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Training Program
MEDICAL STUDENTS

Educational Resources
  1. Textbooks
  2. Operating Room Etiquette
  3. Commonly Used Surgical Instruments
  4. Drains and IV Access
  5. Videos
    1. Surgical Procedures (Medline Plus)
    2. Clinical Medicine (The New England Journal of Medicine)
  6. Best Practice Guidelines - UTI
  7. U-COP
  8. EBM Discussion Topics

 

Textbooks
Of course, you should read the recommended texts for Surg200, including Lawrence, but here are some places previous students have found helpful information:
  • Surgical Recall (Blackbourne)
  • Case Files in Surgery (Toy)
  • NMS Casebook (Jarell)
  • Surgery Pretest (Geller and Nitzberg)
  • Appleton & Lange Surgery Review (Wapnick)
  • The Mont Reid Surgical Handbook (Univ. of Cincinnati Residents)
  • Surgical Review: An Integrated Basic And Clinical Science Study Guide, 2nd Edition (Kaiser)
Operating Room Etiquette
  1. Wear clean scrubs with a white coat in the halls.
  1. White coats are not permitted inside the operating room.
  1. Your hair must always be covered while in the operating room suite (hats are just inside the doors to the main OR).
  1. Masks must be worn at all times once the instruments have been opened.
  1. If you plan to scrub in for a case, eye protection is required (combined face masks and eye shields are available outside each OR).
  1. Be prepared to help out if asked to do so, but never take or use an instrument without being directed – not only does this make things more difficult for the surgeons, but it exposes you to the risk of needlesticks, etc.
  1. To scrub, first wash both hands and wet your arms up to just above your elbows.  At HUP, we use a water-aided, brushless scrub, so you first clean under your fingernails with the nail picks provided above the scrub sinks.  Then, squeeze a palm-sized portion of the scrub soap into one hand, and swirl the fingertips of your other hand in the soap.  Then, switch hands and repeat the motion.  Wash both arms up to just above the elbows and rinse without touching anything with your hands.  Repeat the process, stopping just below the elbows this time, kick the sink off and keep your hands up (above the level of your elbows) at all times.  Do NOT dry your hands.  Open the door to the OR with your body, and wait for the scrub nurse/tech to hand you a towel.  Dry your hands/arms, and put the towel down without touching anything, and wait for your gown.  Once you have your gown on, the circulating nurse will tie it up, and you can work your hands out the cuffs without touching the gown with bare hands.  The scrub nurse/tech will hold out one glove (usually the right glove), and you can put your hand into it.  Then, help him/her to spread out the second glove, and put that one on as well.  It is best to always wear two pairs of gloves in the OR, and you may be asked to put the second pair on yourself once you are sterile.
  1. Remember, nothing below your waist or above the level of your shoulders is sterile, nor is your back, so be careful not to touch any of those places, and be aware of your position so that you do not brush against anyone or anything else, as this would contaminate someone or something, requiring someone to rescrub, or a table/mayo stand to be changed.  The safest place for your hands is on the patient, or folded on your chest!
 
Commonly Used Surgical Instruments
Kelly Kocher Forceps Curved Mayo Scissors Straight Mayo Scissors
Kelly (curved and straight) Kocher Forceps Curved Mayo Scissors Straight Mayo Scissors
       
Metzenbaum Scissors Adson Forceps Debakey Forceps Russian Forceps
Metzenbaum Scissors (Metz) Adson Forceps Debakey Forceps Russian Forceps
       
Right Angle Forceps Mosquito Forceps Needle-Holder Balfour
Right Angle Forceps Mosquito Forceps
(curved and straight)
Needle-Holder Balfour
       
Rake Richardson Retractor Army-Navy Retractor Deaver Retractor
Rake Richardson Retractor Army-Navy Retractor(s) Deaver Retractor
       
Malleable Sweetheart Retractor Bladder Blade Retractor Wheatlander
Malleable Sweetheart Retractor Bladder Blade Retractor Wheatlander - 'Wheatie'
(self-retaining retractor)
       
