Almost Fainted in the OR Twice!!

[gymnut]

This is long but, I need some advice so hang in there with me!

So as a few of you may recall I am enrolled in a surgical technologist program through my hospital. I absolutely LOVE it and am doing great academically. We have started doing our clinicals, well, we are scrubbed to observe for right now but in January is when we officially start setting up, handing off the instruments etc.

The second time we went to clinicals we were just going to observe and not get scrubbed in but, my scrub tech was very enthusiastic about teaching so my instructor let me scrub in. About 20 minutes into the case I felt the heat begin to creep up my body and my vision start to go. The circulator nurse helped me out of my gown and gloves and sat me on the floor until my instructor came and took me to the lounge were I had orange juice. After that I just went back to observe and was fine. I know I can pinpoint why I almost fainted and that was because it was very hot (The heating cooling system was going haywire that day and it was almost 80 in the room) and I was so excited to watch the surgery that I pretty much forgot to breath and along with locked knees and a crap breakfast (a Poptart while running out the door) is a recipe for hitting the floor.

So today I promised I would not make those same mistakes. I got a good nights sleep, had a ginormous muffin and coffee for breakfast, put on my compression stockings (I don't have any vascular problems they just make my legs feel good after being on them for so long) and remembered to breath in through my nose and out through my mouth and shuffle my feet every so often. Everything was going great and I was really enjoying myself and learning a lot when about an hour into the second case I felt that old familiar heat start again. I tried walking around to the back table figuring it would get my blood moving and started taking deep breathes to get more oxygen but I couldn't make it. I let the tech know and again the circulator got me out of my scrubs and before I knew it I was in the hallway and these guys had one arm under each of mine and kept telling me to keep talking as they walked me to the lounge were again I drank orange juice and had a nurse hold my legs up while I laid down. They said I turned a greyish green color and my eyes were rolling the back of my head.

The funny thing is, is that both times I fainted all the nurses and techs began telling me stories of them fainting, doctors fainting in the middle of surgeries, nurses, PAs, and pretty much all who enter the OR. One guy jokingly said that that's the OR welcome mat! So while I'm still embarrassed I don't feel abnormal.

The thing is I have to figure what's wrong. I think I can pinpoint it to my eating a garbage sugar filled breakfast (Poptarts? Giant muffin? What was I thinking?!?!) all washed down with coffee filled with even more sugar and creamer. I know when I felt it today I was thirsty and starting to get hungry. I'm guessing my blood sugar dropped really low and down I went. I was also wearing those sketcher shape up shoes so I don't know if that was messing with my posture as well. They may be great for walking but maybe not for standing. I also made an appointment this Thursday with my doctor to get some blood work done.

The strange thing is when I worked in a factory I worked in hotter conditions will long sleeved heavy scrubs, gloves, gown and mask and many time I would have to stand in one spot and pack or fold and I never fainted. However we did have 3 breaks for snack and lunch. I know when I'm a PCA on the floor I often miss lunch but I still am able to jam a graham cracker or piece of bread into me to keep some fuel in my body. I know I'm not fainting over blood, organs or smells because they don't bother me at all. In fact the more I see the better!!

The thing I'm terrified of is I won't be able to stop the fainting spells. My one friend had to quit the program because if she stood still for too long her BP would drop really low and she's pass out. I want to be a surg tech with all my heart so I don't know what I would do if I couldn't

So any advice would be great right now because I feel like a schmuck :heartbeat

[Horseshoe, BSN, RN]

i had the same thing happen to me. had never fainted in my life and never had a problem with any bodily fluids/surgeries/etc. then one day boom: fainted and threw up, and then passed out again. came to and was given juice, threw up again as soon as i got up, and promptly fainted again. ugh. sooo embarrassing.

one thing i noticed- i felt way more susceptible to fainting after that happened, and i think a lot of it was due to anxiety over whether or not it was going to happen again. fainted once more (watching a picc insertion of all things... granted it was a million degrees in the pt's tiny room) but hasn't happened since, fingers crossed. was so nervous about it happening again and felt it coming on during another procedure but was able to walk it off thank goodness.

you've got some excellent tips from the other posters. the only thing i have to add is, don't psych yourself out like i did. do whatever you can to help yourself relax and not fixate on worrying about whether or not you will faint again. good luck!

i wondered about this as well. fear/anxiety can cause a vaso vagal response, which can cause fainting. it happens to my daughter every time she has to get blood drawn. the same thing used to happen to my patients as i would pull out a femoral sheath-often caused by pain/anxiety/holding breath=val salva. the op could have fainted due to blood sugar problems or other factors, then became anxious about it the second time, snowballing her reaction, especially if she also had some fast blood sugar drop at the same time.

