Ever had surgery? You know how you are not supposed to eat or drink anything for 12 hours beforehand, because you could become dangerously ill, throwing up or drowning in your vomit or some such vileness…
So what’s the deal with emergency surgery? What if the guy with the gunshot wound jsut ate 3 helpings of Thanksgiving dinner right before he got shot, including three servings of pie?? What happens to him when they put him under? And if he can survive it, why can’t others?
Here’s another one: on ER they are forever slicing into the chests of people who have just passed out or “died”, cracking their ribs to start their hearts. It usually works. So…do such people wake up in screaming hysterical agony with their chests cracked open? Dead…cracked chest, zapped heart…awake…conscious…dead again from horror and pain.
Someone fill me in.
(This is a big topic for me: I have only had one minor surgery in my life, tubal ligation, and I WOKE UP TOO SOON. Without going into it here, suffice it to say: it was without question the most deeply terrifying, painful or horrifying experience of my life. The best way to discribe it is this: It’s like dropping a couple hits of acid, getting so tightly bound that you cannot even twitch, much less move, have another tight blindfold rendering you blind, unable even to blink, then be put in cement shoes and dropped into a lake. Imagine that. Then triple it. That’s what it was like. Got myself a little case of PTSD out of the experience.)
Stoid
This is a non-smoking area. If we see you smoking, we will assume you are on fire and act accordingly.
One of the first things they do to you in the ER, if you’re going to need surgery or if you otherwise look like you might crap out, is put a tube down your nose into your stomach so they can empty out your lunch. A lot of times, this comes too late anyway, because if you’re really sick you’ve probably already puked up your enchiladas before you reach the hospital. Surgery goes on, but many, many such patients develop a life-threatening case of aspiration pneumonia. I once spent most of an evening suctioning an entire can of Copenhagen out of a guy’s lungs; he’d swallowed it, puked it up, and inhaled it when he fell into a 35 foot hole onto his head.
As for the chest cracking, we do that from time to time, but I can’t recall any case where the patient actually survived. In real life, cracking a chest is a desperate and almost futile measure. I don’t know how bad the sensations would be to a patient who woke up after surviving such an ordeal, but I assume the medical staff would handle it the way we deal with any other excruciatingly painful thing: give 'em drugs, drugs, drugs.
They didn’t pump my stomach when I had emergency surgery (many, many years ago). I started puking up peanut butter sandwich about 12 hours after the (abdominal) surgery - not a joyful experience.
Nothing compared to Stoidela’s nightmare, of course!
I had a procedure last year. They said there is a chance of throwing up,but if the risk is great enough,obviously,they’re gonna try to save your life over worrying about that. I woke up,but there was no pain,and they just gave me more whatever.
After my appendectomy, I awoke with the intubation (sp?) tube still in my throat. For a second, I thought I’d awoken in the middle of surgury! But then the anesthesiologist started talking to me assuring me everything was fine.
I had been in the hospital for a day and a half before they figured out it was my appendix. They were focusing on my gall bladder since my pain was high and only slightly to the right. Turns out that my appendix was higher than most peoples. My incision is directly to the right of my navel, rather than near the hip. And since it was rupturing, the incision is huge: about 5 inches. (So now I can’t wear bikinis. :))
As I was being wheeled to the OR, the anesthesiologist was having me sign papers for insurance purposes. That was weird.
OK, this is “off topic”, so I hope no one gets upset, but I do want to ask…
I had surgery last year, and was put under. (Those anaesthetics work fast!) When I woke up, the doctor came to me and said “How are you feeling? I already checked with you after the operation, do you remember talking to me?” I couldn’t remember a thing! Was the doctor putting me on?
Jacques Kilchoer
Workers of the world, unite! You have nothing to lose but your chains.
People are supposed to go without eating for eight and without drinking 4-6 hours prior to elective surgery in order to minimize the risk of aspiration pneumonia (which can be fatal in the most healthy person) as well as to lessen the risk of nausea/vomiting post-operatively. In emergency surgery you just have to ‘bite the bullet’ and proceed. We do lessen the risks by giving patients a non-particulate antacid to drink as well as iv medicines to hasten stomach emptying and decrease acid production. During the induction of anesthesia in the so called patient with a ‘full somach,’ pressure is applied to the patients neck to occlude the esophagus as the patient is going to sleep, until an endotracheal tube is inserted. At that point the patient’s airway is said to be protected, then a tube is usually passed to suck out any stomach contents.
