PAGuy55 Posted January 27, 2014 Share Posted January 27, 2014 First off, I want to say excuse me that this is posted in your section of the forums. I am not a PA-C (yet). I decided to post here because I wanted to see if anyone faced a common issue and was able to overcome. I've read a lot about this on the studentdoc forums (vasovagal syncope) but the search button on here only pulled up a few instances. I've gotten advice such as watching youtube videos, not locking knees, eating beforehand, fueling on liquids (gatorades, water), crackers and applesauce. AKA avoiding hypoglycemia shock. What happened in detail: So, I've been shadowing a critical care PA-C. Let me start off by saying that I really love it! (besides all the administrative duties..but that's ok). I've been shadowing consistently on the nightshift and have observed bronchoscopies, A lines, central lines, intubation..etc. But, I keep having the issue of lightheadedness. I haven't gotten to the point of syncope yet, but each time this occurred (numerous already..3 times yesterday) I would have to excuse myself from the room and take a seat + get water/gatorade/applesauce. This was my routine last night before heading in to shadow: I ate around 7:00 PM (big meal), fueled up on water and bananas. I got to my PA around 1:00 AM. Observed a few patient histories, two codes, then finally a patient who needed an A line and central line. I was fine once the procedure began and I made it through the central line operation fine. Then as the PA was putting in the A-line, the patient began moaning and suffering. At this point, I started feeling lightheaded (blurry vision, ears ringing) and I had to sit down. I was fine after about 5 minutes. Then we trailed into the Burn ICU, I downed two gatorades + applesauce while she was writing her notes and then we scrubbed in for the next procedure. I made it through the bronchoscopy with no problems. Then she began the central line (femoral) and an A line. I observed the central line with no issues but once she was sewing up the A-line, I got the feeling again. Lightheaded, blurred vision, ringing…I was pissed. As noted, I had fueled up (two gatorades and applesauce) but still this feeling returned. It was embarrassing. The PA I was shadowing informed that it would be okay and that I only needed more exposure to break this. Is this honestly true? If you were able to overcome this, how did you? I tried fluid/electrolytes but that did not seem to work. I loved every aspect of her work and could see myself continuing in this path but I don't know if I should due to my lightheadedness that seems to take over. My second path is Ph D in biomedical science, but I really don't think I want to leave this career path because of this issue. Any help/suggestions would be great. I appreciate it. Link to comment Share on other sites More sharing options...
wjm7 Posted January 27, 2014 Share Posted January 27, 2014 Might be easier for you to acquaint yourself by shadowing in a less intense setting, maybe in family practice. You'll see all sorts of wild stuff there as well, but I don't think it would be as overwhelming as shadowing a critical care PA. Maybe make that something you work toward by desensitizing yourself via less intense procedures and patients. Good luck, and hang in there! Link to comment Share on other sites More sharing options...
Guest Paula Posted January 27, 2014 Share Posted January 27, 2014 ^^^^^^ I agree. Don't give up the career path for a little bit of nausea and lightheadedness. FP will ease you into all the bodily fluids a bit more gently as well as procedures. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 28, 2014 Moderator Share Posted January 28, 2014 unlock knees tighten up your core muscles tighten up your quads, calfs and hamstrings drive all the blood back up to your noggin so that you don't pass out... hang in there - it does get better Link to comment Share on other sites More sharing options...
JFarnsworth Posted January 28, 2014 Share Posted January 28, 2014 It happens... just try to stay hydrated, exercise frequently, eat every few hours, get lots of sleep, avoid alcohol, and ?check if you're pregnant (not sure if you are male or female, sorry)? or diabetic. You might get some labs and a physical, as near syncope could be from arrythmias, anemia, valve disorders, or other problems. I wouldn't just chalk it up to vasovagal near syncope without excluding other things first . Focus on your breathing (I know that sounds new agey) but remind yourself, big breath in through your nose, slow exhale through the mouth. This has happened to me in the OR during a 3 AM lap chole but a shot of OJ got me right back in there. The only other time this happened to me was when I was pregnant. Good luck and keep us posted! Link to comment Share on other sites More sharing options...
rcdavis Posted January 28, 2014 Share Posted January 28, 2014 I don't stop in often, but may I humbly suggest that when you have these symptoms someone check your vitals and maybe throw you up on a non invasive monitor. Hate to miss intermittent svt/afib, sick sinus and assume neurogenic syncope... Just saying. Link to comment Share on other sites More sharing options...
cbrsmurf Posted January 30, 2014 Share Posted January 30, 2014 Given that this happens specifically during an invasive procedure/bleeding, (and assuming our light-headed friend here is in his 20's or 30's) is an evaluation really necessary? Honest question. Also consider (in addition to what ventana suggested) having a strong-smelling scent (i.e. smelling salts) on hand or rubbing a strong lotion on your upper lip. Sometimes olfactory stimulation mitigates the effects of vasovagal reactions. Link to comment Share on other sites More sharing options...
