Prerequisites: Prerequisites: SFA 271, SFA 273 each with a minimum C (2.
0) grade. Concurrent enrollment in SFA 275. The course is designed to promote an understanding of microbial physiology which precedes the understanding of disease transmission and or prevention, including standard precautions and infection control. The pharmacology section of the course is designed to promote an understanding of the effects of pre, post and operative drugs. The anesthesia section of the course is designed to promote an understanding of general principles/techniques and drugs used by anesthesia and their effects on the patient. The course will also introduce the student diagnostic testing such as radiology, laboratory and cardiographics. Wound healing, All Hazards, Trauma, nutrition perioperatively, fluid and electrolyte balance and techniques in maintaining homeostasis will be reviewed (90-0).
Outcomes and Objectives
Use terminology that is specific to pharmacology.
- Define the differences among a drug's chemical name, generic name, and registered/trade name.
- Discuss the advantages and disadvantages of different routes of administration for drugs.
- Define terms that describe the actions or effects of a pharmacologic agent.
- Analyze perioperative principles of patient assessment and how they relate to anesthesia.
- Consider the goals of anesthesia as it relates to the perioperative patient in the surgical setting.
- Assess the risks and adverse effects of anesthesia, conscious sedation, local anesthetic agents, and pain management in the surgical setting.
- Demonstrate an understanding of anesthesia, conscious sedation, local anesthetic agents, and pain management as it relates to the perioperative patient.
- Understand the principles of local injection techniques.
- Examine the application of topical anesthetic agents.
Discuss disorders of tissue growth related to radiation therapy, chemotherapy, and immunotherapy.
- List the direct and indirect effects of ionizing and non-ionizing radiation on cells.
- List and define the types of purposeful, non-neoplastic, and neoplastic tissue growth and give examples.
- Describe the essential differences benign and malignant tumors.
- Describe the three types/classifications of cancers and the histological and physiological characteristics of each.
- Describe the process if metastasis.
- Explain what ionizing radiation does to both normal and malignant tissue, including the dangers of underdosage and overdosage in therapeutic use.
- Identify the sources, attributes, and uses of external/internal radiation methods.
- Describe how the complications/side effects of radiation therapy relate to the susceptibility of normal cells.
- List the general safety rules for working around radioactive materials. Describe radiation hazards to personnel and the proper monitoring precautions.
- Identify the characteristics of irradiated tissue and their relevance to subsequent surgical intervention.
- Compare and contrast the mechanisms and side effects of radiation therapy, chemotherapy, and immunotherapy.
Discuss routine laboratory tests, diagnostic imaging, and electrocardiogram information in the assessment of the surgical patient.
- List the standard components of a CBC and the normal values of each.
- List the two main mechanisms that can produce anemia.
- Describe in what ways an RBC count, a WBC count, a hemoglobin, and a hematocrit give different and complementary information and how it affects surgical patients.
- Discuss why leukopenia is generally a contraindication for surgery.
- Describe a Differential Count and its clinical relevance.
- Describe what kinds of conditions can elevate or decrease a BUN.
- Describe the difference between HDL’s and LDL’s.
- Describe what information in lab tests can assist with diagnosis and treatment of the most prevalent disorders.
- Describe the differences between hypokalemia and hyperkalemia.
- List the various modalities of diagnostic imaging.
- Compare the various methods of imaging the skull and brain.
- List the kinds of patients that cannot undergo magnetic resonance imaging.
- Describe why most tumors, cysts and edema show up well on MRI.
- Describe when sonography is a preferred method of diagnostic imaging.
- Describe the components of a single EKG configuration and what each represents.
- Describe how an EKG configuration can be used to diagnose cardiac disorders.
- Differentiate among first degree, second degree, and third degree A-V blocks.
- Describe the danger of Complete Heart Block.
- Describe what kind of drug therapy may be associated with heart block.
- Discuss/describe? how diagnostic testing helps in assessing operative mortality and morbidity risks
- Describe how surgical planning differs for a critically ill patient and what the SFA’s role is.
Discuss the various kinds of cardiac pacemakers.
- Describe what the most common indication is for an artificial/mechanical pacemaker.
- Describe the complications associated with a pacemaker.
- Relate the signs and symptoms of shock to the physiologic responses and adaptations occurring.
- Describe the physiological changes of shock and how it is treated.
- Describe the components of external defibrillation on an adult and a child.
Describe pathophysiologic responses in a critically ill surgical patient and identify appropriate therapeutic intervention activities.
- Describe how the SFA can best assist the surgeon (in the larger sense) during the intraoperative care of a critically ill patient.
