Who's gone Vagovasal?

[Quik]

Yesterday: Fourth day of shadowing in an Ortho office, doc begins removing drain from a partially open knee wound, after 18'' of bloody rag is pulled from the joint space, I get a tingly, warm sensation all over my body and feel I should probably excuse myself from the room. My next conscious moment is lying face up in the hallway, feet on chair, with doc smiling down at me "You okay, you passed out on us there" with the rest of the office staff offering their condolences "It's happened to the best of us," and "is your head okay?" I'm not squeamish, in fact, didn't think this case was particularly gross, just rather unacquainted with open wounds and well, dropped like a sac.

Despite being embarrassing, it's a rather warm and blissful sensation. So, I got up drank an apple juice box, and continued rounds. Not a big deal, I hear it's rather common for first timers to go vasovagal. I found out there are things you can do to stop the loss of blood pressure; muscle contractions, squatting, deep breathing, and definitely sitting down, so as to avoid the likelihood of a concussion on impact.

Anybody else been there, waking up on the floor?

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[wholeheartedly]

Never gone totally out. (Knock on wood) but definitely had a few close calls. This was while I was doing cornea procurement, so removing either corneas or whole eyes from deceased donors to be given to recipients. The worst was when I got called in just before I was about to make dinner and didn't have time to eat. So by the time I got called in to my second case in a row I hadn't eaten for over 12 hours, was all gowned up under hot lights and all of a sudden got really nauseaus and light headed and grabbed the side of the autopsy table to keep myself from going down. Glad I didn't as it was 2 a.m. and I was by myself.

I grabbed some water, but didn't have money to buy juice or food from the machines. After that I always tried to chug a bottle of juice and inhale a granola bar en route to cases.

Heat and an empty stomach seem to be my biggest issues. No correlation with how gruesome the case.

 

[Elewynne]

I've never (yet) gone totally out either, but have had all the symptoms and had to leave/sit down/use the bathroom on three separate occasions. Embarassing to be sure, especially since I don't consider myself particularly squeamish. I noticed a trend, though, is that each time it happened I was not well nourished (hadn't eaten in a while, or had a light meal too long ago) and in two cases I had started to sympathize with how uncomfortable XYZ must be. After I realized those two issues it was easier to avoid (we'll test how well it works starting this August when I begin med school!)

 

[Quik]

I don't consider myself particularly squeamish. I noticed a trend, though, is that each time it happened I was not well nourished (hadn't eaten in a while, or had a light meal too long ago) and in two cases I had started to sympathize with how uncomfortable XYZ must be. After I realized those two issues it was easier to avoid (we'll test how well it works starting this August when I begin med school!)

Interesting, the doc had just mentioned cleaning out a bacterial infection from the wound, and the night before a family member had told me they currently had a case of MRSA (methocillin resistant staphylococcus aureaus)... I knew I had a moment of sympathy there. I too was definitely undernourished, which was the first question for me after coming out of my little nap; "did you have breakfast?"

btw, adorable pup in your avatar? Shiba inu? yours???

 

[wholeheartedly]

Actually, I take that back. I've never gone totally out in the line of duty, but did at home once. One minute was having bad abdominal pain, next minute I woke up on the floor with a huge goose egg on my head. That was scary.

 

[Quik]

The bump on the head was definitely the worst part of it all (save for the embarrassment and worry I'd never be let into the O.R.) but worrying that I may be slightly concussed or something more serious... what a PITA. Turns out I'm fine.

 

[MedWonk]

Almost once. Ostomies and urinary catheters kind of unsettle me. I've gradually gotten better, though.

 

[ejw5075]

It's super common, no worries. I think I'm one of two in my class of seventeen to pass out and surgery ended up being my favorite rotation thus far.

It happened during my first vaginal delivery, first cesarean delivery, first chole.... and this afternoon doing a neuro exam on someone with uncontrolled diabetes (read: foot flakes flying in the air)

Eat & Drink regularly.., and if it happens to you repeatedly, there are things you can do at the first sign to prevent it.

 

[Elewynne]

Interesting, the doc had just mentioned cleaning out a bacterial infection from the wound, and the night before a family member had told me they currently had a case of MRSA (methocillin resistant staphylococcus aureaus)... I knew I had a moment of sympathy there. I too was definitely undernourished, which was the first question for me after coming out of my little nap; "did you have breakfast?"

btw, adorable pup in your avatar? Shiba inu? yours???

