Carver Career and Technical Education Center Master

Carver Career and Technical Education Center Master Curriculum for Surgical Technology

CARVER CAREER AND TECHNICAL EDUCATION CENTER SURGICAL TECHNOLOGY PROGRAM

COURSE: ANATOMY AND PHYSIOLOGY COURSE DESCRIPTION: This course is study of human anatomy and physiology. It focuses on the basic organization structures of the human body, basic structure of cells and cellular components, types of tissues that make up organs and an analysis of body systems for composition and function. PRE-REQUISITES: Admission into the Surgical Technology program. TEXTS: Herlihy, The Human Body in Health and Illness, 3rd Edition, © 2003, Elsevier Science

Herlihy, The Human Body in Health and Illness, 3rd Edition TEACHING METHODOLOGIES: Lecture, discussion, classroom demonstrations, self-study, and visual aids METHODS OF EVALUATION: Examinations EXPECTED OUTCOMES: The student will:

1. Identify the basic organizational structures of the human body, including body planes general organization, and terms of reference. 2. Analyze the basic structure of cells and relate cellular components to integrated cell function. 3. Analyze the types of tissue that make up organs and the characteristics of each. 4. Contrast and compare organs of the body. 5. Analyze the different body systems for composition and function. 6. Analyze cell pathology in relationship to its response and adaptation to injury. 7. Analyze surgical cancer treatments. 8. Examine hemodynamic disorders, inflammation and infection. 9. Compare and contrast the various surgical pathologies of each body system.

10. Define the terms anatomy and physiology. 11. List the levels of organization of the human body. 12. Describe the 11 major organ systems 13. Explain the word homeostasis. 14. Define the term anatomical position. 15. List common terms used for relative positions of the body. 16. Describe the three major planes of the body. 17. List anatomical terms for regions of the body. 18. Describe the major cavities of the body. 19. Label a diagram of the main parts of a typical cell. 20. Describe the functions of the main organelles of the cell. 21. Explain the role of the nucleus. 22. Identify the structure of the cell membrane. 23. Differentiate between active and passive transport. 24. Describe the active and passive movement of substances across a cell membrane. 25. Compare isotonic, hypotonic, and hypertonic solutions. 26. Describe the four phases of mitosis. 27. Explain what is meant by cell differentiation. 28. Define metabolism, anabolism, and catabolism. 29. Explain the use of carbohydrates in the body.

30. Differentiate between the anaerobic and aerobic metabolism of carbohydrates. 31. Explain the use of lipids and proteins in the body. 32. Describe the roles of DNA and RNA in protein synthesis. 33. List the four basic types of tissues 34. Describe the functions of epithelial, connective, muscle, and nervous tissue. 35. Explain how epithelial tissue is classified. 36. Differentiate between endocrine and exocrine glands 37. List the types of epithelial and connective tissue membranes. 38. Differentiate between mucous and serous membranes. 39. Define organ. 40. Identify the types of tissues in organs. 41. Describe some of the functions of organs. 42. Identify abnormalities of organs. 43. Define tumors and their classifications. 44. Describe grading and staging of cancer. 45. Identify the functions of the skin. 46. Describe the epidermal layers and their functions. 47. Identify the dermis and its functions. 48. Describe the hypodermis and its functions. 49. Identify diagnostic tests for the integumentary system. 50. Define disease and disorders of the skin. 51. List the functions of the skeletal system. 52. Describe the structure of a long bone. 53. Describe the roles of osteoblasts and osteoclasts. 54. List the bones of the axial skeleton. 55. List the bones of the appendicular skeleton. 56. Label important landmarks for selected bones on the skeleton. 57. List the main types and functions of joints. 58. Describe the types of movement that occur at diarthrotic joints. 59. Identify three types of muscle tissue. 60. Describe the structure of a skeletal muscle. 61. Describe the sliding filament hypothesis of muscle contraction. 62. Describe the events that occur at the neuromuscular junction. 63. Explain the role of calcium and adenosine triphosphate in muscle contraction. 64. Identify the sources of energy for muscle contraction. 65. Trace the sequence of events from nerve stimulation to muscle contraction. 66. Define twitch, tetanus, and recruitment as characteristics of muscle contraction. 67. State the basis for naming muscles. 68. Identify the major muscles. 69. List the actions of the major muscles. 70. Define the two divisions of the nervous system. 71. List three general functions of the nervous system. 72. Compare the structure and functions of the neuroglia and neuron. 73. Explain the function of the myelin sheath. 74. Define the three types of neurons. 75. Explain how a neuron transmits information. 76. Describe what happens at the synapse. 77. Describe the functions of the four major areas of the brain. 78. Describe the functions of the four lobes of the cerebrum. 79. Describe how the skull, meninges, cerebrospinal fluid, and blood-brain barrier protect the central nervous

system. 80. Describe three functions of the spinal cord 81. List four components of the reflex arc. 82. Describe the functions of the 12 pairs of cranial nerves. 83. Identify the classification of spinal nerves 84. List the functions of the three major plexuses. 85. Explain the structure and function of the autonomic nervous system. 86. Compare the structure and function of the sympathetic and parasympathetic nervous systems. 87. State the functions of the sensory system. 88. Define the five types of sensory receptors.

89. Describe the four components involved in the perception of a sensation. 90. Differentiate general senses from special senses. 91. Describe the five general senses: pain, touch, pressure, temperature, and proprioception.

92. Describe five special senses: smell, taste, sight, hearing, and balance. 93. Describe the visual accessory organs. 94. Describe the structure of the eye. 95. Explain the movement of the eye. 96. Describe how the size of the pupils changes. 97. Describe the three divisions of the ear. 98. Describe the functions of the parts of the ear involved in hearing. 99. Explain the role of the ear in maintaining the body's equilibrium.

100. Describe three functions of blood. 101. Describe the composition of blood. 102. Describe the three types of blood cells: erythrocytes, leukocytes, and thrombocytes. 103. Explain the formation of blood cells. 104. Explain the breakdown of red blood cells and the formation of bilirubin. 105. Identify the steps of hemostasis. 106. Describe the four blood types. 107. Describe the Rh factor. 108. Describe the location of the heart. 109. Name the three layers and covering of the heart. 110. Explain the function of the heart as two separate pumps. 111. Identify the four chambers of the heart. 112. Explain the functions of the four heart valves. 113. Describe blood flow through the heart. 114. List the vessels that supply blood to the heart. 115. Identify the major components of the heart's conduction system. 116. Describe the three stages of the cardiac cycle. 117. Define heart rate, stroke volume, and cardiac output. 118. List two ways in which stroke volume may be altered. 119. Describe the pulmonary and systemic circulations. 120. Describe the structure and function of arteries, capillaries, and veins. 121. List the three layers of tissue found in arteries and veins. 122. Explain the functions of conductance, resistance, exchange, and capacitance vessels. 123. List those major arteries of the systemic circulation that are branches of the ascending aorta, aortic arch,

and descending aorta. 124. List the major veins of the systemic circulation. 125. Describe the following special circulations: blood supply to the head and brain, hepatic circulation, and fetal

circulation. 126. Explain the factors that determine blood pressure. 127. List three factors that cause venous blood to flow back to the heart. 128. Explain rapidly acting mechanisms and slowly acting mechanisms that keep blood pressure within normal limits. 129. Describe capillary exchange.

130. List three functions of the lymphatic system. 131. Describe the composition of lymph. 132. Describe the flow path for lymph. 133. Describe the four lymphoid organs: lymph nodes, tonsils, thymus gland, and spleen. 134. State the location of the following lymph nodes: cervical nodes, axillary nodes, and inguinal nodes. 135. Describe the function of the following lymph nodes: cervical nodes, axillary nodes, and inguinal nodes. 136. Describe the structure and functions of the organs of the respiratory system. 137. Trace the movement of air from the nostrils to the alveoli. 138. Describe the role of pulmonary surfactants in reducing surface tension. 139. Explain the role of pressure in maintaining expanded lungs. 140. Describe the relationship of Boyle's law to ventilation. 141. Explain how respiratory muscles affect thoracic volume. 142. List three conditions that make the alveoli well suited for the exchange of oxygen and carbon dioxide. 143. Explain how respiratory gases diffuse. 144. Describe how oxygen and carbon dioxide move to and from the lungs. 145. List lung volumes and capacities.

146. Describe common variations and abnormalities of breathing. 147. Explain the neural and chemical control of respiration. 147. List four functions of the digestive system. 148. Describe the four layers of the digestive tract. 149. List three functions of the peritoneal membranes. 150. List, in sequence, the parts of the alimentary canal from the mouth to the anus. 151. Describe the structure and functions of the organs of the digestive tract. 152. Describe the structure and functions of the accessory organs of the digestive tract. 153. List nine functions of the liver. 154. Explain the physiology of digestion and absorption. 155. List the major enzymes involved in digestion. 156. Describe the role of bile in the digestions of fats. 157. Describe five categories of nutrients. 158. List six factors that affect metabolic rate.

159. List the four organs of excretion. 160. Describe the major organs of the urinary system 161. Describe the location, structure, blood supply, and functions of the kidneys. 162. Explain the role of the nephron unit in the formation of urine. 163. Explain the three processes involved in the formation of urine: filtration, reabsorption, and secretion. 164. Describe control of water and electrolytes through aldosterone: antidiuretic hormone (ADH), atrial natriuretic

factor (ANF); and parathyroid hormone (PTH). 165. List the normal constituents of urine. 166. Describe the structure and function of the ureters, urinary bladder, and urethra. 167. Describe the two fluid compartments; intracellular and extracellular. 168. Describe the concept of intake and output. 169. List factors that affect electrolyte balance. 170. Describe the most common ions found in the intracellular and extracellular compartments. 171. List three mechanisms that regulate pH in the body. 172. Discuss acid-base imbalances: acidosis and alkalosis.

172. List the structures and function of the male and female reproductive systems. 173. Describe the structure and function of the testes. 174. Describe the structure and function of the male genital ducts: epididymis, vas deferens, ejaculatory duct,

and urethra. 175. Describe the accessory glands that add secretions to the semen: seminal vesicles, prostate gland, and bulbourethral glands. 176. Describe the hormonal control of male reproduction, including the effects of testosterone. 177. Describe the structure and function of the ovaries, including the ovarian follicle, ovulation, and ovarian hormones. 178. Describe the structure and function of the female genital tract: fallopian tubes, uterus, and vagina. 179. Explain the hormonal control of the female reproductive cycle. 180. Describe the process of fertilization: when, where, and how it occurs. 181. Describe the process of development: cleavage, growth, morphogenesis, and differentiation. 182. Explain the three periods of prenatal development: early embryonic, embryonic, and fetal periods. 183. State two functions of the placenta. 184. Explain hormonal changes during pregnancy. 185. Describe the process of labor, including the hormonal changes and the individual stages. 186. Describe the structure of the breast. 187. Describe the process of lactation. 188. Describe the relationships among deoxyribonucleic acid (DNA), chromosomes, and genes. 189. Explain dominant genes, recessive genes, and codominance. 190. Explain how the sex of the child is determined. 191. State the difference between congenital and hereditary diseases 192. Define karyotype. 193. List the functions of the endocrine system. 194. Differentiate between protein hormones and steroid hormones. 195. Explain negative feedback control as a control for hormone levels. 196. Describe the relationship of the hypothalamus to the anterior and posterior pituitary glands. 197. Describe the structure and function of the pituitary gland. 198. List the six major hormones secreted by the anterior pituitary gland. 199. Describe the two major hormones of the posterior pituitary gland.

200. Identify the major endocrine glands of the body. 201. Describe the actions of the hormones secreted by the major endocrine glands 202. Explain the effects of hyposecretion and hypersecretion of the following hormones: insulin, growth hormone, thyroxine, cortisol, parathyroid hormone (PTH), and antidiuretic hormone. 203. Relate pathophysiology to surgical interventions. 204. Analyze the relationship between cell pathology and disease. 205. Examine hemodynamic disorders, inflammation and infection. 206. Compare and contrast the various surgical pathologies of each body system.

UNIT OUTLINES UNIT I INTRODUCTION TO THE HUMAN BODY UNIT OBJECTIVES: 1. Define the terms anatomy and physiology. 2. List the levels of organization of the human body. 3. Describe the 11 major organ systems 4. Explain the word homeostasis. 5. Define the term anatomical position. 6. List common terms used for relative positions of the body. 7. Describe the three major planes of the body. 8. List anatomical terms for regions of the body. 9. Describe the major cavities of the body. 10. Relate pathophysiology to surgical interventions.

11. Analyze the relationship between cell pathology and disease. 12. Examine hemodynamic disorders, inflammation and infection. 13. Compare and contrast the various surgical pathologies of each body system.

UNIT OUTLINE: I. Organization of the human body A. body planes 1. sagittal 2. coronal/frontal 3. transverse/ cross-sectional 4. oblique 5. midsagittal B. terms of reference 1. superior/cephalic 2. inferior/ caudal 3. anterior/ventral 4. posterior/dorsal 5. medial/median/midline 6. lateral 7. proximal 8. distal 9. deep 10. superficial 11. internal 12. external 13. central 14. peripheral 15. parietal 16. visceral C. general regions 1. head a. cranium b. face

2. trunk a. neck b. back c. chest (thorax) d. abdomen e. pelvis f. perineum 3. limbs a. upper limbs b. lower limbs 4. quadrants a. RUQ b. RLQ c. LUQ c. LLQ 5. regions a. epigastric b. right hypochondriac c. left hypochondriac e. umbilical f. right lumbar g. left lumbar h. hypogastric i. iliac (right – left) / inguinal

6. cavities a. cranial b. spinal c. thoracic d. abdominal e. pelvic f. dorsal g. ventral D. body organization 1. cell types a. epithelial b. connective c. muscle d. neurons 2. tissue types a. epithelial b. connective c. muscle d. nervous 3. organs 4. systems a. integumentary b. skeletal c. muscular d. nervous e. sensory f. circulatory and lymphatic g. respiratory h. digestive i. urinary j. reproductive k. endocrine l. immune

E. major closed cavities 1. thoracic a. pleural b. pericardial c. mediastinum 2. abdominopelvic 3. cranial 4. spinal F. introduction to disease 1. causes of disease a. etiology b. pathogenesis c. idiopathic 2. manifestations of disease a. signs b. symptoms c. syndrome d. diagnosis

3. terminology a. acute b. chronic c. complication d. exacerbation e. morbidity f. mortality g. prognosis h. relapse i. remission k. terminal UNIT II: CELLS UNIT OBJECTIVE: 1. Label a diagram of the main parts of a typical cell. 2. Describe the functions of the main organelles of the cell. 3. Explain the role of the nucleus. 4. Identify the structure of the cell membrane. 5. Differentiate between active and passive transport. 6. Describe the active and passive movement of substances across a cell membrane. 7. Compare isotonic, hypotonic, and hypertonic solutions. 8. Describe the four phases of mitosis. 9. Explain what is meant by cell differentiation. 10. Define metabolism, anabolism, and catabolism. 11. Explain the use of carbohydrates in the body. 12. Differentiate between the anaerobic and aerobic metabolism of carbohydrates. 13. Explain the use of lipids and proteins in the body. 14. Describe the roles of DNA and RNA in protein synthesis. UNIT OUTLINE:

I. Basic activities A. movement B. responsiveness C. metabolism and growth D. reproduction II. Cellular functions A. movement of substances across cell membranes B. metabolism C. reproduction III. Basic structure and functions A. cell membrane B. cytoplasm C. nucleus 1. nuclear membrane 2. nucleolus 3. chromatin and chromosomes D. Organelles 1. centrosome and centrioles 2. mitochondria 3. ribosomes 4. endoplasmic reticulum a. rough b. smooth 5. Golgi apparatus 6. vacuoles 7. vesicles 8. lysosomes 9. cilia or flagella E. nucleic acids 1. DNA 2. RNA a. messenger b. transfer c. ribosomal IV. Cell division A. DNA replication B. mitosis (somatic cells C. meiosis (sex cells) D. cellular respiration 1. glycolysis 2. anaerobic oxidation (fermintation) 3. aerobic oxidation (Krebs cycle) V. Cell pathology A. structure and function of normal cells B. Response and adaptation to injury VI. Mechanisms of disease A. causes of disease B. aging and death VII. New Technology

A. cell cloning 1. skin 2. cartilage

B. stem cell UNIT III TISSUES UNIT OBJECTIVES: 1. List the four basic types of tissues

2. Describe the functions of epithelial, connective, muscle, and nervous tissue. 3. Explain how epithelial tissue is classified. 4. Differentiate between endocrine and exocrine glands 5. List the types of epithelial and connective tissue membranes. 6. Differentiate between mucous and serous membranes. UNIT OUTLINE: I. Definition A. collection of like cells B. common specialized function C. cellular attachments D. intercellular substances II. Types and functions A. epithelial B. connective C. muscle D. nervous III. Structure and location A. epithelial tissue 1. structural characteristics a. one layer (simple) 1. squamous 2. cuboidal 3. columnar b. multilayer (stratified) 1. squamous 2. cuboidal 3. columnar 2. location a. covering and lining epithelium b. glandular epithelium B. connective tissue 1. structural characteristics a. cells b. fibers 2. classification and location a. loose areolar connective tissue b. dense irregular connective tissue c. dense fibrous connective tissue d. adipose tissue e. cartilage f. bone g. blood and lymph C. muscle tissue 1. skeletal/striated 2. visceral smooth 3. cardiac D. nervous tissue 1. types of neurons a. sensory (afferent) b. motor and secretory (efferent) 2. types of neuroglia E. muscle contraction 1. contractile elements 2. sliding filament mechanism F. neuromuscular excitability (electrophysiology) 1. nerve impulse 2. neuromuscular junction

UNIT IV ORGANS UNIT OBJECTIVES: 1. Define organ. 2. Identify the types of tissues in organs. 3. Describe some of the functions of organs. 4. Identify abnormalities of organs. 5. Define tumors and their classifications. 6. Describe grading and staging of cancer. UNIT OUTLINE: I. Organs A. organ 1. interrelated unit 2. two or more basic tissues 3. complex structure 4. specific function(s) B. types of tissues in organs 1. heart 2. stomach 3. nerves 4. brain C. organ systems activities 1. homeostasis 2. response to external and internal environment 3. exchange of materials 4. regulation and feedback mechanisms D. abnormalities 1. aplasia 2. hypoplasia 3. atrophy 4. hypertrophy 5. hyperplasia 6. dysplasia 7. anaplasia II. Tumors A. terminology B. classification 1. benign 2. malignant C. causes of cancer D. diagnosis of cancer 1. grading of cancer 2. staging of cancer E. surgical treatments according to location, grade and stage F. systemic effects of cancer 1. anemia 2. bleeding 3. infections 4. paraneoplastic syndromes 5. weight loss (cachexia) UNIT V: INTEGUMENTARY SYSTEM UNIT OBJECTIVES: 1. Identify the functions of the skin. 2. Describe the epidermal layers and their functions.

