Uh oh.....

[12loser12]

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So I'm only an M2. I might be interested in surgery so I've gotten set up with a 3rd year student and get to observe on some of the surgeries he scrubs in on. With my dad being a vet, I've assisted in a lot of surgeries on animals before. Also, I did a lot of surgeries on rats for research, so this isn't a totally new thing for me, and I've never had problems before. I've heard all the warnings about students passing out in the OR and didn't think that was me.

Today was first day of observing and during the second surgery I was observing I got light headed and decided to step out before it got worse. Good thing I did because as I was walking around looking for a place to sit things kept getting blurrier and brighter. Finally I crouched down along the side of a hallway for a few minutes. When I thought I could walk again I headed to the locker room and barely made it there as I everything continued to get blurry and white. I parked it there for awhile before calling it a day.

I ate in the morning and I'm not consciously bothered by "blood and guts". My only thoughts are I have been low on sleep lately and hated breathing through the mask.

Anyone with a similar experience? Any tips on how I can keep this from happening next time? I'm still interested in surgery, but obviously need to change something. Hopefully I can figure it out before M3 when I have a surgery rotation, or maybe even so I can observe a few more this year.

 

[Krazykritter]

The major things people always tell med students in the OR centers around eating before (which you said you did), not locking your knees (which you shouldn't have been having to do if not scrubbed in), & not forcing yourself to constantly look down at the field & focus on the blood, guts, or whatever else might be there.

I think the last point is almost the most important. If you are constantly staring at one area you are probably focusing way too hard & I've noticed that you can at times begin to induce that feeling of vertigo & the lightheadedness that goes with it.

Some people just really seem to be bothered by the rebreathing of CO2. I don't know that there is really much you can do about that. Something I noticed is that I feel much more comfortable if I tie my mask snugly on top to keep my eyewear from fogging & I usually tie the lower sting rather loosely so that the air escapes through the side. At times, though, you can garner some flak from the overzealous scrub nurse who decides that this is unacceptable & you will surely contaminate the wound (you must completely disregard the fact that she & her colleagues will routinely leave the OR six times for a break or equipment during the case).

Although you may think that you are not consciously bothered by 'blood & guts' you may be subconsciously. It really bothers some people that they are actually seeing a HUMAN cut open.

Hope some of this helps from a to-be surgical intern.

 

[PeepshowJohnny]

It happens to everybody. You're lack of sleep and breathing through the mask probably played in, also consider if you were locking your legs and causing blood pooling or if you hadn't eaten/drank adequately in the morning. Also, sometimes the OR lights are on you (Where you scrubbed in?) and you can heat you up intensely.

Honestly, for a completely unexplainable reason, it gets better. Maybe you just subconsciously start avoiding triggers like listed above or maybe your body adjusts but it does get better. I remember getting freaking light headed during a regular old D&C in OB/GYN and was worried about my chances in surgery later in the year. But it got better. I was able to scrub into marathon peds surgery cases (Where the room is hotter than Hades) and no problems.

 

[girlofdestiny]

Pretty much the exact same thing happened to me earlier this week on MEDICINE ROUNDS of all places.
I too had eaten before, but I was seriously sleep deprived and wearing a mask cause a pt was on respiratory precautions. I had to step out, get some orange juice, and give myself a good 15 minutes before I could rejoin the team.

It's really not as big of a deal as it feels like in the moment. As long as you excuse yourself, I've found residents, attendings, etc to be very understanding. It's a little embarrassing, but it happens to everyone at one point or another.

 

[DOCpa]

HAHAHA. Hey man don't worry about it. This exact same thing happened to me the first time I observed a surgery during undergrad, and I'm going to be a surgery resident in july so it's not a big deal. You'll get over it. In fact it probably won't even happen again. Plus when you are on your 1st surgery rotation 3rd year you'll be so pre-ocupied with sterile technique, not getting yelled at, retracting, and whatever else that you won't even think about passing out.

