Faint feeling during surgery

[PabsMD]

I've seen a few threads on this subject saying that if you eat before surgery and don't lock your knees, you should be okay. However, yesterday I was observing a vaginal delivery (on my first day of a preceptorship with a new doctor) and started feeling that fainting feeling. I had eaten breakfast that morning and made sure to shift around every few minutes and not lock my knees. I wasn't grossed out or overwhelmed by what I was seeing and I can't figure out a way to prevent this in the future. I'm generally hypotensive; maybe this has something to do with it?

I think I handled the fainting feeling in a professional way- I left the room before I could faint, got some water, and returned within a few minutes. However, my preceptor has not been very understanding about this incident and continues to tell other staff about what happened. Today I was watching her perform an ex lap with another surgical team and she mentioned it to them out of the blue. She also introduces me to patients as her "overwhelmed medical student."

Any advice?

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[GreenShirt]

I'veb had problems with my vaso-vagal response to blood prior to medical school where I felt faint and had to lie down. Miraculosly, I spent a day in the OR two weeks ago without any problems. Here's some tips that helped me that day:

1) Hydrate! I drank a ton of Gatorade the night before to ensure that my fluid and electrolyte levels were good. During clinicals you're up on your feet most of the time and not having enough volume in your body can lead to fainting.
2) Eat! You want to maintian good blood sugar levels.
3) Dress in layers. Getting overheated can contribute to feeling light-headed.
4) If things get bloody, look away for a few moments and give yourself a quick mental pep talk.

(Shifting your legs, ie not locking your knees, prevents blood from pooling in your legs and creating a volume distribution problem).

I think your preceptor is being a little mean in harping on you so much. You might want to talk to your preceptor about your problems with feeling faint and ask for tips. She may have thought you left the room because you became overly emotional or something rather than because you felt faint.

 

[45408]

Don't scrub in when you've been sick that day. I'd had diarrhea earlier, and I skipped lunch because I was feeling nauseated.

Guess who barfed in their face mask while scrubbed in while running out of the OR? yeah, that'd be me.

 

[novastorm]

So cutting open someone in gross anatomy and pulling out their insides while using a saw on their skull didn't get you over this? Just get exposed it gets easier with time. And to go with PreMedMommy and her encouragement, I don't feel faint, I get that throw up in your mouth sensation when I get caught by surprise.

 

[PreMedMommy]

Take the advice already given, and laugh about it. Seriously, when (notice I did not say if) this happens to me, I'm going to joke about it for a long time. It happens. It happens frequently. Get a good giggle out of it, and move on.

 

[DocPsychosis]

However, my preceptor has not been very understanding about this incident and continues to tell other staff about what happened. Today I was watching her perform an ex lap with another surgical team and she mentioned it to them out of the blue. She also introduces me to patients as her "overwhelmed medical student."

Wow, that's crap. I'd be mad about this, not that there's anything to be done. It still seems so unprofessional.

 

[URHere]

So cutting open someone in gross anatomy and pulling out their insides while using a saw on their skull didn't get you over this? Just get exposed it gets easier with time. And to go with PreMedMommy and her encouragement, I don't feel faint, I get that throw up in your mouth sensation when I get caught by surprise.

I've found that "surgical situations" are very different when you are standing in one place and observing, than they are when you are actually an active participant (like in gross anatomy lab). It has helped me to make sure that I move around at least a little while observing a surgery - this could mean moving my fingers, shifting my weight, or occasionally moving from one side of the operating table to the other. As long as you don't look fidgety, it shouldn't be a problem.

 

[PabsMD]

So cutting open someone in gross anatomy and pulling out their insides while using a saw on their skull didn't get you over this? Just get exposed it gets easier with time. And to go with PreMedMommy and her encouragement, I don't feel faint, I get that throw up in your mouth sensation when I get caught by surprise.

As I mentioned in the original post, I wasn't grossed out by what I was observing. Honestly, I've seen worse in the OR before.

 

[PabsMD]

Wow, that's crap. I'd be mad about this, not that there's anything to be done. It still seems so unprofessional.

Glad you agree- I find her overall demeanor unprofessional and condescending. I'm not sure talking to her about it would be to my benefit as I only have 3 days left on this preceptorship.

