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  • Have you ever wondered what it's like to be in the operating room, elbow to elbow with

  • surgeons, using the latest in cutting edge surgical technology to save lives? You've

  • seen it on TV shows, but perhaps never stepped in the OR yourself. It seems mysterious, intense,

  • even a little intimidating. Here's what to expect when you first enter the operating

  • room. Dr. Jubbal, MedSchoolInsiders.com.

  • For many medical students and aspiring surgeons, the first time you enter the operating room

  • will be in your third year, during your clerkship rotations. The common theme of your third

  • year of medical school is that you want to learn, be helpful, and not get in the way.

  • This is most apparent in the operating room, where it's difficult to help and easy to get

  • in the way. When you enter the operating room, always

  • introduce yourself, and usually it's best practice to write your name on the whiteboard.

  • This is because the circulating nurse needs to chart in the computer who all was in the

  • room. Do your best to not get in the way. Your first

  • few times in the OR, you may be confused by all the moving pieces. That's fine, as long

  • as you don't slow other people down in doing their job.

  • Avoid being on your phone. Even if you're trying to be useful or studious, it looks

  • like you're texting and not paying attention. Surgery is often high stress, and there will

  • be moments of high tension where you may be yelled at or not like how someone talks to

  • you. Don't beat yourself up, and don't take it personally. It's more often a reflection

  • of the situation or the character of the individual, and surgery tends to have a higher proportion

  • of more abrasive personality types. Your aim as a medical trainee is to learn,

  • and you should be asking questions, but timing is critical. You don't want to be the annoying

  • student that asks too many questions, and you also don't want to be the student who

  • asks questions at inappropriate moments. During times of high stress and tension, refrain

  • from asking questions and allow the various members of the surgical team to resolve the

  • situation. The more you work with a particular surgeon and other members of the surgical

  • team, the more you'll get a feeling for what is and is not appropriate. Timing is important,

  • as you don't want to interrupt their focus during moments of higher acuity.

  • It's also viewed favorably by all members of the surgical team when you firmly, but

  • with surgical precision, press on both the like and subscribe buttons of this video.

  • Not too hard as to cause unnecessary tissue damage, and not too gently, otherwise it's

  • as if no intervention ever occurred. The single most important thing is that you

  • don't contaminate the sterile field. Doing so won't make you any friends.

  • The purpose of creating a sterile field around the surgical site is to reduce the number

  • of microbes and therefore the risk of infection and complications.

  • How do they decide where to draw the line on sterility? Well, making the whole operating

  • room sterile isn't practical, nor does it confer improved infection risk. On the other

  • hand, sterilizing only the immediate area of the incision would still introduce microbes

  • from movement and touching surrounding unsterilized structures.

  • For this reason, the sterile field generally includes the drapes over the patient, down

  • to about your waist height. If you're scrubbed in, meaning you are wearing a surgical gown

  • and gloves, then your hands and arms, and anterior torso from your chest down to your

  • waist are in the sterile field too. If a sterile object makes contact with a non-sterile

  • object, we call that contaminating the sterile field. If your nose is itchy and you're scrubbed

  • in, too bad, as touching it will contaminate the sterile field. You'll have to wait for

  • it to pass, as touching your face, glasses, mask, or anything that isn't sterile is a

  • big no-no. If your mask is fogging up or you're having issues seeing, then ask one of the

  • nurses who isn't scrubbed in to help make adjustments.

  • Standing by the operating table, your hands should either be resting on the drapes on

  • top of the patient, or you should hold your hands in front of you. Do not drop your hands

  • below your waist or to your sides, as doing so would contaminate them.

  • If you're going to sneeze and you're standing at the sterile field, then take a step or

  • two back and sneeze directly into your mask, facing toward the sterile field. Do not raise

  • your arm to cover your mouth, as that would contaminate your sterile sleeves, and do not

  • turn to the sides, as doing so will allow microbes to escape from the sides of your

  • mask and toward the surgical field. The first time you're in the operating room,

  • you likely won't be scrubbed in, meaning you'll just be wearing regular scrubs and no part

  • of you will be considered sterile. In this case, you always want to maintain a safe distance

  • from the sterile field as to not contaminate it.

