Syncope

We were swapping fainting stories this week at work. I mentioned to Dylan, and apparently I've not recounted the many events to him, or here.

It's so common, at least among those new to the OR, that I have a prepared speech. If you start feeling hot, woozy, nauseated, tingly, back up to the wall and sit on the floor. Don't wait, tell me how you're feeling, follow directions.

Because I know of people who've gotten concussions from a full fainting fall, hit their head on the floor, and wound up in the ER. One of them on my first day with my NG unit, before Basic, and a guy in the back of formation dropped like a plank, cut his head on someone's boot, and knocked himself silly as well.

We were told he "locked his knees" which never made much sense to me, but then a lot of explanations in the military are not the real reason - it's just what is said. Just standing for extended lengths of time is a risk factor, it is a good idea to tense and release leg muscles, wiggle knees and ankles a bit.

We call it the scrub dance, and it does help to keep feet from cramping, joints stiffening, and blood pooling. Do we learn to do it, and stop fainting, or is the psychogenic aspect the key? Dealing with the cold, getting used to standing, eating properly, and the routine of the normal after a while make it very unlikely for those over a year in the OR. Seeing blood and guts - or other internal structures, is very stressful at first. It's not a normal environment.

I was in Army OJT the first time I experienced it. Holding retractors for a surgeon opening a recent surgical finger wound in clinic, to reveal the tendon had been cut clean through. He looked at me and asked me how I was. I said... 'fine'. I was being tough and not complaining. He said, "No, you're not. Let go, sit on the floor."

I said, "I'm fine."

He said, "That's an order."

I managed to sit on the floor as my blood drained away from my brain, did not entirely pass out. I felt so hot and embarrassed and nauseated. It would never be as bad as that again.

Fainting was not something I did. Once, when I got my wisdom teeth (impacted X4, lots of drugs) I actually did lose consciousness. I blame the drugs. Nausea and lightheadedness sure, but other than that, never completely out. I would have a few other OR nausea events, always minor and related to viral infections. Not when I fell on my face, nor when I broke my wrist, did I completely pass out. I could feel the shock, keeping my head down, I was fine. Knocked out once as a small child, which I don't think counts.

My anesthesiologist was talking about this, the reason to keep the head down, to allow the lowered blood pressure to get flow back up to the brain, because if you leave a fainting person sitting up, they can go into seizures, brain damage, even death in extreme cases. We were always taught to lower the head, raise the legs, but until Dr.S, I never was told exactly why.

I have gotten countless med students and nursing students to the floor, took off any excess clothing, mask, hat, got them taken out to the staff lounge for juice and a lie down. They are always embarrassed, to the extent that I'm convinced embarrassment is an artifact of syncope.

One new nurse wasn't feeling well, I got her sitting on a stool, then she dropped head first to the floor. Big knotted bruise on her head. Another, scrubbed in during a long case with the lights low, I noticed her swaying, called her name, she didn't answer. I put my hand on her back, as she slumped into my arms. I slid her down me, and laid her on the floor.

Surgeon asks, "Is she alright?"

"Yeah, just passed out. I'll get you another scrub as soon as I can."

Surgeon "No hurry. Do you need me to scrub out and help you?"

She was coming around, "No, I got her down gently. She'll be fine."

When I was in hand therapy, I saw a young man getting his first splint off, and he looked pasty, his expression fuzzy. But the therapist was in front of him, and I was the patient, so I didn't say anything. Should have, because he went down like a load of bricks, apparently to the therapist's surprise. Lots of practice makes one pretty good at spotting 'em, early.

Pre-op nurses see it more in patients, that needle for the IV gets a LOT of young men woozy. I walk in to say hi, and they have the gurney tipped head down, feet up, with a cold cloth on the forehead. Yup, happened again.

Sin co pee, for the readers who can't pronounce.