NOTES

CHAPTER 1

• CAAHEP is the ones who give the schools accreditation

• ARC/STSA are the ones who make sure the schools are meeting the requirements to be accredited

• NBSTSA are the ones who provide the national exam

• AST are the non profit organization

  • moto is “enhancing the profession to ensure quality patient care”

  • Aeger primo - the patient first

• ST started after WWII

• Andreas Versalius helped physicians gain insight into human anatomy

CHAPTER 2

• Malpractice- proefessional misconduct that results in harm to another ; professionaly negligence

• negligence - either the omission (not doing) or commission (doing) of an act that a resonable and priudent individual would not do under the same conditions; it refers to a breach of duty that can lead to injury or damage, highlighting the importance of adhering to established standards of care in medical practice.

• Doctrine of borrowed servant - the person who is controlling or directing the employee has greater resopisibility than the one who is paying hte employee

• Doctrine of corporate negligence - health care institution may be found negligent for failing to ensure that an acceptable level of patient care was provided

• Doctirine of foreseeability - ability to rpedeict outcome in advance. can be held responsible for failing to recognize and failing to act on a critical event that was foreseeable

• doctrine of personal liability - each person is prespoble for his or her own conduct

• doctrine of reasonably prudent person- persons should perform an action as would any responsblae person or ordinary prudence

• primum non nocere - above all, do no harm

• res ipsa loquitur - the thing speaks for itself

• respondeat superior - let the master answer

CHAPTER 3

• Maslow’s hierarchy of needs

  • physioogical needs- most basic needs like water, oxygen, food

  • safety needs - enviorment is safe

  • love and belonging needs - basic social needs

  • esteem needs - positive evaluation of ones self and others

  • self actualization - need to fulfil what he or she believes is purposeful

  • Sister Callista Roy is best known for the development of the Roy Adaptation Model , which emphasizes the importance of adapting to changes in the environment to meet these various human needs effectively.

  • denial - pt doesnt want it

  • rationization - attempt to rationize illness or disease

  • regresion - regresses to an earlier stage in life

  • repression - represses thoughts and feelings about illness or disease and does not want to hold any discussions about whats happening

  • Cardiac death- irriversible los of cardiac and respiratory function. permanent absence of heartbeat and respiration

  • higher brain death - irreversible loss of higher brain function. respiration, blood pressure and heartbeat without assitance of respirator

  • whole brain death- irreversible loss of all functions of entire brain. incudes flat EEG, unresponsiveness, lack of pupillary reflexes, and decreasing body temp

  • five stages of grief

    • denial

    • anger

    • bargaining

    • depression

    • acceptance

  • passive euthanasia- physcian does nothing to preserve life

  • active euthanasia - requires actions that speed the process of dying like morphine

CHAPTER 4

• pediatric patients may face fear of abandonment

• critical parameters to look out for are

  • temperature

  • urine output

  • cardiac function

  • oxygenation

• accidents are the leading cause of death in children age 1-15

• motor vehicle accidents are the major cause of trauma in children

• obese patients are at risk for deep vein thrombosis

  • have a venous compression device available

• reverse trendeleburg significantly improves pulmonary function

• gallstones and osteoarthritis is common with obese patients

• two types of diabetes mellitus

  • type 1 : insulin dependent diabetes mellitus (IDDM)- pancreas produces little to no insulin and pt needs insuloin

  • type 2 : non insulin deoendent diabetes mellitus (NIDDM)- pancreas produces different amounts of insulin, blood glucose levels are usually controlled by diet, pt not taking insulin

• surgical procedure during first trimester of pregnancy should be postponed, if possible to prevent spontaneous abortion

• abdominal procedures are best performed in the second trimester when the fetus is stable

• geriatric patients are those that are 65 years and older

• Golden hour- a shorter response time can reate a greater chance for survival for the patient

• for trauma patients there is little information available so whats important is the kinematics or mechanism of injury

• blunt trauma - from forces such as deceleration, acceleration, compression and shearing

• penetrating trauma - foreign object passes through tissue

• injuries are scored using the Revised Trauma Score (RTS) to asses the severity of the trauma

CHAPTER 5

• race track plan- series of ORs around a clean central core

• unrestricted areas - located near the entrance of the OR and street clothes are allowed

