akor

Thanks a million...

Thanks...you anwered my question. That's right,you call them R1 and so on( over here, we call them "specializzando"...I remember the attending surgeon always being there for the case except for the emergencies in the evening where the eldest residents would handle the case. We have two attending general surgeons here, each having their own equip of surgeons and residents. First year residents usually retract for a few months then start tying knots and so on...just like you said...the easy stuff first...Thanks again!

I work in Italy and a surgical resident doc had asked me this question. I used to work at a University hospital in the states a long time ago and don't remember. What year can they be the first operator? Do they have specific duties year by year? Thanks

About 20 yrs ago I started my first nursing job in the OR at a large university hospital. It was an orientation of two yrs with 12 specialty areas. I left nursing for 12 yrs and have returned and am back in the operating room in a foreign country and I had alot of learning to do (always learning ). It is important that you keep alert and attentive to everyone in the OR and what is going on. I am circulating and I try to listen to what the surgeon is saying and keeping attentive to where he is in the surgery to be able to help out the scrub nurse as quickly as possible. Eyes and ears open to the monitors and what the anesthesiologist might need. I have been at this busy caotic job for three yrs now and love it even with ALL the stress that goes along with it. Be thoughtful, polite and humble. If in doubt to what is said always repeat to conferm. In a large hospital, there will be many different personalities and it will be difficult to get along with them all so just do your job in the most careful, attentive and thorough fashion. Remember number one priority is the patient. Good luck!

I hear ya! I am three years now in a busy Level 1 trauma center and was scared to take call. It is very nerve racking but with perseverance and time, you get better. I worked in a busy OR from 88 to 93, then took off 12 years. I entered back into nursing in Italy and because I had OR experience, they put me there. I wanted to go to L&D! I do love the OR. It is SO interesting and I am thankful that most of my colleagues help me out when I need them. However, when I am on- call which is 6 time or more a month, I feel less nervous as time goes by. Good luck...... AKOR

At my facility, we recently met with the organ procurement manager to go over the new paper work to be filled out and faxed back to them at the end of the procedure. However, a nurse brought up the difficulty of being in the room cleaning the corpse after the procedure....The manager rplied that they are working on getting a psychologist to be available to be able to go and talk to if needed. I have been in on an organ harvesting case in the different stages....only once did I clean up the patient and it was o.k. because it happened during the evening when there was help. I think it must be harder at night when you are tired and all the caos is over. I think the more organs gone...the harder as well....we harvest bone as well ....it must be hard to see the corpse in that condition.....

Over here in Florence Italy, they have a great childrens' hospital. I work in the OR but when my son had to have an inguinal hernia operation, I got whoosy watching him go to sleep. I am glad though that i was able to be there with him. It is policy that the parents get to be with the child for induction.

Thanks for the replies. At first arrival, they had these flimsy plastic stools to stand on to see the surgery and to position the light. However, if you fell off and hurt yourself which i heard had happened, you are not covered for your injury because the stool was not in regulation (crazy). Now, they have hefty metal step stools in the OR. These OR lights have a handle bar around half of the perimeter so you don't have to reach into the sterile field and it has a red laser beam so you can see if you are in the right spot...... ciao for now.....

Hi....have another question.....have you ever seen the decision to wake up a patient before the surgery started to do an emergency case? I have seen them wake up an anesthetized scheduled cardiac patient to do an aortic dissection emergency case. thanks for the replies...

Hi everyone, I wanted to know of all you OR nurses who are reading this who have docs demanding that the circulating nurse position the overhead lighting. I worked in the states 20 years ago and don't ever remember doctors asking or YELLING at times for the light. I am working in Italy in a 7 OR suite facility with general, thoracic, cardiac and trauma surgery. It's a pretty up to date hospital. They all demand that the circulating nurse position the light even though there is a sterile handle on the light. Sometimes there is a nice resident who will position for us. Quite frankly i find it ridiculous.... thanksfor you replies!!!!

I work in cardiac surgery. We operated on a patient last July for double valve replacements (mitral and aortic). He recovered well, went back to work and then in December came down with flu like symptoms. It wasn't until a week ago he was recovered and was found to have a +blood culture for enterocco fecalis. Could this bacteria been transmitted in the OR and have taken months for the symptoms to show? thanks in advance!!!

Thanks for the reply. It seems in this case as well that it involves mitral valve prolapse with a thickening of one of the mitral valve cusp even though the doc's say that that shouldn't cause the syndrome.... thanks a bunch....anyone else with knowledge of this kind of syndrome that ususally effects the elderly....

Hi everyone, I am curious if any of you have seen the Syndrome Tachycardia Bradycardia in young patients? When I say young I mean around their 40's. If you have, was there a cause or was it idiopathic? Thanks, AKOR:rolleyes:

I am back in the o.r. after 12 years and I am i na foreign country ....sometimes I have to ask the scrub nurse to repeat what she wants....and when I get really good I will know what she wants....it's a mtter of patience and learning.....I have been working in the o.r. now for 8 months and I still feel like everyday is a learning experience.....I have been in cardio for a month and it is hard....it is hard working with different personalities all the time and sometimes that is a good point too to working in the o.r.. just remember that working in the o.r. is TEAM work and try to get along with your colleagues...everyone is bound to have bad days....one time after the operation the surgeon came up to me and hoped that I didn't take offense because he was pretty rude....he said that when he is operating he becomes a different person....the world is beautiful for it's diversity!!!! Good luck....don't give up yet....