[Horseshoe, BSN, RN]

I also have the complete gowning ensemble so I'm going to wear that over my regular scrubs around the house (for a few hours while I study) so my body can adjust again to all that garb. I have a mask with a shield but I think I'll go with just a mask and goggles.

LOL. That is one hilarious image.

Do keep us posted.

[netglow, ASN, RN]

Actually the nature valley granola bars (old fashioned ones with oats and nuts) are not so fast burning. The peanut butter is your protein and your fat. The banana and OJ will give you your fast carbs, hydration and potassium. So I look at it as time-released. The fast ones give you a jump start and then you kick into slow burn. I am tall and thin and am one that needs to eat. I can do this meal and last to say around 1400 without feeling weak.

[SophiaO]

Ive been a surgical tech for 13 years..and have seen my share of people pass out..with that being said...The OR is a stress inducing place. You could be having a vaso-vagal response....So try bearing down (like pretending to push a baby out...) for 5 to 10 seconds.That may get your heart back to normal. Just a thought! Good luck with surgical tech school. Its a wonderful/rewarding/challenging career! I loved my job as a surg tech!

[xtxrn, ASN, RN]

I have an autonomic nervous system disorder, where passing out is essentially my calisthenics

The protein/complex carb thing is very good advice; you don't want rebound hypoglycemia. But food is only part of it :)

Also, doing quadricep squeezes periodically can help before and during a "fade out".... helps pump the blood faster. These can also be done in the car, church, class, grocery store, or on the moon And, they help. Doing them before symptoms hit will keep you from having to figure out the 'steps' during the brain fuzz. They may look a LITTLE funky, but not nearly as bad as being laid out on the floor like fresh cement.

If you can get away with it (for medical reasons) ask if you can wear shorts under the scrub get up. Any part of your body that has fewer layers on it can help. Seriously. I'm still wearing shorts to the MD office, and it's in the 50s during the day tomorrow for my appointment; their office has a western exposure in the afternoon, and I've almost bought it a couple of times. I have mini-ice packs and the reusable ice cubes just to go there

Also, if you can get some reusable ice cubes (check eBay) get them, freeze them, and put them in your bra, wrapped in a very thin (cheap) washcloth- or paper towels....the washcloth/paper towels will collect any condensation. Real ice works well, too- but with the disappearance of latex gloves (that stretch well) the vinyl ones aren't as good at keeping the drips in the glove- but still an option If you drip, and people ask (I had an orthopedic surgeon ask what was sloshing around in my bra one time He was a good guy, and not asked in any sort of harassing sort of way), tell them you are experimenting with undergarment refrigeration....it will either shut them up, and/or just have them think you're nuts.

Good luck :)

[Horseshoe, BSN, RN]

Ive been a surgical tech for 13 years..and have seen my share of people pass out..with that being said...The OR is a stress inducing place. You could be having a vaso-vagal response....So try bearing down (like pretending to push a baby out...) for 5 to 10 seconds.That may get your heart back to normal. Just a thought! Good luck with surgical tech school. Its a wonderful/rewarding/challenging career! I loved my job as a surg tech!

The vaso-vagal response can be CAUSED by the bearing down (val salva). In my unit we used to pull many femoral sheaths per day. Patients always wanted to bear down as a response to the pain. We were always telling them, "don't bear down, keep breathing." Most ignored us, and most experienced a vagal response requiring a little atropine.

A val salva used to be used to counter SVT or asymptomatic V-tach back in the day, but I don't know if that is even done anymore.

[GadgetRN71, ASN, RN]

Maybe try a breakfast with a little more protein, like some eggs. And I've been in the OR for 10 years now, both as a surg tech and a nurse. I have been known to get wobbly during D&Cs.. I've seen trauma- limbs amputated etc. That doesn't bother me. But a little GYN case gives e the shakes, lol.

I think you'll be fine. Smart of you to go to the doctor just to make sure there's nothing going on.