- Describe the physiological changes that occur in the GI, cardiopulmonary, endocrine and renal neurological systems with the critically ill surgical patient.
- Describe in a diabetic patient, which abnormality of blood sugar level is more hazardous and which is more apt to occur after surgery and why.
- Describe what the role of steroids are in a surgical patient.
- Describe what happens to calorie and protein requirements in a post-operative patient.
- List what vitamins and minerals are especially important for wound healing.
- Differentiate causes of post operative blood pressure abnormalities.
- Describe why vomiting is a serious concern in a post operative patient and what factors may promote vomiting.
- Describe the physiologically importance of pain control in a post-operative patient.
- Define the “4 W’s” of post-op fever etiology.
- Describe the relationship to sterile technique, gentle handling of tissue, and the type of suture material and suturing technique used.
- Describe why the early movement and ambulation is important in post-operative patients.
- Describe why elderly debilitated patients are subject to post-operative complications.
Discuss microbial hazards in the operating room and demonstrate knowledge of standard precautions.
- Identify the most common organisms of normal flora, their areas of the body, and their morphologic and staining characteristics (gpc, etc.)
- Describe what patient factors predispose to infection.
- Describe what perioperative activities or techniques can help in the prevention of wound infections.
- Describe what kinds of organisms are most apt to be involved in superficial wound infections, deep wound infections, and peritonitis from a perforated bowel.
- Describe what organisms are most commonly involved in pulmonary infections, infections of intravascular lines, and urinary tract infections.
- Discuss the difference between bacteremia and specticemia.
- Discuss why you get called out in the middle of the night for a wound Irrigation and Debridement.
- Describe what gram negative sepsis is.
- Describe what an “opportunistic infection is.
- Discuss how the immune response and susceptibility to sepsis are altered in an immunocompromised patient and what different pathogens may be involved.
- Describe what general rules apply to antibiotic therapy.
- Discuss how the actions of antibiotics compare with the actions of antineoplastic chemotherapeutic agents.
- Discuss whether there are any patterns to the “generations” within a category of antibiotic agents.
- Describe how you can recognize the names of antibiotics belonging to different categories of agents.
- Discuss when a patient is allergic to penicillins, what other category of antibiotics he is apt to have a cross-sensitivity.
- Discuss what the alternatives are to penicillin for patients who are allergic.
- Identify which antibiotics are usually employed for anaerobic infections.
Discuss the risks of blood transmissible diseases in the surgical environment.
- List and differentiate the types of hepatitis viruses, the diseases they cause, and how they are transmitted.
- Describe the differences among the “c”, “e” and “s” antigens of HBV and comparative risks to Operating Room personnel.
- Discuss the epidemiology of the Human Immunodeficiency Virus and features of HIV infection.
- Describe the risks from an HIV infected patient to Operating Room personnel.
- Describe how the risks of any type of blood-borne infection can be minimized on the O.R.
- Discuss the risks of tuberculosis, the Human Papilloma Virus, and other microbial hazards for Operating Room personnel.
Discuss the role of the surgical assistant in disaster planning.
- Demonstrate an understanding of disaster planning.
- Demonstrate an understanding of putting the plan into action in preparation for a disaster.
- Assess the federal, state and local agencies that are involved in disaster planning and preparation.
- Analyze the legal issues involved in disasters as it relates to surgical assistants.
- Assess the physical and mental stresses that can occur as a caregiver both during disaster and post-disaster.
- Describe the role(s) of the surgical assistant during a disaster.
Discuss the evaluation and preparation of the preoperative patient by anesthesia personnel.
- Discuss which aspects of a patient’s medical history would be most relevant in an anesthesiologist’s pre-operative work-up.
- List the ASA patient classifications of anesthesia risk and give two examples of each class.
- List the major categories of pre-operative medications and the most relevant action(s) of each type of drug.
- Discuss why appropriate psychological preparation of a pre-operative patient is important.
Differentiate surgical considerations of the agents used to achieve surgical anesthesia.
- List and describe the actions of the agents most commonly used for induction of General anesthesia.
- Discuss the purposes, techniques, and possible complications of endotracheal intubation.
- Define a “closed rebreathing system” of administering inhalation anesthesia.
- Compare the physiologic effects of the commonly-used inhalation and neuroleptic anesthetic agents.
- List the advantages, disadvantages and contraindications for each of the above agents.
- Differentiate the mechanism of action and method of reversal for non-depolarizing/antidepolarizing vs. depolarizing neuromuscular blocking agents.
