How to not pass out in the OR?

[Katiezieg]

First off, a little about me. I'm a 21 year old female who was diagnosed with vasonotor instability 3 years ago. My cardiologist told me to just increase my fluids and sodium to keep my blood pressure up and prevent me from passing out when standing up. However throughout my 12 hour nursing clinicals i had multiple near syncope moments from standing too long. But of course i fell in love with surgery...which made me nervous (the last place i would want to pass out is in the OR). So I began a perioperative program 2 weeks ago and had my first clinical last Monday. I drank a ton of water, and ate plenty of salty chips in the days leading up. I also wore TED hoses during my clinical. About an hour and a half of being scrubbed in during a lap hysterectomy, that dreaded feeling hit me. I felt hot, sweaty, nauseous, and was beginning to feel confused. I shifted around my weight, bent my knees, flexed my legs, but nothing was working. So I told my preceptor and she had the circulator immediately sit me down and ungown me. I was so embarrassed, but the surgeon and nurses were all very nice about it and told me all their near syncope moments in the OR. they say my body will get used to standing for long time periods in a hot mask and gown. I just wonder if I'm strong enough to be able to handle the OR. It really puts a damper on my experience. Anybody have any tips on how to avoid near syncope? And how to increase my "standing stamina"?

Thanks!

[brithoover]

This is so crazy but I have that condition too..maybe a little different but exact same symptoms (mines called Dysautonomia or POTS). When I was in school and did my OR rotation I passed out twice in the OR. Standing for long periods of time in the same spot and wearing a mask for more than 10 min gives me the dreaded feeling. I wish I could give you better news but my solution has been to avoid those situations ):

[NP Sam]

My first time in the OR it happened to me. It's the nervousness or the newness if not an actual medical condition. The key is relax and not buckle to knees. Also, don't tie your mask too tight. Most importantly, have a seat! Sit down when you feel those feelings.

[canesdukegirl, BSN, RN]

If you feel better when you are cool, you can request a cooling vest. Many nurses and surgeons use these in the OR. The vasoconstriction of the cooling vest just might be your new best friend.

Make sure that you are eating a high protein breakfast in the morning. Boiled eggs are the best (cook them the night before, shuck the shells, put them into Ziplock bags with a healthy dose of salt, and eat them on your way to work).

What kind of mask are you wearing? I use the mask with the visor attached. One trick I learned was to place the mask on your face, and only tie the top strings. Then pinch the aluminum portion to the bridge of your nose. Before you tie the bottom strings, pull the visor down and away from your face so you create plenty of space between your face and the visor. Then tie the bottom strings. Adjust the visor by pulling out more if you need to.

I totally understand how humiliating it is to have to drop scrub. Brit, almost ALL of us OR nurses have had one episode of syncope, especially in the introductory phase of scrubbing. Some procedures are worse than others. Long cases, where you have to stand for long periods of time are the absolute worst! See if your OR has a gel mat for you to stand on.

The TED hose are a must. Kudos to you for using them! I have horrid spider veins in my legs from standing for many years on those hard tile floors.

Keep some peanut butter in your locker for a quick "in-between-cases" snack. You'll be surprised at how effective a tablespoon of peanut butter tides you over until you can get a real lunch break.

Oh, and FYI...a lap hyst isn't the easiest case to scrub. The entire set up is awkward, and there are many people crammed into a very small space. It doesn't help that the room is dark, and you have to constantly adjust your eyes from the screen to your back table. I have been an OR nurse for many years, and I still struggle with this. Don't beat yourself up!

What's your next rotation?

[kguill975, MSN, APRN, NP]

Don't lock your knees, move from the field to the back table from time to time, and like the others said, hydrate yourself and eat small snacks in between. That used to happen to me as a scrub tech, but I never had that problem as a circulator because it's always "up and down, up and down" to get things. It'll be okay.