Fainting in the OR

Igor4sugry · Jul 24, 2007

A couple of days ago I had a chance to observe a total knee replacement procedure. I was in the OR, watching the anesthesiologist administer spinal anesthesia when all of a sudden I began to feel lightheaded and soon had to sit down and almost passed out. I was very surprised this happened because I had volunteered before and observed around 70 cases without any problems.

Has anyone else had the experience of passing out in the OR?

The nurse told me there was a guy that hit his head on the OR table on his way down, and had to get stitches.

nick_carraway · Jul 24, 2007

Never but I have caught myself with locked knees a few times so I was just lucky, I guess.

Derm surgeries don't last too long anyway. Few go past three hours.

Catalystik · Jul 24, 2007

Igor4sugry said:
Has anyone else had the experience of passing out in the OR?

This is not an unusual situation. I often had the problem of getting light-headed in the OR. I solved the problem by always eating before hand to increase blood sugar levels, and ingesting extra salt to keep my blood pressure high. Doing some deep knee bends on occasion (if possible) helps enhance venous return from the legs. Most important, if it's happening to you, don't try to tough it out. Put your head down. It's more embarrassing if you don't and you hit the floor. Perhaps others will offer further suggestions.

etf · Jul 24, 2007

happened to me. everyone was laughing their ass off, especially the patient (he was awake during the "procedure")

prmdbeach17 · Jul 24, 2007

I haven't had that experience, but I read a thread awhile back that it's a vasovagal reaction which you can't stop and may happen even after experience with surgeries & things like that. You may not think it's gross or anything but it happens anyway. I also shadow a neurologist & we had a case of a young girl who had the reaction once when her knee was bleeding & passed out. It never happened to her before that & hasn't since.

jochi1543 · Jul 24, 2007

It happens to most people....you might have some sort of heightened sensitivity for particular procedures b/c of past experiences. I had a lot of eye and nose issues as a kid, for example, and I absolutely cannot observe any eye or nose surgery. I get nauseous whenever I see those reports about nose jobs on TV. *faints*

Meatwad · Jul 24, 2007

jochi1543 said:
It happens to most people....you might have some sort of heightened sensitivity for particular procedures b/c of past experiences. I had a lot of eye and nose issues as a kid, for example, and I absolutely cannot observe any eye or nose surgery. I get nauseous whenever I see those reports about nose jobs on TV. *faints*

Then I guess it's safe to assume you have no interest in pursuing ENT; score.... one less competitor.

jochi1543 · Jul 24, 2007

Zolar Czakl said:
Then I guess it's safe to assume you have no interest in pursuing ENT; score.... one less competitor.

Yeah, no ENT, plastics, or ophtho. :laugh:

I still have horrifying memories of having 10-inch wires shoved into my skull through my nose. :scared:

The otitis that was accompanied by a rupture of BOTH eardrums was not pleasant, either, as the blood-soaked pillow kept as a relic shall attest. :scared:

I'm not sure what was worse, the 1-month otitis, the 2-month bout of chicken pox (yeah, it took THAT long to completely heal....the entire time I was in isolation), or the 2 weeks of salmonella.... :scared:

Damn, I was a sick kid/teenager. :laugh:

nick_carraway · Jul 25, 2007

jochi1543 said:
Yeah, no ENT, plastics, or ophtho. I still have horrifying memories of having 10-inch wires shoved into my skull through my nose. The otitis that was accompanied by a rupture of BOTH eardrums was not pleasant, either, as the blood-soaked pillow kept as a relic shall attest.

I'm not sure what was worse, the 1-month otitis, the 2-month bout of chicken pox (yeah, it took THAT long to completely heal....the entire time I was in isolation), or the 2 weeks of salmonella....

Damn, I was a sick kid/teenager.

Wow periodically throughout the year, my GF gets vicious nose bleeds that spurt bright red blood for more than 30 minutes even with compressions of Kiesselbach's Area so I can't imagine what you went through. I'm already traumatized by her experiences.