3. Identify the dermis and its functions. 4. Describe the hypodermis and its functions. 5. Identify diagnostic tests for the integumentary system. 6. Define disease and disorders of the skin. UNIT OUTLINE: I. Functions of skin A. Protection B. regulation of body temperature C. prevention of loss of body fluids D. monitoring of external environment E. excretion F. absorption II. Epidermal layers and functions A. structure 1. outermost stratum 2. basal stratum B. functions III. Dermis A. structure B. functions C. auxiliary structures 1. hair follicles 2. nails 3. glands 4. sensory nerve endings IV. Hypodermis/subcutaneous tissue A. structure B. functions V. Inflammation and infection A. effect on healing of the surgical wound B. trauma and effects on tissue healing C. types of infection and effect on surgical wound healing VI. Surgically treatable diseases and disorders A. diagnostic tests B. diseases and disorders 1. mechanical injury 2. thermal injury a. hyperthermia b. hypothermia c. burns 3. electrical injury 4. radiation injury 5. pressure injury a. decubitus ulcer 6. chemical injury 7. neoplasms a. basal cell carcinoma b. melanoma c. keratosis d. squamous cell 8. infectious and inflammatory disease a. cellulitis b. frost bite c. nevus d. warts

9. treatment a. curative b. palliative c. adjunct treatment 1. chemotherapy 2. radiation VII. Fluid and hemodynamic disorders A. dehydration B. edema C. electrolyte imbalances D. embolism E. hemorrhage F. hyperemia G. shock H. sodium/potassium I. thrombosis UNIT VI: SKELETAL SYSTEM UNIT OBJECTIVES: 1. List the functions of the skeletal system. 2. Describe the structure of a long bone. 3. Describe the roles of osteoblasts and osteoclasts. 4. List the bones of the axial skeleton. 5. List the bones of the appendicular skeleton. 6. Label important landmarks for selected bones on the skeleton. 7. List the main types and functions of joints. 8. Describe the types of movement that occur at diarthrotic joints. UNIT OUTLINE: I. Skeletal regions and specific bones A. axial skeleton (80 bones) B. appendicular skeleton (126 bones) II. Types of bones A. long B. short C. flat D. irregular E. sesamoid III. Functions of bone A. framework/support B. protection C. leverage for movement (attachment for muscles) D. storage of calcium E. blood cell production IV. Formation of bone A. osteoblasts B. osteocytes C. osteoclasts D. ossification E. Haversian system F. endochondral bone formation

G. intramembranous bone formation H. callus formation V. Differences between bone and cartilage A. types 1. labrum 2. meniscus B. characteristics C. locations VI. Structure of long bones A. epiphysis B. diaphysis C. epiphseal plate/line D. articular cartilage E. cortical (compact) bone F. cancellous (spongy) bone G. medullary canal/cavity H. endosteium I. periosteum VII. Bone markings and features A. projections B. depressions C. articulating surfaces VIII. Vertebral column

A. vertebral regions 1. cervical 2. thoracic 3. lumbar 4. sacrum 5. coccyx

B. parts of a vertebra and their regional characteristics 1. cervical 2. thoracic 3. lumbar

C. intervertebral disk components D. spinal ligaments IX. Joints A. immovable (synarthrotic) B. slightly movable (amphiarthrotic C. freely movable (diarthrotic) D. articular cartilage E. labrum or meniscus F. capsule G. external ligaments H. external ligaments I. intraarticular ligaments J. synovial membrane k. bursae X. Pathophysiology A. diagnostic tests B. diseases and disorders 1. bone a. osteoporosis b. cysts c. cancer d. deformities (1) scoliosis (2) kyphosis (3) pectus excavatum/carinatum (4) radial dysplasia (5) talipes (clubfoot)

(6) rickets (osteomalacia) e. infectious diseases (1) osteomyelitis f. circulatory disturbances (1) avascular necrosis g. fractures (1) closed (2) open (3) greenstick (4) communited (5) pathologic (6) compression (7) depressed (8) dislocations (9) impacted (10) linear (11) oblique (12) potts (13) simple (14) spiral (15) sprains (16) stress (17) transverse (18) trauma h. bone tumors 2. joints a. osteoarthritis b. rheumatoid arthritis c. infectious arthritis d. gout e. ankylosing spondylitis UNIT VII: MUSCULAR SYSTEM UNIT OBJECTIVES: 1. Identify three types of muscle tissue. 2. Describe the structure of a skeletal muscle. 3. Describe the sliding filament hypothesis of muscle contraction. 4. Describe the events that occur at the neuromuscular junction. 5. Explain the role of calcium and adenosine triphosphate in muscle contraction. 6. Identify the sources of energy for muscle contraction. 7. Trace the sequence of events from nerve stimulation to muscle contraction. 8. Define twitch, tetanus, and recruitment as characteristics of muscle contraction. 9. State the basis for naming muscles. 10. Identify the major muscles. 11. List the actions of the major muscles. UNIT OUTLINE: I. Functions of muscle A. movement B. posture C. heat production II. Types of muscle A. skeletal B. cardiac

C. smooth III. Actions of muscle A. flexion B. extension C. abduction D. adduction E. internal/medial rotation F. external/lateral rotation G. elevation H. depression I. supination J. pronation K. protraction L. retraction M. dorsiflexion N. plantar flexion O. inversion P. eversion IV. Categories of skeletal muscle A. agonist/prime mover B. antagonist C. synergist D. fixator V. Terminology related to skeletal muscle A. muscle belly B. tendon C. origin/insertion D. fascia E. bursa VI. Name, location, and actions of major muscles A. face and head 1. muscles of facial expression 2. scalp muscles 3. muscles of mastication a. temporalis b. masseter c. intrinsic d. extrinsic B. neck 1. sternocleidomastoid 2. sternohyoid 3. omohyoid 4. thyrohyoid 5. sternothyroid 6. scalene muscles 7. platysma

C. back 1. trapezius 2. latissimus dorsi 3. erector spinae D. shoulder 1. deltoid 2. rotator cuff components E. arm 1. biceps brachii 2. triceps brachii F. forearm 1. flexor group 2. extensor group

G. hand and fingers 1. flexor carpi group 2. extensor carpi group 3. flexor digitorum group 4. extensor digitorum group H. chest wall 1. pectoralis major 2. pectoralis minor 3. intercostal I. diaphragm J. abdominal wall 1. external oblique 2. internal oblique 3. transverses abdominis 4. rectus abdominis K. thigh 1. iliopsoas 2. quadriceps femoris (rectus femoris and vasti) 3. sartorius 4. adductor group 5. hamstrings (biceps femoris) 6. gluteal muscles a. gluteus maximus b. gluteus medius c. gluteus minimus L. leg 1. gastrocnemius 2. soleus 3. plantaris 4. extensors 5. peroneus longus and brevis M. foot and toes 1. peroneus longus 2. tibialis anterior 3. flexor digitorum group 4. extensor digitorum group VII. Pathophysiology A. diagnostic tests B. diseases and disorders 1. myasthenia gravis 2. muscular dystrophies 3. marfan's syndrome 4. fibromyalgia 5. carpal tunnel syndrome 6. bursitis UNIT VIII: NERVOUS SYSTEM UNIT OBJECTIVES: 1. Define the two divisions of the nervous system. 2. List three general functions of the nervous system. 3. Compare the structure and functions of the neuroglia and neuron.

4. Explain the function of the myelin sheath. 5. Define the three types of neurons. 6. Explain how a neuron transmits information. 7. Describe what happens at the synapse. 8. Describe the functions of the four major areas of the brain. 9. Describe the functions of the four lobes of the cerebrum. 10. Describe how the skull, meninges, cerebrospinal fluid, and blood-brain barrier protect the central nervous

system. 11. Describe three functions of the spinal cord 12. List four components of the reflex arc. 13. Describe the functions of the 12 pairs of cranial nerves. 14. Identify the classification of spinal nerves 15. List the functions of the three major plexuses. 16. Explain the structure and function of the autonomic nervous system. 17. Compare the structure and function of the sympathetic and parasympathetic nervous systems. UNIT OUTLINE: I. Parts of a neuron and their functions A. dendrites B. cell body C. axon D. myelin E. Schwann cells F. neurilemma II. Major divisions of the nervous system (CNS) A. central nervous system 1. brain 2. spinal cord B. peripheral nervous system (PNS) 1. cranial nerves 2. spinal nerves 3. autonomic nervous system (ANS) a. sympathetic b. parasympathetic III. Terminology related to the central nervous system A. nucleus B. tract (pathways) C. gray matter D. white matter E. cell types 1. astrocytes 2. glial cells 3. ependymal cells IV. Major divisions and functions of the brain A. parts of the brain 1. cerebrum a. hemispheres b. fissures c. lobes d. basal ganglia e. limbic system 2. diencephalons a. thalamus b. hypothalamus 3. mesencephalon a. brain stem (1) midbrain (2) pons (3) medulla oblongata

b. cerebellum B. coverings of the brain and cord: meninges 1. dura mater 2. arachnoid mater 3. pia mater C. ventricular system 1. anatomy a. ventricles (1) lateral (2) third (3) fourth (4) choroids bodies b. connections (1) interventricular foramen of Monro (2) Aqueduct of Sylvius (3) foramen of Magendie (4) foramen of Luscha 2. physiology a. production of cerebrospinal fluid b. circulation of cerebrospinal fluid V. Cranial nerves A. olfactory: I 1. sensory function a. smell B. optic: II 1. sensory function a. vision C. oculomotor: III 1. motor function a. eye globe movement b. iris muscle movement D. trochlear: IV 1. motor function a. oblique eye glove movement E. trigeminal: V 1. motor function a. mandibular branch (1) jaw (2) tympanic membrane 2. sensory function a. ophthalmic branch (1) forehead and eyelids b. maxillary branch (1) tissues of mastication c. mandibular branch (1) jaw (2) tympanic membrane F. abducens: VI 1. motor function a. lateral eye muscle movement G. facial: VII 1. sensory function a. taste (1) anterior 2/3 of tongue b. sensation (1) postauricular area 2. motor function a. motor muscles of facial expression b. parasympathetic innervation of salivary glands and mucous membranes of the oral cavity

H. vestibulocochlear / auditory / acoustic: VIII 1. sensory function a. hearing b. proprioception/ balance I. glossopharyngeal: IX 1. sensory function a. carotid sinus and body b. sensory information of the ear, pharynx, and tongue c. taste (1) posterior 1/3 of tongue 2. motor function a. parasympathetic innervation of the smooth muscle and glands of the pharynx, larynx, and viscera of the thorax and abdomen b. stylopharyngeus muscle J. vagus: X 1. sensory function a. sensation of post-auricular area 2. motor function a. muscles of the pharynx and most of the larynx, trachea, and abdominal and thoracic viscera b. receptors of the aortic arch and body K. accessory/ spinal accessory: XI 1. motor function a. innervates muscles of larynx and pharynx, trapezius and sternocleidomastoid muscles L. hypoglossal: XII 1. motor function a. tongue VI. Spinal Cord A. functions B. external features 1. meninges 2. vertebral segments (regions) 3. conus medullaris 4. cauda equina 5. nerve roots 6. sympathetic trunk and ganglia VII. Peripheral nervous system A. cranial nerves: 12 pairs 1. afferent: somatic, visceral 2. efferent: visceral B. spinal nerves: 31 pairs 1. afferent: somatic, visceral 2. efferent: somatic visceral VIII. Spinal nerve plexuses A. cervical plexus 1. phrenic nerve B. brachial plexus 1. axillary nerve 2. radial nerve 3. median nerve 4. ulnar nerve C. lumbosacral plexus 1. sciatic nerve IX. Autonomic nervous system (ANS) A. functional component of the PNS, not a discrete structure B. involuntary or visceral regulation C. sympathetic division

D. parasympathetic division X. Synapse A. structure B. neurotransmitters C. breakdown of neurotransmitters XI. Pathophysiology A. diagnostic tests B. diseases and disorders 1. vascular a. subarachnoid hemorrhage due to aneurysm rupture b. arteriovenous malformation c. intracerebral hemorrhage d. ischemia e. infarction f. epidural and subdural hematoma 2. functional a. degenerative disk disease b. seizure disorder c. autoimmune disease d. neurodegenerative disease (1) dementia e. abscess f. encephalitis

3. neoplasms of the central nervous system a. glioma b. meningioma c. metastases to the brain d. neural cell precursor tumors e. astrocytoma 4. cranial nerve tumors 5. central nervous system infections 6. trauma a. brain b. spinal cord 7. disorders a. cerebral palsy b. epilepsy c. hydrocephalus d. parkinson’s e. spina bifida UNIT IX: SENSORY SYSTEM UNIT OBJECTIVES: 1. State the functions of the sensory system. 2. Define the five types of sensory receptors. 3. Describe the four components involved in the perception of a sensation. 4. Differentiate general senses from special senses. 5. Describe the five general senses: pain, touch, pressure, temperature, and proprioception.

6. Describe five special senses: smell, taste, sight, hearing, and balance. 7. Describe the visual accessory organs. 8. Describe the structure of the eye. 9. Explain the movement of the eye. 10. Describe how the size of the pupils changes. 11. Describe the three divisions of the ear.

12. Describe the functions of the parts of the ear involved in hearing. 13. Explain the role of the ear in maintaining the body's equilibrium.

UNIT OUTLINE: I. Types A. visual B. auditory C. olfactory D. gustatory E. touch F. proprioception II. Eye A. anatomy 1. orbital bones a. frontal bone b. sphenoid bone c. zygomatic bone d. maxilla e. palatine bone f. lacrimal bone g. ethmoid bone 2. eyelids a. palpebrae b. tarsal plate c. meibomian glands d. eye lashes 3. extraocular muscles a. rectus muscles (1) superior (2) inferior (3) lateral (4) medial b. oblique muscles (1) superior (2) inferior 4. lacrimal apparatus a. lacrimal glands b. lacrimal ducts c. puncta d. lacrimal canals e. nasolacrimal sac f. nasolacrimal duct 5. conjunctiva 6. eyeball/globe a. fibrous tunic (1) cornea (2) sclera b. vascular tunic (1) choroid (2) ciliary body (3) iris (4) pupil c. nervous tunic (1) retina d. chambers of the eye (1) anterior cavity (a) anterior chamber (b) posterior chamber (2) posterior cavity

e. fluids (1) aqueous humor (2) vitreous humor f. optic nerve B. photoreception 1. refractive media 2. accommodation 3. light regulation 4. photoreceptors 5. macula lutea/ fovea centralis 6. optic disc 7. brain pathways III. Ear A. anatomy 1. external ear a. auricle b. pinna c. tragus 2. middle ear (tympanic cavity) a. ossicles (1) malleus (2) incus (3) stapes b. oval window c. round window d. mastoid sinus e. Eustachian tube 3. internal ear a. labyrinth b. cochlea B. Physiology of hearing 1. sound wave reception 2. bone conduction 3. fluid conduction 4. nerve conduction C. physiology of balance/equilibrium 1. semicircular canals and vestibule IV. Pathophysiology A. diagnostic tests 1. eye 2. ear B. diseases and disorders 1. eye a. conjunctivitis b. cataract c. glaucoma d. eye muscle disorders e. trauma f. corneal damage requiring transplant g. retinal detachment h. macular degeneration 2. ear a. otitis media b. otitis externa c. mastoiditis d. otosclerosis e. Meniere's disease f. tinnitus g. vertigo h. trauma

(1) ruptured tympanic membrane UNIT X: CIRCULATORY SYSTEM: BLOOD UNIT OBJECTIVES: 1. Describe three functions of blood. 2. Describe the composition of blood. 3. Describe the three types of blood cells: erythrocytes, leukocytes, and thrombocytes. 4. Explain the formation of blood cells. 5. Explain the breakdown of red blood cells and the formation of bilirubin. 6. Identify the steps of hemostasis. 7. Describe the four blood types. 8. Describe the Rh factor. UNIT OUTLINE: I. Components of blood A. formed elements B. plasma and components II. Functions of blood A. transportation of oxygen, nutrients, and wastes B. protection (immune system) C. clotting mechanism D. acid-base (pH) buffers III. Structure and function of formed elements A. red blood cells (erythrocytes) B. white blood cells (leukocytes) 1. polymorphonuclear leukocytes a. neutrophils b. eosinophils c. basophils 2. mononuclear leukocytes a. monocytes b. lymphocytes C. platelets (thrombocytes) IV. Terminology related to hematology A. red blood cell count B. hemoglobin C. hematocrit D. white blood cell count E. differential white count F. platelet count G. coagulation studies H. electrolyte studies I. arterial blood gases (ABG's) J. serologic studies V. Blood types A. antigen types B. antibodies in serum C. type and crossmatching D. complications of blood transfusion VI. Rh factor A. Rh positive B. Rh negative C. implications in pregnancy VII. Fluid and hemodynamic disorders A. edema B. hyperemia C. embolism

D. thrombosis E. hemorrhage F. shock UNIT XI: CIRCULATORY SYSTEM: CARDIAC UNIT OBJECTIVES: 1. Describe the location of the heart. 2. Name the three layers and covering of the heart. 3. Explain the function of the heart as two separate pumps. 4. Identify the four chambers of the heart. 5. Explain the functions of the four heart valves. 6. Describe blood flow through the heart. 7. List the vessels that supply blood to the heart. 8. Identify the major components of the heart's conduction system. 9. Describe the three stages of the cardiac cycle. 10. Define heart rate, stroke volume, and cardiac output. 11. List two ways in which stroke volume may be altered. UNIT OUTLINE: I. Terminology for cardiovascular function A. heart rate/ pulse rate B. stroke volume C. cardiac output D. blood pressure E. normal sinus rhythm F. tachycardia G. bradycardia H. fibrillation I. ectopic beat J. infarction K. heart block II. Anatomic structures of the heart A. layers 1. epicardium / pericardium 2. myocardium 3. endocardium B. chambers 1. atria (right and left) 2. ventricles (right and left) C. valves 1. tricuspid 2. pulmonary 3. mitral 4. aortic D. venae cavae 1. superior 2. inferior E. pulmonary veins and arteries F. aorta

G. coronary arteries and veins 1. right coronary artery 2. left main coronary artery 3. left circumflex artery 4. left anterior descending artery 5. coronary sinus 6. great cardiac vein 7. anterior cardiac vein 8. oblique vein of the left atrium III. Location and position of the heart A. mediastinum B. apex IV. Flow of blood A. atrial contraction B. ventricular contraction C. relaxation V. Heart sound source A. first heart sound B. second heart sound VI. Regulating mechanisms of heart rate A. autonomic regulation VII. Conductive pathway of the heart A. sinoatrial node (pacemaker of the heart) B. atrial myocardium C. Bundle of His and bundle branches D. Purkinje fibers E. ventricular myocardium F. atrioventricular node VIII. Pathophysiology A. diagnostic tests B. diseases and disorders 1. arterial a. arteriosclerosis b. aterosclerosis 1. ischemia 2. plaque 2. peripheral vascular a. intermittent claudication b. gangrene c. aneurysms d. coronary artery disease e. embolus f. raynaud’s disease g. thrombophlebitis

3. heart a. congenital heart disease 1. coarctation of aorta 2. patent ductus arteriosus 3. tetralogy of fallot b. myocardial infarction c. hypertensive heart disease d. rheumatic heart disease e. congestive heart failure f. cardiomyopathy g. endocarditis, myocarditis, and pericarditis h. valvular disorders 1. mitral stenosis 2. murmur i. angina j. conduction disorders 1. fibrillation a. atrial b. ventricular 2. tachycardia 3. complete heart block 4. veins a. varicose veins 5. embolus a. thrombus b. fat embolus c. air embolus d. foreign body 6. blood cell a. types of clotting disorders 1. anemias 2. DIC 3. hemophilia 4. leukemias 5. lymphoma 6. myeloma UNIT XII: CIRCULATORY SYSTEM: VASCULAR UNIT OBJECTIVES: 1. Describe the pulmonary and systemic circulations. 2. Describe the structure and function of arteries, capillaries, and veins. 3. List the three layers of tissue found in arteries and veins. 4. Explain the functions of conductance, resistance, exchange, and capacitance vessels. 5. List those major arteries of the systemic circulation that are branches of the ascending aorta, aortic arch, and

descending aorta. 6. List the major veins of the systemic circulation. 7. Describe the following special circulations: blood supply to the head and brain, hepatic circulation, and fetal

circulation. 8. Explain the factors that determine blood pressure. 9. List three factors that cause venous blood to flow back to the heart. 10. Explain rapidly acting mechanisms and slowly acting mechanisms that keep blood pressure within normal limits. 11. Describe capillary exchange.

UNIT OUTLINE:

I. Types of blood vessels A. large arteries B. small arteries C. arterioles D. capillaries E. venules F. small veins G. large veins H. venous sinuses II. Structure of each type

1. tunica adventitia 2. tunica media 3. tunica intima

a. valves A. aortic arch B. brachiocephalic (innominate) C. common carotid 1. external carotid 2. internal carotid D. Circle of Willis E. subclavian 1. vertebral 2. internal thoracic/ mammary 3. axillary 4. brachial 5. radial and ulnar F. thoracic aorta 1. intercostal G. abdominal aorta 1. celiac trunk/axis 2. gastric 3. splenic 4. hepatic 5. superior mesenteric 6. renal 7. gonadal 8. inferior mesenteric 9. common iliac a. internal iliac b. external iliac 10. femoral a. superficial b. deep (profunda) 11. popliteal 12. posterior tibial 13. peroneal 14. anterior tibial 15. dorsalis pedis IV. Major systemic veins A. inferior vena cava B. superior vena cava C. cranial venous sinuses D. internal jugular E. azgos system

F. portal system G. superficial system, upper limb 1. cephalic 2. basilic H. superficial system, lower limb 1. greater saphenous 2. lesser saphenous V. Fetal circulation A. placenta B. umbilical vein C. ductus venosus D. foramen ovale E. ductus arteriosus F. umbilical arteries VI. Pulse points A. carotid B. radial C. brachial D. facial E. superficial temporal F. femoral G. popliteal H. posterior tibial I. dorsalis pedis VII. Factors that affect blood pressure A. cardiac output B. peripheral vascular resistance (vasoconstriction or dilation) C. elasticity of arteries D. blood volume E. blood viscosity F. other UNIT XIII: LYMPHATIC SYSTEM UNIT OBJECTIVES: 1. List three functions of the lymphatic system. 2. Describe the composition of lymph. 3. Describe the flow path for lymph. 4. Describe the four lymphoid organs: lymph nodes, tonsils, thymus gland, and spleen. 5. State the location of the following lymph nodes: cervical nodes, axillary nodes, and inguinal nodes. 6. Describe the function of the following lymph nodes: cervical nodes, axillary nodes, and inguinal nodes. UNIT OUTLINE: I. Types and locations of lymphoid tissue A. tonsils 1. pharyngeal 2. palatine 3. lingual B. thymus C. spleen D. Peyer's patches E. regional lymph nodes II. Functions of lymph glands

A. filter lymph fluid B. produce T and B lymphocytes C. produce monocytes D. antibody formation E. special functions of spleen III. Lymph fluid A. composition B. drainage pathways IV. Lymph ducts A. thoracic duct B. right lymphatic duct V. Edema A. definition B. causes UNIT XIV: RESPIRATORY SYSTEM UNIT OBJECTIVES: 1. Describe the structure and functions of the organs of the respiratory system. 2. Trace the movement of air from the nostrils to the alveoli. 3. Describe the role of pulmonary surfactants in reducing surface tension. 4. Explain the role of pressure in maintaining expanded lungs. 5. Describe the relationship of Boyle's law to ventilation. 6. Explain how respiratory muscles affect thoracic volume. 7. List three conditions that make the alveoli well suited for the exchange of oxygen and carbon dioxide. 8. Explain how respiratory gases diffuse. 9. Describe how oxygen and carbon dioxide move to and from the lungs. 10. List lung volumes and capacities.