PS. - Sound like you were smart enough to get out of there in time and save yourself a REALLY embarrassing experience.

 

[tacrum43]

Something I noticed is that I feel much more comfortable if I tie my mask snugly on top to keep my eyewear from fogging & I usually tie the lower sting rather loosely so that the air escapes through the side.

+1. I discovered this too, and it helped a lot.

I also like to bend my legs now and then to keep the blood flowing.

 

[12loser12]

Thanks for the tips. I've had to stand on my legs for jobs before so I'm usually careful to bend them and move a bit. I think it's the rebreathing that's getting me. The last couple of times I've played paintball I got sick from all of the running around and breathing hard with the protective mask on. Maybe next time I'll try the looser bottom tie you guys suggested. I also noticed a few other people in the surgery room had different masks that kind of duck-billed out so they weren't right next to their face. This might help a little, I've never tried them. Any and all other tips are appreciated. I knew I wasn't the only one out there but it's still pretty nice to hear from others with similar experiences.

 

[myrtle]

Thanks for the tips. I've had to stand on my legs for jobs before so I'm usually careful to bend them and move a bit. I think it's the rebreathing that's getting me. The last couple of times I've played paintball I got sick from all of the running around and breathing hard with the protective mask on. Maybe next time I'll try the looser bottom tie you guys suggested. I also noticed a few other people in the surgery room had different masks that kind of duck-billed out so they weren't right next to their face. This might help a little, I've never tried them. Any and all other tips are appreciated. I knew I wasn't the only one out there but it's still pretty nice to hear from others with similar experiences.

Avoid laparoscopic surgeries - I've found that all of the camera jiggling can be disorienting. If the room is really warm and you're scrubbed in, see if you can ask someone to make the room colder. DEFINITELY bend your legs a lot, it helps. I haven't used the duck-bills but other people say that they help. You did the absolute right thing by leaving and walking around - it's much better to do that than to pass out.

Finally, don't worry about it! It's happened to MANY people (myself included, except that I actually passed out) and it's something that everyone has to deal with. Now that you know what it feels like, you have pre-warning to go off and deal with it. Plus, it's good that you're figuring out how to avoid passing out before third year!

 

[LadyWolverine]

Avoid laparoscopic surgeries - I've found that all of the camera jiggling can be disorienting.

The only time I've ever expressely *asked* to sit down during a surgery was during a very complicated laparoscopic hiatal hernia repair. I became so seasick during the operation (I was "holding" the liver and occasionally navigating the scope, that's about it) that I thought for about 30 minutes that I was going to vomit. For the rest of the procedure, I had to keep looking away from the screen. It was much longer and more drawn-out than it should have been due to the pt's anatomy and plethora of adhesions, but seriously, if you have a stomach that is a bit more on the queasy side, you should consider *slowly* working your way into MIS.

 

[bjackrian]

I'd made it through surgery and 7/8 weeks of OB when it happened to me. A regular old fashioned C-Section where I was retracting and I had to excuse myself to the hall so I didn't fall on the field. I'd been feeling fine before the surgery, but the next day I came down with a nasty cold so it was probably brewing when it happened. Everyone was really understanding about it--even some of the attendings who had been unpleasant in the OR during the rotation, so I wouldn't sweat it.

 

[werd]

yeah it happens to most folks. i think it helps when you're actually participating in the surgery rather than observing. i think the whole not-eating, leg locking etc. explanations are a reflection of people's pride; it's really the sight/experience that makes you vagal and want to pass out.

 

[diosa428]

Remember to not just eat but be properly hydrated. I know that some people advise against drinking a lot right before you scrub into a long surgery, but it seems to me that I always get dizzy/lightheaded when I'm not hydrated and it's hot in the OR (I mean, you've already got on a ton of layers). I used to eat a substantial breakfast and make myself drink at least 1/2 a bottle of water (usually a whole bottle) before scrubbing in in the AM. If you make sure to drink a lot 1-2 hours before you're going to be scrubbing in, usually you can use the restroom before surgery and be ok.