Tips for preventing fogging, sweating?

[seelee]

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I am an M2 and scrubbed on my first case ever last week. I wore a surgical mask with the attached plastic face shield and the damn thing drove me nuts the entire time. It kept riding up, which would push the shield against my forehead, which would make my face sweat, making my face shield fog up. My vision was blurry from the sweat and the fog, not to mention the distraction, and I wasn't even operating.

The mess ended when one of the nurses noticed droplets of sweat on my gown, and made me re-scrub.

Is the face shield absolutely necessary? I don't wear eye glasses, but can I provide my own safety glasses in the OR? How do you keep from sweating on your gown? I don't usually sweat that much, but that damn mask was sucking it out of me.

 

[Musashi450]

I feel your pain. What's worse is, it's also a badge of inexperience. The trick is getting a good seal around your nose with the malleable ribbon built in at the top of the mouth/nose mask. If you're using the masks with the plastic shield, I usually put the mask up to my face, put my hands under the bottom of the plastic, and pinch it starting with my nose then pressing down under my eyes as I move out laterally. I then pull down the portion that goes over your mouth and then press and bend around my nose again. I'll tie it at that point and finally will push the top part of the plastic shield down a bit to pull it away from my face and vent. Between some trial and error and some OR time, you'll stop the fogging in its tracks. Some people will put tape around the nose but I've never done this.

 

[njbmd]

I am an M2 and scrubbed on my first case ever last week. I wore a surgical mask with the attached plastic face shield and the damn thing drove me nuts the entire time. It kept riding up, which would push the shield against my forehead, which would make my face sweat, making my face shield fog up. My vision was blurry from the sweat and the fog, not to mention the distraction, and I wasn't even operating.

The mess ended when one of the nurses noticed droplets of sweat on my gown, and made me re-scrub.

Is the face shield absolutely necessary? I don't wear eye glasses, but can I provide my own safety glasses in the OR? How do you keep from sweating on your gown? I don't usually sweat that much, but that damn mask was sucking it out of me.

You can also roll up the "mask" part and tie around your forehead with the shield upside down and then wear a regular maskover your nose and mouth. It looks like a plastic version of a welder helmet but the rolled mask keeps sweat from dripping in your eyes and the face shield covers your eyes without the condensation from your breathing because it doesn't touch your face.

 

[SouthernSurgeon]

I feel your pain. What's worse is, it's also a badge of inexperience. The trick is getting a good seal around your nose with the malleable ribbon built in at the top of the mouth/nose mask. If you're using the masks with the plastic shield, I usually put the mask up to my face, put my hands under the bottom of the plastic, and pinch it starting with my nose then pressing down under my eyes as I move out laterally. I then pull down the portion that goes over your mouth and then press and bend around my nose again. I'll tie it at that point and finally will push the top part of the plastic shield down a bit to pull it away from my face and vent. Between some trial and error and some OR time, you'll stop the fogging in its tracks. Some people will put tape around the nose but I've never done this.

I like the masks with a sticky inner lining for the bridge of the nose - gives a much better seal. You also have to learn how to tie the bottom to give yourself a little slack.

I avoid the masks with attached shield and instead go for a separate disposable eyeguard when available.

 

[SLUser11]

I am an M2 and scrubbed on my first case ever last week. I wore a surgical mask with the attached plastic face shield and the damn thing drove me nuts the entire time. It kept riding up, which would push the shield against my forehead, which would make my face sweat, making my face shield fog up. My vision was blurry from the sweat and the fog, not to mention the distraction, and I wasn't even operating.

The mess ended when one of the nurses noticed droplets of sweat on my gown, and made me re-scrub.

Is the face shield absolutely necessary? I don't wear eye glasses, but can I provide my own safety glasses in the OR? How do you keep from sweating on your gown? I don't usually sweat that much, but that damn mask was sucking it out of me.

Several important points have been brought up:

1. You can opt for other forms of eye protection. Some places have disposable goggles, but otherwise you can get cheap eye protection from most places. I've always gone with $5 racquetball specs from a sporting goods store, but you can also get stuff from home depot, etc.

2. If you stick with the mask, there are plenty of elaborate ways to manipulate it to minimize your problem (as described above), although I've found most of them to be only partially effective.