Yep, proud furmom to the pup in my avatar and another one too. Shibas are great, if you can handle their personality 🙂

 

[QofQuimica]

I've never actually passed out, but I've gotten lightheaded before. Best thing for it is to not try to be a hero. When you start feeling that sensation, go sit down somewhere cool, and have a drink with some sugar in it. The feeling will pass. As for surgery, if you're going to pass out while you're scrubbed in, just make sure that you fall backward and not forward into the field. 😉

Speaking as a physician, I'd also point out that you're much less likely to feel faint if you're performing the procedure versus if you're just watching. When you have to focus on the task itself, you're not thinking about things like how the patient has the same disease as your relative. You're just focused on what you're doing. MRSA abscesses rank up there only a bit behind GI bleeds on the scale of putrid substances from the human body that can make the paint peel off the walls, but I've never fainted while caring for patients with either. A first year med student who was shadowing me once, however, did drop like a rock. Heh.

 

[NCOldie]

I second the comment about not being a hero. I used to pass out constantly while growing up. I kept trying to talk myself out of it. haha I have hit my head on a stove before. My favorite is orange juice! 🙂

 

[Quik]

Best thing for it is to not try to be a hero. When you start feeling that sensation, go sit down somewhere cool, and have a drink with some sugar in it. The feeling will pass. As for surgery, if you're going to pass out while you're scrubbed in, just make sure that you fall backward and not forward into the field. 😉

I had a pretty short length of time before I realized the room was starting to spin, then I tried to remove myself. Sitting down would definitely have been a better reproach, though I thought there was a calm oasis waiting for me outside the room... I suppose there was in the short dream I slipped into.

 

[QofQuimica]

I had a pretty short length of time before I realized the room was starting to spin, then I tried to remove myself. Sitting down would definitely have been a better reproach, though I thought there was a calm oasis waiting for me outside the room... I suppose there was in the short dream I slipped into.

If you have to just stop and sit down where you are, then do what you have to do. I laid down right on the sidewalk outside the blood donation van after giving blood once. Figured if I didn't lie down voluntarily, I'd be lying down involuntarily.

 

[CajunMedic]

Years ago, while I was in Paramedic school. I was doing ED clinicals and got called up to the floor to help hold an elderly patient for
a bone marrow biopsy. The doc missed the iliac crest on the first attempt and the sound of that needle scraping did it. I vaguely remember going pale and trying not to pass out. Made it through the procedure and dropped into the 1st chair I could find.

 

[wholeheartedly]

Years ago, while I was in Paramedic school. I was doing ED clinicals and got called up to the floor to help hold an elderly patient for
a bone marrow biopsy. The doc missed the iliac crest on the first attempt and the sound of that needle scraping did it. I vaguely remember going pale and trying not to pass out. Made it through the procedure and dropped into the 1st chair I could find.

Oh man, yeah needle hitting bone is the worst. Funny thing, I'm trained in phlebotomy, so I'm used to drawing live people. But then I got my side gig doing cornea procurement and we have to draw blood from deceased ppl. Well it's really hard to get blood from someone who has been dead for 6 hours. Plus we're limited to which sites we can draw from so I tended to always wind up drawing from the subclavian. I'd get a lot of blood but tended to hit bone first sometimes, and even though the person wasn't alive to feel it, it just totally wigged me out.

 

[MedSpeech]

Can't believe no one has said putting your head down between your knees. Gets the blood back up there.

 

[QofQuimica]

Oh man, yeah needle hitting bone is the worst. Funny thing, I'm trained in phlebotomy, so I'm used to drawing live people. But then I got my side gig doing cornea procurement and we have to draw blood from deceased ppl. Well it's really hard to get blood from someone who has been dead for 6 hours. Plus we're limited to which sites we can draw from so I tended to always wind up drawing from the subclavian. I'd get a lot of blood but tended to hit bone first sometimes, and even though the person wasn't alive to feel it, it just totally wigged me out.

Look up some of those armed forces videos on Youtube where they're putting in sternal IOs. First time I saw that I was like,

 

[touchpause13]

I have, twice. And I get flushed/light headed at the sight of lots of blood. Good thing I want to go into psych lol. I've learned at exposing myself to stuff is helpful. So for like surgery rotations I'm planning on watching youtube videos until it doesn't bother me. I'm positive I'm going to go vagovasal at least once on rotations tho.

