chest tube

[deleted9493]

Ok, so I'm at work last night and one of the patients on the med/surg unit is deemed in need of a chest tube. I thought it would be a cool thing to see...so I helped get the room set and stood back and watched the resident do his thing.
Anyway, as he starts cutting through the intercostal space, I feel a little flush but thought it was pretty normal. However, once he started prying the opening with his fingers and the hemostat, I became noticeably weakened...on the verge of biffing it. If I hadn't been standing right next to a shelf, I probably would have. I've worked in the hospital for a couple of years now and have seen some pretty nasty stuff...never has it bothered me nor did this chest tube, consciously. In spite of it not grossing me out, I was still about to pass out.
So, my question to you all is if and how this "faint feeling" is able to be overcome and how long it takes. I would appreciate any personal experience or insight any of you might be able to share...it's a feeling that's frustrating.

---

Members don't see this ad.

 

[womansurg]

hudsontc, I think you are describing an almost universal experience. Virtually everyone has some episode early in their training where they had a physiologic reaction to something they were seeing. It's very common and very normal.

My first third year rotation was an ENT elective that I did over the summer. Consequently, the very first surgery I ever scrubbed on was this oropharyngeal carcinoma resection, which involved removing the lower jaw and part of the soft palate of some unfortunate guy in his 40's. Very graphic, as you may imagine. Before the surgery the attending took me aside and said,
"you probably will find that you are getting dizzy, faint, or nauseated at some point during the operation. When that happens, simply step back from the table and ask to be excused. If you feel you are going to faint, sit down on the floor right where you stand. This happens to everyone. It happened to me. I passed out cold during my first craniofacial procedue. IT MEANS NOTHING. It in now way reflects on you or on how you will react in the future in these situations."

Very cool of him. Well, I made it through that surgery without a hitch, and man, was I proud. Then I passed out on my next surgery - a parotidectomy .

The important thing is to not let it get to you. Just keep going right back in. That reaction will lessen and eventually go away entirely.

 

[md03]

It's part of the desensitization process. For me, the few times when that feeling happened wasn't really related to what I'm seeing, but rather how I was feeling at the time. (example: I'd scrubbed plenty of really bloody trauma cases but felt lightheaded during a very bloodless carotid endartarectomy!) If I'm hungry and overheated, it is much more likely to happen. That's why I eat something whenever I feel slightly hungry and I try to eat something with some staying power. And now, in the morning, I make sure I eat a good breakfast before I go to the OR. (I hadn't on the day of the CEA) Just make sure that whenever you get that feeling, you act on it before you pass out. Much better to sit down than to try to wait the feeling out and pass out.

 

[maxheadroom]

When I was in high school I worked for a veterinary surgical group. Sometimes they'd have me help them in the OR. The first time that I was in the OR with them, I passed out cold. Fortunately, I realized what was happening and I backed up and sat down against the wall before the tunnel vision turned to black.

Things that will accentuate queasiness: heat, hunger, realizing that this is a real person. I'd recommend protein bars as a good snack before the OR.

Don't let it get you down -- almost every surgeon has the "when I first passed out" story.

 

[deleted9493]

Thank you everyone for your replies. I was surprised to not to be able to find a discussion on this in the archive.

It's good to know that this reaction shouldn't be a limiting factor when it comes to the areas of medicine I will be able to practice in. Of all the physicians I've worked with, I seem to have the most admiration and respect for surgeons and subsequently wish myself in their role the most. Thanks again.

 

[Skylizard]

Originally posted by hudsontc
...Anyway, as he starts cutting through the intercostal space, I feel a little flush but thought it was pretty normal...once he started prying the opening with his fingers and the hemostat, I became noticeably weakened...on the verge of biffing it...

Actually, I have never almost passed out DURING a procedure but I have "stumbled out" of many gruesome "salvage operations" with my kneees wobbling. It takes time and experience to get accustomed to the unnatural becoming natural. The human mind can be shocked. "It is not natural to jump out of a perfectly good airplane" It has been said that it is un-natural to cut someone open and remove parts of their body while they are alive...sometimes just barely.

The ACS wrote:

...The simultaneously savage and loving act of operative surgery is a natural

I would give this caveat, it isn't natural at first and it takes time....at least five years in the case of general surgery. There is a certain amount of courage to being a surgeon. It sometimes takes desire to overcome the body and mind.

 

[Winged Scapula]

There actually are several threads in the archives about this very subject - people having vasovagal responses when in the OR, etc.

It can even happen to the most desensitized of us when we're feeling sick, hungry etc. - just his evening I was placing an a-line and having a hard time and had to take a break as I got increasingly nauseated and diaphoretic. Bad news when you look worse than your patients!

 

[Celiac Plexus]

Never had a vasovagal reaction. Though I have fallen asleep during a procedure before. Fortunately the movement caused by my knees buckling woke me up before I hit the ground.

 

[Castro Viejo]

I did the same thing. And somehow my head bobbed, dislodging my eyeglasses and allowing them to land in the field (but not in the cavity). Man did I get reamed.