- Discuss the recognition and treatment of complications during General anesthesia.
- Discuss methods, indications/contraindications, and agents used for Regional anesthesia.
- Compare the agents used for Local Infiltration and Topical anesthesia.
- Describe possible untoward effects of Regional, Local and Topical anesthesia.
Discuss special conditions that can affect and/or be affected by surgical procedures.
- Discuss special considerations regarding open and laparoscopic abdominal surgery.
- Discuss special considerations regarding cranial neurosurgery.
- Discuss special considerations regarding thoracic and cardiac procedures.
- Discuss special considerations regarding obese patients.
- Discuss special considerations regarding pregnant patients.
- Discuss special considerations regarding severely burned patients.
- Discuss special considerations regarding pediatric patients.
- Discuss special considerations regarding geriatric patients.
Demonstrate knowledge of pharmacologic agents that are commonly used in the Operating Room.
- Describe the uses and effects of pertinent categories of drugs affecting Central Nervous System as they apply to pre-, intra- and post-operative patients.
- Discuss the pre-, intra-, and post-operative uses and effects of drugs acting on the Autonomic Nervous System.
- Relate drugs affecting cardiovascular function and blood coagulability to surgical patients and uses during operative procedures.
- Classify and discuss drugs acting on the Digestive System, including their mechanisms of action, uses and possible adverse effects.
- Relate drugs and solutions affecting fluid balance to surgical patients and uses during operative procedures.
- Discuss the use of obstetrical agents in relation to surgical patients and procedures.
- Classify and discuss the use of endocrine drugs in surgical patients.
- Discuss the uses and effects of steroids and immunosuppressive drugs in relation to surgical patients and procedures.
- Classify antimicrobial agents and discuss their varying mechanisms of action and ranges of action.
Describe mechanisms of tissue injury to wound healing and possible complications.
- Differentiate “disease”, “illness”, and “disability”.
- Define the field of Pathology.
- Define cellular atrophy and hypertrophy and explain how these adaptations are manifested grossly.
- Describe the sequence of changes that occur during sublethal ischemic and hypoxic injury to the cell.
- Describe the various dimensions of necrosis and autolysis.
- Differentiate between acute and chronic inflammation.
- Describe the physiologic processes occurring during the three stages of wound healing and relate these to different suture materials.
- Describe what factors affect wound healing and/or influence the rate of wound healing.
- Differentiate healing by first, second and third intentions and relate those processes to primary closure, secondary union and delayed primary closure.
- Demonstrate an understanding of the principles of hemostasis and coagulation.
- Analyze disorders of hemostasis and coagulation.
- Analyze congenital hemostasis disorders.
- Demonstrate an understanding of disseminated intravascular coagulation.
- Review clinical indications and uses of blood components.
Discuss types of injuries related to circulatory disturbances.
- List the causes of systemic edema.
- Differentiate hyperemia and congestion.
- Describe the formation and progression of a thrombus and an embolus.
- Differentiate the results of arterial and venous thromboemboli.
- Describe an infarction.
- Define primary and secondary hypertension.
- Relate the possible mechanisms of hypertension with the types of drug therapy that may be employed.
- Describe the three types of arteriosclerosis and the risk factors of each.
- Briefly describe the progression of atherosclerotic changes in a blood vessel.
- Describe the clinical significance of the histologic differences in the walls of the various kinds of blood vessels.
Discuss nutritional, metabolic, and immunologic disorders relevant to the surgical patient.
- Describe “essential” nutrients.
- List the various causes of malnutrition.
- Describe the health effects of chronic alcoholism.
- Relate the physiologic effects of diabetes mellitus to its signs and symptoms.
- Describe how the immune system works in the body during normal and compromised situations.
- Describe the major causes of acquired immunodeficiencies.
- Describe hypersensitivity reactions.
- Differentiate between rheumatoid arthritis and osteoarthritis.
- Summarize the physiological composition of body water and solutes.
- Interpret the physiological acid-base balance of the body.
- Analyze the principles of extracellular fluid distribution between plasma and interstitial lymphatic volumes.
- Assess the clinical signs of hypovolemic, septic, hemorrhagic and cardiogenic shock.
- Analyze the causes of surgical site infections (SSI).
- Assess the clinical signs of specific SSIs.
- Evaluate the methods for the prevention of SSIs.
- Summarize the specific uses of antibiotics.
Discuss pathologic and induced alterations of body temperature.
- Describe and differentiate 1st degree, 2nd degree, and 3rd degree burns.
- Describe the major concerns in the initial treatment of a burn patient.
- Compare the three major types of skin cancers.