• semi restricted areas - scrub suits and hair covering are mandatory

• restricted areas - also masks are required

• ORs have to have at least 2 suction outlets, one for anesthesia and one for the surgical team

• outlets

  • green- oxygen

  • nitrous oxide- blue

  • compressed air - yellow

• OR room should have positive laminar airflow = unidirectional positive pressure , when the OR door is open, air from the room rushes outwats into the corridor rather than from the corridor into the room and that helps keep airborne bacteria from entering the room

• minimum of 15 air exchanges per hour are required with a recommended range of 20 to 25 to keep airborn contamination in the OR at minumum

• CDC has guidelines that recommend that air be filtered and the filter of choice is high efficiency particulate air (HEPA) filters taht are cabable of removing particles as small as 0.5 to 5 micrometers. CDC also recomends that at least 20% of the air exchanges per hour be from fresh outside air

• Temperature in OR should be kept at 68-73 degrees F

• Humidity should be 20-60 percent

• OR tables have breakpoints at the knee, wasit and head

• Most common location for surgical fire is the patients airway

• three components of fire are: fuel, source of ignition and oxygen

• Class A : pressurized water

• Class B: Carbon dioxide

• Class C : Halon

• PASS: Pull, aim, squeeze, sweep

• RACE: remove/rescue, alert, contain, extinguish

• laser- light amplification by the stimulated emission of radiation

• 8-17% of healthcare workers are allergic to latex

• plume - smoke that comes from the laser or ESU

• Polymethyl Methacrylate (PMMA) - chemical compound composed of a mixture of liquid and powder

• formalin- commonly used preservative for tissue specimens to be sent to pathology

• ethylene oxide (EO) liquid chemical converted to a gas for sterilization purposes

• Glutaraldehyde is a liquid disinfectant and sterilizing agent commonly known as Cidex

CHAPTER 6

• physicians recognized the benefits of using heat on wounds to accelerate blood clotting, ergo the ESU

• free electrons create electrical current

• like charges repel and unlike charges attract

• copper is the most commonly used conductor

• insulators are poor conductors

• components of the ESU are generator, optional foot pedal, active electrode and a patinet return electrode

• monopolar ESU- uses grounding pad, and most commonly used to coagulate and to cut tissue

• bipolar- not used bc its only used for coagulation

• CO2 laser- most frequently used and is used with helium-neon laser beams

• Nd:YAG and Holminum lasers- wavelengths are invisible

• Krypton laser- gas laser

• Excimer laser - uses gas and halogens as the active medium

• Argon laser- produces visible blue orgreen light with wavelengths of 450 and 530 nm in the electromagnetic spectrum

CHAPTER 7

• mutualism- both organisms benefit from and depend on one another to a certain extent

• commensalism - one organism benefits but second organism neither benefits nor is harmed

• parasitism - one organism benefits and the host is harmed

• bacteria - living organisms

• virus- nonliving particles that are completely reliant on the host cell for survival

• most commonly transmitted bacterial pathogen in the OR is staphylococcus aureus

• prions are nonliving protein strands and do not contain DNA or RNA . have been dentified as the infectious agent responsible for transmission of Creutzfeldt-Jakob Disease (CJD) in humans

• mycology is the study of fungi

• fungi are eukaryotic organisms that are either unicellular yeasts or multicellular molds and mushrooms

• Most SSI infections are acquired at the time of procedure

• gluteraldehyde is a high level disinfectant aka cidex - this is used on devices that can immersed completely in the liquid

• sodium hypochlorite (household bleach)- effective disinfectant for surfaces, floors, and equipment . never mix with ammonia bc a chlorine gas will form

• isopropyl and ethyl alcohol in a dilution of 60-70% alcohol are not sporicidal

• chelation- binding of minerals like iron and magnesium in the solution. this prevents their deposit on the surface of the surgical instruments which causes spotting

• after instruments are placed in the washer -sterilizer they are placed in the ultrasonic cleaner

• ultrasonic cleaner utilizes the process of cavitation for cleaning instrument

• a biological indicator is a device that contains a specific type of microorganism that is killed when exposed to the sterilizing conditions. that is the only way to guarantee items are sterile and necessary sterilization have been met

• gas sterilization is used to process materials that canot be processed using steam sterilization, such as heat or moisture sensitive materials. ethylene oxide has been used

• The biochemical indicator for ethylene oxide is Bacillus atrophaeus

• hydrogen peroxide gas plasma (HPGP) sterilization, commercailly refered to as Sterrad, usues gas at low temperature to sterilize heat/and or moisture sensitive medical instruments and devices, providing a rapid turnaround time and effective microbial kill.

