I bought compression stockings from a department store but I found that going to the gym and lifting like crazy not only gave me arm and back muscles galore for holding the retractor, but my legs rarely fatigued.

Can't avoid getting your period, but I should have drank a ton of water and ate more protein the morning of the lap chole.

Most attendings want to ensure the safety of the patient and I have a feeling that they can do the surgery without me, so as soon as I mentioned I wasn't feeling well they always tell you to scrub out.

During the lap chole I didn't even realize I was getting lightheaded, I just asked if the room felt really hot to anyone else. The attending said he knew I was going to faint and told me to sit down immediately. The scrub nurse got me a stool, I stepped back, sat down, kept my hands up and stayed sterile. After the sweats stopped and the room returned to normal temperature, I went right back in without having to re-scrub.

Of course, people asked if I was pregnant ...

Funny what the other poster said about women with low bp's being susceptible as mine is 90/60 normally.

 

[Sharkfan]

I too have had heat issues that make me feel light-headed and very uncomfortable/unhappy; my first time to scrub in, I had a T-shirt on under my scrubs, the air in the OR room was broken (so it was fairly warm), I hadn't eaten breakfast that morning, and the procedure was going istrong into hour #3- recipe for disaster. I got the full range of symptoms: feeling flushed, cold sweat, noise/buzzing in my ears, tunnel/black-dot vision. I fought it the best I could, but eventually gave up and asked to scrub out. As soon as I got my mask off and sat down in the OR lounge (air conditioning!) I was fine. Lesson learned; I ALWAYS ate 3 meals a day after that... plus fitness bars or some other snack before scrubbing in. I also began wearing tank-tops under my scrubs instead of T-shirts, which helped with the over-heating issue. Never happened again, so I guess that solved the problem. Those masks STILL make me a little light-headed, but I can deal with it.

On the other hand, some people just seem the fainting type. One of my classmates did it 3 times during our rotation (and she wants to do surgery!!!). She said nothing helped her; sometimes it just happened, and there wasn't anything she could do about it but warn everyone.

I never saw a resident or attending feel woozy though; just students. I hope it's something that can go away with acclimation.

 

[ddrop25]

I know about the common reasons for fainting...and so I try to stay well hydrated and eat..etc....however, as an MS2 all 3 times I have had to wear a mask I feel faint a nurse has to help me leave the OR!!...Very embarrassing as I am just shadowing at this point...and believe me blood and guts don't bother me a bit(I worked in a path lab before)....I think my issues are with actually wearing the mask....Long story short, I used to have a deviated septum and couldn't breathe for 25 yrs, recently got it fixed, but now I am still not used to breathing through just my nose...Anway, I think my fainting issue has to deal with not being able to breathe correctly in a mask..Everytime I wear one I try to breathe in that hot air, and then I can't really catch my breath...and a minute later I see black spots....I want to know has anyone had the same issues???...Now I am totally freaking out b.c I want to resolve this before next year!!!...any suggestions????

 

[smkoepke]

Most pharmacies carry them or can order them. They arent the most comfortable devices to put on, but after a half hour you forget youre wearing them.

People have mentioned some great tricks...here are mine (I apologize if there are repeats)

1. Never skip breakfast. Few surgeons will scoff at the thought that "the med student went to go grab a muffin" unless he/she is told this while actually scrubbing in. Just make sure you are in the OR in time to help prep the patient. Remember, attendings come in later than you (usually) and have an opportunity to eat before hand.

2. Keep yourself well hydrated. It is far less annoying to ask to be excused to use the restroom than it is to face-plant into an open abdomen. Many of the long cases have moments when you can take a quick break...rads need to bring in the c-arm, path needs to call back with a report, nurses need to flash something in the autoclave.

3. Never skip lunch. See #1.

4. Stretch before going into the OR. OK, I know it sounds stupid, but trust me on this one. Proper posture and stretching will help limber you up and allow you to stand more comfortably and avoid NavyDOcs scenario of locking the knees.

5. Don't get into awkward positions in the OR. If you need a stool (or 2), ask for it. If you cant see the field without craning your neck into ungodly positions, then dont look at the field...hopefully youre not first assist in this case!


One attending once told me the medical students who passed out in the OR would make great surgeons...because they wouldnt make the same mistake twice.

I agree with this. i am an RN student and 2 weeks ago before my 9 hour clinical day, I only got 2 hours of sleep, only ate slice of toast and some soy milk and 3 hours in I was doing preop services and going down with patients to seeing same day procedures. I was standing still for probably about 1 hour and I got the cold sweats, skin felt prickly and i was seeing black, I couldn't shake it and knew i was going to go down if I didn't sit for a minute, so i excused myself and sat with my head down for about 5 minutes. Happened again about an hour later. i figure i must have just gotten a bit hypotensive, needed to move around more and get the blood moving in the venous return.

 

[beachbunny]

When you're doing a surgery rotation during your clinical years, what is the longest time you'll ever have to be in the OR for one single case? I bet it just depends on the case, right? But, as a student, is it safe to say you're not stuck in the OR on one 10 hour case?
I'm worried I will have a hard time with this rotation. I've worked in the hospital environment for almost 10 years now, and have seen my share of interesting cases. I have narrowed down my pre-syncopal (and downright syncopal!) episodes to cases involving patients who are clearly in pain and terrified. However, the majority of the times I have been in the OR were for tissue recovery procedures on people who have been dead about 12 hours or so. The removal of bones (arms, legs and pelvis) definitely tops the list for the most gruesome thing I have ever seen. Interestingly enough, I had no presyncopal feelings (my own analysis: because the person was not in pain and this was something they were doing by their own choice to help others). But, I did get claustrophobic with the gown and mask on for 3 hours! I can only imagine how I would feel if I had to have that mask on for 10 hours. I don't think I could handle it! Anyone else feel the same?

 

[dpmd]

I sometimes have a problem with pain related presyncopal events. Interestingly enough, I am much more affected when it is someone else causing the pain (although one time I barely managed to finish putting a foley in before I had to run and put my head between my knees-and it wasn't even my first time doing it). It doesn't happen with everything (I want to do ortho and haven't had a problem watching/doing reductions, or seeing people with bad injuries scream and cry). I associate it with identifying too much with the patient and relating it to my personal experiences with pain (several surgeries and unfortunately very tolerant to narcotics=bad post op recovery). When I am more of an active participant I can't do this and therfore stay upright. If you have a problem once or twice, try not to dwell on it as the anxiety over it happening again will not help prevent it. If it is a recurrent problem, try to analyze what factors might be involved (overheating, hunger, emotional reaction, etc) and do what you can to control them. If all else fails you can try shuffling your feet, bending your knees, biting your tongue to try to hang on but at a certain point you need to concede defeat and avoid falling down by sitting, squatting, or laying down.