Introduction to Surgical PA Student

Question 1

team approach to surgery

Answer 1

• •Surgeon
• •First Assist: Assistant Surgeon or PA or RNFA
• •Scrub/Surgical Tech
• •Circulating RN
• •Anesthesiologist
• •Orderly

Question 2

surgeon

Answer 2

• He/She is the focus when entering the room
• Never talk about another surgeon
• Never talk about personal life – unless asked and then be quick
• Only talk in response to surgeon
• Never initiate conversation with anyone in the room during surgery
• Always call a doctor “doctor” unless a relative or significant other
• If surgeon asks what area of medicine you are interested in – your answer will be the specialty of the surgeon

Question 3

first assist/assistant surgeon

Answer 3

• •To assist the surgeon by EXPOSING the target organ or field using retractors
• •To keep the surgical field clear of blood/fluid by using suction or sponges
• •Knows the surgical technique and relevant anatomy and is able to anticipate the surgeon’s next step

Question 4

who can be an assistant surgeon or first assist

Answer 4

• •A PHYSICIAN ASSISTANT
• •AN MD/DO
• •AN RNFA
• •Not an NP – NOT TRUE! NPs can be first assist but they have to do an additional training program
• A First Assist is written in the OP report – liability is established –have to be covered by Malpractice
• An RNFA is limited by his/her license – has restrictions – LOT of hospitals won’t use them – summit
• Only NP/PA can assist
• Give story of RNFA that was working in capacity of RN

Question 5

what can first assists do under direct supervision?

Answer 5

• •Incisions
• •Placement of laparoscopic and robotic trocars
• •Cutting/tying VESSELS
• •Drilling/sawing/malleting BONE
• •Laparoscopic stapling/clipping/cutting of tissue/vessels
• •Placement of drains
• •Any invasive action

Question 6

what can first assistas do without direct supervision?

Answer 6

• •closing all incisions
• •sewing in drains
• •Stapling skin
• •Steristrips/dressings
• •removal or placement of bladder catheter
• •whatever needs to be done before the patient moves off operating table

Question 7

scrub or surgical tech

Answer 7

• maintains sterile field and control of surgical instruments
• Sterile
• Hands instruments to surgeon and assistant
• Don’t distract them
• Don’t touch their mayo stand
• Can help them by keeping them one step ahead of surgeon – you better be right though!
• •PASSES STERILE INSTRUMENTS AND EQUIPMENT TO SURGEON OR ASSISTANT SURGEON
• •RESPONSIBLE FOR KEEPING COUNT OF SUTURE NEEDLES AND LAP SPONGES ETC

Question 8

circulating nurse

Answer 8

• •Monitors Sterile vs Non-Sterile Field
• •Non-Sterile person
• •Provides Scrub with whatever the Scrub wants!
• •Assists Anesthesiologist
• Is not sterile but monitors sterile vs nonsterile field
• Is the bossy one – make friends first!
• When contaminated – stop what you are doing! Alert the nurse/scrub tech
• If someone says you are contaminated – you are
• If you “think” you have contaminated something – you did
• •Once patient is on the OR table, will ready the patient for surgery by:
  
  • •Placement of EKG leads
  • •BP cuff
  • •Finger oximeter
  • •Sequential Devices for legs – inflatable pillows that squeeze and inflate the legs to prevent DVT
  • •Blankets for warmth
  • •Placement of foley catheter

Question 9

anesthesiologist

Answer 9

• •STANDS AT HEAD OF PATIENT
• •PREOXYGENATES AND PUTS PATIENT’S TO SLEEP
• •PROVIDES LOCAL/REGIONAL ANESTHESIA
• Put patient to sleep
• Stand at head opposite nurse to assist anesthesiologist or to make sure patient has been intubated – don’t’ do this unless you want to be asked to put leads on patient
• Once patient is intubated, you can leave room to scrub
• Don’t get into anesthesiologist space
• Will take over after surgeon leaves
• Try to keep an eye on monitor during surgery – lots of bleeding – look at monitor – is blood pressure up? Is the patient moving, tell anesthesia
• Story of patient de satting during surgery and I climbed over to start compressions
• •MAINTAINS PATIENT’S AIRWAY
• •MONITORS RESPIRATORY AND CARDIOVASCULAR STATE
• •MAINTAINS HEMODYNAMIC STABILITY

Question 10

orderly

Answer 10

• Are responsible for bringing pt to room and transferring patient from bed/gurney after surgery
• Will also get anything you want – the unsung hero-s – lots of obese patients