Wednesday, December 7, 2011

Splattered


One of the workplace hazards of being an anesthesiologists is getting splattered by body fluids. Sure we are all keenly aware of needle sticks and drug addictions, but being splashed by contaminated fluids is a far more common occurrence. Somebody who has never been in an operating room naturally assumes that operations are nice sterile procedures where every surgical instrument sparkles and every surface pristine. But that is far from the truth. Once the knife touches the skin, all manners of human liquids can start pouring out. I've been doused by HIV contaminated water, blood, stool, urine, bile, pus, bone fragments, fatty tissue--virtually anything that can come out of a human being.

But aren't surgeons the ones who are most concerned about getting dirtied with human contaminants? Well yes, and that's why they are covered head to toe behind masks and gowns. In particularly bloody cases like orthopedic surgeries (pictured above) some surgeons even don astronaut suits to completely envelop themselves. The same thing with the nurses. The scrub nurse assisting the surgeon wears the same protection as the surgeon. The circulating nurse is usually sitting far away in a corner of the OR, safe from any bloody projectiles. We anesthesiologists however are right in the line of fire. You may think the ether screen separating the operating field from the anesthesiologist is to preserve the sterility of the operation, but it is really there to protect us from the mess the surgeons are creating.

Unfortunately that little ether screen sometimes is not enough. All manners of debris can come flying over the screen at the most unexpected time and direction. I can be innocently sitting at my anesthesia machine documenting my patient's vitals when a stream of blood drops can come shooting over the screen and land on my records or clothing. Unlike the surgeons, we don't usually wear protective gowns in the room to protect our clothing so this can get really disgusting. Some cases like hip replacements are particularly prone to getting spattered by blood just because of the proximity of the operating field to the ether screen and the impact of the surgeon's hammer on the patient's bone and soft tissue. But the spraying can occur in any operation. I had one colleague who was drenched from head to toe with blood during a carotid endarterectomy when the surgeon somehow lost control of the carotid artery. The force of the bloodstream showered her, her anesthesia cart, and the back wall of the OR before he was able to regain control. She was not pleased.

Perhaps one day we can perform our anesthesia from a separate room. We intubate the patient in the beginning of a case then retreat to a safe room where we will monitor the patient and control the vent settings. Preloaded syringes of drugs can be injected into the patient remotely as necessary. Once the case is finished we then reenter the room to wake up the patient and extubate. Until that fantasy comes to fruition, we best learn to wear surgical gowns or raise the ether screen to the ceiling.

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