EM_Rebuilder · Jul 25, 2007

Its something you will get used to.....yet at the same time, you might get brief episodes like that for the rest of your life.

I felt like I am well broken in.....yet the other day I took a bandage off a gangrenous foot. I had to set down on the stool and just heard mumbles from the patient talking. Breathed deeply, excused myself, and then went back in.

I think part of it is just preparing yourself prior to a surgery or the such... and with time it gets to be the norm. In my instance above, I just never expected what I was going to see under that bandage... and the smell with the looks.. ugh. Needless to say, surgery was called and there was a BKA soon after.

So, I would not worry if you happen to have an episode even after seeing so 'much' before. I think circumstances, your bodies current physiologic state (i.e. lack or food and sleep), etc all play a part. Just understand the warning signs and act on them...just as you did.

AnesthesiaMD · Jul 25, 2007

Igor4sugry said:
A couple of days ago I had a chance to observe a total knee replacement procedure. I was in the OR, watching the anesthesiologist administer spinal anesthesia when all of a sudden I began to feel lightheaded and soon had to sit down and almost passed out. I was very surprised this happened because I had volunteered before and observed around 70 cases without any problems.

Has anyone else had the experience of passing out in the OR?

The nurse told me there was a guy that hit his head on the OR table on his way down, and had to get stitches.

I had a similar situation. I had observed a few cases and those went just fine until one time the surgeon let me literally get within about a foot of where he was operating and when I smelled the burning fat/flesh I got very lightheaded but it soon went away. I think everyone is susceptible to this kind of reaction at least once since it is a pretty unnatural sight/smell.

Bnmakr1 · Jul 25, 2007

I'm a nursing student and we have OR clinicals. My first one or two I became light-headed and needed to sit down. Now I'm fine. My advice is to go to the OR more, EAT before you go, and stuff some candy in your pocket in case you do feel faint.

deleted36260 · Jul 25, 2007

damn, I hope that doesn't happen to me. I have observed a ton as well.

I always eat before hand and watch the knee locking. Some ortho surgeries are killer, especially when I'm following one doc all day - 12 hours later your feet hurt!!

I always do keep myself near the wall though, just in case on the way down I ruin the sterile field.

stiffany · Jul 25, 2007

I've had the same thing happen after already seeing dozens of surgeries (including some really gross stuff) without a problem. I definitely think the key for me is to make sure I've eaten within the last few hours of the first procedure after being away from shadowing or what have you for awhile. I also think it's important to recognize the signs that you're feeling faint and either excuse yourself or ask/go ahead and sit down instead of trying to ride it out (and potentially just making things worse). I also find it helpful to remind myself to breathe regularly and slowly through my mouth if I'm in a situation that makes me feel on edge/grossed out.

lisichka · Jul 25, 2007

Koala 33 · Jul 25, 2007

I almost passed out in the OR once, and the procedure hadn't even began when it happened. I ate a good breakfast, and I'm also not easily grossed out or phased by surgery, blood, etc. One of the nurses told me that I might have been reacting to the temperature of the room - I had been expecting the room to be freezing due to past experiences, but the surgery was being done on a child, and she said that they tend to keep the ORs a lot warmer for them.

MossPoh · Jul 25, 2007

Koala 33 said:
I almost passed out in the OR once, and the procedure hadn't even began when it happened. I ate a good breakfast, and I'm also not easily grossed out or phased by surgery, blood, etc. One of the nurses told me that I might have been reacting to the temperature of the room - I had been expecting the room to be freezing due to past experiences, but the surgery was being done on a child, and she said that they tend to keep the ORs a lot warmer for them.

The temperature can be a killer. Especially with those lights. I always wondered why they kept everything so cold, but after a few days in the OR I realized that it doesn't feel quite that cold when you are layered up standing under those lights.

Law2Doc · Jul 25, 2007

jochi1543 said:
It happens to most people....

