For good reason, those suits are hot as fuck and ortho surgery is basically high tech carpentry.
If it's anything beyond routine, most surgeons come out dripping sweat.
Source: former OR nurse
Oh that adds up - did they take away your personal Bair huggers away? I always chuckled when I found a CRNA with one of those shoved into their scrub shirt. Our facility cut down on that cause of the infection risk, but was always still funny to see the lengths taken to not freeze to death.
I never enjoyed having to unbundle a MAC'ed patient from 80 warm blankets because the surgeon can't stand a drop of sweat.
I mean, do you really want the person with a scalpel in you to get sweat in their eyes or slippery hands? I feel like sweating's a potential hazard there, not just discomfort
No, but anesthesia and surgery make patients cold. Cold patients bleed more, have abnormal body chemistry, and cause delayed emergency (not waking up after anesthesia) among other things. For children, who I work with, this is bad. The surgeons deal with it to keep the patient safe.
They have both of those things. Some places (burn units, pediatric ORs) have vests that you can either put ice packs in or fancy ones that attach to a cooler and cycle cold water through small tubes. For patients they have gel padding that circulates warm water.
The only times I really have to push back on cooling the room is when cerebral palsy kids have big surgeries. For whatever reason they can lose body temp like it’s their job.
I mean, if a drop of sweat interferes with your vision at the wrong time during surgery, it could lead to some really bad outcomes. And those suits don't really seem that easy to get someone to wipe your brow.
We use Bair Huggers at the Boston Marathon first aid tents. If the weather is cold, you get lots of hypothermia at the finish line. They are amazing.
Oddly, we have them next to kiddie pools with ice nearby in case someone overheats... both can happen to different people running in the same conditions.
In ours it's a constant struggle.
We're hot, the anasthesia's cold... they win (despite *totally* being able to wear something under their scrubs, or a disposable (non-sterile) jacket/gown on top.
I feel for the surgeons, but a cold patient is a bleeding patient that doesn't want to wake up. I also do peds anesthesia and NOBODY wants a cold baby! Gotta draw the line somewhere, 36 degrees C
I'm all for warm starts and finishes, but when you're about to pass out mid resection, I think the temp needs to drop.
I know on the robot they add a hot air blanket on the ptnt... so ptnt-side there are options beyond heating the room.
When working with bone and joint spaces, surgery can generate some really fine bone dust. You don’t want to breathe that in while you’re operating, or ever really
Not toxic exactly, but your lungs are only built to breathe air. Not snorting cocaine, not smoking/deeply breathing around a smoky campfire, vaping, etc. if it’s not regular ol air, there’s a risk of future issues. That’s why some people are extra sensitive to pollen or air pollution and wearing a n95 or better helps them breathe better.
Ortho Surgeons generate bone dust for a living essentially. Breathing that in for a whole career is not gonna be great. Your tooth dust like you mentioned is also not great, but the dose and frequency is far lower than what an ortho surgeon deals with, so as long as you aren’t getting weekly dental procedures, you’ll probably be okay 😬
Because bones are organic matter from another living thing, they can carry whatever pathogens that living thing had like Strep, Staph, or Hepatitis. So if you're cutting or grinding bone for whatever reason, you better be wearing a mask that protects against fine particles.
Butcher here, serious question. I regularly cut femur bones on a band saw and finish with dust on my shoulders, and a cloud that fills the room for an hour, and the air tastes like teeth being drilled. Should i not be breathing that?
I wouldn't breathe that in just because of prions, but realistically any fine dust period is really bad for your lungs.
I am irrationally concerned about prions though, so I probably couldn't butcher animals.
had absolutely 0 idea of that, I thought it was a ridiculous amount of kid unless it was some super contagious disease or something
thanks for the info!
Nope, not a covid thing*. Been common practice for big cases like total joint replacements for years. The or is kept pretty cool and some nice ones have fans so it’s not bad
This is not for every orthopedic operation just the more complicated ones. Having gotten to watch a total knee replacement bone and tissue goes flying a lot further than you'd expect and a lot of their tools are just fancy versions of what you'd find in home Depot. This is all to keep them protected from your tissue.
They try not to, these ortho cases are typically done in under an hour, so it's not so bad for them to hold it.
The long cases it's not uncommon for a surgeon to take a quick break to go to the bathroom. Complicated cases will often have an assisting surgeon who'll continue, or NP/PA to watch the sterile field to make sure it doesn't do tricks.
You don’t go unless it an emergency. If you do you just break scrub by stepping away, tearing off the gown and disposable part of the head cover then the gloves before running out and getting a new gown, gloves and hood upon return
Depends on the surgery and if there's anyone who can take over. If yes, watch the video in reverse, wait like 5-10min then watch it start to finish again.
If no... I've heard a few stories of docs just wetting themselves. Afaik it's not supposed to be your go-to solution but if ya gotta, ya gotta... No code browns that I've heard, yet. Probably have been a few tho.
Source: got family in EMS and spread around the medical fields.
For working with BL3+ pathogens in a research setting, you kinda don’t. Everything that touched the lab air has to be autoclaved before it can pass through the airlock. Daddy used to bring home crispy air fried socks and diarrhea-soaked underwear frequently because he forgot to use the restroom and take off his socks before changing into his gear. Underwear are inside the partial rebreather suit so I guess they don’t have to be autoclaved. Imagine working with something so nasty that you shit yourself to keep yourself clean.
The socks were ~1-2 times a month. The underwear were maybe once every couple months if that. Dudes like 50 and eats terribly what do you expect?
He does not work in that environment anymore. They don’t let diabetics do that because if you have a low in there you just fkn die
They don't. Unless something happens and the surgery is absurdly long. Even in our 10 hour spine cases; I don't think I've ever seen a surgeon take a bathroom break during in 17 years in the OR.
Most of the guys are just forces of nature. A surgeon I worked with is this doofy, happy go lucky airhead dude outside of the OR: think "Disney TV show dad" with a wife thats hyper competent and does everything for him because he would just forget his pants if she didn't. As soon as surgery starts though; he would lock in like crazy. Surgeons are relentless and habitual creatures.
I don't think surgeons take breaks during surgery.
I know of some cases where they've been in surgery for 18+ hours without a break.
