Post on 07-May-2015
How to observe in Surgery
By : Kareem Hamimy6th year Medical Student
Kasr Al Ainy Faculty of MedicineCairo University
Preface
This ppt is designed to give a simple tips for Surgery Interns, observers, Medical students About observation in OR ( Operation Room )
Gratitude
I would like to thank everyone who gave me he opportunity to attend and assist in Surgical operations in Kasr Al Aini (Professors, Lecturers, Residents, Nurses, Workers, patients )
Before Attending
Before attending ?
1st : Check The Surgery unit that you are going to attend with.
2nd : Introduce yourself to the Resident, and ask him for the permission to attend.
3rd : Know the schedule of unit . ( when is the grand round, when are the
operations ? ) 4th : The day before operation, get the List
of patients who are going to OR ). 5th : Try to take a brief History and full
Examination to these patients.
6th : Try to read about this Disease, Management, Operative technique, the Night before the Operations, for Maximum benefit
First Day at OR“STEP by STEP”
Scrubs
Scrubs
In Kasr Al Ainy, Scrubs are not provided in OR
So Don't forget to pack your bag with your clean ironed scrubs.
Lockers Room
Before Exiting lockers you have to check that you didn’t miss wearing any of these : Scrubs Overshoes or /
Surgical Clogs Overhead Mask
Finally : The OR
Away Rules
In The OR, You have to be
Away from Aseptic Field 50 cm Away from the operation table Away from The Surgical instruments table Away from scrubbed surgeons
Away from Anesthesia fieldAway from troubles
Don't ask a surgeon when he is nervous, or when there is complete silence as this is an indicator of a precise part of operations which needs ultimate concentration
Observation
While observing, you have to be sure that you know Diagnosis Decision ( & why )
and try to correlate what you read before with what you are observing
What to Observe ?A List of what to observe
Anesthesia
Type ( Spinal, Regional, Epidural, General)
Technique Intubation ( how ? ) Cannulation ( IV cannula, Central line
) Medications used, Dosage Monitor
Surgery
Position of the Patient ( Supine, Prone, Hand Extended, Elevated, Lithotomy )
Exposure Antiseptic application
Borders, one way strokes Surgical Sheets ( how they are
applied ? ) Light ( Direction ? )
Surgery
Incision Extensions When to extend it ? ( Observe when is
this decision taken ) Layers ( what are the layers incised ? )
Surgery
Traction and Counter Traction Surgical Instruements used
And why this specific instruement not the other ?
Surgery
Important Structures ( Anatomy ? ) Dangerous Areas
Surgery
Drainage Why Type ( Suction, …) Size Position How ?
Closure
Layers Sutured Muscle Subcutaneous Skin
Suturing
How? ( Simple, Subcuticular ), and ask the resident to show you how is it done
Material ( proline, Vicryl, silk ) When? ( ask when to use different
types, and size ? ) And why ?
Dressing
Betadine Dressing Plaster
Postoperative
Waking the patient ( anaesthesia ) Postoperative care Visiting patient, the next day of
operation is essential, try to follow to observe Recovery phase, and if complications occurred, and how to manage
After being Familiar, with the OR, and the operations,
You can ask the resident, to scrub in for assistance and better observation
Amazing operative books :
Prof Dr Aly Haseeb : Illustrated Operative Surgery.
Browse Symptoms and Signs of Surgical diseases.
Oxford Handbook of Clinical Surgery. Basic Surgical Techniques ( R M
Kirk ). Essential General Surgical
Operations ( R M Kirk ).
Thank YouFor Comments and Further info :Kareemhamimy89@yahoo.co.uk