3. No matter what method you choose, a good seal at the level of the nose is essential. Bending the mask will only get you so far. Some masks have a sticky part on the inside...these are my favorite. When they're not available, I secure the top part of the mask to the bridge of my nose with paper tape. Sometimes that hurts coming off, but it's worth it in my opinion.

4. Tie the bottom portion of the mask a little bit looser, and hot air will leave the mask in a preferentially downward direction.

 

[SouthernSurgeon]

Several important points have been brought up:

1. You can opt for other forms of eye protection. Some places have disposable goggles, but otherwise you can get cheap eye protection from most places. I've always gone with $5 racquetball specs from a sporting goods store, but you can also get stuff from home depot, etc.

Just don't do what one of the visiting M4s did at my school...show up with a pair of custom Oakley M frames with transparent lenses...

 

[seelee]

Just don't do what one of the visiting M4s did at my school...show up with a pair of custom Oakley M frames with transparent lenses...

Thanks. If forced to choose between having maximum comfort and being known as "that guy", I would have a really hard time choosing.

 

[SLUser11]

Thanks. If forced to choose between having maximum comfort and being known as "that guy", I would have a really hard time choosing.

Says "that guy" trying to justify the cool specs. I think you could find some middle ground.....

 

[Guile]

Just don't do what one of the visiting M4s did at my school...show up with a pair of custom Oakley M frames with transparent lenses...

Did he have loupes that mounted on them? Because that would have been awesome. I bet he didn't match at your program. Surgitel makes loupes that mount on Oakleys so I've seen residents wear just the Oakleys when doing cases that didn't require loupes. I've been tempted but looking like a huge TOOL in front of everyone evaluating you has kept me putting up with lesser solutions like disposable face shields. In residency I won't really have to care what other people think (aside from what they think about my clinical and operative skills of course...)

 

[Winged Scapula]

Did he have loupes that mounted on them? Because that would have been awesome. I bet he didn't match at your program. Surgitel makes loupes that mount on Oakleys so I've seen residents wear just the Oakleys when doing cases that didn't require loupes. I've been tempted but looking like a huge TOOL in front of everyone evaluating you has kept me putting up with lesser solutions like disposable face shields. In residency I won't really have to care what other people think (aside from what they think about my clinical and operative skills of course...)

Be careful - there are still some rules in residency.

For example, in my program the interns and junior residents were frowned upon if they wore "designer" caps. No one would have dared wear those Oakleys or the new fancy loupes either.

 

[Guile]

Be careful - there are still some rules in residency.

For example, in my program the interns and junior residents were frowned upon if they wore "designer" caps. No one would have dared wear those Oakleys or the new fancy loupes either.

The sphincter tone was a little high at your program. What are "fancy loupes," by the way? Anything not Designs for Vision? Junior residents wear the Oakleys here without problem, even interns when they scrub on cases that require them. No one can wear cloth caps here so that's not an issue (all in the name of infection control...silly if you ask me). I'm all for hierarchy so if for whatever reason wearing non-disposable eye protection is frowned upon where I go then I'll fall in line but I didn't think it would matter for anyone above MS4.

 

[Winged Scapula]

The sphincter tone was a little high at your program.

That it was, but I've seen these rules elsewhere as well. We had all sort of such rules especially when I was a junior (as we did have some uptight Chiefs) - one would regularly berate medical students and interns who called with consults. He would only speak with the attendings, Chief or sometimes, if he had to, the senior residents. Of course we all, including the attendings hated him. JAD can you figure out who I'm talking about?

What are "fancy loupes," by the way? Anything not Designs for Vision? Junior residents wear the Oakleys here without problem, even interns when they scrub on cases that require them.

THESE are "fancy loupes". Yes, we made fun of anyone who wore anything but the DFV Buddy Holly style.

No one can wear cloth caps here so that's not an issue (all in the name of infection control...silly if you ask me).

I agree its silly...are they checking the bags we bring in, the sweatshirt anesthesia is wearing, etc.? The paper caps aren't sterile.

I'm all for hierarchy so if for whatever reason wearing non-disposable eye protection is frowned upon where I go then I'll fall in line but I didn't think it would matter for anyone above MS4.