Yankauer Suction      
Yankauer Suction      
 
Drains and IV Access
Jackson-Pratt Drain   Jackson-Pratt Drain
  The Jackson-Pratt Drain ("JP") is a closed suction device that is made of two parts. The bulb ("grenade") is a soft plastic container with two openings at the top in order to facilitate the creation of a vacuum after the drain tubing has bee inserted. The drainage tube is soft and has a long flat surface with multiple small holes which can be trimmed to fit the desired drainage area. The JP drain is used in situations where there is risk of fluid accumulation post operatively (bowel anastomosis, neck surgery, etc.)
     
Nasogastric Salem Sump   Nasogastric Salem Sump
  Commonly known as an NG tube. The system is a sump (“suction pump”) which allows for air and liquids to be injected and then sucked out by vacuum which prevents the system from becoming permanently attached to the wall of the stomach.
The NG is used in situations where the stomach need to be decompressed or emptied. Common uses include: Patients with small bowel obstructions, upper or lower GI bleeds, gastroparesis and situation where there is an aspiration risk.
 
Dobhoff Nasogastric Tubes   Dobhoff Nasogastric Tubes
  The Dobhoff is used to provide fluid and food to patients who are unable to swallow but have an otherwise functional GI tract. Dobhoffs are inserted into the nose for final placement in the stomach.
 
Port-A-Cath   Port-A-Cath
  Port-A-Caths are vascular access devices used in patients who require frequent vascular access (chemotherapy or blood transfusions). Port-A-Caths consist of two parts: a long piece of tubing that is inserted into a large vein, (usually the subclavain), and a reservoir that is placed just underneath the skin. The reservoir has a permeable membrane where needles can be inserted.
 
Hickman Catheter   Hickman Catheter
  A hickman catheter is a vascular access device. It is tunneled underneath the skin from the lateral chest to where it inserts in to the jugular vein and into the SVC. Uses are similar to that of the Port-A-Cath where frequent vascular access is necessary (chemotherapy, blood transfusion or blood analysis).
 
PICC   PICC
  A PICC (Peripherally Inserted Central Catheter) is a vascular access device where catheter tubing is run through a medium size peripheral vein into a larger central vein (SVC). Uses include chemotherapy delivery, TPN delivery or extended antibiotic delivery.
 
Red Rubber Catheter   Red Rubber Catheter
  The Red Rubber Catheter is most often used to access the urethra of patients in order void urine (“straight cath”). It can also be used in a variety of situations to drain small collections of fluid most anywhere. Due to its flexible and versatile nature it can be improvised for non-draining purposes (eg. anchoring NG tubes in place).
 
Pig Tail Catheter   Pig Tail Catheters
  This drain is usually inserted over a straight needle by Interventional Radiology. When the needle is removed it curls into its prescribed shape. It is often used to percutaneously drain abscesses or to treat small pneumothoraces
 
Pediatric Feeding Tube   Pediatric Feeding Tube
  Used for enteral feeding of pediatric patients. This tube can be advanced beyond the pylorus for duodenal or jejunal feeds. This tube is inserted nasally.
 
Percutaneous Gastrostomy Tube   Percutaneous Gastrostomy Tube
  The Percutaneous Gastrostomy Tube or PEG (Percutaneous Endoscopic Gastrostomy) tube is a solution for a patient who cannot swallow or has no appetite but has a functional GI tract. This tube is placed in the OR under endoscopic guidance. The tube is placed in the wall of the stomach and the aperture is pulled through the skin of the abdomen where it can be accessed.
     
Penrose Drain   Penrose Drain
  The Penrose drain is the workhorse of surgical drains. It is an open drainage system that allows fluid to passively drain. It is most often used in open surgical wounds that require drainage for closure. However, due to the floppy and maneuverable nature of the penrose it is often used in the OR and as a make-shift anything.

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