Tuesday, February 2, 2010

My 1st day in the OR

My first day in the OR was actually Wednesday, 27th January,my absolutely most stressful day of work in Haiti. The call for help in OR came around 1040 am. Although not unexpected, it couldn't have come at a worse time. At 1100 am, Joe Lupo, the other anesthesiologist on the wound care team, was due to go outside to help the French with their wound care rounds in the makeshift stepdown unit they were running in tents outside the hospital.

Patients ended up in the OR through many different channels. Either by triage because they were trauma, by the wound care team for I&D or stump/wound revision, or directly by surgeons upon review of their radiographs. Whatever the route, they all end up with a piece of tape on their heads like the patient pictured, who had 6 fractures in both arms that needed to be repaired (pictured). She was made nothing by mouth the night before surgery and scheduled for open reduction and internal fixation (ORIF) on the 27th. I had actually met her on wound care rounds on Monday, but the first opening on the schedule was Wednesday.
So I show up outside the ORs to meet my team: two surgeons who literally arrived at the hospital an hour prior to our meeting, and two nursing students who were to be our scrub tech and circulator who had never been inside an OR before or learned about sterile technique. I could tell this was going to be a long, long, day, because little did the surgeons know this was literally a find it yourself, sterilize it yourself, light it yourself, and do it yourself operation we were running. It was going to take them forever to find all their instruments and supplies, and I knew it was going to be a really long day when they asked for suction and overhead lights.

In effect, I became part scrub tech and circulator in addition to anesthesiologist at the start of this case. The suctuion I couldn't help them with since the only working suction we had was being used in another OR. It would have been nice to have though because her surgery did become a bloody mess. Our nursing students probably thought they had drawn the really short straw, as they became our light holders on top of a folding chair.

For my part I had an anesthesia machine I had no idea how to use (pictured). I tried hooking the oxygen tank up to the back of it since I did have a circuit and a mask I could use if her sats dropped but never did figure out how to get the oxygen to run through the machine. So in effect, I was left with a portable sat monitor (pictured) which only worked half the time since it was precariously perched on her ear (both hands not available to me), and a blood pressure machine.

Since I was doing a ketamine/versed general I was comfortable enough with what I had, but when I lost my sats and could no longer get pressures frm her right leg I had to resort to my hand over her mouth with my fingers on her carotid and my eyes on my watch while counting her pulse and respirations. Definitely not my most comfortable moments since I wasn't sure if loss of sats and pressure meant her pressure was dangerously low or she was cold and the cuff just wasn't working well.

Overall the case went well. I didn't really find anything all that shocking. However, I was rather alarmed by my options for sharps disposal. If you look closely in the picture of stuff on th floor, you will see there are three sharps containers--one big red one that most would properly identify, one small red one with no top full of all kinds of bloody needles and glass ripe for someone to fall on top of, and finally, one old clorox jug that was not marked sharps in English, French, or Creole. Besides the obvious regarding the open sharps box, I did ponder how all the sharps containers were being disposed of.

We dropped the woman off in PACU, and off I went to help Kurt, the nurse anesthetist, with a spinal for the c-section. And we all already know how the night went from there...

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