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  • Does surgery sound sexy to you?

  • Maybe you've been watching Grey's Anatomy, House, or my favorite, Scrubs.

  • Yet surgery isn't just about the surgeon, but an entire healthcare team that ensures

  • the patient is cared for when they're under the knife.

  • Let's dive in on the different parts of the surgical team.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Surgery is a fast moving, complex, multi-faceted aspect of medicine that is deeply dependent

  • on effective teamwork.

  • Without proper respect and communication between all team members, surgery comes to a grinding

  • halt, and the risk of errors and complications shoots up.

  • The surgeon is who we most commonly think of when we think of surgery.

  • This is the attending physician who is responsible for the patient, as they are the one who made

  • the decision to operate on the patient in the first place, and they are the ones in

  • charge.

  • Before even getting to the operating room, however, there's usually significant workup,

  • including labs and tests, that must be performed prior to deciding to operate on a patient.

  • This is obviously not the case with emergency surgeries such as traumas, but the majority

  • of surgeries are planned in advance.

  • This generally includes a clinic visit with the patient, where the surgeon approaches

  • their concern, performs the appropriate workup, and presents the various options of how to

  • best proceed, often including surgery.

  • When the patient first comes to the hospital or surgical center and is waiting in pre-op,

  • the surgeon speaks with the patient, obtains informed consent, meaning they again explain

  • the procedure and it's possible risks, and answer any questions the patient may have.

  • They've also done this during the clinic visit, but doing it again on the day of surgery

  • is essential.

  • Given that the surgeon bears the weight of the greatest responsibility in the operating

  • room, they are subject to the highest degrees of stress.

  • This is often when you see the stereotypical surgeon personality rear its ugly head.

  • This stereotype is generallydecisive, well organized, practical, hard working, but

  • also cantankerous, dominant, arrogant, hostile, egocentric, and a poor communicator.”

  • But stereotypes aren't entirely true, and most surgeons I know don't fit the mold

  • in terms of these negative qualities.

  • I would say, however, that most surgeons I know are more direct, efficient, and pragmatic

  • than most, and perhaps not afraid to be rough around the edges in order to get the job done.

  • Some studies have concluded the surgical personality certainly does exist, but rather highlight

  • their novelty seeking, competitive nature, and reward dependent qualities, in addition

  • to scoring higher in self-discipline and achievement but lower in compliance and vulnerability.

  • At teaching hospitals, the surgeon enters the operating room once the patient is under

  • anesthesia and ready to be operated on.

  • They may have their residents drape, but many surgeons are highly particular and prefer

  • draping the patient themselves.

  • The surgeon performs the surgery and must remain by the patient's side until he or

  • she is extubated, meaning the breathing tube is removed and they are wheeled out to post-op.

  • The surgeon operates in a sterile field to minimize the risk of surgical infections.

  • On the other side of the drape is the anesthesiologist.

  • Think of anesthesiologists as the guardian angel for the patient as they approach a scary

  • time in their life.

  • The anesthesiologist is the other attending physician in the room, and can generally be

  • thought of as second in command.

  • But don't tell any anesthesiologists that.

  • The surgeon is the captain of the ship, but the anesthesiologist is right by their side.

  • That doesn't mean their job isn't equally foundational.

  • Just like the surgeon, the anesthesiologist will visit the patient in pre-op, but rather

  • than the procedure, they'll be focusing on explaining how they'll keep the patient

  • comfortable during the case.

  • This often includes general anesthesia, where the patient goes under, meaning is unconscious,

  • and requires a breathing tube.

  • However, anesthesiologists can also provide sedation, where the patient is deeply sedated

  • and often doesn't remember the procedure, but they're able to breathe on their own.

  • Local or regional anesthetic doesn't interfere with the patient's consciousness, but rather

  • numbs the area that the surgeon will be working on.

  • Prior to the case beginning, the anesthesiologist provides the appropriate anesthetic to the

  • patient.

  • This may include providing certain pre-op medications via IV and intubating the patient

  • if they'll be receiving general anesthesia.

  • During the case, they monitor the cardiopulmonary status of the patient, ensuring they're

  • safe and comfortable.

  • This is done through cardiac leads on the patient's skin to monitor heart activity,

  • a pulse oximeter on the finger to monitor oxygen saturation of the blood, and a blood

  • pressure cuff to monitor circulation.

  • After the surgery, they'll reverse the analgesics and once the patient is stable, wheel them

  • to post-op and hand them off to the nurse in the post-anesthesia care unit, or PACU.

  • The surgical first assist is the person helping the surgeon perform the case, also scrubbed

  • into the sterile surgical field.

  • This is most commonly a resident, physician assistant (PA), nurse practitioner (NP), certified

  • surgical assistant (CSA), or medical student.

  • It's their responsibility to assist the surgeon in performing the procedure, which

  • includes a lot of retracting, suctioning, and performing other supportive measures for

  • the surgeon.