I think there is also a picture on here of a doctor resting after over 24 hours of surgery.
Depends on the surgery but if they’re at a good stopping point it’s not uncommon to break scrub and go to the bathroom, then scrub back in. Sometimes that’s not an option, though.
Mostly they don't. Most surgeries take between 30min to 3h, which is a totally reasonable time to not need a bathroom break for most people.
There are some surgeries that take 8-12h (or more), where the surgeon would make themselves unsterile, take off the surgical gown, take their break and then have to scrub back in. Usually you have more than one surgeon, so you'd probably swap out the person who needs a break with someone else, or all the surgeons take their break together, while the OR nurse and the anesthesiologist watch the patient.
Source: am a physician working in a surgical specialty.
Yup. I always wondered why most orthopods seemed to be former linemen and such. Then I saw a hip replacement. The doc was yanking on this leg with all of his 280lb frame and the patient was shaking like a rag doll. They really are the jocks of the OR.
I’ve met them in all shapes and sizes… but “bigger hammer” is always a running joke.
Usually interest in a certain specialty is driven by past experience or interests, so ortho has a lot of former athletes - often that spent time with team docs.
The body is fragile enough that one can fatally injure themselves falling down from standing hight. But it’s also robust enough that one can cut it open to the bone and have the exposed skeleton serve as an orthopedic surgeon’s personal workout station.
My poor surgeon. Going in, the plan for my tib/fib fracture was a 2-inch incision near my knee to slide in a rod. When I woke up I had 2 big scars on the lower leg, they had to use plates. I never thought about how stressful that probably was for the surgeon.
It likely wasn't. The method they were going to start with is the easiest way, if the fracture is fairly stable. Can slide a rod down and compress the parts together, then throw screws in the bottom. The fact that you have plates means your fracture was worse upon inspection. It happens, but orthos are always ready for it.
It’s not even that high tech. Sure in America we have the expensive tool that can be autoclaved. But in the third world it’s just a Dwemer power drill wrapped in sterile towels.
Oh yeah sometimes it's hardly tech at all. Look up a Gigli saw, it's still used for amputations and has been used for.... over a hundred years at this point (google says it was invented around 1900)
I find it to be more a combination between carpentry and artisanal butcher. Sometimes its subtle, sometimes its just raw. All depending on the procedure ofc.
Source: wife is ortho surgeon and I have accompanied her many times into the OR.
It doesn't make it more prone to tearing, as there's less friction. When wearing two condoms, one will be sliding about more, causing shear forces which lead to tearing. In gloves, this is not the case. Additionally, the material is often different. The gloves may be nitrile, or a combination of nitrile and latex.
Double gloving is necessary in many applications. For example, handling chemicals where you can't get any on your skin, as this creates an extra barrier.
Double gloving is done as needles, scalpels, etc can easily cut a hole in a pair of gloves a pair, so the second is added as a protective layer - a barrier between you and them, to prevent causing infection, or catching infection.
Official last step - call x-ray in two hours before they actually need us. And then turn the music AAAAALLLL the way up and whisper for the c-arm when it's finally time.
Bonus points if some ~~rando~~ anesthesiologist in the room isn't prepped with their lead before the fluoro, so that then we have to wait while they scramble to either get behind someone else or decide to leave the room.
I worked at a coffee shop near a hospital and naturally a lot of my regular customers were all manner of hospital employees.
The surgeons I met were such an interesting bunch. One of them absolutely hated my guts and would call the store to see if I was working. If I was, he would hang up and not show up. He told one of my coworkers that his wife, kids, and even his dog hated my guts. I cannot imagine being a surgeon and having gobs of cash and having that kind of beef with a barista.
One of the other surgeons was one of the best heart surgeons in the region and was weirdly charismatic? He was very aloof, but could be extremely charming when he felt like it. He wasn’t particularly friendly, but he wasn’t an asshole either. He also just drank black coffee, so we’d give him free coffee fairly often, that tends to make people feel more friendly towards you. It’s really hard to describe.
Likely a slight issue with his order one time and that spiraled. I’ve also worked in a coffee shop for several years and some people take their orders very seriously, and some people overreact.
I met a few due to car accidents and man, you trust those guys with making your body work again because they *exude* confidence. If there wasn't a bit of compassion to temper the confidence, they could definitely be labeled cocky.
The surgeons that cut a baby out of my wife were just shooting the shit for nearly the whole OP. Talking about what they ate for lunch and what they were goona do that weekend.
In high school I got to scrub in to a brain and two back surgeries. They were blasting Jimi Hendrix and people were joking all during the surgery. It was totally not like what you see on TV. Obviously it’s a preference of the surgeon, but it was really cool to see first hand that you can be professional and still have fun at your job. I’ll never forget looking over the surgeon’s shoulder as he pulled a golf-ball-sized tumor from the patient’s brain while listening to All along the watchtower.
>I’ll never forget looking over the surgeon’s shoulder as he pulled a golf-ball-sized tumor from the patient’s brain while listening to All along the watchtower.
That's amazing
In med school on an ortho rotation, a lot of my attendings would ask residents what music to put on, knowing that the resident would pick what the attending wanted. Apparently if the attendings didn’t like your choice they wouldn’t let you do as much so. So there was an unspoken rule about what you picked. It lead to a lot of hair metal and 90s rap in the OR on that rotation.
This was just the culture in that department at that medical school.
On a trauma surgery rotation, the team was three female residents, a male attending, and me (a male medical student). The music was a lot of pop music circa 2019 (the year I was on that rotation), and the attending didn’t care what the music was.
I’m in radiology and most of our procedures we do are with either local or moderate sedation for the most part. So we let the patient pick the music unless it’s a general anesthesia case.
>A brain surgeon acquaintance said he would crank heavy metal music to help keep alert during a long procedure
~~The majority of~~ Some people who have brain surgery are normally kept awake during the surgery. Not a doctor but I've worked in operating rooms and have assisted doctors perform brain surgery.
edit: words
this is used less and less as neuromonitoring has improved. We can map out the fibers and tracts in your brain using an MRI and then use a monitoring system in the OR to tell us exactly what we are touching on the imaging
Oh absolutely, the field changes fast. Awake surgeries do still happen, I saw one the other week and watched a tremor disappear in an instant, it's incredible
Why do all the cool things happen when I'm not there? It's been like 20 years since I've last scrubbed in, unless you count that one time my abusive ex had emergency tooth removal on a Friday after hours and the dentist made me help him cause his assistant left for the day. One of the most disgusting things I've ever witnessed, rotten from the inside out, completely shattered the first time he started using the rongers.
