fainting

[beary]

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I am an M3 with surgical rotations coming up. I am starting to get pretty concerned about lightheadedness and fainting in the OR. I have heart disease so I have problems with pre-syncope pretty frequently. It is not a problem during my daily life because I am used to dealing with it. On clinic rotations, it is usually very easy to find a place to sit and it is not obvious that anything is wrong, and sitting doesn't disrupt the flow of anything. However, I know that it is not always easy to sit down in the OR and I am sure that my lightheadness will sometimes be exacerbated by vasovagal stuff and stress, fatigue, etc.

I know about all the tips to prevent fainting (eating and drinking well, compression stockings, clenching leg muscles, etc.), and I will definitely do all those things, but I am wondering how do you actually get out of the OR if you are feeling like you are going to faint? Do you just say, "I don't feel well" and leave immediately? Is it a problem if this happens a lot? I guess that is my biggest concern. I know everybody gets lightheaded once in a while, but I think it may happen more frequently with me. I am going into a specialty that doesn't require prolonged standing, but first I have to get through M3 year!

Thanks a lot for any advice you have.

 

[v-tach]

I am an M3 with surgical rotations coming up. I am starting to get pretty concerned about lightheadedness and fainting in the OR. I have heart disease so I have problems with pre-syncope pretty frequently. It is not a problem during my daily life because I am used to dealing with it. On clinic rotations, it is usually very easy to find a place to sit and it is not obvious that anything is wrong, and sitting doesn't disrupt the flow of anything. However, I know that it is not always easy to sit down in the OR and I am sure that my lightheadness will sometimes be exacerbated by vasovagal stuff and stress, fatigue, etc.

I know about all the tips to prevent fainting (eating and drinking well, compression stockings, clenching leg muscles, etc.), and I will definitely do all those things, but I am wondering how do you actually get out of the OR if you are feeling like you are going to faint? Do you just say, "I don't feel well" and leave immediately? Is it a problem if this happens a lot? I guess that is my biggest concern. I know everybody gets lightheaded once in a while, but I think it may happen more frequently with me. I am going into a specialty that doesn't require prolonged standing, but first I have to get through M3 year!

Thanks a lot for any advice you have.

Would there be anything wrong with advising the attendings etc. beforehand about your condition? Then at least it won't be a huge shock if you do have to step out to recover. Take this with a grain of salt though; I'm not even MS1 yet (praying for acceptances...). However, I would think they'd understand if you have a heart problem!!!

 

[VentdependenT]

If you feel you are going to faint then ask for a chair immediately and say that you are feeling lightheaded. You may not make it out of the OR in time and then things can become a mess (you don't want a head CT do ya). Just sit down and relax. You can even remain sterile if you keep your hands across your chest.

I've almost bit the dust after long GI cases. I just tilted by head back and did some deep breathing and fortunately snapped out of it. Inintially its pretty easy to forget to pump your calves by get completely engulfed in the surgery.

Unfortunately I did faint during blood draw practices in med school. This kid was just digging forever over my biceps aponeurosis and I lost it. Vasovagal all the way to the floor.

 

[v-tach]

If you feel you are going to faint then ask for a chair immediately and say that you are feeling lightheaded. You may not make it out of the OR in time and then things can become a mess (you don't want a head CT do ya). Just sit down and relax. You can even remain sterile if you keep your hands across your chest.

Might not be a bad idea to have a chair readily available in the OR in that case.

 

[Khirurg]

A lot of people are concerned before they go on rotation. Do not build yourself up, because you'll be very anxious coming into the first case. Do however warn about your condition, and if you don't feel well, leave. trust me, you'll be understood, vs you fallling into the open belly of the patient, because you try to tough it out.

 

[Stinger86]

A lot of the surgeons (and OR staff) I scrubbed in with told me right from the start of the case that if I ever felt queasy, just to step away from the operating table and sit down or do whatever I needed to do to feel better. It sure doesn't hurt to have a chair around too. But whatever might happen, it's always a good idea to ask the OR staff what you should do if you ever feel lightheaded.

My first "scrub in" operation ever was a 5+ hour carotid endarterectomy which had blood EVERYWHERE, including an "oopsie" shunt slip which projected a nice pulsing arterial spray across the length of the operating table and all over the scrub nurse's face mask and protective glasses. I nearly lost it then, but somehow managed to get things under control (closed my eyes, flexed leg muscles, etc) within a minute or so.

The nice thing is that operations, no matter how bloody, are now much more tolerable for me thanks to the experience of just being in the OR over and over again. I know the OP has a unique case, but just use some good syncope prophylaxis until you get used to things and everything will likely work itself out.

 

[goooooober]

I would definitely suggest a spring suit. It is a giant plastic suit covered with springs. If you do happen to fall, you'll be right back up.

 

[imtiaz]

as others have said, make sure your attending(s) know about your heart condition. the other thing is, if you ever feel like youre going to faint in the OR, just make sure you dont faint into the sterile field. they always told us if you feel like youre going to faint, just step back from the sterile field and sit down right on the floor, its better than falling into the wound or falling backwards and hitting your head. they dont want to have to take care of YOU and the patient at the same time. also, like someone else mentioned on this thread just dont work yourself up over it. you probably wont have difficulty with it at all. good luck to you!

 

[Boomer]

Unfortunately I did faint during blood draw practices in med school. This kid was just digging forever over my biceps aponeurosis and I lost it. Vasovagal all the way to the floor.

I actually remember this....who stuck you? I know it weren't me...