And it may not, but my advice to you still stands. There are places where these rules are in place and may not be evident to you coming in as a new resident. I suggest that you stick with paper caps, eye protection as provided until you see what the general preferred/accepted behavior is.

 

[VincentAdultman]

Just don't do what one of the visiting M4s did at my school...show up with a pair of custom Oakley M frames with transparent lenses...

Funny..that guy would've been ranked #1 at my program.

 

[JackADeli]

...We had all sort of such rules especially when I was a junior (as we did have some uptight Chiefs) - one would regularly berate medical students and interns who called with consults. He would only speak with the attendings, Chief or sometimes, if he had to, the senior residents. Of course we all, including the attendings hated him. JAD can you figure out who I'm talking about?...

Probably..... would the chief in question remind me of waterfowl or a media commentator recently debated on these forums😕
I'm guessing waterfowl

 

[Winged Scapula]

Probably..... would the chief in question remind me of waterfowl or a media commentator recently debated on these forums😕
I'm guessing waterfowl

Took me awhile to figure out those references...but it was actually the media commentator.

Did I tell you that I saw the waterfowl when I was a Chief (he'd come back to see some peds thoracic case) and I actually hugged him? Stockholm Syndrome or sumthin...

 

[Guile]

And it may not, but my advice to you still stands. There are places where these rules are in place and may not be evident to you coming in as a new resident. I suggest that you stick with paper caps, eye protection as provided until you see what the general preferred/accepted behavior is.

Yeah I'll definitely feel out the program before I do anything as avant garde as wear opt for reusable eyewear or buy Surgitel loupes. I actually don't like the Oakley ones because I'm pretty traditional, but I actually like the non-Oakley Surgitel more than the DFW Buddy Holly ones. Like these:

But it's my hope that I'll end up somewhere there won't be personalities like the ones you describe...

 

[JackADeli]

Took me awhile to figure out those references...but it was actually the media commentator.

Did I tell you that I saw the waterfowl when I was a Chief (he'd come back to see some peds thoracic case) and I actually hugged him? Stockholm Syndrome or sumthin...

Yeh, I took a stab in the dark thinking the waterfowl.... not the nicest, but in generaL was ~introverted and lacked social skills.

Now that we are on same sheet of music, I think I will refer to the "commentator" as "Man-fish"....keep it in the animal kingdom!
So, Man-fish on the other hand always thought he was God's gift and I could definately recall his "status" emphasis. He seemed to believe in a "caste system" in which all were at a different level then he.

Did I tell you Man-fish had me paged out of trauma at ~2-3am to come and stand over him and observe his greatness at vascular anastamosis? I stood there for about an hour before the attending realised the pompous conduct....

i.e. "you can see how I am exquisitely delicate in suturing this..... many residents will go through training, but few will have this ability.... after 5 years you may learn alot but it is statistically unlikely you will have this level of control....". The attending responded, ""JAD" get out of here... he definately does not need an audience to massage his ego..."

Sadly, the anastamosis failed by morning and the patient lost his limb.....

Yep, you told me that story of the enemy hug!😍

...non-Oakley Surgitel more ...Like these:

...

I own a pair of Buddy Hollies and surgitels similar to above. I got the surgitels later at the recommendation of program director. They are lighter, double nose padded, and can have focal length changed with simple screw cap changes on the 3.5+x magnification. Aside from weigth, etc.... I have had quite a bit of problems with the Buddy Hollies having micro-cracks at the lens fittings. Designs for Vis has never been able to properly address this. My surgitels do not suffer the same problems. Honestly, they are just better built IMHO even if they are not "traditional".

 

[opr8n]

1. use seperate mask and glasses, not the combo one
2. use the antifog (green mask)
3. tape over your nose
4. breath with your nose, not your mouth

live by thesefour rules and be fog free!

 

[Guile]

Did I tell you Man-fish had me paged out of trauma at ~2-3am to come and stand over him and observe his greatness at vascular anastamosis? I stood there for about an hour before the attending realised the pompous conduct....

i.e. "you can see how I am exquisitely delicate in suturing this..... many residents will go through training, but few will have this ability.... after 5 years you may learn alot but it is statistically unlikely you will have this level of control....". The attending responded, ""JAD" get out of here... he definately does not need an audience to massage his ego..."

So where did this guy end up? What fellowship?