Gotta choose your battles!

 

[PabsMD]

Don't scrub in when you've been sick that day. I'd had diarrhea earlier, and I skipped lunch because I was feeling nauseated.

Guess who barfed in their face mask while scrubbed in while running out of the OR? yeah, that'd be me.

EXCELLENT advice!

 

[PabsMD]

I'veb had problems with my vaso-vagal response to blood prior to medical school where I felt faint and had to lie down. Miraculosly, I spent a day in the OR two weeks ago without any problems. Here's some tips that helped me that day:

1) Hydrate! I drank a ton of Gatorade the night before to ensure that my fluid and electrolyte levels were good. During clinicals you're up on your feet most of the time and not having enough volume in your body can lead to fainting.
2) Eat! You want to maintian good blood sugar levels.
3) Dress in layers. Getting overheated can contribute to feeling light-headed.
4) If things get bloody, look away for a few moments and give yourself a quick mental pep talk.

(Shifting your legs, ie not locking your knees, prevents blood from pooling in your legs and creating a volume distribution problem).

I think your preceptor is being a little mean in harping on you so much. You might want to talk to your preceptor about your problems with feeling faint and ask for tips. She may have thought you left the room because you became overly emotional or something rather than because you felt faint.

Thanks for the tips! I'll remember these for next time.

 

[njbmd]

I think I handled the fainting feeling in a professional way- I left the room before I could faint, got some water, and returned within a few minutes. However, my preceptor has not been very understanding about this incident and continues to tell other staff about what happened. Today I was watching her perform an ex lap with another surgical team and she mentioned it to them out of the blue. She also introduces me to patients as her "overwhelmed medical student."

Any advice?

Eating is fine but sometimes it's just pure vasovagal and you can't do much about this. Just warn the circulating nurse that you feel faint so that they can push a stool under you.

If the faintess comes on suddenly, just step back from the table. You can just say, "I have to step back" and everyone knows what is happening.

Get over the way your preceptor introduces you. The quicker you can laugh about this, the better. It happens to everyone at some point and it comes with the territory.

 

[Mobius1985]

1) Hydrate! I drank a ton of Gatorade the night before to ensure that my fluid and electrolyte levels were good. During clinicals you're up on your feet most of the time and not having enough volume in your body can lead to fainting.

As a variation on the above, I read to increase salt intake prior to surgery, in order to keep the BP up (and also decrease diuresis after increasing the fluid load). This worked for me, and I, too, am chronically hypotensive.

 

[jonb12997]

If the faintess comes on suddenly, just step back from the table. You can just say, "I have to step back" and everyone knows what is happening.

even before teaching me how to scrub, on my first day of my OR rotation, the scrub techs told me that if I ever feel faint to just step back, that everyone understands.

I figure it's better to be teased about having to step back then get yelled at because you fainted into a surgical field and contaminated everything...

 

[45408]

So cutting open someone in gross anatomy and pulling out their insides while using a saw on their skull didn't get you over this? Just get exposed it gets easier with time.

Totally different. The cadaver just smells like preservative. The OR gets hot, humid, and the bright lights can make you feel a little light after you've been on your feet all day. I've never been the slightest bit grossed out in the OR, but you can still get a head rush.

 

[yeasterbunny]

Totally different. The cadaver just smells like preservative. The OR gets hot, humid, and the bright lights can make you feel a little light after you've been on your feet all day. I've never been the slightest bit grossed out in the OR, but you can still get a head rush.

Hmmmm.... I don't think I would never say I've been grossed out in the OR; a$s pus and dermoids can be pretty gross, but they didn't correlate with times I felt weak or woozy.

 

[bioteach]

However, my preceptor has not been very understanding about this incident and continues to tell other staff about what happened. Today I was watching her perform an ex lap with another surgical team and she mentioned it to them out of the blue. She also introduces me to patients as her "overwhelmed medical student."

Any advice?

That is lame. As a doc she should be pretty aware of what a vasovagal reaction is and that you don't do it on purpose.