There's no way it happens to most people, just a few. Most people have no problem. It probably happens to 1-2 folks per surgically oriented rotation, a rather small percentage. And most of the time any fainting is due to a combination of the length of the procedure (time on your feet), dehydration and lack of sleep, not the procedure itself.

etf · Jul 25, 2007

Law2Doc said:
There's no way it happens to most people, just a few. Most people have no problem. It probably happens to 1-2 folks per surgically oriented rotation, a rather small percentage. And most of the time any fainting is due to a combination of the length of the procedure (time on your feet), dehydration and lack of sleep, not the procedure itself.

I thought it was because of a vasovagal reaction: on the sight of blood, your body goes into "threat mode" and rapidly raises blood pressure. you find out that there really is no threat, and the sudden drop in pressure is what causes you to faint.

M.Furfur · Jul 25, 2007

It happens to everyone, just make sure you never step in a hospital on an empty stomach!

Erina · Jul 25, 2007

i almost passed out one time while watching an abcess being drained. actually watching it wasn't bothering me at all, but when the terrible smell reached me, i got really lightheaded.

146233 · Jul 25, 2007

etf said:
I thought it was because of a vasovagal reaction: on the sight of blood, your body goes into "threat mode" and rapidly raises blood pressure. you find out that there really is no threat, and the sudden drop in pressure is what causes you to faint.

Vasovagal responses are another cause, but not the main culprit. It's typically the low blood glucose (because you didn't have breakfast!), dehydration, standing for long periods of time (don't lock your knees!), etc., that Law2Doc mentioned. It does happen but it's not a big deal. Just sit down and don't fall into the sterile field! 🙂

sivadrd · Jul 25, 2007

a couple months ago i was observing open heart surgery and after like 2 hours i fainted. i was too excited to eat breakfast that morning and i tried to see better so i was standing on my toes (i'm kinda short and i really wanted to ) which made me stand in locked knee. yea i learned my lesson about that one.

this was the only time i ever observed a surgery and now i'm not sure if i should put it on my application because what do i do if it comes up in an interview? should i not tell them that i fainted or should i tell them but then that seems like i wouldnt be able to handle it??

kronickm · Jul 25, 2007

I work in a blood bank/blood donor center and this stuff happens A LOT. Vasovagal reactions are associated with blood donation and a drop in blood volume. There are, however, numerous people who faint w/o actually donating (This is why nobody is allowed to watch/hold hands/provide moral support). This one time some girl wanted her mother to hold her hand (12 year old giving an Autologous unit for her spinal fusion), the mom fainted after the girl was stuck, caught some tubing on her way down, while this 12 y/o had blood spurting out of her arm (yes veins can do that with a turnicate on).

For those without volume loss, I would say the main culprit is anxiety.

It is also interesting to note that feinting is most definetly contagious. As soon as one person feints at a blood drive, watch out, cause others are gonna follow.

Edit:
Thought of another good story.
At a high school blood drive, I am in the unit (where the blood is taken) this kid who had donated a few minutes earlier starts stumbling back over from the canteen saying he doesn't feel so well. About 5 steps away from me, he face plants into the gym floor. When we get to him I notice that he is missing a big piece out of each of his two front teeth, I look over and they are embedded in the gym floor. We had to use hemastats to pull them out of the floor!

146233 · Jul 25, 2007

sivadrd said:
this was the only time i ever observed a surgery and now i'm not sure if i should put it on my application because what do i do if it comes up in an interview? should i not tell them that i fainted or should i tell them but then that seems like i wouldnt be able to handle it??

Fainting in the OR, while not the norm, is a much more common phenomenon than you think. Put it on your application and if they ask about it, tell the truth. You and your interviewer(s) can chuckle about it, and you can talk about how you've already learned that lesson, so you'll be well prepared for your surgical rotations. :laugh:

afugazzi · Sep 10, 2009

This thread seems to apply to me. I have no problem giving/seeing blood, seeing gore, etc. I have shadowed 2 doctors and both times I have fainted. It is very strange because I have fainted outside of this context. It does not happen in response to anything exciting going on. I think I just think to myself "man would it look bad if I fainted right now," and this makes me nervous and feel faint, and then it's just this awful positive feedback loop.