As for ‘cracking the chest’ in the E.R., in eleven years, I’ve never seen one survive.
As to not remembering a thing, there are some “anesthesias” that have that as a side effect.
Versid (did I spell it right, Dr Sue?) is a great one for this. They’ll often give it IV for proceedures that don’t require you to be unconscious, just cooperative and still.
I’ve been put under so many times by now that it doesn’t even scare me anymore, but every time, there’s always a ton of stuff that “happened” that I just don’t remember. Conversations seem to be the worst, which is great because you’re usually babbling anyway.
It’s also really odd the little things that I DO remember, like playing with the pulse oximeter (SP?) and being utterly fascinated by it, or wanting to rip out a nurse’s throat because I was all snuggly comfy and SHE wanted me to sit up. How rude.
Besides the risk of vomiting, the food that’s in the stomach will just sit there during and after anesthesia.
Also, when the breathing tube is inserted, a metal blade is placed at the base of the tongue, causing a gag in most awake people. In fact, when endotracheal intubation is performed on an awake person in an emergency, they almost always heave. If the person performing the procedure is quick and knows what he/she is doing, they airway is protected by the tube before the patient can aspirate any vomit into the lungs. Most breathing tubes come with a balloon at the end that goes in your trachea, and when it’s inflated, you can puke away and nothing gets in the lungs.
<font size=16>
See your doctor for personal medical problems.
</font>
Having a large volume of liquid, or undigested solid food, in one’s stomach while going under for surgery is associated with a small, but not insignificant, risk of having stomach contents pour down the windpipe/trachea into the lungs where they can cause a life-threatening pneumonia. This is why patients undergoing planned or “elective” surgery are told not to eat or drink prior to the procedure. Despite this, the risk/benefit ratio is clearly in favor of immediate surgery for someone with deep gunshot wounds, penetrating knife wounds, or impending peritonitis from an about-to-rupture appendix. The standard order for elective surgery is “NPO p MN” = nothing by mouth after midnight. This obviously is inherently unfair to those whose procedures are not scheduled until mid-late afternoon. Early morning cases are usually ones with kiddos, diabetics, or those which may take most of the day.
Increasingly, anesthesiologists have recognized that this is probably unnecessary. Many now recommend no solid food (and recommend carbohydrates which clear the fastest) for 6 hours before surgery, and no liquids for 2 hours prior to surgery.
<font size=16>
Do what YOUR doctor tells you!
</font>
One key exception to this is surgery involving the gastro-intestinal (GI) tract, for which they may have you on a restricted diet up to 48 hours before your surgery & have you drink a jug of a very tasty clear liquid called “GoLytely” until um… what comes out resembles what went in.
In emergency surgeries involving the GI tract, a tube is often inserted through the nose & throat until the far end is in the stomach. It can be hooked up to suction to empty gastric contents. For non-GI tract surgeries, this is usually unnecessary; there are different ways of inducing anesthesia which reduce the risk of vomiting before the trachea is protected by the “breathing tube” which delivers oxygen & anesthetic gasses during the surgery. (The breathing tube is smaller than the trachea, but has an inflatable cuff near the end of it, which seals off the trachea & prevents air from leaking out of the trachea & liquids from getting into the lungs.)
<font size=20>
sheesh
</font>
(not directed at the OP here…)
In regards to the comment by Jacques
about lack of memory. There is a phenomena called “Retrograde Amnesia”
This explains why right after, say a car accident, you can talk to the victim he sounds OK, but remembers little. It even happens w/o drugs.
Versed (close, Suzeanne :)) belongs to the class of drugs called benzodiazepines. Other well-known drugs in this class are Valium, Serax, Librium, Ativan, & Xanax. Patients sometimes call these the “I don’t care” pills.
Of these, Versed, Xanax, & Ativan are shorter acting, and share a tendency to cause retrograde amnesia. Think of a time where you were the life of the party, but unless there were pictures or videotapes, you couldn’t remember a thing. Yep, you are awake & chatty & totally disinhibited* but an hour later, remember only vaguely, if at all, what went on. Suzeanne, you mentioned this as a “side effect” of these drugs; actually it is very much an intended effect.
the disinhibition is a key reason why many recovery rooms do not allow spouses to come in. Patients sometimes get very flirtatious with the recovery room staff, and even talk about things like past & present affairs & why the cute guy checking their dressing would be so much fun to give a blow job to…
Sue,
thanks so much for having a sense of humor, I believe it’s a necessity for the 'Biz, that and a healthy appreciation for the absurd.