CHAPTER 8

• ABCs- Airway, Breathing, Circulation

• CAB - Chest compressions, Airway, Breathing

• ratio of compressions to breathes is 30:2

• 100 compressions per minute

• depth of compression is 2 in and allow chest to recoil

• when its 2 person CPR then one breath should be given every 6 to 8 seconds without attempting to synchronize between chest compressions. there should be no pause between chest compressions to provide ventilations

• malignant hyperthermia (MH) is a life threatening, acute pharmacogenic disorder, developing during or after anesthesia . It is a rapid increase in body temp, unexplained tachycardia, unstable blood pressure etc.

• Disseminated intravascular coagulation (DIC) is a pathological process in the body that occurs when blood begins to coagulate within the body

CHAPTER 9

• pharmacology is the study of medications and their actions

• drug is the substance used for the diagnosis, treatment, cure, mitigation or prevention of disease or condition

• pharmacokinetics is the main term used to describe the metaboloic processing of a drug within the body . the process of pharmacokinesis involve absorption, distribution, biotransformation, and excretion

• pharmacodynamics involves the study of the interaction of drug molecules with the target cells of living tissue

• agonistic interaction occurs when a drug potentiates or enhances the effect of another substance

• synergists act in combination to produce a stronger or more powerful effect than individually

• medication additives alter some aspect of the action of the original agent

• antagonist bind to the agonists receptor site preventing the agonist from binding there and causing its desired effect

• the concentration of medication is the ration of solute to solvent

• A : B = C : D (B & C are the means; A and D are the extremes)

• cumultative dose - total amount of medication given to the patient

• ampule - lass container that requires the top to be broken off to access the contents

• vial- plastic or glass container that has a rubber stopper at the top that is held in place with a metal retaining ring

• Balanced Salt Solutions (BSS) - used on corneas to keep them from drying out

• blood pressure is the force that blood exerts against the walls of the blood vessels as the heart contracts (systole) and relaxes (diastole)

• systole refers to the contraction of the heart, which forces blood into the arteries.

• diastole is the relaxation phase of the heartbeat

CHAPTER 10

• #12 blade is used exclusively for tonsillectomy

• #20 blade is occasionally used for long and deep abdominal incisions

• potts smith scissors for incisions into ducts, veins, or arteries

• jorgenson scissors for hysterectomy

• cushing scissors for dural incision

• castroviejo scissors for microsurgery

• homografts are skin grafts that come from another person or a cadaver

• xenografts or heterografts involve tissue that is from another species

• passive drains allow for a pathway for fluid or air to move from an area of high pressure to one of lower pressure

• active drains make use of negative pressure and are connected to a collection device

CHAPTER 11

• hemostasis is stopping the loss of blood

• cardiovascular or prostate surgery will often time have blood replacement due to the high volume of blood loss. this is used to increase the circulating blood volume, to increase the number of red blood cells to increase the numbcer of circulating platelets for clotting and to provide plasma clotting factors that have been depleted during surgery

• AB individuals produce neither antibodys so they can recieve any type and are called universal recipients

• O are universal donors bc they produce both antibodys

• abrasion- scrape

• contusion - bruise

• laceration - cut or tear

• puncture - penetration

• thermal - heat or cold (can be chemical)

• classic signs of inflammation are pain, heat, redness, swelling, loss of function

• hematoma - localized swelling filled with blood resulting from a break in a blood vessel

• dehiscence - partial or total separation of a layer of tissue after closure

• edema - condition of abnormally large fluid volume in tissues between the body cells

• evisceration - protrusion of the viscera through the edges of a totally seperated wound

• adhesion - abnormal attachment of two surfaces or structures that are normally separate

• layer closure - peritoneum, fascia, muscle, subcutaneous, subcuticular and skin layers

CHAPTER 12

• intraoperative heat loos include radiation, convection, conduction, and evaporation

• trendelenburg postion is when the patients head is down