OR & Patient temperatures
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- Опубликовано: 27 июл 2024
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As someone who's had 34 surgeries in my life, I want to thank you for all you do at your job and here on YT.
Thank you David P.
I'm 23 years old I had a heart transplant at 12 weeks old and I have to have a heart biopsy/cath once a year, ever since i was little. They always give me a warm blanket and an under body bear hugger. I really like your videos because everything is moving so fast in the OR when i'm in their, and also I'm so drugged up, "cause i stay awake for my biopsy and cath" So since i'm so out of it i never really know what's going on, so its cool to watch your videos and learn what they are actually doing.
I had a severe eye injury 5 weeks ago that required enucleation. I don't remember much when I got to the OR, but I was freezing. I'm not the type to get cold but I was very uncomfortable. One of the last things I remember was a nurse or tech putting a warm blanket on me. It calmed me down and made a real difference in my experience. I felt like there was someone looking out for not only my injury, but cared about the person lying there. Thanks for all you do!! You have chosen a professions that truly makes a difference.
Everyone remembers the warm blankets!
Just before our patient enters the OR I place blanket from the warmer folded over four times to retain the heat on the OR table where their upper back will be and when they are getting on the table I remove it so that they are lying in the warmth then use the blanket to cover them. They all say how wonderful the warmth feels.
Great idea!
We would clamp the blower from the Bair Hugger under the sheet. The whole sheet would be warm.
This is what we are learning right now!!! Helps SO MUCH!
Thank you for sharing this...💕
Thanks!!
😀😅👋
When I had a c-section it was FREEZING in that room! Idk if it was the medication I had or if it was just that darn cold in there but I had like 12 blankets around me
Air conditioners and dehumidifiers use the same technique, so the dehumidification makes the air really really cold.
And humidity can cause Sparks too!
So thankful for your videos! you help me understand a lot in more of laymans terms, instead of just reading from the book. Do you happen to have any videos on prep and draping? We are now learning on that but was just told that the techs don't do the prep majority of the time!
Sometimes they do. You won't be thrown in blind to do anything alone.
The o.r. temperature is a common reason for contradiction between us (the nurses and surgers) and the anesthesiologists.They say that is always too low for them and they feel cold,"forgetting" the fact that the surgery team is under so many lights,wearing extra gowns,getting sweat..I wonder if that is an issue in your hospital as well or in somebody else's hospital..
The temperature war with anesthesia is real! We compromised on 68 degrees unless it was a child or trauma. As hot as I would get, I had to remind myself that it was imperative to the patient to keep their core temperature up. When we wheeled the patient into PACU, the nurse would have a thermometer in hand!
Hey @surgicaltechtips. I want your opinion on something. I'm just starting my surgery tech program and I just recently got a job as an EVS worker so I know the hospital from the ground up. I dont care about the money I genuinely want to help people. I am having a difficult time deciding between a pediatrician/family physician and a surgical assist. In your opinion what are the pros and cons to both professions? Like I said the money I make doesnt matter I want to help people get better and improve people's lives. Thanks!
Number 1 temp drop was when we put the IV in your arm when you got here
I got surgery a few months ago and I hardly remember anything after they put the Medicine in me before they wheeled me in
Yeah, that happens quite a bit. Oddly enough though, some people remember A LOT, which is crazy.
lucky you ...
Hello doc, how can I contact you? Respectfully,
Part 1 Dr. L. Ray Matthews
It’s not often that you hear about an accomplished, mainstream trauma surgeon getting laughed at by his colleagues after presenting an innovative health idea. It is even less often that a doctor receiving that kind of response would admit to the laughter and even take it with a smile. But in the case of Dr. L. Ray Matthews, an assistant professor of surgery at Morehouse School of Medicine and the Surgical Critical Care Director at Grady Memorial Hospital in Atlanta, Georgia, he would also end up winning over those other surgeons who were skeptical of his cutting-edge thinking.
“People always ask me about how a surgeon could get involved in vitamin D research,” Dr. Matthews says. “My answer is that being a surgeon, I’m very interested in wound infections and getting patients off of ventilators. I’m interested in helping my patients heal faster, and I want to decrease the incidence of pneumonia. Essentially, I want my patients healthy and out of the hospital as quickly as possible.”
All of these desires led Dr. Matthews, who wanted to be a physician since he was four years old, to his renowned work with vitamin D.
Power of Vitamin D
Case in point, last summer, Dr. Matthews and a team of Morehouse doctors published a landmark paper in the American Journal of Surgery looking at the benefits of vitamin D’s use in critically ill patients, such as decreased length of hospital stays, decreased hospital costs, and decreased mortality rates.1 Dr. Matthews and his team also pioneered a medical therapy combination of vitamin D, omega 3-fatty acids, glutamine, and progesterone to treat patients with concussions and traumatic brain injuries.