  • Surgery is still very much an old boys' club, and even as a student there will be several

  • unspoken expectations of you, and you should always come prepared.

  • If it's your first time and you're not scrubbing in, still make sure you wear a mask and eye

  • protection. Everyone inside the operating room must wear a mask to reduce airborne microbes,

  • and once you see fluids squirt around, you'll understand why eye protection is paramount.

  • If you are scrubbing in, make sure you know proper scrub technique and follow it closely.

  • To reduce interruptions, use the bathroom prior to entering the surgical suite. It's

  • generally frowned upon to excuse yourself to use the bathroom, particularly if you're

  • scrubbed in, and even more so if it's a shorter case. It shows you simply weren't prepared.

  • You should also avoid chugging a gallon of water right before surgery for obvious reasons.

  • In line with reducing interruptions, put your phone on silent or vibrate, as you don't want

  • to distract the surgeon while your Drake ringtone blasts at max volume.

  • Complications and unexpected delays in the operating room are common, and you should

  • be prepared to stick around longer than expected. No food is allowed in the operating room,

  • so be sure to fuel yourself ahead of time. If you're a medical student rotating on the

  • surgical service, be ready to be pimped, meaning quizzed by your residents or attending. You

  • should absolutely know the patient, why the surgery is indicated, the nature of the surgery,

  • the anatomy you'll be seeing intraoperatively, and other relevant details. Expectations will

  • vary depending on your stage in training and whether or not you're pursuing a surgical

  • specialty for residency. A third year medical student on their first day in the OR will

  • have different expectations than a fourth year who is doing a plastic surgery sub-internship

  • and hoping to match into the field. After a few cases in the OR, you should start

  • to form an understanding of how things work. The room is prepared, the patient is rolled

  • in, anesthesia begun, time out is performed, and the first incision is made. After the

  • incision is closed, the site is properly bandaged or dressed, the patient is woken up and extubated,

  • transferred to a hospital bed, and wheeled out to post-op.

  • Depending on whether or not you're scrubbed in, there will be different tasks you can

  • help with. By being attentive and observant, it won't be difficult to figure out where

  • to be useful. If you're not scrubbed in, you can help the

  • patient get transferred to the operating room table, grab supplies from the back supply

  • room, help gown others who are scrubbing in, pull up imaging on the TV screen if the surgeon

  • needs to reference something while operating, and anything else you're asked of. After closing,

  • you can grab the gurney, which is usually outside the room, transfer the patient, and

  • so on. If you are scrubbed in, do your best to not

  • get in the way, don't contaminate the sterile field, and get great at retracting, since

  • you'll be doing a lot of it. Retracting is when you help hold back organs or tissues,

  • usually with one of many tools, allowing the surgeon to more easily view and operate on

  • the exposed area. You may need to suction, apply pressure, cut sutures, and do other

  • minor tasks too. By first demonstrating proficiency in these basic tasks, you'll then be allowed

  • to close, meaning suture the incision, and even do other simple techniques with the scalpel

  • or bovie. Also understand that each surgeon will have

  • different preferences. Some will appreciate you helping to drape the patient, while others

  • are more particular and would prefer you stay out of the way. When it comes to cutting suture,

  • if you cut the tails too long, then there's excess material in the patient which can lead

  • to inflammation and increased risk of infection. If you cut the tails too short, then there's

  • a higher risk of the knot failing. The running joke amongst medical students is that you'll

  • always cut too long or too short, but never just right. That's fine, just do your best

  • to learn the surgeon's preferences and take all feedback in stride.

  • If you found anything in this video helpful, let me know with a thumbs up and if you want

  • to see more like this, tap that subscribe button firmly and with surgical precision.

  • If you enjoyed this, check out my video explaining the various members of the surgical team.

  • And if you want me to cover something else about surgery or the operating room, let me

  • know with a comment down below. Much love, and I'll see you guys there.

Have you ever wondered what it's like to be in the operating room, elbow to elbow with

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Operating Room 101 | What to Expect in Surgery

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    Summer posted on 2021/07/31
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