Fundamental TechniquesSFA 273
Prerequisite: Admission to the Surgical First Assistant Program. Requires concurrent enrollment in SFA 271. Covers the theory and practice of pre-operative, intra-operative and post-operative functions and techniques of a Surgical First Assistant. (30-30)
Outcomes and Objectives
Discuss physiologic monitoring of patients undergoing surgery and the placement of monitoring devices.
- List the common types of noninvasive and invasive monitors used intra-operatively and discuss their potential complications.
- Discuss the SFA’s responsibilities with regard to intra-operative patient monitoring.
- Define “vital signs”, explain why they are important, describe how they can be measured, and list their normal ranges in an adult.
- Define terms used to describe abnormalities in vital sign measurements.
- Explain the importance of monitoring urine output and body temperature and identify abnormalities that must be reported.
- Discuss CVP lines, PA catheters, end-tidal CO2 monitors, pulse oximeters, peripheral nerve stimulators, and special monitors specific to surgical specialties.
- Define terms related to hemodynamic monitoring.
Explain various methods of post-operative pain control.
- Explain why it is difficult to differentiate whether a patient under Local anesthesia is feeling pain or pressure, and discuss how the O.R. personnel can affect what the patient is experiencing.
- Describe three types of somatic pain sensation (sharp, burning and aching) and explain how visceral pain differs.
- Explain the “gate control” theory of pain, using the diagram provided in class, and relate acupuncture, TENS units and dorsal column stimulators to the “gate” concept.
- Explain “descending” pain control physiology, relating serotonin, enkephalins and Substance P to the diagram provided in class.
- List the physiologic responses to unrelieved pain in a post-operative patient.
- Discuss the mechanism of action, advantages and risks of intrathecal or epidural narcotics.
- Demonstrate the proper method of injecting a local anesthetic into the subcutaneous tissue when closing a wound.
Demonstrate the preparation of a patient prior to surgery.
- Demonstrate an understanding of the preoperative assessment of the patient.
- Recognize the need for surgical intervention.
- Understand patient considerations when preparing the patient for surgery.
- Describe the proper attire for a patient entering the O.R. and explain the safety reasons for these rules.
- List the indications for bladder catheterization and discuss possible complications and appropriate actions.
- Describe the principles of performing urinary catheterization and be able to demonstrate proper technique.
- List the essential elements of proper positioning of a patient and discuss the safety precautions to be observed.
- Discuss pre-operative preps and indications for hair clipping.
- Describe and be able to demonstrate the correct method for various kinds of pre-operative wash preps, including the appropriate choice of antiseptic agent.
- List the basic principles of draping and be able to demonstrate standard draping procedures and variations.
- Discuss the correct placement, pressure settings, inflation time limits, and possible complications of a pneumatic tourniquet.
Demonstrate understanding of methods of tissue handling and techniques of instrument use.
- Identify the indications, advantages and disadvantages for various types of abdominal incisions.
- List the general rules of gentle tissue handling and compare different methods of tissue dissection.
- Discuss the factors involved in the appropriate selection of instrumentation and the potential hazards from the improper use of instruments.
- Describe and demonstrate proper body mechanics when using various kinds of instruments.
- Compare various methods of tissue retraction.
- List the types of surgical lasers and the characteristics, common uses, and preparation and safe use of each.
- Discuss the surgical uses of ultrasound equipment.
Demonstrate methods of providing visualization of the operative site and of hemostasis.
- Discuss the various methods of wound visualization.
- Discuss the principles of selection and proper use of different kinds of sponging materials.
- Describe the proper use of suctioning equipment.
- Discuss the purposes and methods of intraoperative irrigation, and list the types, possible side effects and contraindications for various irrigation solutions.
- Discuss the different types of bleeding and the SFA’s role in achieving hemostasis.
- List and define terms relating to different ligating methods.
- Discuss the uses of operating microscopes and the role of the SFA.
Demonstrate appropriate methods of tissue approximation.
- List characteristics, common uses, and contraindications different types of suture materials.
- Discuss the principles and appropriate uses of the various types of suturing techniques.
- Demonstrate a clinically acceptable level of surgical knot-tying techniques.
- Discuss the uses of different types of surgical stapling appliances.
- Demonstrate a clinically acceptable level of suturing techniques and other methods of tissue approximation.
Discuss actions that complete a surgical procedure.
- Describe the proper methods for handling various types of surgical specimens and discuss the SFA’s role in the care of specimens.
- Discuss the purpose, proper usage, and potential complications of wound drainage.
- Compare the usage of different types of drainage systems.
- Discuss and demonstrate the proper selection and application of wound dressings.
- Discuss the factors concerning the surgical procedure and the patient’s condition that affect the choice of dressing materials and technique of application.
Demonstrate understanding of methods of blood volume replacement.
- Discuss factors involved in blood transfusion compatibility and the techniques of blood compatibility testing.
- List the physiologic effects of massive blood transfusion.
- Compare the risks involved in using banked blood, directed donation, or autotransfusion.
- Describe various methods of preoperative, intraoperative and postoperative procurement of autologous blood.
Discuss human body thermoregulatory mechanisms and their considerations for surgery.
- Discuss the SFA’s responsibility for skin assessment and for reporting and documenting skin changes.
- Identify possible sources of intraoperative heat or cold injuries to tissue.
- List indications for systemic intraoperative warming and cooling, and discuss possible complications from the use of thermoregulatory devices.
- Explain how General anesthetic agents affect the normal thermoregulation mechanism.
- Discuss the indications and proper procedures for measuring intraoperative blood loss and urine output.
Describe special considerations in selected types of surgical procedures.
- Discuss the principles and uses of various circulatory support devices.
- List the advantages, disadvantages, and relative contraindications for laparoscopic General surgery.
- List common types of endoscopic procedures performed in the various surgical specialties.
- Discuss the correct preparation and use of endoscopic and operative video equipment.
- Discuss the appropriate role of the SFA during endoscopic procedures.
- Discuss the SFA's role during vascular surgery.
- Describe the proper preparation and use of biologic and synthetic vascular grafts and other surgical implantable devices
- Define terminology associated with bone fractures and dislocations, types of reduction and fixation, and bone healing.
- Compare and give examples of systems of orthopedic internal and external fixation devices and prosthetic equipment.
- Discuss the healing process of fractures, the problems of non-union, and the use of bone grafts and electrical stimulation.
- Demonstrate an understanding of the SFA role in robotic surgery.