I'm already worried about my time in surgery rotations because I have a pretty jacked up ANS and I get pre-syncopal on a regular basis. Heat, stress, pain, standing for a long time, hypoglycemia will all do it to me. I've had my heart checked out and its fine, so its just one of those things I have to live with. Anyhow, I recommend pretty much what all the other posters said.

Moving around helps, also you can flex your calf and thigh muscles to help keep blood from pooling. Drink plenty of fluids and up your salt intake are what I do when I know I'm going to be in a situation that may make me go vagal. Support hose work well, too. Also, a few slow deep breaths. I've read that taking a few sips of water will actually help raise your blood pressure a little immediately too. I don't know if that is true or not, but it can't hurt.

 

[smq123]

Any advice?

1) Being generally hypotensive might have something to do with it.

2) Were you wearing a mask? Was it tightly tied? Sometimes, re-breathing into the mask can be enough to make you feel lightheaded. I try to stay away from the masks with face shields for that reason (although, in OB, that can be a tough call - an amniotic fluid splash might be enough to make me re-think that!), and leave my mask somewhat loosely tied.

3) Ignore your preceptor. Some are not particularly considerate or thoughtful. It happens to everyone; just forget about it.

 

[LuckyBambooGirl]

Make sure you stay hydrated! I made sure to drink plenty of water while on my surgery rotation at the beginnng of third year and didn't have any problems. Towards the end of the year I had to go back to the OR for some neurosurgery cases and wasn't drinking enough because I didn't want to have to pee during the case. Consequently, I started to feel faint in those surgeries. After it happened two days in a row, I remembered the water thing (and increased my salt) and didn't have another problem. I also think that exercise helps because it strengthens your calf muscles and seems like it would improve your circulation and decrease blood pooling, but I don't have any medical proof for that!

It would be one thing if your preceptor was just joking with you a little bit about what happened, but I think your preceptor is being really inappropriate by introducing you to patients that way! It definitely undermines any trust patients have in you as a health care provider if she says that you are "overwhelmed!"

Best of luck, I hope the rest of your rotation gets better!

 

[78222]

I made the mistake of eating some rather shady looking salmon from the physicians dining hall one day. About midway through a surgery I was scrubbed in on later that day, my stomach cramped up and I suddenly felt like I was about to die. I tried to ride it out but before long I had beads of sweat rolling down my forehead, was feeling light headed, and was holding onto my stomach like an alien was about to burst out. I stepped back, a practically bolted towards teh bathroom, which is where I camped out for the next two hours. Oddly, no one seems to have even noticed that I'd left. Oh, the uselessness of a medstudent.

 

[PabsMD]

1) Being generally hypotensive might have something to do with it.

2) Were you wearing a mask? Was it tightly tied? Sometimes, re-breathing into the mask can be enough to make you feel lightheaded. I try to stay away from the masks with face shields for that reason (although, in OB, that can be a tough call - an amniotic fluid splash might be enough to make me re-think that!), and leave my mask somewhat loosely tied.

No mask, but I was wearing dress clothes and that stupid short white coat. As others have said, it was really hot and humid in the room and I got unbelieveably hot all of the sudden and then felt faint.

 

[PabsMD]

Thanks everyone for the tips! I was more hydrated this morning and and was able to make it though another delivery without another vasovagal episode.

 

[45408]

I made the mistake of eating some rather shady looking salmon from the physicians dining hall one day. About midway through a surgery I was scrubbed in on later that day, my stomach cramped up and I suddenly felt like I was about to die. I tried to ride it out but before long I had beads of sweat rolling down my forehead, was feeling light headed, and was holding onto my stomach like an alien was about to burst out. I stepped back, a practically bolted towards teh bathroom, which is where I camped out for the next two hours. Oddly, no one seems to have even noticed that I'd left. Oh, the uselessness of a medstudent.

one of the surgical techs at the last hospital I was at had to bolt from the OR before she crapped her pants. when she came back and told the surgeon - a normally pretty stern kind of guy - he laughed his ass off.

 

[RisingSun]

I've seen a few threads on this subject saying that if you eat before surgery and don't lock your knees, you should be okay. However, yesterday I was observing a vaginal delivery (on my first day of a preceptorship with a new doctor) and started feeling that fainting feeling. I had eaten breakfast that morning and made sure to shift around every few minutes and not lock my knees. I wasn't grossed out or overwhelmed by what I was seeing and I can't figure out a way to prevent this in the future. I'm generally hypotensive; maybe this has something to do with it?