I don't know how to prevent this. It happens when sitting down, I always eat breakfast first. I try to think of other things but I can't help thinking about trying not to faint. I am currently trying to treat this by exposure (I am shadowing a neurologist tomorrow), but I'd like to avoid more embarrassing situations. Any tips for anxiety-induced fainting?

bkprodigy · Sep 10, 2009

never happened to me. It's probably because my work revolves around OR (pig surgery). I saw two medical students who were observing the surgery pass out on our OR floor. And here goes my first post. 🙂

Thomas Hearns · Sep 10, 2009

kronickm said:
I work in a blood bank/blood donor center and this stuff happens A LOT. Vasovagal reactions are associated with blood donation and a drop in blood volume. There are, however, numerous people who faint w/o actually donating (This is why nobody is allowed to watch/hold hands/provide moral support). This one time some girl wanted her mother to hold her hand (12 year old giving an Autologous unit for her spinal fusion), the mom fainted after the girl was stuck, caught some tubing on her way down, while this 12 y/o had blood spurting out of her arm (yes veins can do that with a turnicate on).

For those without volume loss, I would say the main culprit is anxiety.

It is also interesting to note that feinting is most definetly contagious. As soon as one person feints at a blood drive, watch out, cause others are gonna follow.

Edit:
Thought of another good story.
At a high school blood drive, I am in the unit (where the blood is taken) this kid who had donated a few minutes earlier starts stumbling back over from the canteen saying he doesn't feel so well. About 5 steps away from me, he face plants into the gym floor. When we get to him I notice that he is missing a big piece out of each of his two front teeth, I look over and they are embedded in the gym floor. We had to use hemastats to pull them out of the floor!

🙁😱

papillon2 · Sep 10, 2009

afugazzi said:
This thread seems to apply to me. I have no problem giving/seeing blood, seeing gore, etc. I have shadowed 2 doctors and both times I have fainted. It is very strange because I have fainted outside of this context. It does not happen in response to anything exciting going on. I think I just think to myself "man would it look bad if I fainted right now," and this makes me nervous and feel faint, and then it's just this awful positive feedback loop.

I don't know how to prevent this. It happens when sitting down, I always eat breakfast first. I try to think of other things but I can't help thinking about trying not to faint. I am currently trying to treat this by exposure (I am shadowing a neurologist tomorrow), but I'd like to avoid more embarrassing situations. Any tips for anxiety-induced fainting?

OK here are a couple of tricks that I've learned during rounds (which can be similar to surgery when it requires standing in one spot for a length of time).

First, get a pair of ted hoes or tight socks. This will prevent blood from pulling into your legs. This is the same concept that they use with elderly patients who have worn out venous valves with lower extremity edema. Less blood in your legs means more blood for your cerebral blood flow.

Second, make sure to eat breakfast but do not eat right before going into the OR. Postprandial hypotension is also a very common cause of neurocardiogenic syncope during long periods of standing because blood is shunted from the body to the gut for digestion. So, less blood in gut = more blood for cerebral blood flow.

Lastly, for anxiety - realize that most of these people have been in the same position as you. They just have experience with it, and their bodies have actually developed to their activity. So don't be afraid to say - "Hey I'm feeling a little hypotensive so I'm gonna go ahead and do some squats, move my legs, or sit down to correct this blood flow" In all, the only way that you will kick your anxiety is when you become more comfortable in the situation and with time you will.

Good luck!

Crash88 · Sep 10, 2009

happened to me in high school when I was watching a suture...
though I've watched upwards of 400 surgeries since then and never fainted

Food · Sep 11, 2009

Never. I'm as stoic as ol' Vlad Putin.

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