Dr. Matthews is now writing a manuscript on vitamin D’s use in reducing the incidence of congestive heart failure, which is expensive to treat because of the high readmission rate associated with the condition.
“We can cut the 30-day readmissions rate by at least 50% using vitamin D,” Dr. Matthews says. “Vitamin D is an inexpensive way to increase cardiac contractility because it increases calcium absorption.2 Calcium makes the heart contract, or beat, better.”3
Cutting hospital readmission rates, he says, is a top priority of the Centers for Medicaid and Medicare.
Defining a ‘D’ Deficiency
Vitamin D is a steroid hormone that directly influences over 200 out of some 20,000 to 25,000 human protein-coding genes and notably binds to a number of genes associated with autoimmune disease and cancer.4-6
“You can’t achieve optimal health, athletic performance, or cognitive performance without adequate vitamin D levels. Vitamin D is a very powerful chemical in the human body,” Dr. Matthews says.
He strongly urges people to get their vitamin D levels checked on a regular basis, and he is careful to note that the government’s currently acceptable level of vitamin D in the bloodstream, with a lower limit of 30 ng/mL, is far too low.7
“For me, anything in the 50 to 55 ng/mL range is where you want to be,” he says. “All animals in nature are between 50 and 55 ng/mL in the wild, but once we bring them into captivity, they drop. This happens in its own way to humans as well. When you’re in an Intensive Care Unit or another room in a hospital, your vitamin D level drops 50% in the first 24-48 hours. If you come into the hospital at 30 ng/mL, or below, and you drop below 18 ng/mL, your risk of death increases by 30%. It is a serious problem.”
Wait, I have a question. So when a patient gets rolled into an OR they are gowned and when they are in PACU (recovery) they’re gowned as well. Is a patient essentially naked while in the OR? Or just by the surgical site?
It depends on the surgery. Some surgeries require positioning after the patient is intubated. Then after they're positioned, we have to pad bony prominences and to avoid nerve damage. Then secure the patient for their safety. The gown can interfere with this. As soon as possible, I placed warm blankets wherever I could except for the area to be prepped and draped. Then after the patient is cleaned and bandaged, I put a clean, warm gown and warm blankets on.
While in surgery, does the human body have a smell when it is opened up? Is it a strong smell or mild? Also, have you ever encountered a strong smell that you had a hard time dealing with?
Smells depend on the case. A virgin body should have any distinct smell, but if you are operating on someone with an infection or dead bowel for example, you will have some pretty nasty smells to deal with.
Depends on the surgical site and the presence of an infection. For abdominal surgery, If the patient doesn't have an infection there is no smell other than the smell of cauterized tissue. But if you are draining an abscess, the smell can range from mildly off-putting to absolutely disgusting, same with a perforated bowel or ischemic tissues that have undergone necrosis and secondary infection.
Surgical Tech Tips do you think Vick’s vapo rub would help foil the smells? Would it be allowed?
@@aasldkfja you can put some vicks beforehand in your nostrils. It would also work if the circulator dabbed it on your mask. We kept wintergreen oil and peppermint oil on hand. That worked well on the mask, too.
Hi
HI
Is the patient’s temp constantly monitored like other vitals?
There are temperature strips that the anesthesia provider can stick on the forehead for an approximation.
Part 2.
Since the government has been lagging on this issue, Dr. Matthews has taken it upon himself to educate officials and explain the science and importance of vitamin D. He also believes that insurance companies are going to soon be all over the importance of the vitamin because it can prevent a lot of the chronic injuries that plague otherwise healthy people.
“I’ve met with a lot of government officials who didn’t know about what vitamin D can do,” Matthews says. “I’ve been giving lectures to educate them. You have to have a passion for it. Most people, once they see the evidence, accept what I’m saying. For instance, in our hospital, our mortality rate is down 42% with critically ill patients for all traumas with our new vitamin D protocol.”
Of course, Dr. Matthews wasn’t able to simply walk into his hospital and declare a new strategy for using vitamin D on all patients. It took much convincing, and that convincing began with, of all people, the staff nutritionist.
“The best way I could explain what I was talking about was to show the nutritionist our patients’ vitamin D levels as they were admitted,” he explains. “I would order the test right away and as they’d come back, I’d walk over to the nutritionist and show her. We had some horribly low levels. The average person coming into the ICU at Grady had a hydroxyvitamin D level of 15 ng/mL, which is very, very low. But we’d see people with single digit numbers. Four. Six. Once I showed the nutritionists these numbers, my question to them was, ‘Why aren’t you checking vitamin D levels?’”