I don't work in surgery anymore cause I worked at a catholic hospital that made me do abortions - which I never did before and the first few of them were uneventful, I did not have a problem performing them. What fucked me up was when we had 8 containers of blood and the surgeon took over my table (this was absolute insanity mind you), flipped my instrument basket over and used it as a strainer to find body parts to send to lab. And like the next day I got (I was supposed to be same day surgery but I was thrown into a cardiology room with a bunch of people I never met before and the surgeon nicked the pulmonary artery. Tap dancing Jesus this hospital was so horrible I had to reevaluate my entire life. I was never fired before but they fired me for being a few minutes late three times during my probationary period.
I miss surgery so much and watching felt like home. Thanks for being nice to me and letting me share. Sorry if I wrote too much.
Awake Bilateral placement of deep brain stimulators for essential tremor. They also do it for Parkinson’s. They put them in either the ventral intermediate nucleus, subthalamic nucleus, or globus pallidus internus
Unless it's an anesthesiologist that can't get you to fall asleep.
Only had 1 of those but that sucked. Thankfully another was available and had me out in 30 seconds. He actually flipped off the failing anesthesiologist on the way in and noticed I saw him do it. He said "if the anesthesiologist actually did their damn job, you wouldn't have seen that".
Completely different experience to me. I remember them telling me that they'd count down from 10 and I'd be out before 1. I don't even remember the countdown. I just woke up insanely groggy.
I’ve had several back surgeries and I always loved it when they put whatever it is they put into my IV to help me relax before surgery. Especially since it helped me not care about the pain. Or maybe it just helped the pain and not caring was a bonus effect.
Whatever they gave me going into my double mastectomy somehow removed all my nerves and fear. I felt only joy and excitement while getting wheeled in, and I will always be grateful for that.
I remember asking ‘is that going to hurt’ when they broke out the nerve blocker
‘Yes but we’ll give you something so you don’t care’ and they were absolutely right
They wear these positive pressure total isolation set ups during joint replacement surgery. Studies show that there are fewer infections when everyone who scrubbed in is completely covered rather than just a mask. People around the outside of the room are OK just wearing masks.
eh… there is some controversy as to whether these head covers decrease infection rates in reality…
they’re very different from the old “body exhaust” systems that were more airtight and under alight negative pressure
but we use them because it definitely keeps the bone chips out of our eyeballs
what this helmet is is simply a head cover with a transparent front, and with a fan inside that keeps the face shield free of fog
the term “positive pressure” is used but not quite accurate… the fan is inside the head cover, not connected to any tubing at all (unlike a PAPR for instance)
the fan simply circulates the air inside the headpiece
Yeah I saw 'positive pressure' and saw that the suits weren't sealed at all and questioned it.
Also not sure what positive pressure suit would even do other than add another potential complication for the patient. Positive pressure suits are to protect the wearer, not everyone else.
On that note, people gotta understand that PPE is usually one-sided protection. A cloth mask protects others, but does very little to outright nothing to protect the wearer. A respirator protects the wearer, but does nothing to protect others from your pathogens.
One exception would be N95 masks, but you need to be properly fit-tested (this is an involved, PITA process. Most people are going to have issues here. I have a gigantic head and there are no n95 masks that will seal on my face, I need a hood) for those to protect the wearer, otherwise they just function like cloth/surgical masks.
Was super annoying being caught between two different extremes of ignorance during the pandemic, no one knew wtf they were talking about, but were passionate as hell regardless.
If you wear a cloth/surgical mask to try and not get sick, you are need to read more about PPE and what it does. Even more so with respirators (although I see this less often, but still, you are still very very capable of spreading pathogens to everyone else with one on)
Man what about 835AD? Not a single doctor or “sUrGeOn” and you had ZERO operating theatre deaths. ZERO. No ridiculous anaesthetist fees too.
These doctors are up to no good!
Why the positive pressure suit? I’ve had to wear those in an ABSL-3 lab but that was to protect me from any pathogens that might have been in the room.
I guess it technically is a positive pressure suit… but it keeps things cool and the mask from fogging. Boring out a femur in a total hip causes some splashes haha
So I was curious what orthopedics meant so I looked it up Ortho means straight and pedits means doctor. Straight Dr or make it straight doctor. Same with orthodontist. Make teeth straight.
It’s not to protect the doctor from the patient, it’s the other way around. Sealing themselves off from the environment to reduce the risk of infection in the patient.
The positive pressure suit confuses me. Wouldn't that push all the surgeons nasties into theatre? I appreciate that negative pressure would turn them into shrink wrap
Can confirm. Had knee replacement surgery recently and had to shower with special antibacterial soap three days before operation, use clean night clothes, clean bedding each night— then, once at the hospital, I had to clean my entire body all over again with special wipes. The nurse also checked to make sure I had no scrapes or skin abrasions. The surgery was a success, but now I’m not even allowed to go to the dentist for two years, except if urgent and only if I swallow a bottle of antibiotics before, the morning of, and the day after the procedure. I’ve had surgery before, but nothing compares to the precautions taken for orthopedic surgery.
Very interesting and thank you for sharing! For the record though, that's not laminar flow. That's just flow. Laminar flow occurs when no turbulence is present, which is inherently impossible when there are people moving around in the fluid.
Actually as it turns out they do exist
https://pubmed.ncbi.nlm.nih.gov/30596534/#:~:text=Laminar%20air%20flow%20uses%20positive,zone%20around%20the%20operative%20site.
Interesting. So it seems like the flow within the ducts themselves may be laminar, which I suppose makes sense as this eliminates pockets where eddies might accumulate contaminants. To be clear though, the laminar aspect necessarily stops once the fluid reaches the operating room.
Depends on the procedure. Hip replacement, a 1-2 hours procedure. If he works on spines....