[Horseshoe, BSN, RN]

Actually the nature valley granola bars (old fashioned ones with oats and nuts) are not so fast burning. The peanut butter is your protein and your fat. The banana and OJ will give you your fast carbs, hydration and potassium. So I look at it as time-released. The fast ones give you a jump start and then you kick into slow burn. I am tall and thin and am one that needs to eat. I can do this meal and last to say around 1400 without feeling weak.

Ok, but I was going with the recommendation in your original post, which talks about the oats and honey bars, which have sugar listed as their second ingredient, in addition to honey and brown sugar syrup and weigh in at 27 net carbs per two bars (has only 2 grams of fiber with its 29 grams of carbs). That is a very high glycemic load there, and the other bars they produce don't seem much better at all, at least as I can see on their web site. Coupled with a banana (24 net carbs) and a cup of OJ (roughly 25 carbs per cup, depending on pulp content), this breakfast contains a hefty 76 carbs, not counting any sugar which could be present in most commercial peanut butters (rather than natural peanut butter, which generally contains only peanuts and possibly a little salt). I try to keep my net carbs (as opposed to total carbs) at less than 50 per day. A breakfast like that would have me on the floor in short order, while my husband would be purring like a kitten. If this works for you, that's what you should do. I was simply pointing out that for someone who is carb intolerant, this meal could drop their blood sugar in a short time and it MIGHT be something the OP should consider, given that she has had problems after eating largely carbohydrate breakfasts on the days she fainted.

Regardless of all that it's just my opinion that whole foods vs. processed foods like bars and muffins work better in general, particularly for people who have trouble getting through the morning. But, you know what they say about opinions, lol.

[sugarmagnoliaRN]

Regardless of all that it's just my opinion that whole foods vs. processed foods like bars and muffins work better in general, particularly for people who have trouble getting through the morning. But, you know what they say about opinions, lol.

:yeah:I totally agree! Even if I do like to sit down with some chick fil a in the evening, the morning time is when I want some healthy whole foods!

[xtxrn, ASN, RN]

ok, but i was going with the recommendation in your original post, which talks about the oats and honey bars, which have sugar listed as their second ingredient, in addition to honey and brown sugar syrup and weigh in at 27 net carbs per two bars (has only 2 grams of fiber with its 29 grams of carbs). that is a very high glycemic load there, and the other bars they produce don't seem much better at all, at least as i can see on their web site. coupled with a banana (24 net carbs) and a cup of oj (roughly 25 carbs per cup, depending on pulp content), this breakfast contains a hefty 76 carbs, not counting any sugar which could be present in most commercial peanut butters (rather than natural peanut butter, which generally contains only peanuts and possibly a little salt). i try to keep my net carbs (as opposed to total carbs) at less than 50 per day. a breakfast like that would have me on the floor in short order, while my husband would be purring like a kitten. if this works for you, that's what you should do. i was simply pointing out that for someone who is carb intolerant, this meal could drop their blood sugar in a short time and it might be something the op should consider, given that she has had problems after eating largely carbohydrate breakfasts on the days she fainted.

regardless of all that it's just my opinion that whole foods vs. processed foods like bars and muffins work better in general, particularly for people who have trouble getting through the morning. but, you know what they say about opinions, lol.

ok....

op, please check with your md and/or get a dietician consult before ever doing the low-carb thing. ketones are not the brain's primary fuel. they are waste products. :)

[Trekfan]

You might want to try extend bars they taste bad but they will Even out blood sugar for 9 hours . http://www.extendbar.com/

[chevyv, BSN, RN]

This may sound a bit bizarre, but I worked ER for a bit and normally I was fine. The days I would get a 'meaty' wound (like someone who layed open their knee), would just about put me under. I couldn't figure it out. Pt was intoxicated and felt nothing except the urge to get up and pee, so there was no screaming, not a ton of blood, just this meaty flesh. I had to go into the bathroom and sit on the toilet with my head between my knees for a while.

The second time it happened, same thing but it was an upper lip. No big deal, but there I was back in the bathroom. I feel I have to add my son was 3 days old when he had open heart surgery. They left his chest opened and covered it with something like Tegaderm (clear). I had no problems at all.

I was so upset thinking I would need to find another job. Desperate, I began to pep talk myself and included I would watch my breathing. I think I would take shallow breaths or something because once I monitored my breathing, I was fine. Maybe I was holding my breath and didn't realize it. But maybe, it will help you. Breathe nice deep breaths, nice and regular. It helped me. Good luck!