I think I handled the fainting feeling in a professional way- I left the room before I could faint, got some water, and returned within a few minutes. However, my preceptor has not been very understanding about this incident and continues to tell other staff about what happened. Today I was watching her perform an ex lap with another surgical team and she mentioned it to them out of the blue. She also introduces me to patients as her "overwhelmed medical student."

Any advice?

Not sure if this has been mentioned yet, but particularly if you are wearing a surgical mask make sure you don't hyperventilate and make yourself dizzy.

Hope you can find some way to get over this.

 

[lilnoelle]

I'm pretty sure this can happen to anyone. I thought I'd be able to avoid this type of thing because I'm not one to get grossed out by anything and I'd seen quite a few procedures/surgeries without having any trouble at all.
Well, in family medicine, I was watching my preceptor remove a cyst and all of a sudden (completely out of the blue) I felt a heat wave go over my entire body. I tried to ride it out, leaned up against the table, but I just couldn't get that feeling to go away, so I finally left the room and sat down.
I felt sort of shook up about it because it really surprised me and I was afraid of what my preceptor was going to think. Well, he indicated that it happens to everyone at some point or another and that it doesn't necessarily have anything to do with the grossness of the case.
I've since talked to a few more physicians about it and they said the same thing.... it happens to everyone and it doesn't necessarily have anything to do with the student's sensitivity to such things. The best thing to do is to NOT try to ride it out, but to step back, and get out of the room and sit down if possible. You don't want to faint into a surgical field, nor do you want to force someone that is important to the procedure to contaminate themself in order to catch you when your falling down. Its best just to get out of the room, sit down, and when you feel up to it, get a drink.
Your physician should understand. Most likely they've experienced it, and if not, they've had other students who have had to leave previously.

 

[bambi]

My problem is people mentioning getting faint. If they say beforehand that you can leave or whatever if you feel faint I start thinking about it and end up feeling faint. If no one says anything I am totally fine. Nothing even has to be happening for me to get faint, I love the gross stuff, the more disgusting the better, I could be walking down the street and if someone said I might get faint, I would, it's really weird.

 

[soulofmpatel]

I once nearly passed out in the OR while watching a bloody c-section. I was ill that day, but I decided to suck it up and tell no one. During the surgery, I felt myself getting lightheaded. I tried so suck it up but became progressively more lightheaded and nauseas over the course of several minutes until I was about to faint. I then asked to step out and ended up taking a seat on the floor in the OR. This is the only time this ever happened to me in about 16 wks of OR experience. I don't think I was dehydrated or hypoglycemic. It was just a random vasovagal response to the surgery...which is strange because I wasn't psychologically affected by the blood per se. I probably could have avoided it by clenching my fists and legs to drive blood back to the heart.

 

[uncbluesky]

Well, he indicated that it happens to everyone at some point or another and that it doesn't necessarily have anything to do with the grossness of the case.

I can definitely vouch for this. I had to excuse myself from a exam room once when a patient was talking about his diabetes! Not exactly gross or overwhelming, and I'm sure I looked ridiculous, but I had locked my knees for a couple of seconds while standing there, and once I get that hot, clammy feeling, I'm doomed. After that, I made sure to bring water or juice with me the rest of the week and increased my salt intake a little bit. I was fine the rest of the week.

 

[keisler]

One of my residents told me she wears clogs specifically so that if she starts to feel faint, she can slip off her shoe and set her foot on the cool floor (this works in the OR too, just make sure the floor isn't bloody).

Also, if you feel faint, cough. It raises your BP, and has been helpful to me.

 

[sprinkibrio]

I started phlebotomy this week and had the same problem on the second day. I think it's harder to watch other people do the procedure than to do it yourself. Gatorade helped me (thanks to whoever suggested that), but even better is applied tension:
http://eprints.ucl.ac.uk/1534/
http://www.anxietybc.com/resources/pdfs/AppliedTension.pdf

Genius!!!