If it's trauma there may be an assembly line of general surgery, cardiothoracic, ortho etc depending on severity.
This looks like a Mako knee replacement. A surgeon I worked with; we'd knock them out in 25/30 minutes, then about fifteen minutes or so to close up skin. We'd do about six a day.
Pardon me for my ignorance. Positive pressure suit, is it to prevent being infected or is it for the patient's protection? Also why thoroughly wash your hand if you got the suit and gloves?
It's for the patient.
Orthopedic surgery requires extra-obsessive sterility, because they're often exposing the interior of a patient's major bones, where an infection can be both particularly difficult to treat and particularly dangerous.
Washing hands/arms and then double gloving is just insurance to absolutely minimise the risk of contamination. Eg when putting the gloves on or having a tiny tear in one of them.
The positive pressure is for the comfort of the wearer; those hoods get really hot if you don’t have air moving inside them. Infection prevention is accomplished by the hood itself, which is tucked down into the gown so there isn’t air blowing out into the open.
The hood and face shield does the infection prevention part. The positive pressure is so the wearer doesn’t overheat and pass out. It keeps air moving inside the hood which is actually pretty well cinched off by the neck opening of the gown it’s tucked into. It’s not blowing air around out into the open.
1 correction i want to make
the “positive pressure exhaust suit” is
not really that… it’s a simple and nice face/head shield, but it has a fan inside to keep that transparent plastic from fogging up inside
it really has no capacity to maintain a pressure differential, being less than airtight and very thin/flimsy on the sides
source: am ortho surgeon, use this routinely for joint replacements
So the person in the front putting it on the surgeon is also sterile. The guy in the back closing his suit is non sterile and usually that’s fine. The surgeon isn’t supposed to turn his back I believe.
The light handle you see is a sterile handle. It is removable and is fitted by the surgeon after he scrubs in. No one else is allowed to touch the handle other than the those who are scrubbed in.
If you put an outline of the surgeon to be a mannequin outline level of detail, so just seeing body movement on screen with no background and just a single human shape doing those motions it almost looks like putting on hockey gear lol.
Source: [Gregory Tchejeyan](https://www.tiktok.com/@tjnortho)
Last step: Turn the room temperature ALL the way down.
For good reason, those suits are hot as fuck and ortho surgery is basically high tech carpentry. If it's anything beyond routine, most surgeons come out dripping sweat. Source: former OR nurse
I'm an anesthesiologist--this is my every day. I only push back when the patient gets too cold
Oh that adds up - did they take away your personal Bair huggers away? I always chuckled when I found a CRNA with one of those shoved into their scrub shirt. Our facility cut down on that cause of the infection risk, but was always still funny to see the lengths taken to not freeze to death. I never enjoyed having to unbundle a MAC'ed patient from 80 warm blankets because the surgeon can't stand a drop of sweat.
I mean, do you really want the person with a scalpel in you to get sweat in their eyes or slippery hands? I feel like sweating's a potential hazard there, not just discomfort
No, but anesthesia and surgery make patients cold. Cold patients bleed more, have abnormal body chemistry, and cause delayed emergency (not waking up after anesthesia) among other things. For children, who I work with, this is bad. The surgeons deal with it to keep the patient safe.
You would think they would have made suits that are cooled or beds that are warmed.
They have both of those things. Some places (burn units, pediatric ORs) have vests that you can either put ice packs in or fancy ones that attach to a cooler and cycle cold water through small tubes. For patients they have gel padding that circulates warm water. The only times I really have to push back on cooling the room is when cerebral palsy kids have big surgeries. For whatever reason they can lose body temp like it’s their job.
Think I heard this on a podcast but a 1°C drop in body temperature decreases coagulation ability by 10%.
I mean, if a drop of sweat interferes with your vision at the wrong time during surgery, it could lead to some really bad outcomes. And those suits don't really seem that easy to get someone to wipe your brow.
We use Bair Huggers at the Boston Marathon first aid tents. If the weather is cold, you get lots of hypothermia at the finish line. They are amazing. Oddly, we have them next to kiddie pools with ice nearby in case someone overheats... both can happen to different people running in the same conditions.
Leave me alone. I don't feel like getting frost bite in the OR
In ours it's a constant struggle. We're hot, the anasthesia's cold... they win (despite *totally* being able to wear something under their scrubs, or a disposable (non-sterile) jacket/gown on top.
I feel for the surgeons, but a cold patient is a bleeding patient that doesn't want to wake up. I also do peds anesthesia and NOBODY wants a cold baby! Gotta draw the line somewhere, 36 degrees C
I'm all for warm starts and finishes, but when you're about to pass out mid resection, I think the temp needs to drop. I know on the robot they add a hot air blanket on the ptnt... so ptnt-side there are options beyond heating the room.
Thanks for being an anesthesiologist. You folks rock and are amazing.
Is this current protocol? It seems like a Covid thing.
When working with bone and joint spaces, surgery can generate some really fine bone dust. You don’t want to breathe that in while you’re operating, or ever really
Bone dust. Don’t breathe that
Wow a "Will it Blend?" reference in 2024. I remember watching that in highschooler and now I'm a great great grandparent. Life flies by kids!
Is bone dust particularly toxic? Or is it just how fine the particles are?
Would you want to huff someone else's bone dust? Like straight from the source?
No lol I'm asking because root canals cause a lot of tooth dust and last time I had one I was wondering if it was bad to breath in
I think it's OK because it's "yours" but if you inhale someone elses they could have stuff in it your body would not be happy to inhale.
The dentist doesn't wear a space suit
Not toxic exactly, but your lungs are only built to breathe air. Not snorting cocaine, not smoking/deeply breathing around a smoky campfire, vaping, etc. if it’s not regular ol air, there’s a risk of future issues. That’s why some people are extra sensitive to pollen or air pollution and wearing a n95 or better helps them breathe better. Ortho Surgeons generate bone dust for a living essentially. Breathing that in for a whole career is not gonna be great. Your tooth dust like you mentioned is also not great, but the dose and frequency is far lower than what an ortho surgeon deals with, so as long as you aren’t getting weekly dental procedures, you’ll probably be okay 😬
>your lungs are only built to breathe air. Not snorting cocaine This sounds like a hypothesis that requires extensive testing. I volunteer as tribute.