Not much to add to the empty belly question, but as far as resusitation goes on TV, they are pretty optomistic. IRL about 2-10% of CPR cases survive the immediate arrest, less actually check out of the hosp, less still without significant deficits. OTOH on ER/Chicago Hope et all they average about 2/3 save rate, and those people usually walk out with flowers and smiles. Would that it were so,
Larry, RN ER/PICU
Versed (thanks, Sue) is really too much fun. Really. I can remember watching the colours on the curtains start to dance. I got giggly. That, of course, is always the last thing I remember.
In waking up, it’s saved me from remembering the puking caused by anesthesia (it’s wild to be told you barfed on a doc, and don’t have even the slightest memory of it – you’d think you’d want to BE there for something like that). It was the first time I’d done it, so I couldn’t even warn them that I was prone to power puking.
Just because you followed directions does NOT mean you aren’t going to be sick anyway. Some people are just prone to it, and when going in for elective surgery, the anesthesiologists usually ask about that.
A little off subject, but I was in a car accident and broke my nose so badly the had to do reconstructive surgery. They only used a local anesthetic, so I could feel the bones scraping against each other.Yuck!
Good question! I’ve always wondered that too. I know virtually zippo about medicine, but it seems from what you see on those shows, that in emergency situations they just start carving into people (not necessarily even cracking the chest) with no regard to the level of pain they might be causing. Seems to me like that would create such a shock that it would itself be a big risk. Then again, I don’t know what I’m talking about here.
Relatedly, I recall reading someplace (I don’t remember where) that although general anesthetic “usually” works fine, in a small percentage of the cases it fails. The symptoms sound sort of like what happened to you: the result is that the person cannot move since one component of the anesthetic inhibits movement, but is aware of what’s going on and sometimes can still feel pain. Supposedly such people afterwords have been able to recount precise details of what happened.
That is EXACTLY what happened to me. It is a two-part process: paralyze your body/knowck you out.
And I learned afterwards that the “knowck you out” part fails much more often than you even wanna know about. I got in touch with a woman who has established an organization to address what she calls “awareness”. SHe told me horror stories to curl your toes. I was having a short, simple surgery that wasn’t very invasive, but there are cases of people who have become aware during OPEN HEART SURGERY. This woman was aware virtually throughout her surgery for what was claimed to be a hernia, I think. Turns out she didn’t have one, which she learned lying on the table while the doctor was poking around in her guts and making jokes about her body with the nurses.
It makes you wonder how many people who die during surgery were aware and croaked from pain and fear?
It is deeply horrifying. Pray it never happens to you. (by far the worst aspect of it for me, since my surgery wasn’t that big a deal - just a tiny tube through a small incision near my navel- was the fact that I was absolutely certain I could not breath. I was 100% paralyzed, INCLUDING being unable to control my own breathing, and I was desperate for air. It felt like an elephant sitting on my chest.)
This is a non-smoking area. If we see you smoking, we will assume you are on fire and act accordingly.
Stol-
I don’t want to get into a “contest” of icky surgery stories, but if it makes you feel any better at all, I still have nightmares about waking up after my spinal surgery.
Lets just say that it was an 8.5 hour procedure- they basically “broke” my back straight (fixed the curve in it) then put in a bunch of metal to hold it that way. Then they took bone off my hip (butt)bone to graft onto it.
No problem except that when they were done they woke me up with ABSOLUTELY NO DRUGS WHATSOEVER so they could have me move some parts and make sure I could feel everything. After about 10 seconds of waking up- at first I thought they were waking me during the surgery and something went wrong. They just woke me and said “Suzette- can you move your toes for me?”. I remember thinking “I sure fucking hope so!”. Then I started dry heaving. Just imagine that for a minute- after being cut and worked on for that long- dry heaving. I prayed for death- it didn’t come. Then they mercifully knocked me back out.
I remember it like it was yesterday, and still have bad dreams about it. Scary shit, surgery is. That’s why when I hear that someone is going to have the work done that I did, I offer to talk to them about it. Not to share scary stories, but to help them prepare. I wish I had a clue to what that was going to be like.
On the upside, my doc says labor should be a breeze.
Some mornings it just doesn’t seem worth it to gnaw through the leather straps. Zettecity
