Intro to Surgical Care Quiz

Surgical Care Overview

• Pre-operative activities focus on optimization, safety, risk mitigation, informed consent, patient/family education, and care coordination.
• Intra-operative procedures prioritize safety and risk mitigation, including intubation and extubation.
• Post-operative care emphasizes safety, homeostasis, and vital monitoring including airway management.

Key Surgical Equipment

• MAYO stand, surgical light, back table, operating table, anesthesia cart, BOVIE (electrocautery) essential for procedures.
• Maintenance of a sterile surgical field involves using sterile drapes, towels, and eye protection.

Key Personnel in Surgical Care

• Attending surgeon, fellows, residents (5th year chief, junior), interns, students crucial for surgical teams.
• Anesthesia team includes anesthesiologist, CRNA, anesthesiologist assistants.
• Operating room staff: circulating RN, scrub RN/first assist, certified surgical tech, operating room director, recovery room nurse.

Role of the PA

• Pre-operative: handles risk mitigation, optimization, informed consent, patient education, documentation, and care coordination.
• Intra-operative: assists in safety and optimization, acts as first assist, may participate in closure.
• Post-operative: manages risk mitigation, post-op orders, documentation, education, wound care, care coordination.

Surgical Terminology

• Terms provide insight into procedures:
  • CHOLE: gallbladder
  • MAST: tumor removal
  • THORO: thorax
  • PLEURO: lung
  • SPLEN: spleen
  • NEPH: kidney
  • LAPARO: abdominal
  • ENDO: esophagus
• Suffixes indicate procedure types:
  • -ECTOMY: surgical removal
  • -OTOMY: creating an opening
  • -OSCOPY: using a scope
  • -CENTESIS: draining fluid
  • -PEXY: fixating
  • -PLASTY: repairing or reorganizing
  • -STOMY: opening with a pouch.

Never Events in Surgery

• Defined as serious, preventable adverse events that should never occur:
  • Wrong site, patient, or procedure surgeries.
  • Retained instruments or foreign bodies.
  • Death of a previously healthy patient post-operatively.
• Mitigation strategies include implementing Universal Protocol, strict counting protocols, and robust communication methods.

Fluid Resuscitation

• Maintenance fluid requirements calculated using the Holliday-Segar method.
• Initial bolus of isotonic solutions is crucial for severe dehydration cases.
• Continuous monitoring and adjustments based on vital signs and urine output are essential for patient safety.

Preoperative Testing and Evaluation

• Lower Risk Procedures: Require thorough medical histories; routine testing often unnecessary.
• Intermediate and High Risk Procedures: Require additional screening focused mainly on cardiopulmonary health.
• Key considerations include history of cardiopulmonary disease, significant medical history, anesthetic history, and potential drug interactions.

Identifying Additional Tests

• Elective surgical candidates may require further assessments based on their health, especially those exhibiting risk factors including advanced age and abnormal EKG patterns.
• Pre-operative testing typically includes a resting 12-lead EKG for specific demographics and conditions, with lab tests tailored to the patient's background.

Summary of Patient Preparation

• Optimal outcomes in elective surgeries depend on assessing patient health and mitigating risks associated with surgical stress.
• Continuous assessment of the patient's condition before surgery can lead to improved recovery and surgical efficiency.