Then there was this time, during my anesthesia clerkship, where the resident asked me to change the IV fluids with a new bag. I pulled on the line and the old bag's hook broke, allowing it to drop BAM! right into the field (luckily this was at a different hospital). The anesthesia resident looked as white as a ghost. Man did I get reamed (by the angry anesthesia resident).

 

[robinhudster]

Originally posted by ******
I did the same thing. And somehow my head bobbed, dislodging my eyeglasses and allowing them to land in the field (but not in the cavity). Man did I get reamed.

Then there was this time, during my anesthesia clerkship, where the resident asked me to change the IV fluids with a new bag. I pulled on the line and the old bag's hook broke, allowing it to drop BAM! right into the field (luckily this was at a different hospital). The anesthesia resident looked as white as a ghost. Man did I get reamed (by the angry anesthesia resident).

That's hysterical!! Does anyone else have funny/amuzing stories like that??

 

[Skylizard]

I have a story about a med-student that almost had his hand surgically resected during a open heart surgery!

So, the surgeon who shall remain nameless was well known for being an unusually mellow and patient surgeon and was even a heart surgeon! He always liked to teach in the OR and give students exciting opportunities. One thing he often liked to do is allow students the chance to "touch a beating heart".

One day, after completing a valve replacement and taking the patient off bypass, all was cool. There was a student scrubbed in and assisting and a student at the head of the operating table/bed with anesthesia (one was on a surgical rotation and the other on a anesthesia rotation). The attending looked at the scrubbed in student and said "touch the beating heart...every student should do so". The scrubbed student reached over and touched the heart.

Then....from under the anesthesia drape comes an ungloved unscrubbed hand reaching out for the heart!!! You can imagine who finally lost their cool and who ran from the room very, very fast.

 

[apma77]

funny story my dear skywalker

 

[monkeyarms]

one of the legends at ohio state is about a guy whose glasses fell into the field while he was a student with zollinger. i took a history of medicine class and sat by a retired radiologist who was in the or that day and said they had resectioned a piece of this woman's intestine and flipped it around to induce reverse peristalsis (didn't work, of course). after the surgery, zollinger tied the guy to an iv pole for the next 14 hours.

 

[southerndoc]

Originally posted by monkeyarms
one of the legends at ohio state is about a guy whose glasses fell into the field while he was a student with zollinger. i took a history of medicine class and sat by a retired radiologist who was in the or that day and said they had resectioned a piece of this woman's intestine and flipped it around to induce reverse peristalsis (didn't work, of course). after the surgery, zollinger tied the guy to an iv pole for the next 14 hours.

One of our ENT surgeons said that when he did his third year clerkship, two students were scrubbed in on a case (one of the students was him of course). He said the guy's glasses fell off and landed in the abdomen.

How many years ago did this happen? He went to Case Western and not Ohio State though.

The reason this was all brought up was because I asked him why he taped his glasses to his nose. He then told me the entire story.

 

[womansurg]

Originally posted by Geek Medic
One of our ENT surgeons said that when he did his third year clerkship, two students were scrubbed in on a case (one of the students was him of course). He said the guy's glasses fell off and landed in the abdomen.

How many years ago did this happen? He went to Case Western and not Ohio State though.

The reason this was all brought up was because I asked him why he taped his glasses to his nose. He then told me the entire story.

Nah, this is a quite famous story at Ohio State. Having said that, having your eyewear fall into the field isn't that rare. Makes sense - folks are wearing poor fitting goggles etc. with their heads bent forward for hours. One of our CT surgeons had his loupes fall into the chest when he was desperately trying to control massive hemorrhage from a great vessel injury. He just dug them out and handed them off. Patient died - but from bleeding, not from the breach of sterile technique.

 

[Celiac Plexus]

Wow, I've heard the ol' "glasses in the sterile field" story several times. It seems like everyone I know at different med schools all have the same story about the oldest, crankiest attending and his 3rd year student....

At my university, the attending yells at the 3rd year, "Why don't you just drop your pants and rub your ass in there (apparently referring to the sterile field)"?

 

[md03]

One of our attendings did recently drop his pants in the OR (or, rather, he had the circulator do it for him) though not into the field. It was a blood on the floor trauma case, and after they got the blood controlled, the attending didnt' want to continue to wear bloody pants. So, he got the circulator to take them off under his gown. Then when they were done, he took the gown off and there he was in the OR in his shorts! (got quite a few shocked looks from other, more conservative, folks at the scrub sink.

 

[panacea]

I passed-out after seeing some legs. I was in the autopsy suite and the tech was doing some amputated legs. They were brutal. The legs were from causians... yet the toes were black... had sticky open sores and lots of sutures (the vascular surgeons were obviously trying really hard to salvage them). Oh and the smell... it wasn't so good either because they were a couple days old.

I walked-out feeling faint... next thing I remember is lying on the floor. I was okay (just had a big goose egg on my forehead)... but my pride sure was bruised and my friend (he followed me out) didn't let me hear the end of it for a while.

One thing I learned is... a good hearty breakfast helps.

The redo CABG and cartoid endartectomy I saw after that were tame in comparison... as was a removal of the pituitary gland from an autopsy case.