VITAMIN D: THE EXPERIENCES OF A CUTTING-EDGE SURGEON
Vitamin D: The Experiences of a Cutting-Edge Surgeon
Dr. Matthews and a team of Morehouse doctors published a landmark paper describing the benefits of vitamin D’s use in critically ill patients, such as decreased length of hospital stays, decreased hospital costs, and decreased mortality rates.
Vitamin D is a steroid hormone that directly influences over 200 of some 20,000 to 25,000 human protein-encoding genes and notably binds to a number of genes associated with autoimmune disease and cancer.
“You can’t achieve optimal health, athletic performance, or cognitive performance without adequate vitamin D levels. Vitamin D is a very powerful chemical in the human body,” Dr. Matthews says.
Dr. Matthews presided over a parent-led vitamin D supplementation protocol at Martin Luther King, Jr. High School in Lithonia, Georgia, where the MLK football team has only had one concussion and almost a 100% reduction in sports injuries over the past two years.
Dissecting Low D Levels
Dr. Matthews points out that up until this most recent generation of children, people didn’t use much sunscreen, and they didn’t limit their time outdoors. Also, as technology gets better and better, fewer and fewer Americans are working outside. When you’re indoors, 98% of sunlight is blocked out.
“You can only make vitamin D from the last week in March until the first week in October,” he explains. “You need the sun at a ninety degree angle in the Northern Hemisphere to make vitamin D. Even in the winter we can’t grow crops or food or vegetables. This means most Americans aren’t making any D for close to five months a year. This is why D levels plummet in the winter and so many people get sick due to compromised immune systems. People get the winter blues and become ill.”
When you combine massively reduced sun exposure with an overall vitamin-deficient diet, you get the perfect storm of D deficiency that we see today.
“This deficiency is showing up everywhere,” Dr. Matthews says. Elite military personnel such as Navy SEALs experience a high rate of stress fractures-up to 23% during unit training.8 “They’re testing these soldiers, and their vitamin D levels and intakes are low.9 There is now a push trying to get the military to supplement the Navy SEALs with vitamin D,” reports Dr. Matthews.
“When your vitamin D level gets too low, it affects your skeletal system,” Dr. Matthews explains.12 “If your skull is made of bone, you can strengthen it with D levels to help it withstand hits. There is a direct correlation between the levels of vitamin D dropping in young athletes and the current rise of concussions.”
Beyond D
In addition to a vitamin D deficiency making skulls softer, Dr. Matthews has noticed how this deficiency, coupled with a few others, can negatively affect the human brain.
“The human brain is made up of 30% of the omega-3 fatty acid DHA,” he says.13 “Most people are omega-3 deficient. You don’t repair a brick wall with straw, but that’s what so many people are doing. Their brains and skull need reinforcements, and we’re not giving them the nutrients they need. Instead we’re feeding them omega-6s, sugars, chemicals, cakes, pies, and cookies, all of which are associated with inflammation. That’s like throwing gas on the fire. If you’re deficient in either omega-3s or vitamin D, you’re in trouble. Much of America is deficient in both.”
One of the most impressive things about Dr. Matthews is that he isn’t just lecturing based on an untested hypothesis. Time and again his protocols involving vitamin D supplementation along with other nutrients have shown remarkable results in his hospital.
A recent case in particular brought him some notoriety, when a 17-year-old girl showed up in his trauma unit after she was in a horrific car accident, including a devastating head injury. According to Dr. Matthews, over half of the patients with her type of head injury do not survive and another 47% are in permanent comas or severely impaired for the rest of their lives. The remaining 3% regain consciousness.
When the young woman was admitted to the hospital, she was immediately administered a regimen of vitamin D3, omega-3 fatty acids, glutamine, and progesterone. These nutrients saved her life. The doctors saw slight improvements every day and, only six months after an accident that should have either killed or incapacitated her, the young woman was walking and talking and close to acting as if the accident never happened.
Summary
“The body needs hundreds of different vitamins, minerals, enzymes, and nutrients to function properly,” Dr. Matthews says. “Americans may have nearly 60 deficiencies.14 I don’t have time to waste on something that’s not working, which is why I call vitamin D ‘God’s miracle vitamin’. It is the backbone drug supplement in treating traumatic brain injury because it works on so many levels.15 Vitamin D3 directly influences hundreds of human genes.4 That makes vitamin D a very powerful substance.”
Dr. Matthews is a full-time faculty member of Morehouse School of Medicine, Department of Surgery. He was appointed Assistant Professor of Clinical Surgery in February 2007. Dr. Matthews serves as a surgical critical care and trauma surgeon. Dr. Matthews completed a two-year surgical critical care fellowship at the Mayo Clinical College of Medicine in Rochester, Minnesota. He was a Senior Associate Consultant at Mayo Clinic in Rochester, Minnesota from 2004-2006. Matthews is a diplomat of the American Board of Surgery receiving certification in both General Surgery and Surgical Critical Care.
References
Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients.