Falling asleep in the OR, especially during 24's - tips?

[Robotic Wis-Hipple]

Agree with reporting the program unless this was just a strange week or two stretch caused by resident shortage/vacation/holiday.

And agree x1000 to definitely don’t try to “rest your eyes”. That’s how accidents during long drives happen and in the OR that’s how you get fired or drug tested at best and seriously hurt a patient at worst.

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[JOHNBROCHILL]

Make no mistake about it Q2-3 24hr call is not about your education one bit. Perhaps it is the millennial in me but the current respect of physicians, the current pay of physicians, and current loans of physicians compared to years past do NOT validate that sort of labor abuse. This is in addition to patient safety issues which are the original reason for work hour restrictions. I am sorry your program thinks so low of you. I would start by speaking to your PD about it. If he or she does not care and if there are actual work hour violations averaged over the month then submit a formal complaint to ACGME.

 

[drmwvr]

Don't have to be pulling hard call hours to be fighting the 'nods' during long boring cases, especially after over doing the burrito bar. Sipping off of a covered solo cup full of ice water is a really effective way to stave off sleepiness. Helps if you have OR nurses that are will look the other way.

 

[MoMoGesiologist]

If you are so sleepy during a case you consider closing your eyes, you MUST tell your attending or a colleague and take a break. Patient safety comes first. How would you defend yourself if you deliver suboptimal care or miss something? No one will have sympathy if you say “sorry, I was tired”.

Have you talked to your chiefs? Q2 24hr call doesn’t sound safe.

 

[Daveizzy]

Low dose twitch monitor while waiting for someone to give you a break

 

[Gern Blansten]

Get eyes tattooed on your eyelids?

 

[blockstar]

This is one crazy thread! First of all you should NEVER be Q2 for 24 hr call...ever. Especially as a resident in a room. Your program needs an overhaul ASAP or will be shut down. Someone is going to say something. It has nothing to do with being a millenial its just nonsense to be awake that often and thinking its safe.

And you should never fall asleep in the OR...its not going to help and you look high on drugs. Which is understandable working Q2 24 hours.

I have also never seen someone working out in the OR. Maybe as a joke but doing pushup, dips and bringing elastic bands in the OR just sounds like a youtube vid waiting to happen.

 

[chocomorsel]

This is one crazy thread! First of all you should NEVER be Q2 for 24 hr call...ever. Especially as a resident in a room. Your program needs an overhaul ASAP or will be shut down. Someone is going to say something. It has nothing to do with being a millenial its just nonsense to be awake that often and thinking its safe.

And you should never fall asleep in the OR...its not going to help and you look high on drugs. Which is understandable working Q2 24 hours.

I have also never seen someone working out in the OR. Maybe as a joke but doing pushup, dips and bringing elastic bands in the OR just sounds like a youtube vid waiting to happen.

I have done push ups. On the super long boring cases.

 

[MirrorTodd]

I've done some yoga.

 

[AdmiralChz]

I've done some yoga.

“Hey, table up”

“Hold on, I need to finish this Downward Dog”

 

[Status Sciaticus]

People get fired and sued for using their phone during a case when nothing bad occurred? But they do get fired for closing their eyes for ten seconds?



Regarding the homeless anesthesiologist comment, check out the bathroom break topic here: How often should I ask for bathroom break?

I think the last thing this profession needs is doctors using the operating room as their personal bathroom. You WILL get sued for that if a patient gets a bad surgical infection and the circulator says you pissed in a garbage can. Try defending that in court.

Urine is sterile.... by definition cant cause SSIs...

 

[AnonymousPD]

I had absolutely zero problems during CA-1 year with fatigue, but I was only doing 24 hour call once a week, and because I prioritized my sleep I was alway able to get 7-8 hours on non-call days. I still prioritize my sleep and get 7-8 on non-call days, but as a CA-2 now doing anywhere between q2-q4 24 hour call, the chronic sleep deficit has been building and I've recently been struggling to fight off sleep during cases.

I imagine this is a common issue in residency with the hours we work and the call frequency. If I find myself dozing off, my only options are to stand up and move around, or try to find something stimulating on my phone (this rarely works). I drink coffee in the morning, but wonder if I should start using a second caffeine boost in the afternoon, and a third caffeine boost around hour 16 to get through the last 8? Any develop a good system for dealing with 24's and combatting sleepiness in the OR? Dealing with sleepiness during 24's is par for the course, but with the build up of the sleep deprivation it's gotten to the point where I am struggling on non-call days as well. The obvious solution is not to have residents work 24 hours straight, but that is a completely different issue, and I'm just trying to survive.