11. Describe common variations and abnormalities of breathing. 12. Explain the neural and chemical control of respiration. UNIT OUTLINE: I. Respiratory pathway A. nares B. nasal cavity (choanae) C. nasal conchae (turbinates) D. nasopharynx E. oropharynx F. laryngopharynx G. epiglottis H. larynx I. vocal cords/ arytenoids J. trachea K. carina L. primary bronchi M. secondary bronchi N. bronchioles

O. alveolar ducts P. alveoli Q. pulmonary capillaries II. Physiology of respiratory pathway A. characteristics of aforementioned structures B. functions of aforementioned structures III. Lungs A. hilum B. lobes C. bronchopulmonary segments D. right and left sides IV. Blood supply A. pulmonary artery B. pulmonary vein V. Pleural space A. parietal pleura B. visceral pleura C. pleural recesses D. pleural fluid VI. Mechanisms of inspiration and expiration A. nervous control 1. medullary respiratory center 2. phrenic and intercostal nerves 3. vagus nerves B. chemical control 1. carbon dioxide 2. oxygen C. diaphragm in inspiration and expiration D. intercostal muscles in inspiration and expiration E. changes in intrapleural pressures F. changes in intrapulmonic (lung) pressures VII. Terminology related to respiratory volume A. tidal volume B. vital capacity C. inspiratory reserve D. expiratory reserve E. residual volume F. total capacity G. other VIII. Terminology for breathing abnormalities A. hyperventilation 1. tachypnea 2. hyperpnea B. apnea C. dyspnea D. hypoxia E. hypercapnia F. cyanosis G. Cheyne-Stokes respiration H. other IX. Pathophysiology A. diagnostic tests B. diseases and disorders 1. lower respiratory diseases (lungs) a. congenital diseases (1) cyctic fibrosis b. atelectasis c. infectious diseases (1) tuberculosis (2) empyema

(3) bronchitis (4) legionnaires disease (5) pneumonia d. chronic obstructive pulmonary diseases e. neoplasms of the respiratory tract f. trauma (1) hemothorax/pneumothorax h. pleuritis and removal of pleural sac I. aspiration j. chronic obstructive pulmonary diseases (1) pleural effusion (2) pulmonary embolus 2. upper respiratory diseases a. laryngitis b. nasal polyps c. sinusitis d. tonsillitis and adenoiditis UNIT XV: DIGESTIVE SYSTEM UNIT OBJECTIVES: 1. List four functions of the digestive system. 2. Describe the four layers of the digestive tract. 3. List three functions of the peritoneal membranes. 4. List, in sequence, the parts of the alimentary canal from the mouth to the anus. 5. Describe the structure and functions of the organs of the digestive tract. 6. Describe the structure and functions of the accessory organs of the digestive tract. 7. List nine functions of the liver. 8. Explain the physiology of digestion and absorption. 9. List the major enzymes involved in digestion. 10. Describe the role of bile in the digestions of fats. 11. Describe five categories of nutrients. 12. List six factors that affect metabolic rate. UNIT OUTLINE I. Anatomic pathway A. mouth B. pharynx C. esophagus D. stomach E. small intestine 1. duodenum 2. jejunum 3. ileum F. large intestine/colon 1. cecum 2. appendix 3. ascending colon 4. transverse colon 5. descending colon 6. sigmoid colon G. rectum H. anus II. Anatomic points of attachment A. ligament of Treitz B. hepatic flexure C. splenic flexure III. Abdominal cavity features

A. peritoneum 1. parietal 2. visceral B. peritoneal cavity C. retroperitoneal space IV. peritoneal duplications A. greater omentum B. lesser omentum C. omental bursa D. mesentery E. mesocolon V. Layers of digestive tube wall A. mucosa B. submucosa C. muscularis D. serosa VI. Alimentary tract/canal A. mouth/oral cavity 1. hard palate 2. soft palate and uvula 3. tongue 4. salivary glands a. parotid (stenson’s duct) b. submaxillary/submandibular (wharton’s duct) c. sublingual (rivinus duct) 5. teeth 6. function a. saliva secretion b. form food bolus B. pharynx C. esophagus 1. structure and location 2. function D. Stomach 1. structure and location a. cardiac sphincter b. fundus c. body d. antrum e. pylorus f. pyloric sphincter g. rugae h. greater curvature i. lesser curvature k. omentum

1. greater 2. lesser 2. enzymes a. hydrochloric acid b. pepsin c. other 3. functions a. secrete mucus b. chemical digestion of carbohydrates, proteins c. mechanical digestion of carbohydrates, protesin d. absorption (1) water (2) simple sugars (3) alcohol (4) salts (5) some medications E. small intestine 1. structure and location a. duodenum (1) duodenal bulb (2) second portion (3) third portion b. jejunum c. ileum d. microvilli

2. functions a. further breakdown of food into basic elements b. absorption c. nutrients d. water e. electrolytes f. vitamins g. hormone secretion F. large intestine 1. structure and location a. cecum b. appendix c. aascending colon d. transverse colon e. descending colon f. sigmoid colon g. mesocolon 2. associated structures a. teniae coli b. haustra c. epiploic appendices d. hepatic flexure e. splenic flexure f. ligament of treitz g. mesentery 3. functions a. final digestion b. decompose bilirubin c. absorption of vitamins (1) B12 (2) Vitamin K d. water absorption e. compaction

G. anal canal 1. structure and location a. rectum b. anus c. sphincters (1) internal (2) external 2. functions a. storage of stool b. defecation VII. Accessory digestive structures A. salivary glands 1. types a. parotid b. submaxillary/submandibular c. sublingual 2. structure and location a. gland b. duct (1) Wharton's duct (2) Stensen's duct 3. functions a. saliva secretion B. liver 1. structure and location a. right lobe b. left lobe c. falciform ligaments/ligamentum teres d. capsule 2. functions a. bile production b. production of certain proteins for blood plasma c. production of cholesterol d. conversion of excess glucose into glycogen for storage e. regulation of blood levels of amino acids f. processing of hemoglobin for use of its iron content g. conversion of ammonia to urea h. clearing the blood of drugs and other toxins i. regulating blood clotting j. producing immune factors and removing bacteria from the blood stream C. biliary system 1. structure and location a. gallbladder (1) pear-shaped organ (2) located under the liver in the gallbladder fossa (3) cystic duct (4) cystic artery (5) triangle of calot b. biliary tree (1) right and left hepatic duct (2) common hepatic duct (3) common bile duct (4) sphincter of Oddi (5) ampulla/ papilla of Vater 2. functions a. gallbladder (1) storage of bile (2) concentration of bile b. biliary tree

(1) transport waste from liver to small intestine (2) provide bile for fat digestion D. pancreas 1. structure and location a. head b. body c. tail d. Islet of Langerhans (1) alpha cells (2) beta cells e. neck 2. functions a. secretions (1) insulin (2) glucagons (3) somatostatin

b. enzymes of protein digestion (1) lipases (2) protease (3) amylases (4) chymotrypsin c. sodium bicarbonate VIII. Basic nutrients A. carbohydrates B. fats C. proteins D. mineral salts E. vitamins F. water IX. Terminology related to digestion and elimination A. catabolism B. anabolism C. digestion D. absorption E. metabolism F. peristalsis G. defecation H. regurgitation I. reflux J. ulcer K. jaundice L. diarrhea M. constipation N. incontinence O. flatus P. ingestion Q. bolus X. Pathophysiology A. diagnostic tests B. diseases and disorders 1. mouth a. periodontal disease b. cancer of the mouth and mandible c. trauma d. Infections e. Inflammatory disease f. Salivary gland disorders

g. Congential defects 2. esophagus a. Zenker's diverticulum b. hiatal hernia c. reflux esophagitis d. esophageal varices e. trauma f. Atresia g. Cancer h. Fistula

3. stomach a. ulcer b. cancer c. trauma d. Gastritis e. Pyloric stenosis 4. small intestine a. duodenal ulcer b. obstruction c. Crohn's disease d. Meckel's diverticulum e. entrapment within a hernia f. trauma g. Chronic inflammatory bowel disease h. Celiac disease 5. colon a. appendicitis b. obstruction c. volvulus d. intussusception e. ulcerative colitis f. inflammatory bowel disease g. diverticulosis/diverticulitis h. polyps i. cancer j. trauma k. peritonitis 6. diseases of the rectum a. hemorrhoids b. cancer c. trauma d. fissure e. pediatric atresia 7. Liver a. cirrhosis b. cancer c. trauma d. portal hypertension e. hepatitis 8. gallbladder a. cholecystitis b. cholelithiasis c. cancer of the biliary duct system and gallbladder 9. pancreas diseases a. pancreatitis

b. cancer c. diabetes C. Nutrition 1. Anorexia nervosa 2. Bulimia nervosa 3. Obesity UNIT XVI: URINARY SYSTEM UNIT OBJECTIVES: 1. List the four organs of excretion. 2. Describe the major organs of the urinary system 3. Describe the location, structure, blood supply, and functions of the kidneys. 4. Explain the role of the nephron unit in the formation of urine. 5. Explain the three processes involved in the formation of urine: filtration, reabsorption, and secretion. 6. Describe control of water and electrolytes through aldosterone: antidiuretic hormone (ADH), atrial natriuretic

factor (ANF); and parathyroid hormone (PTH). 7. List the normal constituents of urine. 8. Describe the structure and function of the ureters, urinary bladder, and urethra. 9. Describe the two fluid compartments; intracellular and extracellular. 10. Describe the concept of intake and output. 11. List factors that affect electrolyte balance. 12. Describe the most common ions found in the intracellular and extracellular compartments. 13. List three mechanisms that regulate pH in the body. 14. Discuss acid-base imbalances: acidosis and alkalosis.

UNIT OUTLINE: I. Structures and functions A. kidneys 1. anatomy a. nephron (1) glomerulus (2) renal tubule (3) Bowman's capsule (4) proximal convoluted tubule (5) intermediate segment - descending loop, loop of Henle, ascending loop

(6) distal convoluted tubule (7) collecting ducts - juxtaglomerular apparatus (JGA)

b. calyx (1) minor (2) major c. renal pelvis 2. function a. filters, cleans and excretes waste b. blood pressure and fluid volume (rennin) c. vitamin D and metabolism of Ca2++ d. regulates non-waste, including all major electrolytes e. JGA - release of angiotensin B. renal vessels 1. renal artery 2. renal vein C. ureters 1. function a. transportation of urine from kidney to bladder

b. peristalsis

D. bladder 1. anatomy a. dome b. wall c. muscle d. mucous membrane e. peritoneum f. trigone g. bladder neck/sphincters 2. function a. storage of urine b. evacuation of urine E. urethra 1. anatomy a. male (1) bladder neck (2) prostatic urethra (3) distal urethra (4) meatus b. female (1) urethra (2) meatus 2. function a. transportation of urine b. transportation/delivery of semen (male) 3. urine composition a. normal components (1) water (2) nitrogenous/metabolic wastes (3) mineral salts (4) pigment b. abnormal components of urine (1) glucose (2) albumin (3) blood (4) ketones/acetone (5) plasma proteins (6) bacterial/pus cells (7) casts (8) other (9) crystals II. Pathophysiology A. diagnostic tests B. diseases and disorders 1. kidney a. renal calculi b. glomerulonephritis c. hydronephrosis d. polycystic disease e. pyelonephritis f. renal failure g. cancer h. nephrosclerosis i. renal calculi j. wilm's tumor

2. bladder

a. urinary incontinence b. cystitis c. calculi d. urinary reflux e. neurogenic bladder f. cancer g. trauma (1) straddled injuries h. retention i. urinary tract infection UNIT XVII: REPRODUCTIVE SYSTEM UNIT OBJECTIVES: 1. List the structures and function of the male and female reproductive systems. 2. Describe the structure and function of the testes. 3. Describe the structure and function of the male genital ducts: epididymis, vas deferens, ejaculatory duct, and

urethra. 4. Describe the accessory glands that add secretions to the semen: seminal vesicles, prostate gland, and bulbourethral glands. 5. Describe the hormonal control of male reproduction, including the effects of testosterone. 6. Describe the structure and function of the ovaries, including the ovarian follicle, ovulation, and ovarian hormones. 7. Describe the structure and function of the female genital tract: fallopian tubes, uterus, and vagina. 8. Explain the hormonal control of the female reproductive cycle. 9. Describe the process of fertilization: when, where, and how it occurs. 10. Describe the process of development: cleavage, growth, morphogenesis, and differentiation. 11. Explain the three periods of prenatal development: early embryonic, embryonic, and fetal periods. 12. State two functions of the placenta. 13. Explain hormonal changes during pregnancy. 14. Describe the process of labor, including the hormonal changes and the individual stages. 15. Describe the structure of the breast. 16. Describe the process of lactation. 17. Describe the relationships among deoxyribonucleic acid (DNA), chromosomes, and genes. 18. Explain dominant genes, recessive genes, and codominance. 19. Explain how the sex of the child is determined. 20. State the difference between congenital and hereditary diseases 21. Define karyotype.

UNIT OUTLINE: I. Structures of the female reproductive system A. external 1. vulva 2. labia a. majora b. minora 3. clitoris 4. vestibule a. distal urethral meatus b. introitus B. internal 1. ovaries a. oocyte formation b. hormone production 1. estrogen

2. progesterone 2. fallopian tubes 3. uterus a. fundus b. corpus c. cervix d. endometrium e. myometrium f. visceral peritoneum g. ligaments (1) round (2) ovarian (3) broad (4) cardinal (5) uterosacral 4. vagina and associated structures a. vagina b. Bartholin's glands c. Skene's glands C. Breast 1. mammary glands 2. mammary ducts 3. areola/nipple II. Functions of the female reproductive organs A. vulva B. vagina C. glands 1. Bartholin's glands 2. Skene's glands D. ovaries 1. oocyte maturation 2. hormone production a. estrogen b. progesterone E. fallopian tubes F. uterus/cervix G. breasts III. Menstrual cycle A. proliferative phase B. ovulation C. progestational phase D. menstrual phase IV. Terminology related to pregnancy A. fertilization B. implantation C. placenta D. amnion E. chorion F. embryo G. fetus H. gestation

I. gravity J. parity K. abortion 1. spontaneous (miscarriage) 2. induced L. prematurity M. other V. Pathophysiology of female reproductive system A. diagnostic tests B. diseases and disorders 1. menstrual disorders a. dysfunctional uterine bleeding b. menorrhagia 2. pelvic inflammatory disease a. toxic shock syndrome 3. ovarian cyst/torsion 4. leiomyoma uteri/fibroid tumor 5. endometriosis 6. uterine descensus/prolapse 7. cystocele 8. rectocele 9. sexually transmitted diseases a. genital warts 10 cancer a. cervical b. uterine c. ovarian d. vulvar 11. breast diseases a. fibrocystic disease b. cancer c. Paget's disease 12. emergency obstetrical disorders a. ectopic pregnancy b. spontaneous abortion c. toxemia d. abruptio placentae e. placenta previa f. nuchal cord g. breech presentation h. cephalopelvic disproportion i. prolapsed cord VI. Structures of the male reproductive system A. external 1. scrotum

2. testes a. seminiferous tubules b. appendix testes 3. epididymis 4. vas deferens 5. inguinal canal 6. spermatic cord 7. penis a. shaft (1) corpus cavernosum (2) corpus spongiosum (3) urethra (4) meatus

b. distal penis (1) glans penis (2) prepuce/foreskin (3) distal urethral meatus B. internal 1. ejaculatory duct 2. seminal vesicles 3. prostate 4. bulborethral gland 5. Cowper's glands VII. Functions of the male reproductive organs A. penis B. scrotum C. urethra D. testes 1. testosterone production 2. spermatogenesis E. epididymis F. vas deferens G. seminal vesicles H. ejaculatory ducts I. prostate gland VIII. Terminology related to male reproduction A. ejaculation B. retrograde ejaculation C. impotence D. spermatogenesis E. semen F. flaccid G. erection IX. Pathophysiology of male reproductive system A. diagnostic tests

B. diseases and disorders 1. phimosis and paraphimosis 2. balanoposthitis 3. prostatitis 4. benign prostatic hypertrophy (BPH) 5. prostatic cancer 6. epispadius/hypospadius 7. erectile dysfunction 8. penile cancer 9. epididymitis 10. hydrocele 11. orchitis 12. testicular cancer 13. testicular torsion 14. cryptorchidism 15. varicocele 16. balanoposthitis

17. spermatocele 18. sexually transmitted diseases a. genital warts b. genital herpes c. chlamydia d. gonorrhea e. syphilis f. trichomoniasis 19. congenital and genetic disorders a. dwarfism b. marfan syndrome c. polydactyly d. syndactyly e. albinism f. phenylketonuria (PKU) g. sickle cell anemia h. tay-sachs i. down syndrome j. defects k. developmental disorders UNIT XVIII: ENDOCRINE SYSTEM UNIT OBJECTIVES: 1. List the functions of the endocrine system. 2. Differentiate between protein hormones and steroid hormones. 3. Explain negative feedback control as a control for hormone levels. 4. Describe the relationship of the hypothalamus to the anterior and posterior pituitary glands.

5. Describe the structure and function of the pituitary gland. 6. List the six major hormones secreted by the anterior pituitary gland. 7. Describe the two major hormones of the posterior pituitary gland. 8. Identify the major endocrine glands of the body. 9. Describe the actions of the hormones secreted by the major endocrine glands 10. Explain the effects of hyposecretion and hypersecretion of the following hormones: insulin, growth hormone, thyroxin, cortisol, parathyroid hormone (PTH), and antidiuretic hormone.

UNIT OUTLINE: I. Pituitary gland (hypophysis) A. location and structure 1. anterior lobe/ adenohypophysis 2. posterior lobe/ neurohypophysis B. functions 1. trophic hormone transmitter production 2. thyroid-stimulating hormone (TSH) 3. follicle-stimulating hormone (FSH) 4. luteinizing hormone (LH 5. growth hormone (GH) 6. adrenocorticotropic hormone (ACTH) 7. prolactin (PRL) 8. neural transmitter production 9. oxytocin (OXT) 10. antidiuretic hormone (ADH) 11. vasopressin (VP) II. Thyroid gland A. location and structure 1. right lobe

2. isthmus 3. left lobe B. functions 1. regulation of body metabolism 2. action(s) of hormones produced a. thyroxine b. calcitonin III. Parathyroid glands A. location and structure 1. 4- 6 glands B. functions 1. action(s) of hormone produced a. parathormone IV. Adrenal/suprarenal glands A. location and structure 1. medulla a. chromaffin cell 2. cortex B. functions 1. medulla a. source of epinephrine b. norepinephrine 2. cortex a. secretes steroid hormones (1) glucocorticoids (2) mineralocorticoids (3) androgens (4) catecholamines V. Pancreas: islets of Langerhans A. location and structure B. functions 1. action(s) of hormones produced a. insulin b. glucagons c. somatostatin VI. Gonads A. location and structure 1. female 2. male B. functions 1. action(s) of hormones produced a. estrogens b. progesterone c. testosterone VII. Thymus A. location and structure 1. mediastinum B. functions 1. production/secretion of hormones a. thymosin VIII. Pineal gland

A. structure 1. posterior to pituitary gland

B. function 1. melatonin

a. synthesize b. secretes IX. Pathophysiology A. diagnostic tests B. diseases and disorders

1. pituitary gland a. tumor 2. thyroid gland a. hyperthyroidism ( Grave's disease) b. hypothyroidism ( Hashimoto's disease) c. goiter d. cancer 3. parathyroid gland a. hyperparathyroidism 4. adrenal gland a. cancer b. hyperadrenalism (Cushing's disease) c. hypoadrenalism ( Addison's disease)


COURSE: SURGICAL PHARMACOLOGY COURSE DESCRIPTION: This course focuses on essential concepts and principles of pharmacology as they relate to surgical technology. Care and handling of drugs and solutions, drugs used in surgery including those used in anesthesia, methods for the administration and monitoring of drugs are introduced. These concepts are reinforced throughout the curriculum. PRE-REQUISITES: Admission into the Surgical Technology program. TEXT: Snyder & Keegan, Pharmacology for the Surgical Technologist , © 2006, W. B. Saunders TEACHING METHODOLOGIES: Lecture, discussion, classroom demonstrations METHODS OF EVALUATION: Examinations EXPECTED OUTCOMES: The student will: 1. Calculate medication conversions and dosages 2. Apply general terminology to medication use. 3. Prepare and manage medications and solutions. 4. Use medications in the care of the surgical patient. 5. Recognize different measurement systems and explain their uses. 6. Identify equivalent values between measurement systems. 7. List sources of drugs and give an example of each. 8. Distinguish between generic and trade names of drugs and recognize what chemical names are. 9. Discuss drug order used in surgery. 10. List the forms that drugs come in and recognize their abbreviations. 11. Discuss the drug administration routes used in surgery. 12. Recognize the abbreviations used for units of measure in basic pharmacology. 13. Discuss federal and state roles in regulating drugs. 14. Characterize the phases of human drug testing. 15. Obtain drug information from pharmacology resources. 16. Describe the role of the surgical technologist in medication administration. 17. Explain the five “rights” of medication administration. 18. Describe the steps of medication identification. 19. Discuss aseptic techniques for delivery of medications to the sterile field. 20. List methods for labeling drugs on the sterile back table. 21. Discuss the purpose of antibiotic therapy in surgery. 22. Discuss antibiotic resistance. 23. List categories of diagnostic agents used in surgery and give examples of each. 24. Discuss the uses of various diagnostic agents in surgery. 25. State the general purpose of a diuretic. 26. Describe the impact of long-term diuretic therapy on the patient about to undergo a surgical procedure. 27. List the two most common diuretics administered intraoperatively and their purpose. 28. Discuss gastric physiology as it affects the surgical patient. 29. List basic categories of gastric drugs, give examples of each, and explain the purpose of each.

30. Describe surgical uses for hormones. 31. List hormones that may be administered from the sterile field. 32. List procedures that may require administration of hormones from the sterile field. 33. Describe the physiology of blood clot formation. 34. List agents that affect coagulation by category. 35. Describe the impact of preoperative oral anticoagulant therapy on the surgical patient. 36. List examples of surgical procedures in which agents that affect coagulation are administered.