  • Being a good first assist requires knowledge of anatomy and physiology, surgical handling

  • of tissues, understanding surgical instrumentation and its use, and the nature of the procedure.

  • The first assist should also be skilled in suturing, positioning, sterile technique,

  • prepping and draping, and the use of splints and casts.

  • Things generally go smoother when they're also highly perceptive and have an intuition

  • in predicting the needs of the surgeon.

  • The scrub nurse is also scrubbed in the surgical field, and is the one preparing, organizing,

  • and providing the various surgical tools and instruments to the surgeon and first assist

  • during the case.

  • While that may sound simple, it's extremely fast paced, demanding, and requires a similar

  • understanding, perception, and familiarity as a first assist to keep things moving smoothly.

  • A guaranteed way to annoy a surgeon and increase tension in the room is to keep them waiting

  • longer than needed for the necessary instrument.

  • Prior to the case beginning, the scrub nurse gathers the necessary supplies, including

  • the sets of surgical instruments needed for that particular type of procedure.

  • They'll be the first one to scrub in and set up a sterile surgical field for others

  • to join, helping the surgeon and assistants with their sterile gown and gloves.

  • The scrub nurse is critical to things moving smoothly, and is one of the primary drivers

  • in anticipating the needs of the surgical team.

  • The circulator is the point person in helping assist the surgical team outside of the sterile

  • surgical field.

  • Along with the scrub nurse, they are also responsible for gathering supplies, sterile

  • equipment, and tool sets needed for surgery and anesthesia.

  • They also manage the documentation at the computer before and during the case, including

  • verifying the patient's ID, who all is in the room, getting the patient comfortable

  • with warming blankets, and the like.

  • Together with the scrub nurse, they'll help the surgeon and assistants get gowned in sterile

  • fashion, and it's common for them to also help prep the surgical site with washing agent

  • and other prep materials.

  • During a case, they'll grab additional supplies as needed and help out the surgical team who

  • cannot leave the sterile field.

  • Toward the end of the case, they'll ensure an accurate count of sutures, needles, sponges,

  • and lap pads.

  • You don't want to accidentally leave a sponge or needle in a patientand yes, it happens.

  • They'll help apply dressings and get the patient safely transferred to the PACU.

  • In addition to the core team, you'll often see medical students or residents in surgical

  • cases at teaching hospitals.

  • Junior medical students are generally observing, doing their best to stay out of the way, and

  • of course not contaminate the sterile field.

  • If they're scrubbed in, they may be retracting, suctioning, and essentially learning the ropes

  • as a first assist.

  • Medical students who are deliberate in applying themselves will also earn the right to close,

  • meaning suture the incision shut at the end of the case.

  • Closing the superficial layers, such as the skin, is easier and lower risk, so attendings

  • are more willing to hand out that responsibility.

  • Closing deeper layers, however, requires that the attending trusts you given the added complexity

  • and risk if poorly executed.

  • The responsibilities and tasks of a resident will be highly variable depending on their

  • year in training and the institution.

  • Junior residents serve as first assist at minimum, but depending on their skill level

  • and aptitude, may be granted substantial responsibility in helping with various aspects of the case.

  • After all, this is how attending surgeons are madethey must learn in residency.

  • Senior residents have taken on additional responsibility and generally take ownership

  • of the case, performing the majority themselves with oversight from the attending.

  • They will soon be out in the world as attendings themselves handling cases on their own.

  • There are several other key members who are directly related to surgery that don't step

  • foot in the operating room.

  • The OR supervisor manages all operating theaters, ensuring things run smoothly.

  • They book and schedule cases, assign rooms, and act as a coordinator between the preoperative

  • holding area, OR, and PACU.

  • The preoperative holding nurse preps the patient before the case, checking them in, organizing

  • consent, notes, and orders.

  • They also check vitals, start the IV, and administer medications.

  • The PACU or recovery room nurse accepts the patient from the OR and provides a secure

  • environment for recovery.

  • There may be additional team members in the OR depending on the case or the institution.

  • Surgical techs provide further assistance and are key in preparing the operating room,

  • tools, and equipment.

  • Medical device reps in the OR help the surgeon use their company's devices properly.

  • CRNA's provide anesthesia under anesthesiologist supervision.

  • Together, all parts working in harmony translate to a successful and nearly seamless experience

  • for the patient.

  • It's not about you or your ego, or who said what or whose toes whoever stepped on.

  • And at the end of the day, it's all about the patient.

  • Which surgical team role most resonates with you?

  • Let us know with a comment down below.

  • If you enjoyed this video, please leave us a thumbs up and consider subscribing, as it

  • really helps out the channel.

  • Much love to you all, and I will see you guys in that next one.

Does surgery sound sexy to you?

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B2 patient surgical surgeon sterile assist surgery

The Surgical Team | Surgeon, Anesthesiologist, First Assist, Scrub Nurse, & More

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    Summer posted on 2020/07/30
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