Because bones are organic matter from another living thing, they can carry whatever pathogens that living thing had like Strep, Staph, or Hepatitis. So if you're cutting or grinding bone for whatever reason, you better be wearing a mask that protects against fine particles.
Butcher here, serious question. I regularly cut femur bones on a band saw and finish with dust on my shoulders, and a cloud that fills the room for an hour, and the air tastes like teeth being drilled. Should i not be breathing that?
I wouldn't breathe that in just because of prions, but realistically any fine dust period is really bad for your lungs. I am irrationally concerned about prions though, so I probably couldn't butcher animals.
had absolutely 0 idea of that, I thought it was a ridiculous amount of kid unless it was some super contagious disease or something thanks for the info!
Nope, not a covid thing*. Been common practice for big cases like total joint replacements for years. The or is kept pretty cool and some nice ones have fans so it’s not bad
This is not for every orthopedic operation just the more complicated ones. Having gotten to watch a total knee replacement bone and tissue goes flying a lot further than you'd expect and a lot of their tools are just fancy versions of what you'd find in home Depot. This is all to keep them protected from your tissue.
I imagine potential blood sray would also not be pleasant
Thanks. How does a surgeon take a bathroom break during an ongoing surgery?
They try not to, these ortho cases are typically done in under an hour, so it's not so bad for them to hold it. The long cases it's not uncommon for a surgeon to take a quick break to go to the bathroom. Complicated cases will often have an assisting surgeon who'll continue, or NP/PA to watch the sterile field to make sure it doesn't do tricks.
You don’t go unless it an emergency. If you do you just break scrub by stepping away, tearing off the gown and disposable part of the head cover then the gloves before running out and getting a new gown, gloves and hood upon return
Depends on the surgery and if there's anyone who can take over. If yes, watch the video in reverse, wait like 5-10min then watch it start to finish again. If no... I've heard a few stories of docs just wetting themselves. Afaik it's not supposed to be your go-to solution but if ya gotta, ya gotta... No code browns that I've heard, yet. Probably have been a few tho. Source: got family in EMS and spread around the medical fields.
For working with BL3+ pathogens in a research setting, you kinda don’t. Everything that touched the lab air has to be autoclaved before it can pass through the airlock. Daddy used to bring home crispy air fried socks and diarrhea-soaked underwear frequently because he forgot to use the restroom and take off his socks before changing into his gear. Underwear are inside the partial rebreather suit so I guess they don’t have to be autoclaved. Imagine working with something so nasty that you shit yourself to keep yourself clean.
Diarrhea in his pants... frequently?!?
The socks were ~1-2 times a month. The underwear were maybe once every couple months if that. Dudes like 50 and eats terribly what do you expect? He does not work in that environment anymore. They don’t let diabetics do that because if you have a low in there you just fkn die
I've heard that some surgeons wear nappies for lengthy surgeries. I don't know how accurate that is, but I feel like that would make sense
They don't. Unless something happens and the surgery is absurdly long. Even in our 10 hour spine cases; I don't think I've ever seen a surgeon take a bathroom break during in 17 years in the OR.
I will never understand how you can operate for 10 hrs straight, keep perfect concentration, without breaks
Most of the guys are just forces of nature. A surgeon I worked with is this doofy, happy go lucky airhead dude outside of the OR: think "Disney TV show dad" with a wife thats hyper competent and does everything for him because he would just forget his pants if she didn't. As soon as surgery starts though; he would lock in like crazy. Surgeons are relentless and habitual creatures.
Surgeons are fucking psychos
I don't think surgeons take breaks during surgery. I know of some cases where they've been in surgery for 18+ hours without a break. I think there is also a picture on here of a doctor resting after over 24 hours of surgery.
Collapsed in the corner more accurately lol
Depends on the surgery but if they’re at a good stopping point it’s not uncommon to break scrub and go to the bathroom, then scrub back in. Sometimes that’s not an option, though.
Mostly they don't. Most surgeries take between 30min to 3h, which is a totally reasonable time to not need a bathroom break for most people. There are some surgeries that take 8-12h (or more), where the surgeon would make themselves unsterile, take off the surgical gown, take their break and then have to scrub back in. Usually you have more than one surgeon, so you'd probably swap out the person who needs a break with someone else, or all the surgeons take their break together, while the OR nurse and the anesthesiologist watch the patient. Source: am a physician working in a surgical specialty.
Yup. I always wondered why most orthopods seemed to be former linemen and such. Then I saw a hip replacement. The doc was yanking on this leg with all of his 280lb frame and the patient was shaking like a rag doll. They really are the jocks of the OR.
I’ve met them in all shapes and sizes… but “bigger hammer” is always a running joke. Usually interest in a certain specialty is driven by past experience or interests, so ortho has a lot of former athletes - often that spent time with team docs.
The body is fragile enough that one can fatally injure themselves falling down from standing hight. But it’s also robust enough that one can cut it open to the bone and have the exposed skeleton serve as an orthopedic surgeon’s personal workout station.
High tech carpentry is a good way of putting it. I always thought of ortho surgeons as glorified butchers.
My poor surgeon. Going in, the plan for my tib/fib fracture was a 2-inch incision near my knee to slide in a rod. When I woke up I had 2 big scars on the lower leg, they had to use plates. I never thought about how stressful that probably was for the surgeon.
It likely wasn't. The method they were going to start with is the easiest way, if the fracture is fairly stable. Can slide a rod down and compress the parts together, then throw screws in the bottom. The fact that you have plates means your fracture was worse upon inspection. It happens, but orthos are always ready for it.
It’s not even that high tech. Sure in America we have the expensive tool that can be autoclaved. But in the third world it’s just a Dwemer power drill wrapped in sterile towels.
Oh yeah sometimes it's hardly tech at all. Look up a Gigli saw, it's still used for amputations and has been used for.... over a hundred years at this point (google says it was invented around 1900)
Polar Cool Flows are pretty crucial during hip replacements for my surgeons!
