Sometimes the middle of the night surgical case is because it truly can’t wait the handful of hours before day shift. In the OR world we call that a life or limb emergency and it trumps everything, including power outages.
The thing is that most of these life or limb cases require more hands than the anesthesia team, scrub tech, surgeon, and circulator. I’ve already talked about calling in the PACU nurses for that extra set of hands, but what do you do while you are waiting for them to show? It’s not like you can tell the patient and the surgeon to chill out while you get more help.
The first thing you do is call the nursing supervisor and ask for any nurse or CNA that is free to come help. This is a move that is highly irregular and you will hear about it in the daytime from your manager. But remind them that the patient on the table who is actively trying to die but not actively enough to call the code button.
Another option is to call and wake up the manager and put them to the task of finding you a second set of hands. Once upon a time I lived less than a block from the hospital and they all knew it. I was as open then as I am now about pitching in and lending a hand when needed. One night the phone rang and it was L&D. There was a mother in full arrest and they were running the code blue but they needed to get the baby out pronto. Of course I threw some clothes on and ran down the street. They were doing chest compressions as I entered the OR to prepare for the section. The mom and the baby both lived. Apgar 6 and 8 for the kid.
But what do you do when you have the person who is pitching in? You give them an abbreviated version of the nursing student in the OR talk.
- Don’t touch anything blue
- If you do, just tell me and we can make it right
- If you feel faint sit down, don’t even try to make it out of the room because you will not be able to
With a few questions you can ascertain their comfort level with basic nursing care and you can assign them. Anesthesia probably needs a second set of hands too. Get them to assist anesthesia. There will probably be STAT blood tests to order and vials to run to the lab. There may also be the need to hang stat blood and that is another thing they can do. This will free you the circulator from having to serve two masters and you can focus on the operative field.
One night there was a patient with belly bleed and we had suddenly gone through an entire basin full of laps when the surgeon asked for a blood loss estimate. This was when I had the PACU nurse who had arrived by then pulling the bloody sponges out of the basin and weighing them and putting them into the counter. A quick and dirty blood loss estimate is the weight of the sponge minus 20 grams because that is how much the sponge weighs. And a cc of blood roughly is a gram. For instance, it the bloody sponge weighs 55 grams minus 20 grams for the sponge equals 35 grams equals 35 cc of blood for that sponge. It isn’t wholly accurate and off by a couple of ccs give or take but it is a good ballpark figure to give the surgeon.
Remember your extra person doesn’t know what you know, and doesn’t know where anything is in the OR. This is where you curse that the Vulcan Mind Meld isn’t real and you can’t just download the information to their brain. But they do know how to make phone calls and put labs in. There are things that are too complicated for them to do like count instrument if you have to open another tray. Also they should not write on the count board. Only one person, you, should do that to decrease the chance of a miscount.
You can also show the extra set of hands how to open a package sterilely. Start them with something easy like a pack of sponges and show them how to hold the package in your hand and open the inner package like a present while it is resting on your palm with you thumb stabilizing it. If this is delegated be sure to keep an eye on them as they open sponges.
Someone needs to keep the family in the loop while also managing their expectation. This phone call is best from you as you know what to say. If you are too busy, ask the surgeon what message to give the family and the extra set of hands can relay it to the family word for word.
The patient is most likely going to a higher level of care floor in the hospital or even to a higher level of care hospital. Making those phone calls is something that the extra set of hands can absolutely do.
Congratulations, you and the extra set of hands saved the patient’s life. Tuck the patient in to whatever unit they end up on, or help the nursing supervisor send them to a higher level of care hospital. Now go write a wow card for them or a glowing email to their boss. After you’ve finished your charting.
Dispatches from the Evening Shift 