Guest Paula Posted January 30, 2014 Share Posted January 30, 2014 ^^^^^^ you triggered my memory of cadaver lab. I rubbed spearmint aromatherapy lotion under my nose before each class. Prevented me from throwing up from the smells. Link to comment Share on other sites More sharing options...
winterallsummer Posted January 30, 2014 Share Posted January 30, 2014 I think most of us experience this feeling with different procedures. It does absolutely get better with more exposure. Nothing to be embarrassed about. There are ER PAs who at once point in their lives used to get sick at the sight of blood, ICU PAs who used to dislike needles, etc. I also second shadowing a less procedure based specialty such as family med or any out patient setting, because it is a totally different experience all together. It certainly can be embarrassing but in all honestly, it is really only a big deal to you. Most PAs and docs can relate and emphasize with this situation. Pre-syncope 3 times in a row in 1 day is a little bit of a red flag, I think would be worth mentioning to your PCP on next visit, but I still think it's most likely vasovagal unless you experience pre-syncope in other settings. For example with exertion or excitement or even unprovoked. Or if you experience shortness of breath or palpitations in other occasions, or if you are older than 20s/early 30s. Link to comment Share on other sites More sharing options...
PAGuy55 Posted January 30, 2014 Author Share Posted January 30, 2014 Thanks for all of the great feedback. I appreciate it. A few things. I called around and found a PA who will let me shadow at a family practice. I'm still shadowing critical care and emergency room PAs as well, so hopefully with more exposure this can settle. Second, I'm only 22. And I have never had a response like that before. The only time I felt something similar was a time where I felt dehydrated. The whole 3 times in a row definitey was out of the ordinary. Blood doesn't make me nauseous either so I'm not too certain what was going on. Again, thanks for the feedback, encouragement and advice! Link to comment Share on other sites More sharing options...
PAGuy55 Posted October 20, 2014 Author Share Posted October 20, 2014 Well I know this is old, but to follow up this does not occur any longer! I will be applying this upcoming cycle and I cannot wait! On a side note, after shadowing more and developing my HCE this year, I've noticed a trend. Various health professionals asking me asking me "You're so young, why not medical school?" Some make it seem as if I'm settling for PA school (makes me gag). I had a nurse tell me the other night at work, "Most PAs went to PA school because they couldn't make it to med school" Literally To. My. Face. This individual was studying for NP school (go figure). I usually don't give a crap what others say but it gets frustrating and pretty disrespectful. Is this something you all experience on the daily? Talk about trying to get a brother down lol. Link to comment Share on other sites More sharing options...
RichardLPeeA Posted October 20, 2014 Share Posted October 20, 2014 Well I know this is old, but to follow up this does not occur any longer! I will be applying this upcoming cycle and I cannot wait! On a side note, after shadowing more and developing my HCE this year, I've noticed a trend. Various health professionals asking me asking me "You're so young, why not medical school?" Some make it seem as if I'm settling for PA school (makes me gag). I had a nurse tell me the other night at work, "Most PAs went to PA school because they couldn't make it to med school" Literally To. My. Face. This individual was studying for NP school (go figure). I usually don't give a crap what others say but it gets frustrating and pretty disrespectful. Is this something you all experience on the daily? Talk about trying to get a brother down lol. She is either socially inept, or just a petty person to say something like that to someone who is following their dreams. Remember, never punch down. Link to comment Share on other sites More sharing options...
Boatswain2PA Posted October 20, 2014 Share Posted October 20, 2014 So....why NOT medical school? You certainly dont have to answer me, but you owe YOURSELF an answer to that question. Link to comment Share on other sites More sharing options...
PAGuy55 Posted October 20, 2014 Author Share Posted October 20, 2014 Yeah definitely. It's just not what I want in life/career. Too much sacrifice of my personal life for a career. I just took my first airplane ride last month and there is still so much of the world I want to see. I don't want to live a hospital but I don't want to work anywhere else. I've seen how much autonomy PAs can have (in critical care we never once were with the attending except during a code call. She updated him when we all met at the patients room who was coding but it was a false alarm, then left and we were on our way to finish rounds, intubations, central lines, bronchs, etc. on her own). What I have seen is definitely more than enough work for a day. In the end of the day, she loved her job and thats what I want. The physicians she worked for were excellent and treated all the practitioners with the upmost respect. In the end, you will almost always have a boss unless you run the damn practice and all in all I just want to be happy. I know being a PA will bring that for me. Now that I know (after shadowing ER) that I can also continue with my education with a residency program designed for PAs then it makes it so much more enticing. Link to comment Share on other sites More sharing options...
PAGuy55 Posted October 20, 2014 Author Share Posted October 20, 2014 It was a male who said that not a female btw. That guy was the worst lol Link to comment Share on other sites More sharing options...
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