37. Compare and contrast administration route, onset of action, antagonist, and purpose of parenteral and oral anticoagulants. 38. Describe the use of ophthalmic drugs in surgery and list examples of drugs used in each category. 39. Identify the purposes of preoperative evaluation. 40. List classifications of preoperative medications and give examples of each. 41. Identify the purpose of each group of preoperative medications. 42. Describe the major types of anesthesia and list applications for each type. 43. Recognize common agents used in local and regional anesthesia. 44. Compare and contrast local anesthesia and MAC. 45. Explain the four basic components of a general anesthetic. 46. Define the phases of general anesthesia. 47. Match generic and trade names of drugs used in anesthesia. 48. Compare and contrast depolarizing and nondepolarizing muscle relaxants. 49. List five basic functions of the blood. 50. List the formed elements present in blood. 51. List major blood types. 52. Briefly describe antigen/antibody interactions in blood types. 53. State indications for blood replacement in the surgical patient. 54. List blood substitutes used in surgery. 55. List three fluid electrolytes crucial to homeostasis and describe three functions of electrolytes in homeostasis. 56. List common IV fluids and their purposes in surgery. 57. Identify potential complications associated with anesthesia. 58. Match drugs used in emergency situations with their purposes. 59. List the clinical signs of malignant hyperthermia. 60. Discuss the role of the surgical technologist in an MH crisis.

COURSE OUTLINE: I. Definition of anesthesia II. Medication measurements A. Conversion and equivalent tables 1. Metric system a. terminology b. conversions 2. Household system a. terminology b. conversions 3. Temperature conversion a. Fahrenheit to Celsius b. Celsius to Fahrenheit

4. Units of measure a. oz b. dram c. ml, cc d. l e. gtt f. kg g. mg B. Basic mathematics 1. fractions 2. decimals 3. ratios 4. proportions 5. percentages

C. Dosage calculations 1. calculating unit per milliliter dosages 2. calculating amount/dosage delivered D. Mixing medications 1. combining medications 2. reconstituting medications 3. diluting medications III Terminology A. General definitions 1. pharmacology 2. pharmacokinetics a. absorption b. distribution c. biotransformation d. excretion 3. pharmacodynamics a. onset b. peak affect c. duration of action d. indication e. contraindication B. Types of medication actions/effects 1. actions a. synergist b. agonist c. antagonist d. additive 2. effects a. side effects b. adverse effects 3. therapeutic actions a. indications b. contraindications

C. Abbreviations 1. stat

2. IV 3. IM 4. sc, subq 5. po 6. os, od, ou 7. qid, tid, bid 8. prn 9. npo 10. other

IV. Medications A. medication nomenclature 1. chemical name 2. generic name 3. trade or brand name B. Medication control classifications 1. controlled substance

2. prescription medications 3. nonprescription medications – over the counter (OTC) 4. other (alternative) C. Medication/solution violations 1. narcotic precautions 2. personal negligence 3. consequences to patient D. Laws, policies and procedures 1. hospital policies and procedures 2. state and federal law 3. types of orders a. verbal orders as accepted practice b. stat c. prn d. verbal E. Medication publications 1. Physician’s Desk Reference – PDR 2. The National Formulary 3. Pharmacopedia of the United States of America – (the U. S. P.) 4. The Joint Commission National Patient Safety Goals 5. American Hospital Formulary Service Index – (AHFS) F. Sources of medications 1. plants 2. animals 3. minerals 4. laboratory synthesis 5. biotechnology – recombinant DNA technology G. Pharmaceutical preparations (drug forms) 1. gas 2. liquid a. solution b. suspension c. emulsion 3. solid 4. semisolid

H. Routes of administration 1. parenteral a. intravenous – IV b. intramuscular – IM c. subcutaneous – sc d. intrathecal e. intracardiac d. intraarticular 2. oral – po 3. topical application 4. inhalation 5. enteral 6.instillation V. Care and handling of medications and solutions A. Medication identification 1. label information 2. trade name 3. generic name 4. concentration 5. amount 6. expiration date 7. directions for reconstitution/dilution

8. storage/handling precautions/warnings 9. route of administration 10. circulator duty/responsibility 11. surgical technologist (STSR) B. Medication preparation 1. nonsterile area a. draw up medication into a syringe 2. nonsterile to sterile field transfer a. circulator b. stsr c. methods of transfer 3. techniques of identification a. labeling devices b. containers on sterile field c. identifying medication or solution to other team members d. six rights C. Packaging measurement and delivery 1. syringes a. leur-lock b. slip-tip 2. finger control a. preloaded syringes b. tubex

c. irrigatiang 1. ear syringe 2. asepto 3. toomey 4. catheter tip 5. vial 6. ampule 7. tube 8. sterile packets 9. metal containers 10. graduated pitcher 11. plastic containers 12. intrathecal pump VI. Medications used in surgery A. Classifications of agents 1. analgesics 2. antiemetics and antihistamines 3. anticoagulants and fibrinolytics 4. analgesic antipyretic agents 5. anti-infective agents 6. anticonvulsants a. aminoglycoside b. antifungals c. antimicrobial d. penicillins and cephalosporins e. polymyxins

f. sulfonamides g. tetracyclines 7. antineoplastic chemotherapy 8. autonomic agents a. andrenergics (alpha/beta) b. adrenergic blockers c. cholinergics d. cholinergic blockers 9. blood replacement interventions a. autologous 1. transfusion 2. principles 3. techniques b. donated 1. type and cross match 2. component thearapy 3. principles of c. whole 1. principles of d. expanders (plasma) 1. medication 2. infusion 10. cardiac medication a. antiarrhythmics b. coronary dilators c. inotropic agents 11. (cns) stimulants a. analeptics b. emetics c. neuroleptics 12. coagulants and hemostatics 13, contrast media 14. diuretics 15. dyes 16. emergency drugs a. malignant hyperthermia b. cardiac arrest c. respiratory arrest 17. gastric medication a. H2 blockers 18. hormones a. corticosteroids b. insulin/glucagon c. prostaglandins d. sex hormones 19. inhalation a. nasal sprays b. respiratory inhalers 20. irrigation solutions 21. iv fluids 22. narcotics 23. narcotic intagonists 24. obstetrical agents a. oxytocics b. RhoGAM 25. opthalmic medications a. antibiotics b. dyes and stains c. enzymes 1. zonulysis

d. irrigating solutions e. local anesthesia adjuncts f. lubricants g. miotics h. mydriatics i. viscoelastics 26. sedative-hypnotic agents 27. staining agents 28. tranquilizers D. Alternative medications 1. herbal medicine 2. nutritional supplemets VII. Assessment to determine anesthesia choice A. American Society of Anesthesiologists determination B. Patient factors 1. age 2. height 3. weight 4. general health 5. co-morbid condition a. diabetes b. blood pressure c. heart disease 6. current medications 7. allergies 8. substance abuse 9. emergency conditions 10. patient's psychological state C. Type of procedure 1. duration 2. surgical position D. Surgeon preference E. Patient preference F. Anesthesia provider preference G. Choices of anesthesia administration 1. general a. intravenous b. inhalation 2. regional a. spinal (intrathecal) b. epidural c. caudal d. rectal 3. local (nerve block) a. intramuscular b. topical 4. bier block a. infiltration 5. related terms a. balanced anesthesia b. neuroleptanalgesia c. neuroleptanesthesia d. monitored anesthesia care (mac) VIII. Surgical team roles during administration A. Health care facility policy B. Assisting anesthesia personnel 1. general anesthesia 2. spinal/epidural 3. regional 4. local

C. Dispensing medications D. Monitoring E. Documentation IX. Preoperative medication of the patient A. Sedative-hypnotic agents 1. diazepam 2. lorazepam 3. midazolam B. Analgesics 1. natural opoid a. morphine 2. synthetic opoids a. meperidine b. fentanyl c. sufentanil d. alfentanil e. remifentanil C. Anti-cholinergics 1. atropine 2. glycopyrrolate 3. scopolamine

D. Antacid/H2 blocking agents 1. sodium citrate with citric acid 2. cimetidine 3. famotidine 4. ranitidine E. Antiemetics 1. promethazine 2. ondansetron 3. metoclopramide X. General anesthesia A. Patient position 1. supine B. Patient monitoring devices 1. electrocardiogram (ECG) a. principles b. equipment c. electrode placement d. recording e. values (adult/child) 2. blood pressure a. principles b. equipment 1. automated cuff 2. stethoscope and cuff c. techniques d. sites e. recording f. values 1. normal 2. abnormal 3. pulse a. principles b. equipment c. techniques 1. manual 2. pulse oximeter a. principles b. equipment

c. techniques d. values (normal/abnormal) d. sites e. recording f. values 1. normal 2. abnormal 4. bispectral index monitor (BIS) 5. intravascular catheters a. arterial line 1. principles 2. equipment 3. techniques 4. recording 5. values

b. swan-ganz pulmonary artery catheter 1. principles 2. equipment 3. techniques 4. recording 5. values c. central venous pressure 1. principles 2. equipment 3. techniques 4. recording 5. values 6. temperature a. principles b. equipment 1. probe a. rectal 2. foley temperature catheter 3. skin temperature strip c. techniques d. sites e. recording f. values (normal/abnormal) 7. capnography 8. respiration a. principles b. techniques 1. manual c. recording d. values (normal/abnormal) 9. system for anesthetic and respiratory analysis (SARA) 10. doplar 11. arterial blood gases a. priciples b. equipment c. techniques d. values (lab) C. Related patient care devices 1. hypo- and hyperthermia unit a. principles b. equipment c. techniques

d. temperature 2. fluid warming devices 3. fluid pump 4. infusion control devices 5. double-cuffed pneumatic tourniquet D. Anesthesia machine 1. vaporizer 2. ventilator 3. re-breathing apparatus 4. scavenging system E. Methods for delivering inhalation general anesthesia 1. mask 2. laryngeal mask airway (LMA) 3. endotracheal intubation F. Intubation and extubation assistive devices 1. laryngoscope a. rigid b. flexible 2. mcgill forceps 3. stylet 4. oral airway 5. nasal airway 6. nerve stimulator G. Phases of general anesthesia 1. induction 2. maintenance 3. emergence 4. recovery H. Stages of general anesthesia 1. stage one 2. stage two 3. stage three 4. stage four I. Anesthetic agents 1. inhalation a. oxygen b. nitrous oxide c. isoflurane d. desflurane e. sevoflurane 2. intravenous a. benzodiazepines (sedative hypnotic agents) b. thiopental c. methohexital d. propofol e. etomidate f. dissociative agent 1. ketamine 3. neuromuscular blocking agents a. depolarizing 1. succinylcholine b. non-depolarizing 1. atracurium 2. rocuronium 3. vecuronium 4. pancuronium 4. neuromuscular blocking reversal agents for non-depolarizing agents a. edrophonium b. neostigmine 5. neuroleptic agents

a. droperidol 6. antagonistic agents a. agents that reverse opioid analgesic agents 1. naloxone 2. nalmefene 3. naltrexone b. agent that reverses benzodiazepines 1. flumazenil

XI. Local anesthesia A. Delivery methods 1. topical 2. injection B. Local and topical agents 1. amides a. lidocaine b. bupivacaine c. mepivacaine 2. esters a. cocaine b. pontocaine c. tetracaine d. cetacaine XII. Complications of anesthesia A. Allergic reaction B. Aspiration 1. sellick's maneuver C. Laryngospasm D. Bronchospasm E. Malignant hyperthermia F. Shock 1. hemorrhagic 2. cardiogenic G. Cardiac dysrhythmias H. Cardiac arrest XIII. Alternative anesthesia methods A. Cryoanesthesia B. Acupuncture


COURSE: MEDICAL/SURGICAL TERMINOLOGY COURSE DESCRIPTION: This course focuses on the study of the structure, definition, and usage of medical and/or surgical words and terms common to the surgical specialty area in a variety of health care settings. PRE-REQUISITES: Admission into the Surgical Technology program. TEXT: Ehrlich and Schroeder, Medical Terminology for Health Professions, 5th Edition, © 2001 Delmar Thomson Learning Clayton E. Thomas, Editor, Taber’s Cyclopedic Medical Dictionary, 21st Edition, © 2003 F. A. Davis TEACHING METHODOLOGIES: Lecture, discussion, audio visual aids, and self-study METHODS OF EVALUATION: Examinations EXPECTED OUTCOMES: The student will: 1. Combine prefixes, word roots, and suffixes to create medical terms related to surgery. 2. Construct and combine compound words. 3. Pronounce medical terms related to surgery. 4. Write medical terms using correct spelling. 5. Analyze unfamiliar medical terms using your knowledge of word parts. 6. Describe the steps in locating a term in a medical dictionary. 7. Recognize the importance of always spelling medical terms correctly. 8. Define anatomy and physiology and use anatomic reference systems to identify the anatomic position, body

planes, directions, and cavities. 9. Recognize, define, spell, and pronounce the terms related to the structure, function, pathology and procedures

of cells, tissues, and glands. 10. Define terms associated with genetics including mutation, genetic engineering, and genetic counseling. 11. Identify the body systems in terms of their major structures, functions, and related word parts. 12. Identify and describe the major functions and structures of the skeletal system. 13. Describe three types of joints. 14. Differentiate between the axial and appendicular skeletons. 15. Recognize, define, spell, and pronounce terms related to the pathology and diagnostic and treatment

procedures of the skeletal system. 16. Describe the functions and structures of the muscular system including muscle fibers, fascia, tendons and the three types of muscles. 17. Recognize, define spell, and pronounce the terms related to muscle movements and how muscles are named. 18. Recognize, define, pronounce, and spell the terms related to the pathology and diagnostic and treatment procedures of the muscular system. 19. Describe the heart in terms of chambers, valves, blood flow, heartbeat, blood supply, and heart sounds. 20. Identify the major components of blood and the major functions of each. 21. State the difference between pulmonary and systemic circulation. 22. Describe the major functions and structures of the lymphatic and immune systems. 23. Recognize, define, spell, and pronounce the major terms related to pathology and diagnostic and treatment procedures of the lymphatic systems. 24. Recognize, define, spell, and pronounce terms related to oncology. 25. Identify and describe the major structures and functions of the respiratory system. 26. Recognize, define, spell, and pronounce terms related to the pathology and diagnostic and treatment procedures of the respiratory system. 27. Identify and describe the major structures and functions of the digestive system.

28. Describe the processes of digestion, absorption, and metabolism. 29. Recognize, define, spell, and pronounce terms related to the pathology and diagnostic and treatment procedures of the digestive system. 30. Describe the major functions of the urinary system. 31. Name and describe the structures of the urinary system. 32. Recognize, define, spell, and pronounce terms related to the pathology and diagnostic and treatment procedures of the urinary system. 33. Describe the functions and structures of the nervous system. 34. Identify the major divisions of the nervous system and describe the structures of each by location and function. 35. Recognize, define, spell, and pronounce terms related to the pathology and diagnostic and treatment procedures of the nervous system. 36. Describe the functions and structures of the eyes and adnexa. 37. Recognize, define, spell, and pronounce terms related to the pathology and diagnostic and treatment procedures of eye disorders. 38. Describe the functions and structures of the ears. 39. Recognize, define, spell, and pronounce terms related to the pathology and diagnostic and treatment procedures of ear disorders. 40. Identify and describe the functions and structures of the integumentary system. 41. Recognize, define, spell, and pronounce the terms related to the pathology and diagnostic and treatment procedures related to the skin, hair, nails, and sebaceous glands. 42. Describe the role of the hypothalamus and endocrine glands in maintaining homeostasis. 43. Name and describe the functions of the primary hormones secreted by each of the endocrine glands. 44. Recognize, define, spell, and pronounce terms relating to the pathology and diagnostic and treatment procedures of the endocrine glands. 45. Identify and describe the major functions and structures of the male reproductive system. 46. Recognize, define, spell, and pronounce the terms related to the pathology and diagnostic and treatment procedures of the male reproductive system. 47. Name at least six sexually transmitted diseases. 46. Identify and describe the major functions and structures of the female reproductive system. 47. Recognize, define, spell, and pronounce the terms related to the pathology and diagnostic and treatment procedures of the female reproductive system. 48. Describe the four vital signs recorded for most patients. 49. Recognize, define, spell, and pronounce the terms associated with basic examination positions. 50. Identify and describe the basic examination positions. 51. Recognize, define, spell, and pronounce terms associated with frequently performed blood and urinalysis laboratory tests. 52. Recognize, define, spell, and pronounce terms associated with radiography and other imaging techniques.

COURSE OUTLINE: I. Prefix, suffix, direction, amount, and color A. prefix 1. a- 2. ab- 3. ad- 4. an- 5. ante- 6. anti- 7. brady-

8. contra- 9. crypt- 10. dia- 11. dys- 12. ecto- 13. en- 14. endo- 15. epi- 16. eu- 17. ex- 18. exo- 19. hemi- 20. hyper- 21. hypo- 22. inter- 23. intra- 24. mal- 25. para- 26. per- 27. peri- 28. post- 29. pre- 30. retro- 31. semi- 32. sub- 33. super- 34. supra- 35. tachy- B. suffix 1. -al 2. -algia 3. -cele 4. -centesis 5. -ectasia 6. -ectasis 7. -ectomy 8. -edema 9. -emesis 10. -gram 11. -graph 12. -graphy 13. -ia 14. -iasis 15. -ism 16. -ist 17. -itis 18. -ium 19. -logist 20. -logy 21. -lysis 22. -malacia 23. -megaly 24. -oid 25. -oma 26. -osis 27. -pathy 28. -pexy 29. -plasty 30. -ptosis 31. -rrhage

32. -rrhagia 33. -rrhaphy 34. -rrhea 35. -sclerosis 36. -scope 37. -scopy 38. -sis 39. -spasm 40. -stasis 41. -stomy 42. -tome 43. -tomy 44. -tripsy C. word roots/combining forms 1. forms describing planes and direction of reference a. anter/o b. caud/o c. dist/o d. dors/o e. infer/o f. later/o g. medi/o h. poster/o i. proxim/o j. super/o k. ventr/o l. cephal/o m. central n. extern/o o. intern/o p. pariet/o q. peripeher/o r. viscer/o

2. forms describing amount or number a. bi- b. di- c. mono- d. multi- e. nulli- f. poly- g. primi- h. quad- i. quadra- j. tetra- k. tri- l. uni- 3. forms describing color or description a. chlor/o b. cyan/o c. erythro/o d. melan/o e. xanth/o

D. medical term components by system 1. word roots related to the digestive system a. an/o b. append/o c. appendic/o d. bil/i e. cec/o f. cheil/o g. chol/e h. cholecyst/o i. col/o j. colon/o k. dent/o l. doch/o m. doch/o n. duoden/o o. enter/o p. esophag/o q. gastr/o r. gingiv/o s. gloss/o t. hepat/o u. ile/o v. intentin/o w. jejun/o x. lingu/o y. odont/o z. or/o aa. pancreat/o bb. periton/o cc. proct/o dd. rect/o ee. sial/o ff. sigmoid/o gg. stomat/o hh. omphal/o ii. abdomin/o 2. Forms related to the respiratory system a. word roots a) alveoli/o b) bronch/o c) bronchi/o d) bronchiol/o e) laryng/o f) lob/o g) nas/o h) ox/o i) pharyng/o j) phren/o k) pleur/o l) pneum/o m) pneumon/o n) pulm/o o) pulmon/o p) rhin/o q) thorac/o r) trache/o b. suffixes (1) -ole (2) -pnea

3. Word roots related to the musculoskeletal system a. ankyl/o b. arthr/o c. burs/o d. calc/i e. carp.o f. cervic/o g. chondr/o h. claviclu/o i. coccyg/o j. cost/o j. cost/o k. crani/o l. femor/o m. fibul/o n. humer/o o. ili/o p. ischi/o q. lumb/o r. metacarp/o s. metatars/o t. muscul/o u. myo v. myel/o w. oste/o x. patell/o y. pelvi/i z. phalang/o aa. pub/o bb. pubic cc. radi/o dd. sacr/o ee. scapul/o ff. spondyl/o gg. stern/o hh. tars/o ii. ten/o jj. tend/o kk. thorac/o ll. tibi/o mm. uln/o nn. vertebr/o 4. Word roots related to the cardiovascular system a. aneurysm/o b. aort/o c. arteri/o d. arter/o e. arther/o f. atri/o g. angi/o h. cardi/o i. coron/o j. lymph/o k. lymphat/o l. phleb/o m. cyan/o n. isch/o o. my/o p. vas/o q. venul/o

r. ventricul/o s. valv/o t. sphygm/o u. pericardi/o 5. Word roots related to the genitourinary and male reproductive systems a. cyst/o b. genit/o c. glomerul/o d. hydr/o e. albumin/o f. orchi/o g. orchid/o h. pen/o i. prostate/o j. pyel/o k. ren/o l. scrot/o m. semin/o n. spermat/o o. test/o p. testic/o q. trigon/o r. ureter/o s. urethr/o t. urin/o u. vas/o v. vesic/o w. lith/o x. olig/o y. varic/o 6. Word roots related to the female reproductive system a. amni/o b. cervic/o c. colp/o d. culd/o e. fet/o f. gon/o g. gynec/o h. hyster/o i. lapar/o j. mamm/o k. mast/o l. men/o m. metr/o n. nat/i o. oophor/o p. ovar/o q. par/o r. salping/o s. uter/o t. vagin/o u. vulv/o v. myom/o 7. Word roots related to the integumentary system a. adip/o b. caus/o c. cauter/o d. cutane/o e. derm/o f. dermat/o

g. diaphor/o h. erythem/o i. erythemat/o j. hydr/o k. kerat/o l. leuk/o m. lip/o n. melan/o o. myc/o p. onych/o q. phyt/o r. pil/o s. py/o t. seb/o u. sebace/o v. squam/o w. steat/o x. trich/o y. ungu/o z. xer/o 8. Word roots related to the nervous system a. alges/o b. angi/o c. caus/o d. cerebell/o e. cerebr/o f. comat/o g. crani/o h. cry/o i. dur/o j. encephal/o k. gli/o l. hydr/o m. mening/o n. meningi/o o. my/o p. myel/o q. narc/o r. neur/o s. pont/o t. radicul/o u. spin/o v. syncop/o w. tax/o x. thalam/o y. troph/o z. vag/o 9. Word roots related to the sensory system 1. eye a. word roots 1. aque/o 2. ambly/o 3. blephar/o 4. conjunctiv/o 5. cor/o 6. corne/o 7. cycl/o 8. dacry/o 9. dipl/o 10. glauc/o

