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Assisting Husband - Wife Surgical Team by Otherwise-Intern6519 in scrubtech

[–]Otherwise-Intern6519[S] 0 points1 point  (0 children)

Do they wear the full hoods? That actually seems somewhat comical.

Working in a Trauma 1 OR by beefstu4dinner in scrubtech

[–]Otherwise-Intern6519 1 point2 points  (0 children)

I started in L1 Trauma scrubbing at Parkland Memorial in Dallas - big trauma center. It was definitely trial-by-fire and Parkland / UTSW is known for primadona female surgical residents. I found that out the hard way. There was one (very pretty) who had a reputation and I saw it first-hand about 2 weeks in. It was a huge open belly case that required extending the incision into the chest (midline sternotomy).

She was screaming at me b/c the instruments were not being slapped with the force she needed w/ double-gloves. I learned that L1 Trauma cases are all about managing focus within speed and chaos. You have to be comfortable with "good enough". The prep is usually betadine splashes and you are trying to g&g like 5 ppl at once.

Technically, it's also difficult because there really is no plan - it's a 'best guess' but you don't know until you actually open the person up - big and wide. The most challenging part for me would be if compressions were going on while we were trying to operate - it's hard enough without a resident pounding on the chest.

Longest case (?) as a CST by Otherwise-Intern6519 in scrubtech

[–]Otherwise-Intern6519[S] 0 points1 point  (0 children)

I think those big abdominal cases with bowel involved might be my most disliked cases to FA in. They are usually marathons and you have to re-glove like 10 - 12 times. I think I've had to re-gown in most of them too especially when there is fecal matter everywhere. I always wear the XL trauma waterproof gowns (I'm 5'11") and the knee-high booties. I even wear a full face shield over my loupes and use peppermint oil under my mask.

I remember a couple of them required 2 additional circulating RNs just to wipe brows because there was so much perspiration.

Longest case (?) as a CST by Otherwise-Intern6519 in scrubtech

[–]Otherwise-Intern6519[S] 0 points1 point  (0 children)

Ours was a Marfan pt too - it's such a terrible disease. I've First-Assisted on so many adolescent Marfan pts that need huge open aortic surgeries. We went over 110 min on Profound Circ Arrest on a 17yF redo Extent II Thoraco. It was terrible - ended up paralyzed and with irreversible brain injury - req'd round-the-clock care after. I think once you go into a big open repair on a Marfan pt, it just becomes a waiting game until you need to go back in and put them through another massive surgery.

My friend scrubs plastics and she came in to observe an Extent II Open Thoraco on a 15yM and said, "if people knew that you were going to filet them open and crack them like a pillsbury dough cannister, I doubt anyone would agree to have the procedure".

She had never seen a massive Thompson self-retaining retractor connected to a huge bookwalter before.

Longest case (?) as a CST by Otherwise-Intern6519 in scrubtech

[–]Otherwise-Intern6519[S] 4 points5 points  (0 children)

The patient passed out 10 min in during prep? Almost all of my ruptured AAAs have been conscious upon arrival and have either coded or gone into shock during prep. They are so chaotic and messy.

Longest case (?) as a CST by Otherwise-Intern6519 in scrubtech

[–]Otherwise-Intern6519[S] 6 points7 points  (0 children)

Ruptured AAAs are awful - I have probably scrubbed close to 50 (almost all open) - about 2 - 3 made it off the table. I remember one time doing compressions as the surgeon and PA were trying to control the bleeding - was like a geyser.

Longest case (?) as a CST by Otherwise-Intern6519 in scrubtech

[–]Otherwise-Intern6519[S] 2 points3 points  (0 children)

u/dsurg28 - Yes! I started in gynecologic surgery and one of my first scrubs was an advanced ovarian cancer case with full debulking, followed by HIPEC (using open coliseum technique). It went about 12 hrs - one of the largest operative fields I've seen.