I am an American living in a foreign country and I get made fun of for how I speak their language....It takes much more energy to stick wit hnursing in a foreign language. You have to be very persistent and take the advice of one colleague by reading the paper, watching T.V. in English...just absorb yourself in the language....also read nursing books in English...I find that helps me here in my nursing profession....good luck! you can do it....especially if you are younger than 42 years of age....that's my age and I am finding it exhausting but exhilirating at the same time!!!!!!!

sorry replying so late....but i think they used a verres needle (they usually use a verres needle in this division) . i heard that when the trocar was going in through her umbilcal, her hand slipped where she was pulling up the skin...sometimes they use a clamp to hold up the skin and fascia while inserting the first trocar.....something like that....

We had a three day wee-end this week-end and the nurse who was on-call called in sick on Friday so the head nurse went around to every nurse to ask them if they wanted the call duty....Everybody said "NO" so he had to write all the names down on pieces of paper and had someone pick a name out of the box!!!!! Than kgoodness I didn't get picked..... Have you ever heard that one before.....

I hear you. The hospital that I work in now is a university trauma hopsital too....I have never heard the attending doc's scream so much before....When I worked in New York at the busy university hospital for 5 years....I NEVER heard a doc raise his/her voice...The doc's here have some sympathy for me because I am foreign and new...one time one of the docs said something offensive towards me but I didn't get offended...I knew it was just the moment ...probably didn't sleep well the night before?! It's nice that we are not always in the same operating room with the same doc's all the time....we are also with different nurses and different anesthesiologists daily.....

Your great!!! I love explanations.... It has happened that we have had to convert because the patient's CO2 expired ventilation is way to high. I would have never even thought of a ruptured diaphragm. I will not count on the alarms to go off first before the intraabdominal pressure is too high....We have had also subcutaneous emphysema happen in the chest area.....that was when we were doing a video left colon resection and the patient is Trendelenburg position for a couple of hours. I will definitely be aware of the Argon laser versus Argon Beam coagulator....we do not use it too often however I think I saw the laser in one open procedure on the liver maybe....have to get it straight....THANKS a million....

I appreciate your detailed info....I have been out of the O.R. for 12 years and am busting my brain to keep up with all the procedures and materials. There is really no official training program....it is a sink or swim type of thing. We DO do video Nissen surgery and it is the attending doc who does it....so far so good... Thanks for the info on the splenic hemorrhage complication... I will know where the Argon Laser is when I am present....

Here in Italy I don't think the surgeon can get kicked out so easily...I believe there will be a big lawsuit and she will be a bit more humblier..... Thanks for your reply.....

Thanks for sharing your experience...I will be aware of where the vascular trays are the next time I am in one of those Videolap surgeries....the doc's weren't aware of the intial hemorrhaging because they didn't continue the surgery:after the initial blind trocar through the umbilica...they stopped the surgery to do BLS....heart massage...the surgeons realized it was an arterial problem when the hemogas analysis came back with a hemoglobin of 4 or something like that.....they opened her up immediately...but it was after a good 6 or 7 minutes.....I hear that they have extubated her and she seems to be fine neurologically....thank you for letting me know that it can be handled calmly because I heard there was much tension and yelling in the room at the time. ( I was not in the room but did walk in once. ) The scrub nurse had to ask for a second scrub nurse because of the yelling and tension to have everything right there in less then a second....

I worked in N.Y. hospital in a very busy O.R. for 5 years...I worked a couple years full time, then decided to go back and get my BSN so I went part time and then I worked per diem for a few years....it is very scary returning after so much time off....I still am learning things everyday...everyday is a learning process...and I just have to accept that for a few years....I work with a nurse who is there for four years and she is still learning things....it's all about team work in the O.R....helping each other because we do not have a great orientation program.....

That's SO nice to hear...it is a real tragedy when it happens...I just kept on thinking throughout the day of that woman's family members and it's effect on them....I work with a nurse who had that happen to her mother....she did not work in the operating room at the time but she was a nurse on tha floor and she was in the operating room accompaning her. Her mother died of that complication . Now she is an excellent O.R. nurse... Here in my institution the attending doc was written as the first operator but was not there at the time it happened...he was operating in the room I was in...Alyce

Yes, the flu was bad in February here in Italy. Our kids got sick and because it was the flu no doctor likes to prescibe antibiotics so I let it ride giving them over the counter medicines to make the mucous more fluid....Two weeks passed and they still had terrible coughs. Went to the doctor again and this time with antibiotics, they were much better after two days.....I had a sore throat for two weeks.....I had to nearly twist the doctor's arm to prescribe antibiotics....I understand the danger in over prescibing antibiotics but if it helps me get better quicker (which it did)....then give them to me.....anyway, the same situation with the schools here in Florence, Italy.....kids were out of class for a couple of weeks.....one day the teachers just took the small amount of children to the park to play because there weren't enough kids to go on with the lessons.