 

[oingoboingo]

Eat & Drink regularly.., and if it happens to you repeatedly, there are things you can do at the first sign to prevent it.[/quote]

What are your tricks to prevent it?

 

[wholeheartedly]

Look up some of those armed forces videos on Youtube where they're putting in sternal IOs. First time I saw that I was like,

Speaking of IOs, saw one of those put in a woman in the ED once. Kinda like watching a train wreck. You don't want to see it but you do. Also cringeworthy was watching orthotic put a pin in someone's leg to straighten out a broken femur.

 

[wholeheartedly]

Re: sternal IO....

Ow! How the heck do they not break it?

 

[EMDO2018]

Yesterday: Fourth day of shadowing in an Ortho office, doc begins removing drain from a partially open knee wound, after 18'' of bloody rag is pulled from the joint space, I get a tingly, warm sensation all over my body and feel I should probably excuse myself from the room. My next conscious moment is lying face up in the hallway, feet on chair, with doc smiling down at me "You okay, you passed out on us there" with the rest of the office staff offering their condolences "It's happened to the best of us," and "is your head okay?" I'm not squeamish, in fact, didn't think this case was particularly gross, just rather unacquainted with open wounds and well, dropped like a sac.

Despite being embarrassing, it's a rather warm and blissful sensation. So, I got up drank an apple juice box, and continued rounds. Not a big deal, I hear it's rather common for first timers to go vasovagal. I found out there are things you can do to stop the loss of blood pressure; muscle contractions, squatting, deep breathing, and definitely sitting down, so as to avoid the likelihood of a concussion on impact.

Anybody else been there, waking up on the floor?

I have, shadowing in the ER I have seen some gross stuff. The first couple times I went down. The attending had a couple of big burly nurses stand next to me every time there was a lot of blood in procedures. I got use to the blood and gore, but don't think I could do em, surg, obgyn for a living. Mainly interested in psych, neuro, im.

 

[musicalMD]

I experience extreme vasovagal syncope with needles- so much so that I passed out getting my flu shot this year. Totally embarrassing- but I know now that I need to tell people before I get stuck with a needle- no matter how small the needle. As far as I know my episodes are only triggered by needles being put into me- but then again I have not seen anything too gory in person so I could be wrong. Now that you know this about yourself, you can be prepared for this to happen, so you can get yourself in a chair or laying down before you actually pass out. I often feel a warm sensation in my throat (since the vagus nerve runs directly through the throat) seconds to a minute before I pass out. Look for warning signs like this in the future. If you prop your feet up- you may be able to restore enough blood flow and avoid passing out at all. Hope this helps!

 

[ejw5075]

Eat & Drink regularly.., and if it happens to you repeatedly, there are things you can do at the first sign to prevent it.

What are your tricks to prevent it?

Like someone mentioned above, it is much less likely to happen if you are the one doing whatever is making you pass out- that's obviously not likely to happen as a premed/med student BUT you are able to do something to distract yourself. Getting pimped in an OR, going through the steps of the procedure in your mind, quizzing yourself on anatomic structures, naming instruments, etc, can help because you aren't just watching.

What helps me- talking myself out of it. Deep breathing. I've never tried guided imagery but one PA i worked with swears by it.

One of my biggest issues getting into the clinical world was watching people in pain. The best thing for this is learning what one of my attendings calls "cold empathy"

 

[TravelingRunner]

The best thing for this is learning what one of my attendings calls "cold empathy"

That is my best coping mechanism.

Few things bother me, but one thing that can make me go woozy is lumbar punctures...probably because I know unpleasant they are from experience.

 

[Quik]

I'm the running joke now in the office, which is fun. Today's was, "we'll have a helmet for you when you return..."

My response "I'd really prefer you would just pad the walls and floor, a helmet would mess up my hair." For what it's worth, it's nice to break the superficial layer with the staff and introduce a little humor, even at my own expense.

I saw necrotic toes after amputation (from frostbite) today, and an incision made into the shin, and nuthin... Though the doc did ask me to sit down before beginning the incision. Hope that was just my one time initiation into the club.


What are your tricks to prevent it?[/quote]

I don't know about tricks to prevent the automatic response aside from normal blood sugar and desensitization from exposure to wounds, but at the signs of it coming on, doing muscle contractions, squatting (so as to limit blood flow into lower legs), and SITTING DOWN, are recommended. At the sight of blood or anything remotely 'gross' I'm clinching muscles and moving around to avoid any possibility...