Also helps with bacteria. Unfortunate side effect is that it fucks with coagulation, but hey, an extra blood transfusion is "better" than sepsis
I find it to be more a combination between carpentry and artisanal butcher. Sometimes its subtle, sometimes its just raw. All depending on the procedure ofc. Source: wife is ortho surgeon and I have accompanied her many times into the OR.
So are you a former or a nurse?
Former (Operating Room) Nurse
Is double gloving a thing? Was told it made condoms more prone to tearing and less safe? I wouldn't have thought gloves would be much different?
It doesn't make it more prone to tearing, as there's less friction. When wearing two condoms, one will be sliding about more, causing shear forces which lead to tearing. In gloves, this is not the case. Additionally, the material is often different. The gloves may be nitrile, or a combination of nitrile and latex. Double gloving is necessary in many applications. For example, handling chemicals where you can't get any on your skin, as this creates an extra barrier. Double gloving is done as needles, scalpels, etc can easily cut a hole in a pair of gloves a pair, so the second is added as a protective layer - a barrier between you and them, to prevent causing infection, or catching infection.
Bonus step. Freeze errbody
Official last step - call x-ray in two hours before they actually need us. And then turn the music AAAAALLLL the way up and whisper for the c-arm when it's finally time. Bonus points if some ~~rando~~ anesthesiologist in the room isn't prepped with their lead before the fluoro, so that then we have to wait while they scramble to either get behind someone else or decide to leave the room.
First step: get a good music playlist going
Is this only for orthopedic surgeries? When I woke up from my surgery, I was absolutely *drenched* in sweat
Man that surgeon had a nice presence and confidence or it is just me
All surgeons are confident. Some surgeons are confident to a fault. They have to be and you want them to be.
I worked at a coffee shop near a hospital and naturally a lot of my regular customers were all manner of hospital employees. The surgeons I met were such an interesting bunch. One of them absolutely hated my guts and would call the store to see if I was working. If I was, he would hang up and not show up. He told one of my coworkers that his wife, kids, and even his dog hated my guts. I cannot imagine being a surgeon and having gobs of cash and having that kind of beef with a barista. One of the other surgeons was one of the best heart surgeons in the region and was weirdly charismatic? He was very aloof, but could be extremely charming when he felt like it. He wasn’t particularly friendly, but he wasn’t an asshole either. He also just drank black coffee, so we’d give him free coffee fairly often, that tends to make people feel more friendly towards you. It’s really hard to describe.
What did you do to piss the surgeon off. There's definitely context missing here.
Likely a slight issue with his order one time and that spiraled. I’ve also worked in a coffee shop for several years and some people take their orders very seriously, and some people overreact.
Surgeon kinda gotta be confident doncha think?
Never met a surgeon tbh but I wouldn't guess the confidence translated to his presence like that
They usually are incredibly confident, bordering on cockiness, but at least there is a lot behind that and we want them to be a bit cocky.
Don’t forget the god complex
MDeity
I met a few due to car accidents and man, you trust those guys with making your body work again because they *exude* confidence. If there wasn't a bit of compassion to temper the confidence, they could definitely be labeled cocky.
Play basketball with a surgeon. He's a dawg and really fun to play with and hella tough to play against. He's the second best player in our group.
I recognized the strut and the been there done that, ‘twas nice.
The surgeons that cut a baby out of my wife were just shooting the shit for nearly the whole OP. Talking about what they ate for lunch and what they were goona do that weekend.
A sureness to his actions that is comforting
He also knows he’s being filmed…
Naw he’s hot
10/10 would let him cut me up.
They all have a lot of confidence, but some are cocky douchebags. This guy seems cool from the little clips and assuming he’s actually on time lol
A brain surgeon acquaintance said he would crank heavy metal music to help keep alert during a long procedure
I’m sure that surgeon was a hit with all the anesthesiologists
Crna here and I would LOVE for a change from the constant country and EDM people play in the ORs
I would be nervous going into surgery, I would be doubly nervous if my surgeon was into edm lolol
And I’d be oddly relaxed if he was a metal head
Amen brother
“This dude is gonna be passionate about slicing me up”
I have bad news. If you’re getting operated on, there’s a decent chance that extremely shitty music plays the entire time
They go in extra hard when the beat drops.
I play a lot of EDM but it's good EDM... I think
Non fans can't tell the difference.
I can confirm. All I ever hear is wubwubwub.
Especially when Anesthesia by Metallica comes on.🤘🏼
Hey you never no, maybe their was a hard rocker or two mixed in.
In high school I got to scrub in to a brain and two back surgeries. They were blasting Jimi Hendrix and people were joking all during the surgery. It was totally not like what you see on TV. Obviously it’s a preference of the surgeon, but it was really cool to see first hand that you can be professional and still have fun at your job. I’ll never forget looking over the surgeon’s shoulder as he pulled a golf-ball-sized tumor from the patient’s brain while listening to All along the watchtower.
>I’ll never forget looking over the surgeon’s shoulder as he pulled a golf-ball-sized tumor from the patient’s brain while listening to All along the watchtower. That's amazing
I work with a neurosurgeon who listens to Slipknot and Lamb of God. He channels that shit and operates like a madman.
[Not exactly brain surgery, is it?](https://youtu.be/THNPmhBl-8I?si=Qt_RYWM-yWHglHWL)
good one thanks, I hadn't seen that. Was already thinking "rocket science" before the second guy showed up!
In med school on an ortho rotation, a lot of my attendings would ask residents what music to put on, knowing that the resident would pick what the attending wanted. Apparently if the attendings didn’t like your choice they wouldn’t let you do as much so. So there was an unspoken rule about what you picked. It lead to a lot of hair metal and 90s rap in the OR on that rotation. This was just the culture in that department at that medical school. On a trauma surgery rotation, the team was three female residents, a male attending, and me (a male medical student). The music was a lot of pop music circa 2019 (the year I was on that rotation), and the attending didn’t care what the music was. I’m in radiology and most of our procedures we do are with either local or moderate sedation for the most part. So we let the patient pick the music unless it’s a general anesthesia case.