11. ir/o 12. irid/o 13. kerat/o 14. lacrim/o 15. mi/o 16. mydr/o 17. ocul/o 18. ophthalm/o 19. opt/o 20. optic/o 21. palpebr/o 22. papill/o 23.phac/o 24. phot/o 25. presby/o 26. pupill/o 27. retin/o 28. scler/o 29. uve/o 30. vitre/o 31. xer/o b. Suffixes 1. -opia 2. opsia 3. tropia 2.ear a. word roots 1. acous/o 2.audi/o 3.aur/o 4.auricul/o 5.cochle/o 6. mastoid/o 7. myring/o 8. ossicul/o 9. ot/o 10.staped/o 11. tympan/o b.Suffixes 1. -cusis 2. -otia 10. Word roots related to the circulatory system (blood) a. word roots 1.agglutin/o 2. bas/o 3.chrom/o 4. coagul/o 5. cyt/o 6. eosin/o 7 .erythr/o 8. granul/o 9. hem/o 10. hemat/o 11. hemoglobin/o 12. leuk/o 13. mon/o 14. morph/o 15. neutr/o 16. nucle/o 17. phag/o

18. thromb/o b. suffixes 1. -apheresis 2. -blast 3. -cytosis 4. -emia 5.-globin 6. -globulin 7. -lytic 8. phoresis 9. -plasis 10. -poiesis 11. Words roots related to the lymphatic system a. cervic/o b. immun/o c. lymph/o d. lymphaden/o e. lymphangi/o f. splen/o g. thym/o 12. Word roots related to the endocrine system a. aden/o b. adren/o c. adrenal/o d. calc/o e. cortic/o f. crin/o g. estr/o h. gluc/o i. glyc/o j. home/o k. kal/i l. pancreat/o m. parathyroid/o n. pituitar/o o. thyr/o p. thyroid/o II. Rules for combining forms A. combining word parts B. plural forms C. compound words III. Abbreviations A. commonly used abbreviations 1. ABG (arterial blood gas) 2. ACLS (advanced cardiac life support) 3. AD ( right ear) 4. AF ( atrial fibrillation) 5. AIDS ( acquired immunodeficiency syndrome) 6. AK ( above the knee) 7. A/P ( anterior-posterior) 8. ARD ( acute respiratory disease) 9. AS ( left ear) 10. ASD ( atrial septal defect) 11.A/V ( atrioventricular) 12. BCLS (basic cardiac life support) 13. b.i.d. (twice a day) 14.BK ( below the knee) 15. BP ( blood pressure) 16. BPH ( benign prostatic hypertrophy) 17. BSA ( body surface area)

18. BUN ( blood urea nitrogen) 19. Bx ( biopsy) 20. Ca ( cancer) 21. CABG ( cardiac artery bypass graft) 22. CAD ( coronary artery disease) 23. CAT ( computed axial tomography) 24. CBC ( complete blood count) 25. CHF ( congestive heart failure) 26. CNS ( central nervous system) 27. COPD ( chronic obstructive pulmonary disease) 28. CPR ( cardiopulmonary resuscitation) 29. CSF ( cerebrospinal fluid) 30. CVA ( cerebrovascular accident) 31. CVP ( central venous pressure) 32. D&C (dilation and curettage) 33. D/C ( discontinue) 34. DIC ( disseminated intravascular coagulation) 35. DJD ( degenerative joint disease) 36. DNR ( do not resuscitate) 37. DX ( diagnosis) 38. ECG, EKG ( electrocardiogram, electrocardiograph) 39. EEG ( electroencephalogram, electroencephalograph) 40. ENT ( ear, nose, throat) 41. Fx (fracture) 42. GERD ( gastroesophageal reflux disease) 43. gm (gram) 44. GSW ( gunshot wound) 45. gt, gtt (drop) 46. GU ( genitourinary) 47. GYN ( gynecology) 48. H&P ( history & physical) 49. HBV ( hepatitis B virus) 50. HCT ( hematocrit) 51. HIV ( human immunodeficiency virus) 52. I&D ( incision & drainage) 53. ICP ( intracranial pressure) 54. ICU ( intensive care unit) 55. IM ( intramuscular) 56. IOP (intraocular pressure) 57. IV ( intravenous) 58.KUB ( kidney, ureter, bladder) 59. L&D ( labor & delivery) 60. LLQ ( left lower quadrant) 61. LUQ ( left upper quadrant) 62. MRI ( magnetic resonance imaging) 63. NKA ( no know allergies) 64. NPO (nothing by mouth) 65. NS ( normal saline) 66. OD ( right eye) 67. OS ( left eye) 68. OU ( both eyes) 69. P/A ( posterior-anterior) 70. PAD ( peripheral artery disease) 71. PACU (post-anesthesia care unit) 72.PDA( patent ductus arteriosus) 73. PET ( positron emission tomography) 74. PID ( pelvic inflammatory disease) 75. PRN ( as needed) 76. PVC ( premature ventricular contraction) 77. RBC ( red blood cell)

78. RLQ ( right lower quadrant) 79. ROM ( range of motion) 80. RUQ ( right upper quadrant) 81. RX ( drug prescription) 82. stat ( immediately) 83. STD ( sexually transmitted disease) 84. TAH/BSO ( total abdominal hysterectomy w/ bilateral salpingo- oophorectomy) 85. T&A ( tonsillectomy & adenoidectomy) 86. TB( tuberculosis) 87. TENS ( transcutaneous electrical nerve stimulation) 88. TIA ( transient ischemic attack) 89. t.i.d ( three times a day) 90. TMJ ( temporomandibular joint) 91. TPR ( temperature, pulse, respiration) 92. TURP ( transurethral resection of the prostate) 93. UA, U/A ( urinalysis) 94. URI ( upper respiratory infection) 95. UTI ( urinary tract infection) 96. VSD ( ventricular septal defect) 97. WBC ( white blood cell count) B. The Joint Commission “Do Not Use” abbreviation list (http://www.jointcommission.org/patientsafety/donotuselist/) Do Not Use Use Instead U (unit) Write “unit” IU (international unit) Write “international unit” Q.D., QD, q.d., qd (daily) Write “daily” Q.O.D.,QOD, q.o.d., qod (every other day) Write “every other day” Trailing zero (X.0mg) Write Xmg Lack of leading zero (.Xmg) Write 0.Xmg MS Write “morphine sulfate” MSO4 and MgSO4 Write “magnesium sulfate” C. The Joint Commission abbreviations for possible future inclusion on “Do Not Use” list Do Not Use Use Instead > (greater than) Write “greater than” < (less than) Write “less than” Abbreviations for drug names Write drug names in full Apothecary units Use metric units @ Write “at” cc Write “mL”, “ml” or “milliliters” ug Write “mcg” or “micrograms”


COURSE: MICROBIOLOGY COURSE DESCRIPTION: This course is an introduction to the biology of microorganisms with special emphasis on bacteria and viruses. Includes aspects of disease prevention and control, and human immunology and wound healing. PRE-REQUISITES: Admission into the Surgical Technology Program CO-REQUISITES: Surgical Technology II, Surgical Procedures, and Surgical Pharmacology TEXTS: Price, Frey, Microbiology for Surgical Technologists, © 2003, Thomson-Delmar Learning TEACHING METHODOLOGIES: Lecture, discussion, classroom demonstrations, visual aids METHODS OF EVALUATION: Examinations EXPECTED OUTCOMES: The student will: 1. Correlate the impact of microbiology in relationship to the practice of sterile technique and infection control in the operative setting. 2. Identify the name and function of various parts of the compound microscope. 3. Contrast and compare the structure and characteristics of different microorganisms. 4. Analyze the various immune responses that occur in the body as defenses against invasion by pathogens. 5. Relate the infectious process to surgical practice. 6. Define key terms. 7. Discuss significant historical events. 8. Define and discuss the various theories of microbiology. 9. Compare and contrast theories of spontaneous generation and biogenesis. 10. List Koch's postulates and exceptions to the postulates. 11. List and describe the parts of a light microscope. 12. Describe other types of microscopes used by a microbiologist. 13. Discuss the techniques for obtaining an aseptic and pure culture. 14. List and describe the primary methods used to identify bacteria. 15. List and describe the growth mediums. 16. Define key terms of cell structure. 17. Identify the primary characteristics of bacteria. 18. Compare and contrast the three basic shapes of bacteria. 19. Identify classifications of bacteria according to their CO2 and O2 requirements. 20. Describe the functions of the nucleus, endoplasmic reticulum, ribosomes, Golgi complex, mitochondria, lysosomes, and centrioles. 21. Describe endospores and their relation to sterilization. 22. Define key terms of genetics. 23. Describe the list of objectives of taxonomy. 24. Compare and contrast the system of binomial nomenclature for the naming of

organisms and five-kingdom system for classification. 25. Compare and contrast the methods for identifying microorganisms. 26. Explain the concepts of mutation and why it is necessary for the survival of bacteria. 27. Describe the ways that bacteria exchange genetic information.

28. Describe the characteristics of algae, protozoa, fungi, bacteria, rickettsiae viruses, and prions. 29. Identify the diseases associated with common microbes. 30. Define the key terms associated with immunology. 31. Contrast and compare the body's defenses against foreign invaders. 32. Describe the components of the immunity system.

33. Distinguish between active and passive acquired immunity. 34. Explain cell-mediated immunity. 35. Evaluate hypersensitivity reactions. 36. Compare and contrast intentional, unintentional, and incidental/chronic wounds. 37. Analyze the mechanisms of wound healing, the inflammatory process, and the healing process. 38. Evaluate the classifications of surgical wounds, analyze factors that influence healing, and devise a plan to prevent postoperative wound infections. 39. Demonstrate basic wound care concepts and apply the principles of asepsis to the practice of sterile technique. UNIT OUTLINES UNIT I: INTRODUCTION TO MICROBIOLOGY UNIT OBJECTIVES: 1. Define key terms. 2. Discuss significant historical events. 3. Define and discuss the various theories of microbiology. 4. Compare and contrast theories of spontaneous generation and biogenesis. 5. List Koch's postulates and exceptions to the postulates. 6. List and describe the parts of a light microscope. 7. Describe other types of microscopes used by a microbiologist. 8. Discuss the techniques for obtaining an aseptic and pure culture. 9. List and describe the primary methods used to identify bacteria. 10. List and describe the growth mediums. UNIT OUTLINE: I. Introduction to microbiology A. historical background B. microbiology today C. basic chemistry of life II. Introduction to the microscope A. microscope 1. parts of a microscope 2. use of a microscope (in a lab setting) 3. types of a microscope UNIT II: CELL STRUCTURE UNIT OBJECTIVES: 1. Define key terms of cell structure. 2. Identify the primary characteristics of bacteria. 3. Compare and contrast the three basic shapes of bacteria. 4. Identify classifications of bacteria according to their CO2 and O2 requirements. 5. Describe the functions of the nucleus, endoplasmic reticulum, ribosomes, Golgi complex, mitochondria, lysosomes, and centrioles. 6. Describe endospores and their relation to sterilization. UNIT OUTLINE: I. Cell structure A. cells 1. cell theory 2. basic characteristics 3. cell classification a. prokaryotic b. eukaryotic

B. cell structure - eukaryotic 1. nucleus a. nuclear membrane b. chromatin/chromosomes 2. cell membrane 3. cytoplasm a. extoplasm b. endoplasm 4. nucleoid 5. ribosomes 6. endoplasmic reticulum 7. mitochondria 8. Golgi apparatus 9. lysosomes 10. pinocytotic vesicles 11. centrioles 12. microtubules/microfilaments 13. cilia/ flagella C. cell structure - prokaryotic cells 1. cell envelope a. capsule or slime layer b. cell wall c. cytoplasmic membrane 2. mesosomes a. nucleoid b. plasmids c. ribosomes d. flagella e. pili/fimbriae II. Transport across the cytoplasmic membrane 1. passive transport a. diffusion b. osmosis c. filtration 2. active transport a. endocytosis 1. phagocytosis 2. pinocytosis b. exocytosis UNIT III: CLASSIFICATION OF ORGANISMS AND GENETICS UNIT OBJECTIVES: 1. Define key terms of genetics. 2. Describe the list of objectives of taxonomy. 3. Compare and contrast the system of binomial nomenclature for the naming of

organisms and five-kingdom system for classification. 4. Compare and contrast the methods for identifying microorganisms. 5. Explain the concepts of mutation and why it is necessary for the survival of bacteria. 6. Describe the ways that bacteria exchange genetic information.

UNIT OUTLINE:

I. Classification of organisms (Taxonomy) A. kingdom 1. Plantae 2. Animalia 3. Fungi 4. Protista 5. Monera (Procaryotae) B. phylum C. class D. order E. family G. genus H. species I. domains 1. archaea 2. bacteria 3. eukarya II. Binomial nomenclature III. Staining methods A. simple stains B. different stains 1. gram stain 2. acid-fast stain 3. endospore stain 4. capsule stain IV. Culture media A. general culture media 1. defined 2. complex 3. selective 4. differential 5. anaerobic 6. transport B. special culture techniques 1. cell 2. animal 3. low-oxygen 4. enrichment C. preserving cultures V. Host-microbe relationships A. symbiosis 1. mutualism 2. commensalism 3. parasitism B. normal flora UNIT IV: CLASSES OF MICROORGANISMS UNIT OBJECTIVES: 1. Describe the characteristics of algae, protozoa, fungi, bacteria, rickettsiae viruses, and prions. UNIT OUTLINE: I. Specific classes of microorganisms A. algae 1. morphology

2. occurrence 3. relationship to humans 4. uses B. protozoa 1. morphology 2. nutrition 3. classification according to locomotion 4. pathogenicity 5. occurrence in humans 6. occurrence in nature C. fungi (yeasts and molds) 1. morphology 2. nutrition 3. reproduction 4. pathogenicity 5. occurrence in humans 6. occurrence in nature D. bacteria 1. morphology and grouping a. cocci b. spiral c. bacilli d. diplococcic e. streptococci f. staphylococci 2. endospores 3. classification 4. colonization a.growth requirements 1. nutrients 2. oxygen 3. environmental requirements 5. reproduction 6. biochemical activities 7. pathogenicity 8. healthcare concerns

a. occurrence in humans b. occurrence in nature 9. significance E. rickettsiae 1. morphology 2. staining 3. transmission 4. pathogenicity 5. occurrence in humans 6. occurrence in nature F. viruses 1. classification 2. morphology 3. differentiation from other cells 4. replication

a. lysogenic cycle b. lytic cycle

5. bacteriophages 6. genetic changes 7. transmission 8. pathogenicity 9. healthcare concerns

a. occurrence in humans b. occurrence in nature

10. role in cancer 11. significance 12. environmental requirements G. prions 1. classification 2. morphology 3. pathogenicity 4. healthcare concerns

a. occurrence in humans b. occurrence in nature 5. environmental requirements 6. significance H. viroids 1. general characteristics UNIT V: COMMON MICROBES AND THEIR DISEASES UNIT OBJECTIVES: 1. Identify the diseases associated with common microbes. UNIT OUTLINE: I. Bacteria A. Staphyloccus aureus B. Streptococci - differentiated by reactions on agar plates 1. Streptococcus pyrogenes 2. Streptoccus pneumoniae 3. hemolytic sptrepococcus, alpha type & beta type 4. nonhemolytic streptococcus - gamma type C. Neisseria 1. Neisseria gonorrhoeae 2. Neisseria meningitides D. E. coli E. Pseduomonas aeruginosa F. Hemophilus influenzae G. Clostridium 1. Clostridium perfringens 2. Clostridium tetani H. Mycobacterium tuberculosis I. Bacteroides species II. Yeasts A. Candida albicans III. Viruses A. Hepatitis A B. Hepatitis B C. Hepatitis C. D. Hepatitis D E. Human immunodeficiency virus (HIV) IV. Prion disease A. subacute spongioform encephalopathies UNIT VI: IMMUNOLOGIC DEFENSE MECHANISMS UNIT OBJECTIVES: 1. Define the key terms associated with immunology. 2. Contrast and compare the body's defenses against foreign invaders. 3. Describe the components of the immunity system. 4. Distinguish between active and passive acquired immunity.

5. Explain cell-mediated immunity. 6. Evaluate hypersensitivity reactions. UNIT OUTLINE: I. Immunologic defense mechanisms A. immunology 1. antigen 2. antibody/immunoglobulin 3. antigen-antibody reaction B. immune response 1. lag phase 2. primary response 3. secondary response C. acquired immunity 1. active a. natural b. artificial 2. passive a. natural b. artificial D. vaccines 1. nonpathogenic strains 2. closely related microorganisms 3. attenuated living pathogens 4. killed pathogens 5. extracts of pathogens 6. toxoids 7. recombinant DNA II. Hypersensitivity A. immediate B. delayed C. autoimmunity D. terminology 1. allergen 2. allergy 3. localized allergic reaction 4. anaphylactic shock III. Process of infection A. terminology 1. abscess 2. acute infection 3. aerobic 4. anaerobic 5. antibiotic 6. antibody 7. antigen 8. antisepsis 9. antiseptic 10. bacteremia 11. bactericide 12. bacteriostasis 13. bioburden 14. carrier 15. chronic infection 16. chronic/permanent 17. community-acquired infection 18. contaminated 19. comtamination 20. convalescent carrier

21. cross-contamination 22. cross-infection 23. culture 24. disease 25. disinfectant 26. disinfection 27. droplet 28. endogenous source 29. endotoxin 30. exogenous source 31. exotoxin 32. facultative 33. flora 34. fomite 35. host 36. infection 37. infectious agent 38. inflammation 39. local infection 40. necrotic 41. nonsterile 42. nosocomial infection 43. obligatory 44. parasite 45. pathogens 46. phagocytosis 47. primary infection 48. principles of asepsis 49. pus 50. reservoir 51. resident microorganism 52. saprophyte 53. secondary infection 54. sepsis 55. septicemia 56. source 57. spore 58. sterile 59. sterile field 60. sterile technique 61. sterilization 62. sterilizer 63. superinfection 64. suppuration 65. surgically clean 66. systemic infection 67. toxin 68. transient microorganism 69. transitory/temporary 70. vector B. pathogenicity 1. aggressiveness and virulence of the pathogen 2. size and composition of the microbe population 3. physical environment 4. susceptibility of the host C. inflammatory process 1. signs of inflammation a. redness (rubor) b. heat (calor) c. swelling

d. pain 2. Physiology

a. increased blood supply to the site and dilation of blood vessels = heat and increased # WBC's + phagocytosis b. edema, swelling from fluid formation = pain c. accumulation of dead/living microbes + WBC's = pus

3. infection a. invasion b. localization c. resolution UNIT VII: WOUND HEALING UNIT OBJECTIVES: 1. Compare and contrast intentional, unintentional, and incidental/chronic wounds. 2. Analyze the mechanisms of wound healing, the inflammatory process, and the healing process. 3. Evaluate the classifications of surgical wounds, analyze factors that influence healing, and devise a plan to prevent postoperative wound infections. 4. Demonstrate basic wound care concepts and apply the principles of asepsis to the practice of sterile technique. UNIT OUTLINE I. Wound healing A. historical background B. definitions 1. adhesions 2. dehiscence 3. dead space 4. debridement 5. granuloma 6. collagen 7. evisceration 8. hemostasis 9. scar 10. necorsis 11. trauma 12. hematoma 13. keloid 14. edema 15. seroma 16. exudates 17. granulation tissue 18. contracture 19. gangrene 20. serosanguinous C. structure and function of the skin D. types of wounds 1. intentional a. surgical site incision/excision b. chemical wounds c. occlusion banding 2. unintentional a. traumatic injuries b. closed wounds c. open wounds d. simple wounds e. clean wounds

f. complicated wounds g. delayed full-thickness injury h. contaminated wounds 3. incidental and chronic wounds a. pressure sores b. ulcers E. mechanism of wound healing 1. first intention/primary union 2. second intention/granulation 3. third intention/delayed primary closure F. inflammatory process 1. pain 2. heat 3. swelling 4. redness G. healing process 1. fibrinogen 2. fibroblasts 3. collagen 4. network of fibers 5. scar tissue H. stages of wound healing 1. lag phase/inflammatory response phase 2. proliferation phase 3. maturation or differentiation phase I. factors influencing healing 1. physical condition a. general health (1) smoking (2) circulatory status (3) age (4) nutritional status (5) obesity (6) inflammatory and immune responses b. related disease processes (1) hematology (2) fluid and electrolyte balance (3) immunosuppression (4) drug therapy (5) radiation (6) acute/chronic disease process (7) co-morbidity 2. surgical technique a. sterile technique b. tissue handling c. methods of hemostasis d. wound security e. tissue approximation J. complications 1. hematoma/seroma 2. infection 3. wound disruption a. dehiscence b. herniation c. evisceration 4. hemorrhage 5. sinus tract formation 6. fistula 7. scar/surgical cicatrix/keloid 8. adhesion

9. suture complications II. Surgical site infection (SSI) A. incisional infection B. deep wound infection C. nosocomial infections 1. endogenous infection 2. exogenous infection III. Prevention of wound infections A. reduce sources of contamination B. sterile technique 1. sterile supplies 2. sterile gloves C. physician's orders D. procedural steps 1. old dressings removed 2. sterile gloves donned 3. wound cleansed/debridement a. sterile normal saline b. antiseptics c. wound cleaned before surrounding area d. wound care products and dressings applied and secured IV. Common causative agents 1. Affecting skin and wounds A. bacteria 1. acinetobacter 2. bacillus anthracis 3. clostridium perfringens 4. pseudomonas aeruginosa 5. rickettsia rickettsii 6. staphylococcus aureus 7. staphylococcus epidermidis 8. streptococcus pyogenes 9. mrsa 10. mrse 11. vrse 12. vre B. viruses 1. cytomegalovirus 2. herpes simplex virus-1 (HSV-1) 3. herpes simplex virus-2 (HSV-2) 4. human herpes virus 4 (HHV-4 or Epstein-Barr virus EBV) 5. human papillomavirus 6. morbillivirus (measles virus) 7. rubella virus 8. varicella-zoster virus 9. variola virus 2. Affecting the nervous system A. Bacteria 1. clostridium botulinum 2. clostridium tetani 3. escherichia coli 4. haemophilus influenzae 5. klebsiella pneumoniae 6. listeria monocytogenes 7. mycobacterium leprae 8. nisseria meningitides 9. staphylococcus 10. streptococcus agalactiae 11. streptococcus pneumoniae 12. streptococcus pyogenes