 

[CajunMedic]

Look up some of those armed forces videos on Youtube where they're putting in sternal IOs. First time I saw that I was like,

I'm going through a Tactical Combat Casualty Care course and getting instructor qualified next week. I'm curious to see how those work, we use the EZIO and place it into the tibia.
I gotta admit, I did get a little queasy watching the training videos for it. They use live actor/patients and there's no way it was special effects putting that thing in....Couldn't pay me enough!

 

[BurberryDoc]

Just for future reference, it's vasovagal, not vagovasal. There is also vagovagal, but that is something different.

 

[Quik]

Just for future reference, it's vasovagal, not vagovasal. There is also vagovagal, but that is something different.

Heh.... That's helpful, thanks for saving me any more embarrassment.

 

[Mad Jack]

Never passed out, but I go ghost white every now and then when I see something extremely gross or traumatizing. It can visibly shake you, even years on in. I wouldn't feel bad about it.

 

[QofQuimica]

Just for future reference, it's vasovagal, not vagovasal. There is also vagovagal, but that is something different.

Ha, I didn't even notice the transposition. Just goes to show you that your mind sees exactly what it expects to see.

 

[Aminex]

Hahaha those sternal IO videos. *PLOCK* go the needles when they hit paydirt. That would be tough to take in real life. A 340p YouTube video through a smartphone is a safe distance

 

[GC1000]

Passing out is definitely embarrassing. I start medical school in a few months. For those of you already in medical school, do you recommend telling those around you (other students and doctors during rotations) that you are likely going to pass out at some point? I have found that taking deep breaths and squeezing my leg muscles does help, but sometimes fainting is unavoidable. For me, the biggest problem is my perception of pain the patient is going to feel. Even if it isn't that bad, some things just make me feel uncomfortable. It is like I put myself in the patients position, like I am actually having the procedure done on me. I hope that gross anatomy helps desensitize me, but I have a feel that there will be many rough moments for me during 3rd and 4th year. Any thoughts?

 

[EMDO2018]

Med students please help, is there any go to move that you can do to keep from passing out?

 

[Quik]

Med students please help, is there any go to move that you can do to keep from passing out?

Yes, muscle contractions, squatting, etc. Physically increase your blood pressure and prevent the collection of blood in your lower extremities at the sight of something gory. Begin doing these, especially muscle contractions before you feel the typical vaso symptons (hot-> flush-> dizzy---> waking up on the floor with a bump on your head).

 

[kraskadva]

I've never passed out, but definitely have come close -first wound debridement, emptying drainage tubes, first autopsy. Always when I haven't eaten and start feeling warm. Just started an internship at the local morgue, so breakfast has become a priority on those days. In the moment though- looking away for starters, slow breathing, walk away for a minute if I can, cross my legs at the ankle and squeeze them together if I can't.

 

[QofQuimica]

Med students please help, is there any go to move that you can do to keep from passing out?

I already told you: SIT DOWN. Heck, even lie down if you need to. It's best if you can go sit down somewhere cool and away from the procedure. But yes, seriously, sit or lie down right there on the floor if you can't make it out of the room in time. Again, better to go down voluntarily than involuntarily.

Passing out is definitely embarrassing. I start medical school in a few months. For those of you already in medical school, do you recommend telling those around you (other students and doctors during rotations) that you are likely going to pass out at some point?

No. That sounds like a recipe for a self-fulfilling prophecy, and it also has a significant chance of being misinterpreted as you being lazy or uninterested.

 

[GC1000]

No. That sounds like a recipe for a self-fulfilling prophecy, and it also has a significant chance of being misinterpreted as you being lazy or uninterested.

I don't want to be viewed as being lazy or uninterested. I just thought it may be better if those I'm working with knew if I need to take a step back in advance. Since it is embarrassing, I find it a little easier to avoid fainting if others around me are aware b/c it reduces my anxiety about it. To me, it seems a self-fulfilling prophecy that I will pass out (especially if others don't know). It almost seems like a mental mind game that sometimes I can't seem to win. After I passed out with the doctor I shadow, he knew about my problem and asked me how I felt sometimes. That seemed to help a lot, but I don't want to be a burden or get in the way b/c I may go vasovagal during clinicals. Honestly, this is probably the one thing about medical school that concerns me the most. If I don't tell anyone before hand, once I feel it coming do I just take a step back for a few minutes until I regain composure (just sit on the floor)? What about during surgery or other sterile conditions, do I just sit one the floor in the OR and scrub in again after I feel better? I believe everything will work out, but I'm unsure on how to handle this the best way. Thanks for taking the time to reply QofQuimica.