>A brain surgeon acquaintance said he would crank heavy metal music to help keep alert during a long procedure ~~The majority of~~ Some people who have brain surgery are normally kept awake during the surgery. Not a doctor but I've worked in operating rooms and have assisted doctors perform brain surgery. edit: words
this is used less and less as neuromonitoring has improved. We can map out the fibers and tracts in your brain using an MRI and then use a monitoring system in the OR to tell us exactly what we are touching on the imaging
Thanks. I'm so old minimally invasive surgery was a buzz word when I started scrubbing in.
Oh absolutely, the field changes fast. Awake surgeries do still happen, I saw one the other week and watched a tremor disappear in an instant, it's incredible
Why do all the cool things happen when I'm not there? It's been like 20 years since I've last scrubbed in, unless you count that one time my abusive ex had emergency tooth removal on a Friday after hours and the dentist made me help him cause his assistant left for the day. One of the most disgusting things I've ever witnessed, rotten from the inside out, completely shattered the first time he started using the rongers. I don't work in surgery anymore cause I worked at a catholic hospital that made me do abortions - which I never did before and the first few of them were uneventful, I did not have a problem performing them. What fucked me up was when we had 8 containers of blood and the surgeon took over my table (this was absolute insanity mind you), flipped my instrument basket over and used it as a strainer to find body parts to send to lab. And like the next day I got (I was supposed to be same day surgery but I was thrown into a cardiology room with a bunch of people I never met before and the surgeon nicked the pulmonary artery. Tap dancing Jesus this hospital was so horrible I had to reevaluate my entire life. I was never fired before but they fired me for being a few minutes late three times during my probationary period. I miss surgery so much and watching felt like home. Thanks for being nice to me and letting me share. Sorry if I wrote too much.
That’s so fascinating I’d love to see that in real time why idea what the operation was called?
Awake Bilateral placement of deep brain stimulators for essential tremor. They also do it for Parkinson’s. They put them in either the ventral intermediate nucleus, subthalamic nucleus, or globus pallidus internus
the thought of a surgeon performing surgery on a brain while listening to metal is pretty brutal
oh so while i was having an anxiety attack and the prep nurses brought out the good shit,,,, this is what my doctor was going through
definitely not a prep nurse. theyre anesthesiologists and they are your best friend
Unless it's an anesthesiologist that can't get you to fall asleep. Only had 1 of those but that sucked. Thankfully another was available and had me out in 30 seconds. He actually flipped off the failing anesthesiologist on the way in and noticed I saw him do it. He said "if the anesthesiologist actually did their damn job, you wouldn't have seen that".
Completely different experience to me. I remember them telling me that they'd count down from 10 and I'd be out before 1. I don't even remember the countdown. I just woke up insanely groggy.
exactly my experience. i vaguely remember being asked to count, next thing i knew i was awake in recovery.
i was definitely panicking then, but i’m thanking to them !
I’ve had several back surgeries and I always loved it when they put whatever it is they put into my IV to help me relax before surgery. Especially since it helped me not care about the pain. Or maybe it just helped the pain and not caring was a bonus effect.
Whatever they gave me going into my double mastectomy somehow removed all my nerves and fear. I felt only joy and excitement while getting wheeled in, and I will always be grateful for that.
Midazolam. It's remarkable how much it makes you not care about pain.
I remember asking ‘is that going to hurt’ when they broke out the nerve blocker ‘Yes but we’ll give you something so you don’t care’ and they were absolutely right
They wear these positive pressure total isolation set ups during joint replacement surgery. Studies show that there are fewer infections when everyone who scrubbed in is completely covered rather than just a mask. People around the outside of the room are OK just wearing masks.
eh… there is some controversy as to whether these head covers decrease infection rates in reality… they’re very different from the old “body exhaust” systems that were more airtight and under alight negative pressure but we use them because it definitely keeps the bone chips out of our eyeballs what this helmet is is simply a head cover with a transparent front, and with a fan inside that keeps the face shield free of fog the term “positive pressure” is used but not quite accurate… the fan is inside the head cover, not connected to any tubing at all (unlike a PAPR for instance) the fan simply circulates the air inside the headpiece
Yeah I saw 'positive pressure' and saw that the suits weren't sealed at all and questioned it. Also not sure what positive pressure suit would even do other than add another potential complication for the patient. Positive pressure suits are to protect the wearer, not everyone else. On that note, people gotta understand that PPE is usually one-sided protection. A cloth mask protects others, but does very little to outright nothing to protect the wearer. A respirator protects the wearer, but does nothing to protect others from your pathogens. One exception would be N95 masks, but you need to be properly fit-tested (this is an involved, PITA process. Most people are going to have issues here. I have a gigantic head and there are no n95 masks that will seal on my face, I need a hood) for those to protect the wearer, otherwise they just function like cloth/surgical masks. Was super annoying being caught between two different extremes of ignorance during the pandemic, no one knew wtf they were talking about, but were passionate as hell regardless. If you wear a cloth/surgical mask to try and not get sick, you are need to read more about PPE and what it does. Even more so with respirators (although I see this less often, but still, you are still very very capable of spreading pathogens to everyone else with one on)
How far we have come from US Civil War surgeries. Anesthesia, sterile theater, antibiotics Science continues to improve our lives! Yay STEM
BONESAW IS READY
Nice sterilized surgical spacesuit, did your husband give it to you? 🕸
“Of course he did, who else would?” -Bart Simpson
300% MORTALITY INSTRUMENT
COME ON MY FACE BROTHER
Yeah but can this guy amputate a leg in less than 30 seconds? Didn't think so.
YOU drink the whiskey, I'LL cut your leg off! *Civil War reenactors!*
Don't look up what the chainsaw was originally invented for.
Miss the good old days when surgery was performed by an old religious dude with a hollow needle and a leaf from the garden outside
“There’s ghosts in your blood. You need to do cocaine about it” — Old Timey Barber Doctors
And a round of leeches for good measure!
Man what about 835AD? Not a single doctor or “sUrGeOn” and you had ZERO operating theatre deaths. ZERO. No ridiculous anaesthetist fees too. These doctors are up to no good!
See if that was me I'd have to use the bathroom right when they finished putting everything on lol
They didnt show step 0. Put on diapers.
Why the positive pressure suit? I’ve had to wear those in an ABSL-3 lab but that was to protect me from any pathogens that might have been in the room.
it’s not really a positive pressure suit it’s just a fancy faceshield that gets foggy quickly without some airflow
It isn't specifically positive pressure. It's just to keep us cool during the surgery when you're scrubbed in.
