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