B. Viruses 1. enteroviruses (polio virus) 2. lyssavirus (rabies virus) C. Prions 1. new variant creutzfeldt-jacob disease (nvCJD) 3 .Affecting the eyes A. Bacteria 1. chlamydia trachomatis 2. haemophylus influenza 3. nisseria gonorrhoeae 4. staphylococcus system 4. Affecting the cardiovascular system A . Bacteria 1. bacteroides 2 bartonella 3. enterococcus 4. escherichia coli 5. mycobacterium 6. neisseria meningitides 7. psuedomonas aoruginosa 8. salmonella 9. staphylococcus aureus 10. staphylococcus epidermidis 11. streptococcus pneumoniae 12. streptoccus pyogenes 13. VRE 5. Affecting the respiratory system A. Bacteria 1. bacillus anthracis 2. bordetella pertussis 3. corynebacterium diphtheriae 4. haemophilus influenzae 5. klebsiella pneumoniae 6. legionella pneumophila 7. moraxella catarrhalis 8. mycobacterium tuberculosis 9. staphylococcus aureus 10. streptococcus pneumonia 11. streptococcus pyogenes B. Fungi 1. blastomyces dermatitidis 2. coccidiodes 3. histoplasma capsulatum 4. pneumocystis jiroveci 6. Affecting the digestive system A. Bacteria 1. clostridium difficile 2. campylobacter jejuni 3. escherichia coli 4. helicobacter pyori 5. lactobacillus 6. porphyromonas gingivalis 7. salmonella enterica 8. staphylococcus aureus 9. streptococcus niutans 10. vibrio cholerae B. Viruses 1. hepatitis A ( HAV) 2. hepatitis B ( HBV) 3. hepatitis C ( HCV)

4. hepatitis D ( HDV) 5. hepatitis E ( HEV) 7. Affecting the urinary and reproductive systems A. Bacteria 1. a streptococcus 2. chlamydia trachomatis 3. escherichia coli 4. gardnerella vaginalis 5. klebsiella 6. mycoplasma hominis 7. neisseria gonorrhoeae 8. proteus 9. pseudomonas 10. treponema pallidum B. Viruses 1. HSV-1 2. HSV-2 3. human papillomaviruses C. Protozoa 1.trichomonas vaginalis D. Fungi 1. candida albicans 8. Affecting the immunological system A. Human immunodeficiency virus V. Immunology A. Innate immunology 1. first line of defense 2. second line of defense B. Acquired immunity 1. components 2. immune response a. cell-mediated b. humoral 3. Types of acquired immunity C. Immunization 1. Active immunization a. attenuated vaccines b. inactivated vaccines c. toxoid vaccines d. recombinant gene technology vaccines 2. Passive immunization D. Immune disorders 1. Hypersensitivities a, type II b. type II c. type III d. type IV 2. Autoimmune diseases a. single-organ autoimmune diseases b. systemic autoimmune diseases 3. Immunodeficiency diseases a. primary immunodeficiency diseases b. acquired immunodeficiency diseases VI. Process of infection A. Symbiotic relationship between microbes and their hosts 1. Normal microbiota a. resident b. transient 2. Opportunistic pathogens B. Reservoirs of infectious pathogens

1. animal 2. human 3. non-living C. Infection 1. contamination 2. portal of entry 3. portals of exit 4. modes of transmission a. direct b. indirect 5. classification of infectious disease D. Nature of infectious disease 1. symptoms, signs and syndromes 2. etiology 3. virulence 4. stages of infectious diseases a. incubation b. prodromal c. illness d. decline e. convalescence E. Epidemiology 1. frequency of disease 2. epidemiological studies 3. health care and facility epidemiology 4. public health a. epidemic b. pandemic c. endemic

CARVER CAREER AND TECHNICAL EDUCATION CENTER PROGRAM IN SURGICAL TECHNOLOGY

COURSE: SURGICAL TECHNOLOGY COURSE DESCRIPTION: This course introduces the student to basic principles and skills necessary to begin practice as a surgical technologist. The course focuses on the patient care aspect of surgical technology. Students study about health and wellness, as well as exploring feelings about death and dying. Focus is on asepsis, sterilization, disinfection, antisepsis, safety, the importance of team work, surgical conscience, the physical environment of the surgical suite, and preparing the patient for his/her trip to the operating room. Emphasis is on aseptic technique, scrubbing, gowning, gloving, backtable set-up and organization. PREREQUISITES: Admission to the surgical technology program. TEXTS: Frey, Ross Surgical Technology for the Surgical Technologist, Delmar-Thomson Learning, 2008. Surgical Technology for the Surgical Technologist Study Guide to accompany text. SPECIAL RESCOURCES: Phillips, Berry & Kohn’s Operating Room Technique, Mosby, 2007 TEACHING METHODOLOGIES: Lecture, Discussion, Audio-visual aids, self-study, and lab’s METHODS OF EVALUATION: Examinations, and pass / fail skilled competencies EXPECTED OUTCOMES: The student will: 1. Relate total quality management (TQM) concepts to the operating room environment. 2. Explain the function of work groups 3. Compare and contrast each stage of group formation. 4. Classify the common types/ sources of conflict in the workplace. 5. Distinguish between assertive and aggressive behavior 6. Acknowledge the importance of cooperative behavior by group

members. 7. Develop awareness of different cultural perspective.

8. Classify types of body language. 9. Demonstrate effective speaking skills. 10. Demonstrate effective listening skills. 11. Compare and contrast leadership styles. 12. Recognize the importance of leaders. 13. Evaluate theories of motivation. 14. Apply steps of problem solving process for a given situation. 15. Compare and contrast the concepts of team management. 16. Work towards common team goals. 17. Describe each behavior as it relates to the role of the surgical team member. 18. Analyze activities that reflect positive examples of each behavior.

19. Integrate the behaviors into professional practice. 20. Organize information with a procedural/ individual patient focus. 21. Perform analysis based on data and knowledge. 22. Implement activities based on patient/procedural/surgeon knowledge.

23. Integrate information and knowledge for application to each patient situation.

24. Contrast and compare the various roles in the surgical technology profession. 25. Demonstrate responsible and accountable behavior within the role and competencies of the surgical technologist.

26. Assess the various functions of professional credentialing and relate their significance to the profession of surgical technology. 27. Compare and contrast certification, registration, and licensure.

28. Assess the personal and professional importance of becoming certified 29. Compare and contrast the various methods of professional development. 30. Formulate a plan for professional development.

31. Compare and contrast professional organizations and credentialing related to the profession. 32. Describe the professional organization for surgical technologists. 33. Explain various methods of covering health care costs. 34. Identify behaviors that promote professionalism. 35. Compare and contrast the roles of team members in the operating room. 36. Acknowledge the proper chain of command in the operating room. 37. Compare and contrast hospital departments that relate to direct and indirect patient care in the surgical suite. 38. Recognize when information is needed. 39. Locate and evaluate information using the latest technology available. 40. Apply the information effectively in a variety of formats - including written, verbal, and electronic. 41. Identify the basic components of a computer system. 42. Perform basic word processing. 43. Perform graphics importation. 44. Print/save computer information 45. Apply computer knowledge to the educational process and safe patient care practices in the OR. 46. Define electricity. 47. Identify the terms related to electricity and electrical flow. 48. Identify the basic principle of electrical flow. 49. Identify the types of electrical current. 50. Define the components of an electrical receptacle. 51. Apply electrical knowledge to safe patient care practices in the OR. 52. Define terms related to physics. 53. Apply the principles of physics to safe patient care practices in the OR. 54. Discuss the basic concepts related to robotics. 55. Describe the concepts of geometry that are used in the design of surgical robots. 56. Identify the basic components and mechanisms of the robotic system. 57. List the clinical applications of robotics in the OR. 58. Apply the principles of robotics to safe patient care practices in the OR.

59. Define terms related to asepsis. 60. Discuss sources of contamination. 61. Apply sterile technique when necessary. 62. Perform decontamination of the OR environment and equipment 63. Analyze the factors and variables of disinfecting agents. 64. Contrast and compare disinfecting agents.

65. Define terms related to the terminal sterilization/ disinfection process. 66. Identify the methods of processing items during terminal sterilization and/or disinfection. 67. Identify the concepts of microbial barriers. 68. Contrast and compare the materials used for creating microbial barriers. 69. List the methods for sealing microbial barriers. 70. List the process for preparing items for sterilization. 71. Define terms related to the sterilization process.

72. Identify variables related to the sterilization process and the materials to be processed. 73. Compare and contrast methods of sterilization. 74. Identify process monitoring devices and methods. 75. Identify systems used for sterile storage. 76. Apply principles of sterile storage to handling of sterile supplies.

77. Compare and contrast shelf life and event related sterility 78. Assess distribution systems used by sterile processing departments. 79. Demonstrate proper technique in storing, handling, and

distributing sterile supplies. 80. Demonstrate awareness of improper handling and use of sterile supplies.

81. Recognize appropriate surgical attire. 82. Employ principles involved in donning surgical attire.

83. Discuss the location of the surgical suite within the health care facility and describe basic floor plan designs. 84. Identify the rationale behind the principles of the surgical suite layout. 85. Explain and describe the location and floor plan of a basic surgical suite. 86. Explain and identify the environmental systems and environmental controls within the operative environment. 87. State the proper ranges for temperature and humidity controls. 88. Describe the various components of the operating room ventilation system. 89. Identify and describe the principles of environmental

safety controls and guidelines. 90. Discuss and describe potential hazards to the patient in

the operative environment. 91. Identify methods used to access the needs for the case. 92. Gather the instruments, supplies, and equipment needed for a procedure.

93. Assess the function, assembly, use, and care of equipment in the surgical environment. 94. Describe the application of surgical equipment.

95. Identify the classifications, names, parts, materials, finishes and uses of basic surgical instruments. 96. Understand the relationship between instrument type and usage.

97. Apply knowledge of basic surgical instrumentation to specific surgical procedures.

98. Describe the function of the physical components of the operative suite. 99. Plan methods of care, handling, and assembly of basic operating room furniture. 100. Identify the use of various supplies and accessory supplies in the operative environment.

101. Demonstrate the initial steps for starting a surgical procedure 102. Position furniture and equipment to begin the surgical procedure 103. Place and secure supplies on the sterile field.

104. Identify the preliminary preparation for the surgical scrub. 105. Demonstrate the steps of the surgical scrub. 106. Employ sterile technique during surgical scrub. 107. Identify techniques for drying hands and arms 108. Demonstrate self-gowning. 109. Describe gowning others. 110. Compare and contrast closed gloving and open gloving. 111. Discuss the proper technique for removing gown and gloves. 112. Employ sterile technique when self-gowning and/or gloving and when assisting other team members. 113. Demonstrate initial techniques for preparing instruments and supplies on the sterile field. 114. Drape furniture and equipment needed for the surgical procedure. 115. Apply the three principles of asepsis to the practice of sterile

technique. 116. Demonstrate the procedures for counting instruments, sponges, needles, and other items on the field. 117. Discuss the purposes and legal responsibilities of counts. 118. Employ the techniques, timing and methods of counts.

119. Describe various types of draping material used in surgical procedures. 120. Use the appropriate drapes for specific positions and surgical procedures. 121. Demonstrate the general principles of draping the patient, equipment, and furniture. 122. Employ basic routines of case management. 123. Assess specific variations of intraoperative technique. 124. Identify the various tissue layers of the abdominal wall 125. Describe the creation and usage of the surgical incision. 126. Describe principles of exposure. 127. Identify criteria used to select exposure devices. 128. Apply techniques for tissue exposure. 129. Analyze the principles of hemostasis. 130. Differentiate among various methods of hemostasis. 131. Assess special techniques of hemostasis. 132. Compare and contrast the types and characteristics of various catheters and drainage devices. 133. Correlate the correct drainage device for each drain. 134. Compare and contrast the conceptual differences between gravity and vacuum drainage. 135. Prepare catheters and drains for intraoperative use. 136. Prepare anchoring devices for drains. 137. Analyze and assess the factors that influence the closure of each

wound layer. 138. Compare and contrast suture materials, suture sizing and suture coatings and analyze their significance. 139. Demonstrate proper suture selection, preparation, handling and cutting techniques 140. Diagram and describe needle points and needle bodies and demonstrate the proper placement, handling, loading and disposal of surgical needles. 141. Evaluate various applications of surgical stapling instruments and demonstrate proper assembly of stapling instrumentation. 142. Compare and contrast reusable and disposable surgical stapling instruments, and analyze the advantages and disadvantages of utilizing surgical staplers. 143. Compare and contrast biological adhesives and synthetic adhesives. 144. Analyze and evaluate various tissue repair and replacement materials, and assess the advantages and disadvantages of utilizing repair and replacement materials. 145. Interpret the specific applications of synthetic mesh, synthetic tissue replacement materials, and biological wound cover materials. 146. Compare and contrast the utilization of tissue transplants and xenograft biomaterials.

147. Evaluate the purposes of surgical dressings. 148. Analyze their importance to postoperative wound care. 149. Compare and contrast the most commonly used types of surgical and specialty dressings. 150. Acknowledge the importance of proper surgical dressing application techniques. 151. Apply proper principles of sterile technique and demonstrate the application of commonly used types of surgical and specialty dressings 152. Perform postoperative case management duties in an organized and timely manner. 153. Apply standard precautions to the performance of postoperative

case management activities. 154. Demonstrate the initial steps for starting a surgical procedure 155. Position furniture and equipment to begin the surgical procedure 156. Place and secure supplies on the sterile field.

157. Compare and contrast intentional, unintentional, and incidental/chronic wounds. 158. Analyze the mechanisms of wound healing, the inflammatory process, and the healing process. 159. Evaluate the classifications of surgical wounds, analyze factors that influence healing, and devise a plan to prevent postoperative wound infections. 160. Demonstrate basic wound care concepts and apply the principles of asepsis to the practice of sterile technique.

161. Assess current trends and employment opportunities for the surgical technologist. 162. Develop a plan of action to secure employment in the health care field. 163. Evaluate personal employability qualities and develop an employment strategy that includes positive characteristics. 164. Develop a professional resume. 165. Compare and contrast various types of employment/application correspondence. 166. Analyze various interview strategies. 167. Discuss the basic physical and biological needs required to sustain life. 168. Describe patient and family response to hospitalization and surgical intervention. 169. Compare and contrast various spiritual and cultural needs of the surgical patient. 170. Demonstrate appropriate behavior in response to the needs manifested by the surgical patient. 171. Analyze and describe the potential psychological needs of the surgical patient. 172. List and describe potential sources of anxiety and fear in the surgical patient. 173. Identify and discuss the specific needs of pediatric, geriatric, and immunocompromised surgical patients.

174. State the purposes of proper identification. 175. Demonstrate the identification process for a surgical patient

admitted to the surgical suite. 176. Identify the methods of patient transportation. 177. Demonstrate the principles of safe transportation for each of the aforementioned methods. 178. Discuss methods of patient transfer. 179. Identify equipment utilized for safe transfer of the surgical patient. 180. Employ the principles of body mechanics when transferring the surgical patient. 181. Describe and perform the physical preparation and care that the surgical patient may receive prior to the surgical procedure. 182. Evaluate the items on the pre-operative checklist. 183. Analyze laboratory reports in relationship to patient diagnosis and intervention. 184. Review the patient chart for completeness. 185. Analyze the procedure for obtaining informed surgical consent. 186. Analyze the legal concepts of obtaining informed consent. 187. Explain the necessity of each component of anesthesia preparation of the surgical patient.

188. Analyze the use, components, and aides utilized to achieve various surgical positions 189. Detail the sections and functions of the OR table

190. Perform basic positioning. 191. Contrast and compare different types of skin preparations. 192. Contrast and compare different chemical agents used for skin preparation. 193. Describe the steps and rationales for surgical skin preparation.

194. List the indications for urinary catheterizations. 155. Discuss the basic considerations for urinary catheterizations. 196. List the supplies required to perform urinary catheterization. 197. Demonstrate urinary catheterization (simulation may be used). 198. Discuss the principles of monitoring urine output.

199. Describe the homeostatic parameters monitored in the OR setting. 200. Perform basic monitoring of patient homeostatic parameters.

201. Perform duties within their scope of practice related to emergencies in the OR setting. 202. Describe the emergency procedures carried out in the OR setting. 203. Be CPR certified. 204. Initiate the beginning steps for the intraoperative phase of a surgical

procedure. 205. Monitor the sterile field and assess the needs of the surgical team. 206. Provide for the needs of the sterile team members. 207. Initiate the beginning steps for the intraoperative phase of a surgical procedure. 208. Monitor the sterile field and assess the needs of the surgical team. 209. Provide for the needs of the sterile team members.

210. Analyze the classifications of surgical wounds. 211. Distinguish surgical procedures that fit the various categories. 212. Evaluate the common sources of documentation utilized in the operating room. 213. Judge the importance and impact of proper documentation. 214. Analyze the recommended practices and legal elements of proper documentation.

215. Define specimen 216. Assess methods of obtaining specimens. 217. Describe the handling of tissue specimens. 218. Identify types of containers. 219. Describe the procedure for specimen labeling and transfer to appropriate department. 220. Evaluate the care given to specific types of specimens.

221. Discuss areas for specimen storage. 222. Analyze the immediate postoperative care of the surgical patient. 223. Describe potential postoperative discomforts and complications. 224. List necessary equipment in the postanesthesia care unit (PACU). 225. Assess the standards and policies to promote patient satisfaction in the perioperative setting. 226. Apply the various assessment methods to optimize quality patient care to promote safe discharge from the facility. 227. Develop a plan to education patients regarding the anticipated recovery process. 228. Determine ways to proficiently manage patients to minimize costs to the patient, medical facility, and third party payers.

229. Evaluate the role of the risk management department in the health care facility. 230. Assess errors that may occur in the operating room and devise a plan for investigation, correction and notification. 231. Interpret prevention, correction, and documentation techniques that may positively impact risk management issues. 232. Compare and contrast professional liability insurance policies.

233. Analyze major concepts inherent in professional practice law. 234. Interpret the legal responsibilities of the surgical technologist and other surgical team members.

235. Compare and contrast major criminal and civil liabilities and the consequences for these acts. 236. Assess the resources that aid the surgical technologist in interpreting and following professional standards of conduct. 237. Analyze the American Hospital Association's (AHA) Patient's Bill of Rights. 238. Develop an increased sensitivity to the influence of ethics in professional practice. 239. Analyze the role of morality during ethical decision making. 240. Cite examples of ethical situations and problems in the health professions. 241. Analyze the key elements related to developing a surgical conscience. 242. Apply principles of problem solving in ethical decision making. 243. List and define the five components of physical health (cardiopulmonary, muscular strength, muscular endurance, flexibility, and body composition). 244. Discuss and describe food sources of energy and the metabolic processes involved, and relate both of these to wellness and disease. 245. Differentiate internal and external sources of stress, and the effect of stress on various body systems. 246. Compare and contrast alternative healing methodologies, including mental health and spiritual attunement. 247. Evaluate attitudes, beliefs and classifications regarding death and dying. 248. Compare and contrast responses to the process of death and various coping mechanisms.

249. Debate quality of life vs. quantity of life. 250. Trace the steps that are implemented when a patient death occurs in the operating room. GROUP DYNAMICS UNIT OBJECTIVES: 1. Relate total quality management (TQM) concepts to the operating room environment. 2. Explain the function of work groups 3. Compare and contrast each stage of group formation. 4. Classify the common types/ sources of conflict in the workplace. 5. Distinguish between assertive and aggressive behavior 6. Acknowledge the importance of cooperative behavior by group

members. 7. Develop awareness of different cultural perspective.

UNIT OUTLINE: I. Total quality management

A. group behavior B. mission C. proactive style D. empowerment E. multi-directional communication F. do what you say II. Groups A. formal work groups 1. forming 2. storming 3. norming 4. performing

III. Conflict Management A. types

B. personal C. between employees D. individuals and groups E. between groups F. sources G. limited resources H. difference of opinion

I. disagreement about how to attain goals J. employee hostility K. communication problems IV. Assertive and cooperative behavior

A. positive communication techniques B. focus on behavior rather than individual LEADERSHIP UNIT OBJECTIVES: 1. Classify types of body language. 2. Demonstrate effective speaking skills. 3. Demonstrate effective listening skills. 4. Compare and contrast leadership styles. 5. Recognize the importance of leaders. 6. Evaluate theories of motivation. 7. Apply steps of problem solving process for a given situation. UNIT OUTLINE: I. Communication

A. body language B. barriers to effective communication 1. prejudice 2. emotion 3. lack of knowledge 4. personality 5. perception C. basic communication skills 1. parts of communication a. sending the message b. listening to the message c. interpreting the message d. feedback 2. types of communication a. verbal (1) concepts (2) components b. nonverbal (1) concepts (2) components 3. effective communication techniques 4. ineffective communication techniques 5. block to effective communication II. Leadership

A. leadership skills B. types 1. formal leaders a. team leaders b. supervisors

2. informal leaders C. leadership styles 1. autocratic 2. bureaucratic 3. democratic 4. laissez-faire 5. transformational D. motivation 1. principles 2. theories a. Maslow's Hierarchy of Needs Theory E. precepting and training 1. principles 2. problem resolution TEAMWORK UNIT OBJECTIVES: 1. Compare and contrast the concepts of team management. 2. Work towards common team goals. UNIT OUTLINE: I. Team concept

A. group skills 1. professional attitude 2. autonomy 3. respect 4. accountability 5. harassment 6. privacy 7. loyalty 8. commitment 9. cooperation B. team building 1. define 2. interpersonal skills 3. recognition 4. positive environment 5. appreciation 6. support 7. leadership II. Networking

A. staff B. team C. healthcare system D. profession AFFECTIVE BEHAVIOR UNIT OBJECTIVES:

1. Describe each behavior as it relates to the role of the surgical team member. 2. Analyze activities that reflect positive examples of each behavior. 3. Integrate the behaviors into professional practice. UNIT OUTLINE: I. Professional behaviors

A. surgical conscience B. autonomy C. critical thinking D. prioritization E. discrimination F. motivation G. commitment H. flexibility I. adaptability J. self-direction K. internalization L. work ethic M. anticipation CRITICAL THINKING UNIT OBJECTIVES:

1. Organize information with a procedural/ individual patient focus. 2. Perform analysis based on data and knowledge. 3. Implement activities based on patient/procedural/surgeon knowledge.