Propofabulous,

The conditions you describe are sincerely troubling and I think all of us empathize with the situation you are in. I tried to send you a message outlining a few things that might be longer term solutions to working out in the OR and pharmacology, but it looks like you've disabled that feature in your account.

First of all, you need to understand that the ACGME has your back on this. Properly recognizing and mitigating fatigue along with insuring safe patient care during instances of fatigue are all core program requirements. They also have to "ensure there are "no negative consequences and/or stigma for using fatigue mitigation strategies."

If you're still reading this after 7 months, shoot me a message and maybe there's something that can be done.

 

[aneftp]

As “older” anesthesiologist 15 plus years out. Multiple studies done in trucking industry have been carried over to many trauma one/24/7 hospital facilities.

What this entails is no more than 12 continuous hours of on duty work Anesthesia like the trucking industry. If you are working continuously for long stretches. It’s dangerous. And it’s especially dangerous as you get older.

now young people may get away with it. But we are moving away from 24 hour continuous level 1 calls with Anesthesia.

 

[anbuitachi]

wait what exactly is q2 24? i never really thought about it until now.. a 24 hour shift spans 2 days unless you are starting at midnight. so if you go from 8am to 8am monday-tuesday, you work days on wednesday, and back to 8am-8am thursday-friday? is that a q2? or is a q2 24 hour followed by 24 hours? (monday-tuesday, then wed-thursday?)

 

[deleted697535]

I'd say it's the latter. On call mon-Tues, sleep Tuesday day and night then back for 24 more hours Wed-Thurs.
That's very bad in fairness. No good for anyone. Maybe you can get away with it if you have no exams or kids.

I'm so happy I don't have to do that rubbish anymore

 

[Shimmy8]

24 hour shift Monday and Wednesday would be q2. Happens sometimes with a small call pool and vacations. Not the worst if you get some sleep and not working post call. But if either of those happen...gross.

 

[anbuitachi]

cant imagine any residency doin gthis to their anesthesiology residents. that is unsafe for the patient, and for the resident. the resident will die 40 years younger.

 

[Muller21QQQ]

wait what exactly is q2 24? i never really thought about it until now.. a 24 hour shift spans 2 days unless you are starting at midnight. so if you go from 8am to 8am monday-tuesday, you work days on wednesday, and back to 8am-8am thursday-friday? is that a q2? or is a q2 24 hour followed by 24 hours? (monday-tuesday, then wed-thursday?)

it's simply unbearable...
especially it's difficult at the first times when your body tries to adopt to the such a working day...

 

[DM27]

24 hour q2 in residency not only sounds terrible, but it also sounds like a tall order to be able to consistently do this call and 1) Live, 2) Accomplish your ACGME required cases and procedures and 3) Not ultimately violate hours since you'd end up with a 72 hour week simply from having one week of this, and depending on the timing it could hit 96.

 

[vector2]

I'd say it's the latter. On call mon-Tues, sleep Tuesday day and night then back for 24 more hours Wed-Thurs.
That's very bad in fairness. No good for anyone. Maybe you can get away with it if you have no exams or kids.

I'm so happy I don't have to do that rubbish anymore

Is it PGY 11 or 12 where your hours become really good or does it start as early as PGY 6 or 7?

 

[deleted500612]

I think where the disconnect between you and everyone else here is that everyone else seems to recognize that closing your eyes even for a short time when you're that exhausted carries an unacceptable risk of actually falling asleep.

You presented this terrible idea and then your defense of something indefensible branched out into absurdities involving peeing and pooping (again there's that weird fecal obsession), conjured fears of nurses, and comparison to active wakeful activities (which may themselves sometimes be a bad idea).

Closing your eyes to rest a while when you're so tired you post about how tired you are on SDN is foolish and reckless, full stop.

Exactly, not to mention if you are charting or reading on your phone everyone can see that you are at least awake and able to respond to immediate auditory monitor cues while also consciously checking the monitors at frequent intervals. If someone in the OR sees you sitting in a chair with your eyes closed for 10 seconds it could easily be mistaken for sleeping and "I was just resting my eyes for a bit!" might not be a convincing enough argument to the powers that be to prove you weren't being negligent, especially as a resident.

 

[jope]

We had these brutal
rotations during icu as well. I was able to get by with several cups of instant coffee.

However a keener surgical colleague of mine was able to get himself diagnosed with “shift work sleep disorder” and got prescribed modafanil. I’m not aware of any major adverse effects but he was able to stay up and definitely able to perform better on call than most of us.