 

[Quik]

I don't want to be viewed as being lazy or uninterested. I just thought it may be better if those I'm working with knew if I need to take a step back in advance. Since it is embarrassing, I find it a little easier to avoid fainting if others around me are aware b/c it reduces my anxiety about it. To me, it seems a self-fulfilling prophecy that I will pass out (especially if others don't know). It almost seems like a mental mind game that sometimes I can't seem to win. After I passed out with the doctor I shadow, he knew about my problem and asked me how I felt sometimes. That seemed to help a lot, but I don't want to be a burden or get in the way b/c I may go vasovagal during clinicals. Honestly, this is probably the one thing about medical school that concerns me the most. If I don't tell anyone before hand, once I feel it coming do I just take a step back for a few minutes until I regain composure (just sit on the floor)? What about during surgery or other sterile conditions, do I just sit one the floor in the OR and scrub in again after I feel better? I believe everything will work out, but I'm unsure on how to handle this the best way. Thanks for taking the time to reply QofQuimica.

I wouldn't announce it ahead of time, not because it is or isn't embarrassing or may be a self-fulfilling prophecy, but there's just no need; there's nothing anyone can do about it besides you being aware and knowing where the nearest chair is located. The worst thing you can do is pass out in the OR and either contaminate the operation or disrupt the procedure and take the attention away from the patient. There's nothing embarrassing about stepping out or away to avoid either of the two prior possibilities. Also, if you were to go vaso during one of your clinicals, chances are you won't be the only one. Apparently it's quite common. You'll look much better (less embarrassed) stepping away for a few moments rather than waking up on the floor with the rest of your class talking/laughing about you.

 

[Quizlet04]

I did. Mid-interview. You want to talk about ****up? (Not eating enough + nerves + period = bleh). I had to excuse myself for a snack.

 

[DrOMG]

I was doing clinical rounds in the military. Day X was Women's Health. Following the GYN doc around and we go see Patient Y. She was a dependent wife coming in for a colpo. I'd seen many paps, colpos, etc so I wasn't too worried about it. I walk in the room and the smell was overwhelming. Add to that, the room was like 1000 degrees. I'm watching on the screen and this woman has the worst looking cervix I have ever seen. It had seepage and all kinds of grossness in there. Now I am not squeamish in the least, but looking at that while dealing with the smell and sweltering heat, I could feel myself swaying back and forth. I didn't want to look like a wimp and step-out so I tried to brave it out. I had to wear a mask too so that also contributed to me sweating on my face and adding to the claustrophobic feeling. I started getting starry eyed and that was that.

TL;DR Lady with gross vag + high heat = Me on the floor

 

[QofQuimica]

If I don't tell anyone before hand, once I feel it coming do I just take a step back for a few minutes until I regain composure (just sit on the floor)? What about during surgery or other sterile conditions, do I just sit one the floor in the OR and scrub in again after I feel better? I believe everything will work out, but I'm unsure on how to handle this the best way. Thanks for taking the time to reply QofQuimica.

Ideally, it's best to leave the room and go sit down. But if you have to sit down right there on the floor while in the OR because you can't make it to the door, then do it. The surgeons will much more upset with you if you faint into the field than they will if you have to re-scrub.

Again, it's easy to psych yourself into being lightheaded. The best thing to do is to occupy yourself with the task at hand so that you don't think about it too much. So, during surgery, read up on the anatomy and the procedure so that you can focus on that. Get as involved with it as you can. And please don't take away the impression that you're the only one who has this problem. Med students feeling lightheaded is *very* common. I had a fourth year student have to leave the room yesterday while I was doing a lumbar puncture on a large patient using the seven inch needle that we fondly nicknamed "the harpoon." I didn't even know why she had left until afterward. No big deal, and it's a lot better than a student I had last year who hit the floor right in the room.

 

[wholeheartedly]

.....

Also, because it isn't that uncommon of an occurrence, I wouldn't be surprised if the scrub nurse or someone gives you a brief "what to do if you feel faint" lecture before you get in.