4. Integrate information and knowledge for application to each patient situation. UNIT OUTLINE: I. Management skills

A. assessment B. planning C. implementation D. evaluation E. predicted outcomes II. Procedural management A. knowledge base B. patient factors 1. preoperative 2. intraoperative C. surgeon factors 1. preference 2. new technology D. procedural factors 1. preoperative 2. intraoperative E. unanticipated factors 1. pathology/ comorbidity 2. unintended tissue injury 3. hemorrhage 4. anesthesia related 5. other

SCOPE OF PRACTICE UNIT OBJECTIVES:

1. Contrast and compare the various roles in the surgical technology profession. 2. Demonstrate responsible and accountable behavior within the role and competencies of the surgical technologist.

UNIT OUTLINE: I. Description of the profession

A. definition B. components of the job description 1. job title 2. entry criteria 3. nature of the position a. able to stand, bend, stoop, and/or sit for long periods of time in one

location with minimum/no breaks b. able to lift a minimum of 20 pounds c. able to refrain from nourishment or restroom breaks for periods up to 6 hours d. demonstrate sufficient visual ability enough to load a fine (10-0) suture onto needles and needleholders with/without corrective lenses and while wearing safety glasses e. demonstrate sufficient peripheral vision to anticipate and function while in the sterile surgical environment f. hear and understand muffled communication without visualization of the communicator's mouth/lips and within 20 feet g. hear activation/warning signals on equipment h. able to detect odors sufficient to maintain environmental safety and patient needs i. manipulate instruments, supplies and equipment with speed, dexterity, and good eye-hand coordination j. ambulate/move around without assistive devices k. able to assist with and/or lift, move, position, and manipulate the patient who is unconscious with or without assistive devices l. communicate and understand fluent English both verbally and in writing m. to be free of reportable communicable diseases and chemical abuse n. able to demonstrate immunity (natural or artificial) to Rubella, Rubeola, Tuberculosis, and Hepatitis B, or be vaccinated against these diseases, or willing to sign a waiver of release of liability regarding these diseases o. possess short- and long-term memory sufficient to perform tasks such as, but not limited to, mentally tracking surgical supplies and performing anticipation skills intraoperatively p. able to make appropriate judgment decisions q. demonstrate the use of positive coping skills under stress r. demonstrate calm and effective responses, especially in emergency situations s. exhibit positive interpersonal skills during patient, staff, and faculty interactions

4. duties 5. accountability 6. supervision II. Roles and competencies A. career development B. requirements 1. responsibilities of the surgical technologist in the scrub role a. preoperative

(1) don operating room attire and personal protective equipment (2) prepare the OR (3) gather/check necessary instrumentation, equipment and supplies (4) create and maintain the sterile field (5) perform surgical scrub (6) don sterile gown and gloves (7) organize the sterile field for use (8) counts necessary items with circulator (9) assist team members during entry of the sterile field (10) expose the operative site with sterile drapes b. intraoperative (1) maintains highest standard of sterile technique during the

procedure (2) maintains the sterile field (3) pass instrumentation, equipment and supplies to the surgeon and surgical assistant as needed (4) assess and predict (anticipate) the needs of the patient and surgeon and provide the necessary items in order of need (5) medication preparation and handling (6) count necessary items (7) specimen care (8) assists with other intraoperative tasks (9) prepares and applies sterile dressings

c. postoperative (1) assists surgical team with patient care, when needed (2) prepares instruments for terminal sterilization (3) assists other members of the team with terminal cleaning of the surgical suite (4) assists in preparing the surgical suite for the next patient 2. responsibilities of the surgical technologist in the circulating role a. preoperative (1) obtains appropriate sterile and nonsterile items needed for the surgical procedure (2) opens sterile instruments, supplies, and equipment (3) checks patient's chart, identifies patient, verifies surgery to be performed with consent form (4) transfers patient to operating room table (5) provide comfort and safety measures (6) provide verbal and tactile reassurance to the patient (7) assists anesthesia personnel (8) positions the patient, using appropriate equipment and safety measures (9) applies electrosurgical grounding pads, tourniquets, and monitors on the patient, using appropriate safety measures (10) performs preoperative skin preparation (11) performs counts b. intraoperative (1) positions and operates equipment needed for the procedure (2) anticipates additional supplies needed during the procedure (3) facilitates communication between sterile and nonsterile

areas (4) records accurate documentation throughout the procedure (5) cares for specimens (6) secures dressings after incison closure

c. postoperative (1) helps transport patient to recovery room (2) assists in terminal cleaning of the surgical suite (3) prepares for the next patient C. related career opportunities

1. central sterile manager 2. educator 3. surgical assistant 4. materials manager 5. medical salesperson 6. organ and tissue procurement/preservation technician 7. physician/surgeon's assistant 8. research assistant 9. veterinary assistant 10. labor and delivery staff 11. office manager 12. surgery scheduler 13. anesthesia technologist 14. self-employed 15. other PROFESSIONAL CREDENTIALING UNIT OBJECTIVES: 1. Assess the various functions of professional credentialing and relate their significance to the profession of surgical technology. 2. Compare and contrast certification, registration, and licensure. 3. Assess the personal and professional importance of becoming certified 4. Compare and contrast the various methods of professional development. 5. Formulate a plan for professional development. UNIT OUTLINE: I. Credentialing A. functions 1. establishes professional and national performance standards 2. provides accountability 3. recognition of the profession 4. mode of occupational regulation 5. establishes initial and continuing competence 6. protects and promotes the public's health II. Certification

A. qualifiers 1. voluntary 2. benefits a. strengthens profession b. assures standards of competency and practice c. links candidacy for certification to graduation

from accredited program d. should be required as a condition of employment

III. Registration A. required by a state agency

B. mandatory - enforcement by state agency C. may be enforced with or without requiring minimum standards or testing

D. benefits and limitations 1. restricts unqualified practitioners 2. limits scope of practice 3. establishes minimum standards IV. Licensure

A. most restrictive form of occupational regulation B. controlled by the state government

C. requires standards of practice, education, minimum competency, and inspection/ enforcement D. benefits and limitations

1. standards of practice 2. education requirements 3. minimum competency 4. civil/ criminal penalties

IV. Continuing education A. purpose

1. maintain currency 2. expand knowledge base 3. learn about technology advancements B. types 1. hospital in-service 2. nation conferences/ specialty forums 3. state and local workshops 4. academic courses 5. journals/ home study 6. industry specific PROFESSIONAL ORGANIZATIONS UNIT OBJECTIVES:

1. Compare and contrast professional organizations and credentialing related to the profession. 2. Describe the professional organization for surgical technologists. 3. Explain various methods of covering health care costs. 4. Identify behaviors that promote professionalism. UNIT OUTLINE: I. Professional organizations and credentialing

A. Commission on Accreditation of Allied Health Education Programs (CAAHEP) B. Accreditation Review committee on Education in Surgical Technology Surgical Assisting (ARC-STSA) C. Association of Surgical Technologists (AST) 1. Historical background 2. Goals 3. Purpose 4. Membership composition 5. Committees 6. Meetings 7. Annual national conference 8. Workshops and forums 9. Professional liability insurance D. Credentialing organization E. Related professional organizations 1. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 2. American College of Surgeons (ACS) 3. Association of periOperative Registered Nurses (AORN) 4. Association for the Advancement of Medical Instrumentation (AAMI) 5. National Institute of Occupational Safety and Health (NIOSH) 6. Occupational Safety and Health Administration (OSHA) 7. American National Standards Institute (ANSI) 8. American Hospital Association (AHA)

9. American Medical Association (AMA) 10. Center for Disease Control (CDC) 11. Food and Drug Administration (FDA) 12. National Fire Protection Association (NFPA) 13. World Health Organization (WHO) 2. Healthcare agencies a. Health insurance a1. Medicare a2. Medicaid a3. Private a4. Health maintenance organizations (HMOs) a5. Preferred provider organizations (PPOs) b. Prospective payment systems b1. Diagnosis-related groups (DRGs) b2. Other methods b3. Impact c. Governmental organizations c1. HCFA c2. OSHA c3. CDC c4. Other d. Private volunteer agencies d1. American Red Cross d2. American Heart Association d3. American Diabetes Society d4. Other 3. Professionalism a. Membership in the Association of Surgical Technologists (AST) b. Certification c. Continuing education d. Community service e. Role model f. Ethical behavior HOSPITAL ORGANIZATION AND MANAGEMENT UNIT OBJECTIVES: 1. Compare and contrast the roles of team members in the operating room. 2. Acknowledge the proper chain of command in the operating room. 3. Compare and contrast hospital departments that relate to direct and indirect patient care in the surgical suite. UNIT OUTLINE: I. Team members

A. surgical technologist B. registered nurse C. surgeon 1. medical doctor (MD) 2. doctor of osteopathy (DO) 3. doctor of dental science/doctor of dental medicine (DDS/DMD) 4. podiatrist (DPM) D. assistants 1. residents/interns/medical students 2. surgical assistant (SA) 3. surgical technologist (ST)

4. registered nurse first assistant (RNFA) 5. physician assistant (PA) E. anesthesia provider 1. anesthesiologist (MD/ DO) 2. nurse anesthetist (CRNA) F. support personnel 1. anesthesia technologist 2. aides/orderly 3. secretary/ unit clerk/ controller 4. equipment technicians a. X-ray/ fluoroscopy b. EEG II. Roles in the operating room

A. surgical technologist in the scrub role B. circulator C. surgeon D. assistant E. anesthesia provider F. support personnel III. Chain of command

A. area/shift manager B. department manager C. perioperative services director (Director of Surgical Services) D. vice president E. president/ CEO F. board of directors/ trustees IV. Related hospital departments

A. direct patient care 1. nursing care units 2. diagnostic imaging (radiology department) 3. blood bank 4. pathology 5. clinical laboratories 6. pharmacy B. indirect patient care 1. housekeeping 2. maintenance 3. central supply 4. food and nutrition 5. biomedical engineering INFORMATION MANAGEMENT (Technology) UNIT OBJECTIVES: 1. Recognize when information is needed. 2. Locate and evaluate information using the latest technology available. 3. Apply the information effectively in a variety of formats - including written, verbal, and electronic.

UNIT OUTLINE: I. Information sources

A. library resource center B. world wide web C. databases D. periodicals E. books F. CD-ROMs G. videos H. DVDs I. manufacturer/ industry educational resources COMPUTER SKILLS UNIT OBJECTIVES: 1. Identify the basic components of a computer system. 2. Perform basic word processing. 3. Perform graphics importation. 4. Print/save computer information 5. Apply computer knowledge to the educational process and safe patient care practices in the OR. UNIT OUTLINE: I. Computer hardware A. basic computer components 1. on/off switch a. switch user b. shut down c. log off 2. drives a. C:drive (hard) b. A:drive (floppy) c. D:drive (CD-ROM) d. E:drive (Zip) 3. monitor 4. keyboard 5. mouse 6. printer 7. modem / wireless card 8. speakers 9. scanner 10. fax 11. accessory ports II. Computer applications A. word processing 1. desktop 2. toolbars a. icons 3. finding/opening files 4. text manipulation a. changing font style/size b. changing case c. cut/copy/paste d. creating footnotes/endnotes e. underlining/italicizing/bolding f. numbering of text

g. spacing of text h. hanging indents 5. page numbering 6. spell/grammar check 7. saving files 8. scrolling 9. printing documents 10. saving and closing files/applications 11. opening documents B. graphics 1. saving 2. importing 3. manipulation C. internet 1. e-mail a. attaching documents 2. research a. bookmarking b. creating favorites 3. saving graphics 4. saving information a. source validation b. copyright D. patient confidentiality ELECTRICITY UNIT OBJECTIVES: 1. Define electricity. 2. Identify the terms related to electricity and electrical flow. 3. Identify the basic principles of electrical flow. 4. Identify the types of electrical current. 5. Define the components of an electrical receptacle. 6. Apply electrical knowledge to safe patient care practices in the OR. UNIT OUTLINE: I. Definition II. Terms A. circuit B. conductor C. current D. frequency E. ground F. insulator G. isolated circuit H. radio frequency I. receptacle J. resistance K. voltage III. Basic principle of electrical flow IV. Types of current

A. direct current B. alternating current C. cycle D. frequencies V. Electrical receptacles A. hot wire B. neutral wire C. ground wire PHYSICS UNIT OBJECTIVES: 1. Define terms related to physics. 2. Apply the principles of physics to safe patient care practices in the OR. UNIT OUTLINE: I. Physics A. Mechanics 1. study of motion 2. projectile and satellite motion 3. Newton's Law of Motion 4. Newton's Law of Gravity 5. momentum 6. energy and work B. Properties of matter 1. atomic nature of matter 2. solids 3. liquids 4. gases and plasmas C. Heat 1. temperature, heat and expansion 2. heat transfer 3. change of state D. Sound, vibrations and waves 1. simple harmonic motion 2. vibrating strings

E. Electricity and magnetism 1. electrostatics 2. electric current 3. magnetism 4. electromagnetic interactions F. Light 1. reflection and refraction 2. color 3. light waves 4. light emission G. Modern physics 1. atomic and nuclear physics 2. relativity ROBOTICS UNIT OBJECTIVES: 1. Discuss the basic concepts related to robotics. 2. Describe the concepts of geometry that are used in the design of surgical robots.

3. Identify the basic components and mechanisms of the robotic system. 4. List the clinical applications of robotics in the OR. 5. Apply the principles of robotics to safe patient care practices in the OR UNIT OUTLINE: I. Robotics A. basic concepts 1. terminology a. articulated b. binaural hearing c. cartesian coordinate geometry d. cylindrical coordinate geometry e. degrees of freedom f. degrees of rotation g. manipulators h. pitch i. resolution j. revolute geometry k. roll l. telechir m. telepresence n. yaw 2. design a. endoscopic positioner b. surgeon console c. manipulators and instrumentation d. telesurgery 3. robotic components and mechanisms 4. preparation/ positioning of the robotic arm(s) a. role of the CST 5. decontamination and sterilization of robotic components B. Clinical applications 1. robotics in minimally invasive surgery 2. robotics in the operating suite 3. troubleshooting 4. patient safety C. Other technologies 1. navigation systems ASEPSIS AND STERILE TECHNIQUE

UNIT OBJECTIVES:

1. Define terms related to asepsis.

2. Discuss sources of contamination. 3. Apply sterile technique when necessary. UNIT OUTLINE:

I. Terminology

A. antiseptic B. asepsis C. aseptic technique D. bacteriocidal E. bacteriostatic F. bioburden G. contaminated H. cross contamination I. decontamination

J. disinfect K. fomite L. infection M. nosocomial N. pathogen O. sepsis P. shelf life Q. spore R. sporicidal S. sterile T. sterile field U. sterile technique V. sterilize W. surgically clean X. terminal sterilization and disinfection Y. vectors Z. virucide AA. droplet BB. event related sterility CC. fungicide DD. mode of transmission EE. resident flora FF. airborne contamination GG. strike through contamination HH. surgical conscience II. transient flora JJ. Surgical site infection (SSI)

II. Sources of contamination A. patient (Endogenous) B. personnel ( Exogenous) C. environment ( Exogenous) III. Principles of asepsis A. A sterile field is created for each surgical procedure B. Sterile team members must be appropriately attired prior to entering the sterile field

C. Movement in and around the sterile field must not compromise the field.

IV. Practice of sterile technique A. All materials in contact with the wound and used within the sterile field must be sterile. B. Gown sterility 1. in front from midchest to table level 2. sleeves - cuff to 2" above the elbow C. Only the top surface of the draped table is sterile D. Packages 1. After a sterile package or container is opened, the edges are considered unsterile 2. 4-way folded packages - 1" margin or edge of horizontal surface 3. Paper/ plastic packages - width of the seal E. Caps should not be replaced on bottles. F. Sterile items and personnel touch only sterile items; conversely, nonsterile items and personnel touch only nonsterile items 1. sterile above - nonsterile below 2. do NOT reach over the sterile field 3. Opening/ draping

a. Circulator - away first b. Scrub - toward first G. Sterile team members stay close to the field

H. Personnel do NOT walk between sterile fields 1. Face to face, back to back transfers for sterile personnel. 2. Nonsterile personnel face the sterile field when passing, maintaining a safe distance. I. Talking/ movement is kept to a minimum. J. Whenever a sterile barrier is permeated, it is considered contaminated 1. Liquid - strike-through 2. Holes K. Items of doubtful sterility must be considered nonsterile 1. Items that fall on the floor are contaminated 2. Prepare the sterile field as close to use time as possible 3. Do not cover the sterile field 4. Do not leave the sterile field unattended DECONTAMINATION / DISINFECTION

UNIT OBJECTIVES:

1. Perform decontamination of the OR environment and equipment. 2. Analyze the factors and variables of disinfecting agents. 3. Contrast and compare disinfecting agents.

UNIT OUTLINE:

I. Goals of terminal disinfection/ sterilization A. reduction in the bioburden created by the surgical intervention

B. prevention of cross-contamination C. prevention of nosocomial infections in the subsequent surgical patient D. prevention of employee exposure

II. Process A. confine B. contain C. reduce/ eliminate III. Procedure A. Terminal disinfection of the OR 1. fluids treated and discarded according to hospital policy 2. suction canister discarded 3. linens removed from bed/ table accessories 4. table accessories disinfected with a high-level disinfectant and stored 5. trash/ linen removed from the suite 6. surfaces wiped/ cleaned with high level disinfectant a. vertical surface contaminated with visible body substances b. all horizontal surfaces wiped 7. floor is mopped with clean mop head and high- level disinfectant or wet-vaccumed 8. furniture/ equipment returned to proper storage location 9. Gloves discarded and hands washed

B. Preparation of the OR 1. OR table remade with linen a. cover sheet b. lift sheet c. coverings for table accessories 2. suction canister replaced 3. linen hamper replaced 4. trash bags accessible IV. Disinfection A. Terminology review 1. disinfectant 2. germicide 3. concurrent disinfection 4. terminal disinfection B. Factors when choosing a disinfecting agent 1. microbe resistance to chemicals a. low-level b. intermediate-level c. high-level 2. level of cidal action and their mechanism of destruction a. coagulate/ denature cell protein b. oxidase or bind enzymes c. alter cell membranes 3. nature of the microbe contamination a. normal flora b. organic soil 4. requirements of the cleaning agents vary 5. kill time 6. porosity of the surface/ material 7. method of application 8. temperature 9. surface tension C. Type of disinfectants 1. Chemical a. halogens and halogen compounds (1) Chlorine compounds (a) chlorinated lime (b) sodium hypchlorite, bleach (2) Iodophors/ iodine-based compounds b. heavy metals (1) Mercurochrome (2) Methiolate c. Phenols and their derivatives (1) hexachlorophene (2) carbolic acid (phenol) d. synthetic detergent disinfectants (quaternary ammonium compounds) e. alcohols (1) ethyl (grain) (2) isopropyl (rubbing) f. formaldehyde (formalin) g. glutaraldehyde ( 2% solution) 2. Physical a. boiling water b. ultraviolet irradiation REPROCESSING (Methods of disinfection and sterilization) UNIT OBJECTIVES:

1. Define terms related to the terminal sterilization/ disinfection process. 2. Identify the methods of processing items during terminal sterilization and/or disinfection. 3. Identify the concepts of microbial barriers. 4. Contrast and compare the materials used for creating microbial barriers. 5. List the methods for sealing microbial barriers. 6. List the process for preparing items for sterilization. 7. Define terms related to the sterilization process. 8. Identify variables related to the sterilization process and the materials to be processed. 9. Compare and contrast methods of sterilization. 10. Identify process monitoring devices and methods. UNIT OUTLINE: I. Terminal sterilization/ disinfection A. concepts 1. reduce bioburden 2. reduce risk of transmission of pathogens B. considerations 1. submersible/ non-submersible 2. heat sensitive/ non-heat-sensitive 3. lumens C. methods 1. manual washing/ disinfection a. process b. considerations c. types of chemical cleaners 2. washer-sterilizer a. process b. considerations c. types of chemical cleaners 3. ultrasonic cleaner a. process b. considerations c. types of chemical cleaners 4. washer / decontaminator a. process b. considerations c. types of chemical cleaners D. concepts of disinfection 1. factors affecting disinfectant efficiency 2. levels of disinfection a. high b. intermediate c. low 3. categories of items to be disinfected or sterilized a. critical b. semi-critical c. non-critical 4. actions of disinfecting agents a. chelation b. enzymatic c. emulsification

d. solubilization II. Wrapping/ creating a microbial barrier A. Concepts 1. ease in application 2. microbial barrier 3. ability to deliver sterile items to the sterile field/ margin of sterility (wrapper application) a. flat four-way folded item (envelope) b. paper/ plastic pouch c. sterilization cases d. square fold e. sealing method 1. chemical tape (external monitor) 4. packaging methods (performance standards and characteristics of) a. maintain sterility of items b. easy removal of items c. sterilizing agent reach all surfaces d. efficiency e. ease of opening f. sterilization suitability g. seal integrity h. safety i. sterility maintenance B. materials 1. muslin/cotton/polypropylene (woven - nonwoven) a. concepts b. advantages c. disadvantages 2. paper a. concepts b. advantages c. disadvantages 3. paper/ plastic pouches a. concepts of use b. tyvek / plastic combination 1. concepts of use c. sealing methods 1. heat seal 2. adhesive seal 4. sterilization cases a. concepts b. advantages c. disadvantages d. case locking devices C. sealing methods 1. process tape 2. heat seal 3. adhesive seal 4. sterilization case locking devise D. process 1. instrument inspection 2. instrument preparation a. instrument disassembly b. separation of surfaces for agent penetration c. contents protection (1) tip protectors (2) internal indicator strip 3. process monitors a. biological b. chemical