I own a pair of Buddy Hollies and surgitels similar to above. I got the surgitels later at the recommendation of program director. They are lighter, double nose padded, and can have focal length changed with simple screw cap changes on the 3.5+x magnification. Aside from weigth, etc.... I have had quite a bit of problems with the Buddy Hollies having micro-cracks at the lens fittings. Designs for Vis has never been able to properly address this. My surgitels do not suffer the same problems. Honestly, they are just better built IMHO even if they are not "traditional".

Yeah I've heard similar things about the DFV loupes. More reasons why I'll probably get the Surgitels.

3.5+x magnification

So you're in CT then?

 

[ESU_MD]

I had a similar problem and I just started taping the nose on every case- you have to find out which tape wont cause an allergic reaction or hurt too much coming off. I like the micro-pore tape.

Interestingly, sometimes I cant find the tape I like and I've noticed that my glasses dont fog up as much, so maybe I'm not as nervous in the OR anymore, who knows.

alot of surgeons besides ct guys wear 3.5x, and quite a few ct guys use 2.5x loupes. There is even the few legendary ct surgeons who do coronaries with NO loupes, (but ive never seen them in person)

I think I am becoming soft in my old age and have actually thought about getting non-buddy hollies for my 3rd pair. i'm looking for 3.5x+ and the most important feature now is preservation of my cervical spine. any ideas?

The 3.5x DFV std fields i have now are pretty nice, essentially same size and weight as the 2.5x but the depth sucks. maybe it wont matter when I'm staff and can raise and lower the table to my height

I couldnt imagine wearing those 3.5x extendeds for a long case, they just LOOK heavy

 

[Guile]

What would you need 3.5x for besides distals? Thyroids or parathyroids maybe. Anything else is weak sauce.

 

[igap]

I only have a problem with fogging when I wear the mask/faceshield combo. Recently I learned from a scrub tech to apply micropore tape to the inside of the upper part of the mask that crosses the bridge of the nose. This actually works the best for me of any of the taping strategies. It also has the added benefit of not irritating the skin of my midface.

 

[JackADeli]

...So you're in CT then?...

What would you need 3.5x for besides distals? Thyroids or parathyroids maybe. Anything else is weak sauce.

My CT attendings during general surgery residency used standard 2.5x DFV.
I have always had 3.5x loupes. I got my first pair [loupes] 3.5x expanded field, DFV PGY2 year general surgery. Always used them for thyroid/parathyroid/transplant/micro plastics/pedes & vascular. I'm not trying to prove my hardcore strength or such with minimalist magnification. I don't know about what sauce you speak of.... I just saw no reason to have less mag when the expanded field had about the same field as the 2.5 regulars but more magnification. It is useful in the micro work and doesn't hurt in anything else using loupes. I have found numerous occassions that I was able to identify something prior to some of the attendings and other residents with the magnification.

You state, "thyroids or parathyroids maybe".... well, I don't use them for colectomies or gall bladders.... so of course they are used for thyroid/parathyroid/transplant/micro plastics/pedes & vascular. Isn't that what general surgery residents use their loupes for anyways?

My advice to new surgery residents is this:

1. Choose a frame that will last but not be heavy like a tank.
2. Get the magnification you want either 2.5 or 3.5x. If you do a 3.5x get an expanded field.
3. when choosing, consider weight in every step of your choice.
4. These are a big investment and an IMPORTANT investment. Take your choices seriously and do not skimp or choose based on simple tradition or peer pressure. It can potentially be a one time life long investment. I know plenty of attendings that still use the loupes they got in residency. Some because they like them... others say, while they dislike the weight, shape, magnification, they are what they trained with! So, do not under power just "because" and do not choose a frame or model that will not last or will be so heavy as to assure your neck does not last. These will be used during some of the most intense training that will have an impact on how you function for years to come in the future.

 

[JackADeli]

I ...have actually thought about getting non-buddy hollies for my 3rd pair. i'm looking for 3.5x+ and the most important feature now is preservation of my cervical spine. any ideas?...

Speak with the surgitel rep. The frames are light and they have the double nose bridge padding to help displace the support. I got them as my second set of loupes and never looked back. I haven't worn my DFV buddy Hollies in about 3 years. yes, the DFV expanded field 3.5x were hard on my neck for long cases.

