Tunnel Vision

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Causes

  • Extreme fear or distress, most often in the context of a panic attack.
  • During periods of high adrenaline production, such as an intense physical fight.
  • Altitude sickness, hypoxia in passenger aircraft
  • Exposure to oxygen at a partial pressure above 1.5-2 atmospheres, producing central nervous system oxygen toxicity, notably while diving.  Other symptoms can include dizziness, nausea, blindness, fatigue, anxiety, confusion and lack of coordination.
  • Other loss of blood to the brain.

I think every Perfusionist has at some time experienced a Tunnel Vision episode.

It is almost a syrup like lethargy in our thinking process

that directs us to the safest outcome when confronted with unexpected events

The question is… Who’s safety?

Obviously it is concern for patient outcome that would or might induce a bit of panic if clinical circumstances were to start to spiral out of control.

But the deeper issue may be in confronting loss of control of the outcome on the part of the perfusionist.  We are used to controlling the pump-run from our side of the equation, and acquired coping mechanisms or algorithms for how to deal with unexpected events.

Typically that comes from experience, but what I have seen time and time again- is that somehow a new and very unique set of circumstances WILL congeal together, in an uncommon cascade of linear events that build upon each other as their timeline progresses, and present themselves to the clinician at hand with a whole new set of negative challenges, that need to be identified before constructing a framework for fixing it.

So what exactly sets off the Fight or Flight  reflex when an unexpected event occurs?

FEAR OF:

  • Loss of control
  • Making a Mistake
  • Patient outcome (death)
  • Loss of Composure
  • Loss of Surgeon Confidence
  • Inadequate Preperation
  • Unavailable Resources

And How can that be mediated ?

  • Trust yourself
  • Know your equipment
  • Know your available disposables
  • Know your staff capabilities- a non-perfusionist who you can turn to
  • Maintain your composure
  • Slow down a bit…  Think it through
  • Make a game plan, and don’t vacillate
  • Have a game plan for:
    • Oxygenator failure
    • Power Failure
    • Redirecting the ECC via alternative cannulation
    • Fixing broken or blown up parts of the circuit (eg; over pressurized and ruptured Cardioplegia system, pressure domes, line separations
    • Know where your hand cranks, flash lights, O2 supply, power sources, and backup equipment is
    • Ask for and ALLOW people to help
    • Be able to talk anesthesia, the surgeon, the scrub team, or the circulating nurse through the steps they need to take to assist you.
    • Realize everybody wants to- and is- trying to help.  Listen to them.
    • Just trust yourself.

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