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Published byClaude Moody Modified over 9 years ago
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Requires a working knowledge of the sequential steps for a specific surgical procedure based upon four concepts: Approach Procedure Possible Complications Closure
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Determined by Physician Approved by Anesthesia Based upon positioning of patient Offers the best exposure Has the lowest amount of tissue trauma Subject to change given the situation
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Determined by the Physician Agreed to by the patient Specific principles of surgery Basic principles applied from similar surgeries Services related to surgical intervention
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Known and unknown factors Short term and long term Direct and indirect Towards the patient Towards the Surgical team Towards the environment
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Determined by Physician Many different methods May not be able to close operative site Marks the beginning of recovery
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Preparation Preincision Operative Sequence Closing Post operative
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Selection of room and supplies Preincision count
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Transfer and positioning of Patient Induction Prep and drape Suction and electrosurgical equipment
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The skin and subcutaneous tissue are divided with a skin knife Knife is placed on backtable
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Bleeders are dealt with by electrical or mechanical hemostatic means according to surgeon’s preference A raytex sponge or laparotomy sponge (lap) is used to aid in further visualization for sources of bleeding
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A clean knife, Metz scissors, or cautery are used to incise deep fascia and peritoneum Various instrumentation is used to elevate tissue and expose tissue that is to have surgery performed on it For example a hemostat may be used to elevate the peritoneum to avoid damage to underlying contents as it is penetrated and cut with a cautery Toothed forceps are use on fascia
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Operative area is explored and pathology is isolated At times the operative site is obscured by surrounding tissue Bone will be scraped to expose a fracture for plating and screw application Sponges, retractors, tissue extraction, and manual manipulation of tissue may be used to maximize exposure
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Excision or revision Depends upon purpose and local anatomy May require a certain amount of dissection Instrument length increases with depth of incision Needed instruments and supplies given to surgeon as needed
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Operation focuses on removal, resection, reconstruction, or all to correct abnormality May require specialized instruments
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Prep for closing Control bleeding Irrigate wound with saline with or without antibiotics Insert drain if needed
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Gather specimen Identify specimen verbally to surgeon then to circulator prior to passing off Pass off field to circulator (ask surgeon’s permission) Be sure to ask how specimen is to be preserved (permanent or frozen/fresh)
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The first count takes place before the any cavity is closed. This means everything! The second count is done after the cavity and fascia are closed serially, again everything! If a cavity has not been entered all sponges and miscellaneous items must be counted and verified prior to wound closure Anesthesia reversal and stabilization Application of dressing and tape
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Maintain sterile field until patient stability has ensured by the anesthesia provider Get their permission to break down Some cases require preservation of the sterile field until the patient has left the room: any case where airway compromise is a potential complication (Thyroidectomy/parathyroidectomy/facial or throat surgery) and any case that has potential hemorrhage as a complication (Carotid artery endarterectomy/Abdominal aortic aneurysmectomy /trauma) Prepare to transfer Transfer to PACU Post-procedural routine
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Discussed the four concepts of surgery Named five phases of surgery and discussed them Discussed preparation, preincision operative, closing, postoperative phases. Discussed in depth the seven steps in the operative sequence
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