Recent comments in /f/askscience

Equal-Dinner t1_j1zdv3k wrote

Reply to comment by Sylvurphlame in How do shifts work on really long medical operations? by TerjiD

they do, but is not like they would eat cookies which would crumble, but yes. The OR is clean but not completely sterile, what's sterile is the tools, instruments, operating bed and some other things that go in direct contact with the patient. So like a bonbon is not that weird. Plus, they don't feed them while being directly over the patient.

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aedes t1_j1zanp5 wrote

Reply to How do shifts work on really long medical operations? by TerjiD

To add to what others have said, and to make this more generalizable outside of just medicine...

Swapping out people who have been working a long time for fresh people is limited by two factors:

  1. The availability of fresh people. There are often alternate nurses available for a very long case. In some situations there may simply not be another surgeon available. This is part of the responsibility that comes from being in positions of leadership, or having a very specialized knowledge base and skill set. In times of “crises,” you may be working absurdly long hours for a very long time.

  2. Transitioning to a fresh team is associated with its own risks. The fresh team will be less familiar with what’s going on, and miscommunications about the situation may occur during the transition. A critical event that happens during the transition may also be disastrous due to unclear individual responsibilities and communication flow.

There have been scientific studies on patient outcomes with physicians working either very long shifts, or shorter shifts but with more “signovers” of care happening. There was no improvement in patient outcomes with shorter working hours, presumably because of the risks that occur due to care transitions.

Balancing the above points is something that must be done in many situations, not just medicine.

How does the military decide when to switch out troops in a war zone?

How should government deal with decision making during a prolonged and intense period of time?

Etc.

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Sylvurphlame t1_j1z93ti wrote

Reply to comment by ryanveilleux1 in How do shifts work on really long medical operations? by TerjiD

The poor dude running the fluoroscopy might have to stay there the whole time. Source: I’m that dude. My personal record is about 9 hours, although I took a couple quick pee breaks. (Busy day so no longer term relief available.)

I’ve also seen a few cases where a partner comes in to relive the attending on particularly long spine cases. I’ve seen a couple 10-12 hour cases. I don’t have personal experience with those legendary 16-24+ hour traumas though.

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przyssawka t1_j1z731i wrote

Reply to comment by skisushi in How do shifts work on really long medical operations? by TerjiD

Yes but as you mentioned for stuff like anterior or lateral approach skull base surgery or large tumor dissections we do take turns. it’s usually a combined effort by neuro, maxfac and ENT. Compare it to stuff like transplantology where one team usually handles the entirety of the procedure.

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skisushi t1_j1z6n2a wrote

Reply to comment by przyssawka in How do shifts work on really long medical operations? by TerjiD

Head and neck surgeons do orchestrate some of the most complex and difficult surgeries though. You may have several teams doing different parts of a surgery and take turns. I have seen as many as 4 or 5 teams work together. Neurosurgery, ophthalmology, plastics, OMFS and ENT/ HNS all can participate on some large tumor resections and reconstructions. When actively involved you can get so focused that food, pee breaks, etc don't cross your mind for 8 to 12 hours. Then you finish and it all catches up to you.

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enricobasilica t1_j1z5kfv wrote

Reply to How do shifts work on really long medical operations? by TerjiD

Watched a couple of BBC documentaries on specialty surgeries. Depending on the kind of surgery and if you are lucky enough to have 2 specialists in the same hospital, you miiiight be able to do a handover partway through. In cases where its not possible, you would try and limit the amount of time the specialist is actually working (eg where they let someone else do the "easy" bits and only have the specialist work where needed). But otherwise it seems 12-18 hour operations arent uncommon. Not sure if this is varies by country, but at least the episodes I saw, if it was going to be crazy long they might try and see if its possible to do the surgery in 2 phases to break it up so the surgeon can have a break in between. But thats not always possible obviously.

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przyssawka t1_j1z3ra4 wrote

Reply to comment by Wireeeee in How do shifts work on really long medical operations? by TerjiD

We eat and drink coffee during shifts, nothing different compared to an office job. Part of resilience is definitely adaptation though, residency is exploitative. My speciality doesn’t have those 20-ish hour procedures (at least none that would be all-HNS team) so no surgeon rotation, if it’s 4-5h in the OT you’re stuck there for 4-5h. Then again, hunger or sore legs is the last thing you’re concerned with assuming you’re actively participating, even more so if you’re the primary surgeon.

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