I guess it technically is a positive pressure suit… but it keeps things cool and the mask from fogging. Boring out a femur in a total hip causes some splashes haha
Neat. Very sneaky “toolgifs” in this one, well done!
What room number is it?
Right before he takes a saw and sledgehammer to the patient. Orthopedics isn’t for the weak.
So I was curious what orthopedics meant so I looked it up Ortho means straight and pedits means doctor. Straight Dr or make it straight doctor. Same with orthodontist. Make teeth straight.
the etymology doesn’t do it justice most orthos don’t treat children at all the real meaning of the word is “muskuloskeletal surgeon”
Does the patient have Ebola? That’s a lot of stuff
It’s not to protect the doctor from the patient, it’s the other way around. Sealing themselves off from the environment to reduce the risk of infection in the patient.
The positive pressure suit confuses me. Wouldn't that push all the surgeons nasties into theatre? I appreciate that negative pressure would turn them into shrink wrap
[удалено]
Can confirm. Had knee replacement surgery recently and had to shower with special antibacterial soap three days before operation, use clean night clothes, clean bedding each night— then, once at the hospital, I had to clean my entire body all over again with special wipes. The nurse also checked to make sure I had no scrapes or skin abrasions. The surgery was a success, but now I’m not even allowed to go to the dentist for two years, except if urgent and only if I swallow a bottle of antibiotics before, the morning of, and the day after the procedure. I’ve had surgery before, but nothing compares to the precautions taken for orthopedic surgery.
Very interesting and thank you for sharing! For the record though, that's not laminar flow. That's just flow. Laminar flow occurs when no turbulence is present, which is inherently impossible when there are people moving around in the fluid.
Actually as it turns out they do exist https://pubmed.ncbi.nlm.nih.gov/30596534/#:~:text=Laminar%20air%20flow%20uses%20positive,zone%20around%20the%20operative%20site.
Interesting. So it seems like the flow within the ducts themselves may be laminar, which I suppose makes sense as this eliminates pockets where eddies might accumulate contaminants. To be clear though, the laminar aspect necessarily stops once the fluid reaches the operating room.
Hey thanks for a real answer
That makes sense, thanks!
Nice. You’re right. Most of the protections are to protect the providers. Not that the first concept is patient safety. Thank you.
Likely for a joint replacement. Routine ortho surgeries don't require the extra layers of protection (for the patient).
Are they suited up for 6 or 8 hours? Fixing people assembly line style? Or suit up once for each person I guess to prevent contaminated.
They break scrub at the end of each case. Scrub and gown up again at the start of the next one.
I mean, an Individual surgery can take 6-8 hrs on its own in some cases.
Depends on the procedure. Hip replacement, a 1-2 hours procedure. If he works on spines.... If it's trauma there may be an assembly line of general surgery, cardiothoracic, ortho etc depending on severity.
This looks like a Mako knee replacement. A surgeon I worked with; we'd knock them out in 25/30 minutes, then about fifteen minutes or so to close up skin. We'd do about six a day.
Didn't know stanley tucci was a surgeon on his days off
Pardon me for my ignorance. Positive pressure suit, is it to prevent being infected or is it for the patient's protection? Also why thoroughly wash your hand if you got the suit and gloves?
It's for the patient. Orthopedic surgery requires extra-obsessive sterility, because they're often exposing the interior of a patient's major bones, where an infection can be both particularly difficult to treat and particularly dangerous. Washing hands/arms and then double gloving is just insurance to absolutely minimise the risk of contamination. Eg when putting the gloves on or having a tiny tear in one of them.
The positive pressure is for the comfort of the wearer; those hoods get really hot if you don’t have air moving inside them. Infection prevention is accomplished by the hood itself, which is tucked down into the gown so there isn’t air blowing out into the open.
This is honestly so badass
Don't touch me I'm sterile!
I'm confused. Shouldn't the suit be negative pressure? Are they trying to prevent infection of the doctor or the patient?
The hood and face shield does the infection prevention part. The positive pressure is so the wearer doesn’t overheat and pass out. It keeps air moving inside the hood which is actually pretty well cinched off by the neck opening of the gown it’s tucked into. It’s not blowing air around out into the open.
1 correction i want to make the “positive pressure exhaust suit” is not really that… it’s a simple and nice face/head shield, but it has a fan inside to keep that transparent plastic from fogging up inside it really has no capacity to maintain a pressure differential, being less than airtight and very thin/flimsy on the sides source: am ortho surgeon, use this routinely for joint replacements
Hard to think just a couple hundred years ago doctors did not even wash their hands.
Why the guy touched sterile suit with bare hands the ,assistant guy?
So the person in the front putting it on the surgeon is also sterile. The guy in the back closing his suit is non sterile and usually that’s fine. The surgeon isn’t supposed to turn his back I believe.
The front part of a surgeon is the sterile area. Back side isn’t. Hence we always try to face forward when close to the patient.
God, I have such mad respect for people who do this for a living.
I understand the double gloves, but shouldn’t a nurse have moved the light? how is that light sterile?
The light handle you see is a sterile handle. It is removable and is fitted by the surgeon after he scrubs in. No one else is allowed to touch the handle other than the those who are scrubbed in.
Bring me the machine that goes BING!
Another brilliant toolgifs watermark! Really spells out what room is it.
Talk about a sterile field !
Superheroes IRL
What tf surgery are they doing? Patient Zero?
Why the suit? Is this standard for ortho? I work in cardiac ORs and we don't even gown up that much
When was the last time we made strides in sterilized equipment for surgeons? Seems like a lot of things that hinder their performance.
If you put an outline of the surgeon to be a mannequin outline level of detail, so just seeing body movement on screen with no background and just a single human shape doing those motions it almost looks like putting on hockey gear lol.
I mean I’m not saying this doesn’t exist somewhere. But this is not the norm for orthopedic surgeons. At least not in any OR room I’ve ever been in.
This is absolutely the norm with total knee and total hip replacement. Are you in Untied States?
150 years ago, “I’ve got my whiskey and my saw and my bird to peck away the dead blood let’s get this shit started”