Sunday, November 20, 2011

Cold OR s

Once again I am poaching one of Great Z's posts.

When patients arrive in the room and remark how cold the room is, the nurse will inevitably reply, "But our hearts are warm."

Canadian surgeons like their American colleagues, like the room cold. Some anaesthesiologists try to fight back. This has lead to at least one surgeon storming out of the room stating they would cancel the rest of their list unless the room temperature was turned down. Some orthopods claim the bone cement won't set properly. I used to turn the temperature up at the end of the case while the resident was closing, stating that the patient was cold and I needed to warm him up. My real motive was to make the resident uncomfortable that he would actually work faster and win the race against the fibroblasts. I once made a resident almost faint, something that I am immensely proud of.

During the summer our hospital runs the air conditioning on full blast. I once asked the resident how much fossil fuel was being burned to make everybody uncomfortable. Once when the recovery room nurses noted how cold my patient was, I asked them to take my temperature, which they did with their ear thermometer. My temperature was 35. I am sure it has been colder. One of the rooms at the C of E had a vent which blew cold air full-blast over the chair of anaesthesia. They liked to do long cases at night in this room, so you could be both cold and tired.

Our ortho surgeons are not just content to make everybody else uncomfortable. They have made the hospital spring for water cooled vests for long cases and elaborate helmets with fans for total joints. Meanwhile I have asked for a desk light for my anaesthetic table so I can read the ampoules when they turn off the room lights and am always told it is too expensive.

Meanwhile Bair Huggers proliferate around the ORs; our patients even get them pre-operatively now. This is wasted because mainly nurses will not allow you to turn on the Bair Hugger until the patient is draped believing that the Bair will blow germs all around the sterile field (I turn it on anyway). Nobody ever asks if there might be a cheaper way to keep patients warm. Surgeons and nurses don't make it easy by insisting on huge operative fields. Every time I get asked to move one of my EKG chest leads so they can prep the chest for an abdominal procedure, I ask them if they are going to take the gall bladder out thru the sternum.

Of course people go too far in the other direction. Our charge nurse in plastics made keeping patients warm her mission which meant that our burn patients had an array of warming blankets, fluid warmers and radiant heaters. Periodically burn patients would come to the OR febrile so I would turn off everything, she would come back from one of her many breaks, turn everything back on and so it went. Pointing out the patient's temperature was of no help.

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