 

[Guile]

My CT attendings during general surgery residency used standard 2.5x DFV.
I have always had 3.5x loupes. I got my first pair [loupes] 3.5x expanded field, DFV PGY2 year general surgery. Always used them for thyroid/parathyroid/pedes & vascular. I'm not trying to prove my hardcore strength or such with minimalist magnification. I don't know about what sauce you speak of.... I just saw no reason to have less mag when the expanded field had about the same field as the 2.5 regulars but more magnification. It is useful in the micro work and doesn't hurt in anything else using loupes. I have found numerous occassions that I was able to identify something prior to some of the attendings and other residents with the magnification.

You state, "thyroids or parathyroids maybe".... well, I don't use them for colectomies or gall bladders.... so of course they are used for thyroids/parathyroids/vascular. Isn't that what general surgery residents use their loupes for anyways?

It was a joke. Some attendings frown on loupes for anything but distals. I think the basis of that is the thought that loupes slow you down, but it's probably more machismo than anything.

 

[JackADeli]

It was a joke...

Ok

 

[phantomx87]

There is even the few legendary ct surgeons who do coronaries with NO loupes

Definitely Joe Bavaria at Penn. He's freaking amazing and will talk your ear off for hours on end about Cincinnati trivia (for anyone rotating there 😉)

 

[45408]

I was impressed at how stylish the safety glasses are that I just got. They had some really sturdy ones with the clunky wraparound pieces, but there was also a more sleek pair that I opted for. I'll probably use those, since the face shields on the masks reflect too much glare back at me.

 

[Guile]

I was impressed at how stylish the safety glasses are that I just got. They had some really sturdy ones with the clunky wraparound pieces, but there was also a more sleek pair that I opted for. I'll probably use those, since the face shields on the masks reflect too much glare back at me.

Pic?

 

[Ronin2258]

I have been using the rolled up visor mask trick since I was a scrub tech, many years ago. Using that particular mask in its normal way, despite the fact I taped the nose, would still cause me to fog up. I would try to adjust that miserable shield several times before scrubbing in, and it still. fogged. up. For the longest time, my mask technique was the green adhesive-nosed mask, with the addition of TransPore plastic tape on the nose, then the rolled up safety mask on the forehead.

When I got into surgery, I would do add-on side shields to my normal glasses. The two problems that occur would be: 1. they wouldn't be allowed by IC, or 2. you forget to decon your glasses with a quat wipe or some other disinfectant after each case (you don't want to go home with gods knows what on your glasses and have someone else touch it. Blech.)

The rep for the loops did come to visit my program. I was seriously considering it (I thought the sports glasses fit better on me,) even as a prelim-2, because I did a lot of plastics and small vascular cases. But I came to the realization that I couldn't justify them due to the fact I would be on the north side of the drape for most of my career, and the only thing I could think of using them for would be for detail work on my miniature painting hobby. $700-1k+ is a lot for a pair of hobby loops.

In the end, one of my fellow 2s let me borrow his when I did things that needed them. I just paged him when they were necessary to make sure he didn't need them.

 

[SocialistMD]

For example, in my program the interns and junior residents were frowned upon if they wore "designer" caps. No one would have dared wear those Oakleys or the new fancy loupes either.

You know, DFV no longer sells the Buddy Holly's with the wooden box because of issues with the foam and cleanliness or something, so you have to get them in a space-age metal box. I decided to go with the Nike frames because (a) they were the same price (b) they were lighter and (c) they better matched the box in which they were housed.

 

[-Goose-]

I wonder why DFV doesn't make a buddy holly frame out of a lighter material (carbon fiber, etc). This would make sense to me.

As far as safety glasses, find a local smith and nephew rep and he should have about a hundred of these laying around his car (seriously): http://www.smithandnephewonline.com/proddetail.php?prod=15191240

 

[Winged Scapula]

You know, DFV no longer sells the Buddy Holly's with the wooden box because of issues with the foam and cleanliness or something, so you have to get them in a space-age metal box. I decided to go with the Nike frames because (a) they were the same price (b) they were lighter and (c) they better matched the box in which they were housed.

Awww...end of an era. They were showing that metal box but it was pretty thin and we all envisioned denting it. IM more old skool with my wooden box than I thought.

I might be getting some new lenses as my vision has changed; maybe time to look at some of the lighter ones.

 

[Guile]

You know, DFV no longer sells the Buddy Holly's with the wooden box because of issues with the foam and cleanliness or something, so you have to get them in a space-age metal box. I decided to go with the Nike frames because (a) they were the same price (b) they were lighter and (c) they better matched the box in which they were housed.

But at least the Nike ones have metal frames. You don't look like a chotch as much in them as you would in the Oakley frames.

 

[SocialistMD]

But at least the Nike ones have metal frames. You don't look like a chotch as much in them as you would in the Oakley frames.

I don't look like a chotch, period.

 

[Guile]

I don't look like a chotch, period.

Whatever man, I saw you and your spiked hair at the bar on Friday night, fistpumping in your Ed Hardy tee.

 

[phantomx87]

Whatever man, I saw you and your spiked hair at the bar on Friday night, fistpumping in your Ed Hardy tee.

 

[Apollyon]

(c) they better matched the box in which they were housed.

I get your first two points, but how is this relevant? Cosmetically matched, or fit?

 

[SocialistMD]

I get your first two points, but how is this relevant? Cosmetically matched, or fit?

Cosmetically. The buddy holly's were perfect in the old wooden box but seem very out of place in the metal box, whereas the Nike frames look like the box was designed for them.

It isn't relevant to patient care, but if I'm going to buy heavy, uncomfortable loupes, I want them housed in a box that reflects that.

 

[JackADeli]

I get your first two points, but how is this relevant? Cosmetically matched, or fit?

I may be a little to much of a modernist.... but, contrary to old school, I think it is relevant. Maybe not to direct patient care, but to the physician. I think the Buddy Holly frames, cumbersome and neck straining equipment persist because of "tradition" or "old school". That is all good and well.... but, honestly an investment/sacrifice that costs and does not pay dividends.

Today, I think physicians shelling out $600-2,000 for a piece of equipment have no reason to be ashamed of the aesthetics and/or ~ergonomics of their investment. I don't think I have met a surgeon that has a good back (or neck) after ten years of practice. If you are splurging for the gear, pay for the tech and get lightweight, strong, and cases that properly matches... (and decent looking is not bad... although, I wouldn't start going for designer brand name frames).

On another note, i had patients comment about "that old guy with the wooden box" and the "young hotshot with that hightech space box". I also heard from DFV for several years trying to push the wood box tradition, etc.... they kept making comments about the "quality frames speak for themselves" and the "hightech boxes are a crutch for the lesser brands"....

 

[Guile]

Hi...,

I am also suffering with same problem.

Spammers gotta spam.

 

[JPdrain1]

Just don't do what one of the visiting M4s did at my school...show up with a pair of custom Oakley M frames with transparent lenses...

Is that worse than the MS2 I saw in the OR today with her own custom scrub cap from blue sky?

 

[MrBigLips]

Those visor disposable glasses most OR's have laying around are top notch. Lightweight, comfortable fit, and comes in 10 colors. Match em with the same same color as your boxers and watch the nurses crumble.

 

[skiz knot]

I wonder why DFV doesn't make a buddy holly frame out of a lighter material (carbon fiber, etc). This would make sense to me.

As far as safety glasses, find a local smith and nephew rep and he should have about a hundred of these laying around his car (seriously): http://www.smithandnephewonline.com/proddetail.php?prod=15191240

Ortho reps are not allowed to give out glasses/scrub caps/bags/etc... anymore. Now if one happens to be left lying around and you find it...

 

[aashiq]

I would suggest to use a thin strip of tape over the mask on your nose. It will definitely do away with the fogging
You get to loose the black heads too after you peel it off🙂

 

[ZagDoc]

I would suggest to use a thin strip of tape over the mask on your nose. It will definitely do away with the fogging
You get to loose the black heads too after you peel it off🙂

This stuff is golden, was gifted to me by a chief resident when I was a third year med student. Doesn't take off a layer of epidermis and isn't gooey when you remove it like the paper and plastic tapes do.

I tried all the tricks and still had fogging (probably a combination of my bridge of my nose being shallow/not allowing a good seal and my deviated septum making it difficult to nose breathe). So I'm a tape devotee.