(1) internal (2) external

4. wrapper application a. four-way folded wrapping (envelope) b. paper/plastic pouch wrapping 5. labeling a. department to receive item b. contents c. initials of processor d. date and lot number of sterilization e. cycle number f. I.D. of sterilizer used 6. concepts of loading packages on sterilizer cart III. Sterilization A. definitions 1. bioburden 2. sterilization 3. disinfection 4. terminal sterilization 5. terminal disinfection 6. final sterilization 7. event related sterility B. considerations 1. related to the product a. bioburden b. bioresistance c. heat/moisture sensitivity/product stability d. bioshedding of the packaging material e. biostate f. nutritional/health state of the microbe g. density of the packaging for the sterilizing agent 2. related to the process a. temperature b. time c. purity of the agent and the air d. saturation/penetration e. capacity of the sterilizer f. humidity g. pressure h. purity of agent/air C. methods/agents for sterilization 1. variables a. nature of the item to be sterilized (1) submersible/non-submersible (2) heat-sensitive/non-heat-sensitive (3) lumens b. length of sterilization time c. cost d. other 2. agents

a. thermal (1) steam under pressure (a) gravity displacement (b) pre-vacuum (1) uses (2) parameters (3) advantages / disadvantages (4) bowie dick test (c) flash (1) uses

(2) parameters (3) advantages / disadvantages (2) dry heat

b. chemical (1) EO/ETO - ethylene oxide (2) activated glutaraldehyde (3) peracetic acid (4) acetic acid (5) hydrogen peroxide plasma

c. ionizing radiation 3. Concepts

a. method of microbial destruction and gravity displacement (1) denaturation of protein (2) oxidation (3) interference with growth and reproduction

b. indications/ uses c. parameters d. advantages e. disadvantages f. special considerations of the method

4. process monitors a. concepts (1) sterility

(2) exposure to the sterilizing parameters b. methods (1) chemical (a) Ethylene oxide (EtO) (1) microbial destruction (a) interferes with protein metabolism (2) uses (3) parameters (4) advantages / disadvantages (5) biological monitor (a) Bacillus atropheous (b) types of test packs (c) placement in autoclave (d) incubation and reading results (e) frequency of BI monitoring (f) implantables (2) biological (a) Geobacillus stearothermophilus (b) types of test packs (1) Bacillus stearothermopolis

(2) Bacillus subtilis (c) frequency of BI monitoring (d) incubation and reading results (e) placement in autoclave (f) implantables (3) gluteraldehyde (a) microbial destruction (1) denaturation of cellular protein (b) uses (c) parameters (d) advantages / disadvantages (4) peracetic and acetic acid (a) microbial destruction (1) reacts with cellular systems (b) uses (c) parameters

(d) advantages / disadvantages (5) hydrogen peroxide plasma (a) microbial destruction (1) interferes with cell membrane, enzymes, nucleic acid (b) uses (c) parameters (d) advantages / disadvantages (6) ozone gas (a) microbial destruction (1) oxidizes bacteris (b) uses (c) parameters (d) advantages / disadvantages (7) chlorine dioxide gas (a) microbial destruction (1) interferes with cellular processes (b) uses (c) parameters (d) advantages / disadvantages (8) ionizing radiation (a) microbial destruction (1) disrupts DNA (b) uses (c) parameters (d) advantages / disadvantages ENVIRONMENTAL DISINFECTION OF THE OR UNIT OBJECTIVES: 1. Perform decontamination of the OR environment. 2. Analyze the factors and variables of disinfecting agents. 3. Compare and contrast disinfecting agents. UNIT OUTLINE: I. Purpose of environmental decontamination A. reduce bioburden B. prevent cross-contamination C. prevent nosocomial infection D. prevent employee exposure II. Procedure A. intraoperative decontamination B. decontamination between procedures C. terminal cleaning III. Disinfection A. factors for choosing an agent 1. microbial resistance to chemicals a. low-level b. intermediate-level c. high-level 2. mechanism of destruction a. coagulate cell protein b. denature cell protein c. oxidase enzymes d. bind enzymes e. alter cell membranes 3. nature of microbial contamination a. normal flora

b. organic soil 4. kill time 5. methods of application 6. porosity of surface 7. requirements of cleaning agents 8. surface tension 9. temperature of agent B. types of disinfectants 1. halogens and halogen compounds a. chlorine compounds 1. chlorinated lime 2. sodium hypochlorite b. iodine-based compounds 2. phenols and derivatives a. hexachlorophene b. carbolic acid (phenol) 3. alcohols a. ethyl b. isopropyl 4. glutaraldehyde 5. ortho-phthaldehyde (cidex OPA) STERILE STORAGE AND DISTRIBUTION UNIT OBJECTIVES: 1. Identify systems used for sterile storage. 2. Apply principles of sterile storage to handling of sterile supplies. 3. Compare and contrast shelf life and event related sterility 4. Assess distribution systems used by sterile processing departments. 5. Demonstrate proper technique in storing, handling, and

distributing sterile supplies. 6. Demonstrate awareness of improper handling and use of sterile supplies.

UNIT OUTLINE: I. Sterile storage A. systems B. parameters C. shelf life D. event related sterility E. handling 1. stock rotation 2. inspection 3. transport 4. out dates II. Distribution A. systems B. selection of inventory C. delivery D. patient charging methods E. record keeping F. safety practices SURGICAL ATTIRE UNIT OBJECTIVES: 1. Recognize appropriate surgical attire.

2. Employ principles involved in donning surgical attire. UNIT OUTLINE: I. Basic OR attire A. scrubs B. hair covering 1. surgeon’s cap 2. bouffant 3. surgical hood C. shoes/ covers D. warm-up jacket E. mask II. Accessory attire A. lab coat B. personal protective equipment 1. face protection 2. eye protection a. mask with shield b. glass types with side protection c. eye glass side inserts d. goggles C. name tag/picture identification badge III. Handwashing IV. Restrictions A. no jewelry B. no nail polish/ artificial nails C. full coverage of head/ facial hair, except eyebrows/lashes D. body piercings E. excessive perfume F. hygiene G. name tag/ID 1. confine when around neck H. no false eyelashes I. tattoos PHYSICAL ENVIRONMENT UNIT OBJECTIVES:

1. Discuss the location of the surgical suite within the health care facility and describe basic floor plan designs. 2. Identify the rationale behind the principles of the surgical suite layout. 3. Explain and describe the location and floor plan of a basic surgical suite. 4. Explain and identify the environmental systems and environmental controls within the operative environment. 5. State the proper ranges for temperature and humidity controls.

6. Describe the various components of the operating room ventilation system. 7. Identify and describe the principles of environmental

safety controls and guidelines. 8. Discuss and describe potential hazards to the patient in

the operative environment. UNIT OUTLINE:

I. Surgical suite A. locations within the hospital

B. floor plan II. Principles of the layout

A. traffic patterns B. environmental control C. communication systems III. Operating room

A. location B. floor plan C. environmental systems 1. gases a. oxygen b. nitrous oxide c. nitrogen d. suction e. compressed air 2. electrical outlets 3. environmental control a. temperature b. humidity c. ventilation systems (1) positive pressure (2) air exchange rate (3) laminar flow 4. Environmental safety a. traffic control b. electrical hazards c. fire safety d. radiation precautions e. LASER precautions f. OSHA guidelines h. CDC guidelines (1) standard precautions (2) universal precautions (3) personal protective equipment (4) workplace protocols (5) engineering protocols (6) housekeeping protocols (7) post-exposure protocols CASE SELECTION UNIT OBJECTIVES: 1. Identify methods used to access the needs for the case. 2. Gather the instruments, supplies, and equipment needed for a procedure. UNIT OUTLINE: I. Information A. surgery schedule B. surgeon's preference card II. Selection A. instrumentation B. supplies 1. sterile 2. non-sterile C. equipment

1. sterile 2. non-sterile EQUIPMENT UNIT OBJECTIVES: 1. Assess the function, assembly, use, and care of equipment in the surgical environment. 2. Describe the application of surgical equipment. UNIT OUTLINE: I. Specialty equipment A. lasers(biophysics) 1. laser tissue interaction 2. laser versus electrosurgery 3. laser wavelengths and colors 4. laser system parts B. laser benefits C. laser systems 1. CO2 2. yttrium-aluminum garnet (YAG) a. erbium b. holmium c. neodymium (Nd) 3. alexandrite 4. Q-switched ruby 5. diode 6. tunable dye 7. krypton 8. KTP 9. argon 10. excimer 11. free electron D. laser safety 1. fire 2. plume 3. eye protection a. surgical team b. patient 4. controlled treatment zone a. signs b. zone regions 5. use of backstops 6. use of mirrors 7. use of non-reflective instruments 8. endoscopic precautions 9. foot pedals 10. electrical haqzards 11. transportation hazards 12. patient safety a. non-flammable endotracheal tube b. wet draping towels c. wet sponges d. rectal packing 13. laser safety checklist a. knowledge of laser control panel II. Ultrasonic scapel A. harmonic scalpel

III. Specialty equipment A. endoscopes B. microscope C. CUSA D. video/monitor/recorder/camera E. fiberoptic headlight F. light sources

G insufflator H. dopplar I. irrigation/aspiration unit J. cryotherapy unit K. nerve stimulator L. cell saver M. power tools IV. Accessory equipment A. suction systems B. lights C. electrosurgical equipment D. sequential compression devices E. thermoregulatory devices F. tourniquets 1. single and double- cuff INSTRUMENTATION UNIT OBJECTIVES: 1. Identify the classifications, names, parts, materials, finishes and uses of basic surgical instruments. 2. Understand the relationship between instrument type and usage.

3. Apply knowledge of basic surgical instrumentation to specific surgical procedures. UNIT OUTLINE: I. Instruments A. Classifications 1. cutting/ dissecting 2. grasping/ holding 3. clamping/ occluding 4. retracting/ exposing 5. probing 6. suturing 7. viewing 8. dilating 9. aspirating and suctioning 10. accessory 11 . microi8nstrumentation 12. stapling B. Parts 1. tip 2. jaw 3. box lock 4. shank 5. ratchet 6. finger rings C. Materials 1. stainless steel 2. titanium 3. alloys

D. Finishes 1. bright, mirror 2. satin, dulled 3. ebonized II. Care and handling A. Intraoperative 1. passing techniques 2. safety precautions B. Prior to use

1. cleansing method a. washer/sterilizer b. ultrasonic cleaner c. terminal sterilization 2. lubrication 3. preparation for sterilization a. check function and integrity b. set assembly

ROOM PREPARATION

UNIT OBJECTIVES:

1. Describe the function of the physical components of the operative suite. 2. Plan methods of care, handling, and assembly of basic operating room furniture. 3. Identify the use of various supplies and accessory supplies in the operative environment.

UNIT OUTLINE: I. Preparation of the environment A. furniture 1. Mayo stand 2. back table 3. ring stand a. single b. double 4. prep table 5. OR table and accessories 6. kick bucket 7. sitting stool 8. standing/ step stool 9. linen hamper 10. trash receptacle 11. biohazardous waste receptacle B. other 1. blanket warmer 2. clock with a second hand 3. timing clock 4. X-ray view boc 5. documentation center II. Supplies A. sterile packe 1. drape packs 2. custom packs B. surgical sponges 1. types 2. uses

C. dressings 1. types 2. uses D. catheters, drains, tubes, collection devices 1. types 2. uses 3. applications E. accessory supplies 1. syringes and irrigators 2. hypodermic and spinal needles 3. basins and containers III. Preliminary preparations A. gather instruments, supplies and equipment for case 1. surgery schedule 2. surgeon's preference card B. OR preparation 1. arrange furniture 2. gather positioning devices 3. damp-dust lights, furniture and surfaces 4. verify functionality of equipment 5. place items to be opened in appropriate locations IV. Opening sterile supplies A. verify exposure to sterilization process and integrity of barrier material B. use sterile technique C. open as close to the time of surgery as possible D. open back table pack, gown and gloves, basin set and instruments in appropriate locations E. open additional supplies onto the sterile field PREOPERATIVE CASE MANAGEMENT UNIT OBJECTIVES: 1. Demonstrate methods utilized toanalyze and plan for the needs of the surgical case. 2. Select the instruments, supplies and equipment needed for a surgical procedure. 3. Describe the function of the physical components of the operating room. 4. Demonstrate the arrangement, care, handling and assembly of operation room furniture and

equipment. 5. Describe the use of instruments and supplies. 6. Demonstrate techniques for preparing the sterile field. 7. Explain the procedures for draping furniture and equipment. 8. Describe placing and securing supplies and equipment for use on the sterile field. 9. Explain methods for monitoring the sterile field. 10. Apply the priciples of asepsis to the practice of sterile technique. 11. Assess and anticipate the needs of the surgical team. 12. Integrate variations of case management according to the surgical procedure. 13. Demonstrate postoperative case management duties in an organized manner. 14. Apply standard precautions to the performance of perioperative case management activities. UNIT OUTLINE: I. Perioperative concepts A. Time & motion economy

1. Awareness of OR environment 2. Follow established routine 3. One touch method 4. Work rapidly B. Perioperative monitoring of the sterile field 1. Observe for breaks in sterile technique 2. Correct breaks 3. Protect sterile field 4. Sterile technique awareness II. Preoperative case management A. Surgical case information 1. Surgery schedule 2. Surgeon's preference card 3. Patient review a. Assessment b. Interview c. Chart 4. Surgeon consultation B. Preliminary preparations 1. Case cart(s) 2. Select items for case a. Instrumentation (1) Basic (2) Specialty b. Supplies (1) Sterile (2) Non-sterile c. Equipment: Specialty and accessory (1) Sterile (2) Non-sterile (3) Very functionality C. Preparation of the operating room 1. Damp dust surfaces 2. Arrange furniture 3. Obtain OR table positioning devices 4. Test non-sterile equipment, e.g. suction. x-ray viewing box, OR table 5. Position sterile supplies 6. Open sterile supplies a. Establish sequence (1) Back table pack (2) Basin set (3) Instruments (4) Sterile supplies 7. First scrub CST prepare sterile back table and Mayo stand 8. Counts 9. Gown and glove surgeon(s) 10. Establish sterile field 11. Timeout procedures III. Intraoperative case management A. Skin incision and procedural concepts 1. Hemostasis a. Ties ready b. Clamps available 2. Dissection a. Blunt b. Sharp

3. Retraction a. Skin incision b. Deep wound 4. Clamp/clamp/cut/tie (CCCT) 5. Hand signals 6. Sponge exchange 7. Sharps management a. Suture and needle (1) Preparation (2) Passing (a) Right handed (b) Left handed (3) Neutral zone (4) Sharps container on back table 8. Instrument management a. Passing b. Cleaning c. Maintain organization d. Tracking 9. Medication and irrigation management a. Dispensing b. Labeling c. Passing d. Tracking amounts used 10. Specimen management 11. Counts management a. Relieved from procedure b. Major case, e.g. trauma B. Specific variations 1. Bowel technique 2. Cancer technique 3. Isolation technique a. Specimen(s) b. Tuberculosis C. Closing 1. Counts management 2. Retraction a. Deep wound b. Shallow wound 3. Suture and needle management 4. Irrigation IV. Postoperative case management A. Drains B. Apply dressings C. Breakdown sterile field 1. Remove non-disposables from surgical field, e.g. instruments power cords 2. Remove and discard disposable supplies, e.g. light handles, drapes, suction tubing, ESU cord, sponges a. Biohazardous bag b. Regular bag 3. Discard linen a. Biohazardous bag b. Regular bag 4. Discard sharps 5. Prepare instruments for decontamination D. Remove gown and gloves E. Wash hands F. Complete documentation

G. Patient transfer-OR table to stretcher H. Transport case cart to decontamination room HAND HYGIENE AND SURGICAL SCRUB UNIT OBJECTIVES:

1. Identify the preliminary preparation for the surgical scrub. 2. Demonstrate the steps of the surgical scrub. 3. Employ sterile technique during surgical scrub. 4. Demonstrate the steps of a hand wash.

UNIT OUTLINE: I. Medical handwash A. gather neede supplies B. critical elements 1. remove jewelrt 2. wet wrists and hands 3. keep fingers pointed downward/hands lower than elbows 4. avoid contact with non-sterile surfaces 5. wash to 2” above wrists 6. do not shake water from hands 7. dry hands from fingers to wrists 8. follow healthcare facility policy

II. Surgical scrub Preliminary preparations A. remove jewelry B. don personal protective equipment C. inspect integrity of nails and skin D. gather appropriate scrub supplies E. open sterile gown and gloves 1. separate surface from sterile set-up III. Surgical scrub A. preliminary wash and subungual cleaning B. antiseptic agents C. timed method D. counted brush stroke method E. waterless/scrubless methods 1. scrub from fingertips to elbows 2. maintain hands/ wrists above the level of the elbow 3. avoid contact with nonsterile surfaces F. antiseptic agents G. critical elemnts 1. scrub fingertips to 2” above elbow 2. keep fingertips above elbows 3. avoid contact with non-sterile surfaces 4. brush method utilize four planes 5. follow healthcare facility policy GOWNING AND GLOVING UNIT OBJECTIVES: 1. Identify techniques for drying hands and arms 2. Demonstrate self-gowning. 3. Describe gowning others. 4. Compare and contrast closed gloving and open gloving. 5. Discuss the proper technique for removing gown and gloves.

6. Employ sterile technique when self-gowning and/or gloving and when assisting other team members. UNIT OUTLINE: I. Gowning A. drying hands and arms B. gowning 1. gowning of self 2. gowning of others 3. turning the back of gown II. Gloving

A. closed gloving B. open gloving

1. self - without gown 2. others

C. double gloving III. Assist team members IV. Removal of gown and gloves

A. for replacement during the procedure B. at completion of the procedure

V. Other gloving techniques A. replacing contaminated glove(s) (best to optimal technique 1 – 4) 1. replace gown and gloves 2. circulator removes glove; other sterile team member regloves 3. circulator removes glove; surgical technologist re-gloves using open technique 4. surgical technologist dons glove over contaminated glove B. sterile sleeve PREPARATION OF THE STERILE FIELD UNIT OBJECTIVES:

1. Demonstrate initial techniques for preparing instruments and supplies on the sterile field. 2. Drape furniture and equipment needed for the surgical procedure. 3. Apply the three principles of asepsis to the practice of sterile technique.

UNIT OUTLINE: I. Preparation of instruments and supplies on the sterile field.

A. arrange basins, drapes, gowns, gloves and other supplies needed B. arrange instruments, sponges, sutures, and other supplies on sterile field C. apply blades to scalpel handles D. prepare and load appropriate suture material E. prepare and label necessary medications and solutions F. prepare prep table

II. Drape Mayo stand, furniture, and other equipment as needed A. arrange instruments and other appropriate items to begin the case on the Mayo stand B. prepare electrosurgical pencil and suction apparatus

III. Time and motion economy A. follow functional organizational patterns B. work rapidly without compromise of the sterile field

COUNTS

UNIT OBJECTIVES:

1. Demonstrate the procedures for counting instruments, sponges, needles, and other items on the field. 2. Discuss the purposes and legal responsibilities of counts. 3. Employ the techniques, timing and methods of counts.

UNIT OUTLINE: I. Counting

A. purpose B. legal responsibility

1. documentation 2. incorrect counts 3. omitted counts II. Concepts

A. technique 1. two-person verification 2. visual/ audible counting 3. order of counts a. field/ Mayo/ back table/ off the field B. timing 1. initial 2. closure of organ 3. closure of body cavity 4. closure of subcutaneous/ skin 5. additional counts a. change of staff b. addition of subsequent items C. methods 1. sponge 2. needles/ sharps 3. instruments 4. accessories D. procedure for handling an incorrect count 1. pre-op 2. intra-op E. electronic methods of tracking counts 1. bar coding 2. radio-frequency identification

DRAPING UNIT OBJECTIVES 1. Describe various types of draping material used in surgical procedures. 2. Use the appropriate drapes for specific positions and surgical procedures. 3. Demonstrate the general principles of draping the patient, equipment, and furniture. UNIT OUTLINE: I. Materials A. woven B. non-woven C. plastic II. Types of drapes A. towels B. fenestrated

C. non-fenestrated D. adhesive 1. barrier 2. fire prevention strategy E. specialty III. Principles of draping A. cuffing B. handling C. towel placement order D. recognition and correction of contamination IV. Draping OR furniture A. tables B. ring stands C. mayo stand V. Draping of equipment A. microscope B. phacoemulsification equipment C. LASER D. x-ray equipment E. video equipment F. other VI. Draping OR furniture A. tables B. ring stands C. Mayo stand INTRAOPERATIVE CASE MANAGEMENT UNIT OBJECTIVES: 1. Employ basic routines of case management. 2. Assess specific variations of intraoperative technique. UNIT OUTLINE: I. Intraoperative techniques A. basic routines 1. hand signals 2. clamp/ clamp/ cut/ tie 3. sponge exchange 4. instrument passing and maintenance 5. sharps management 6. suture preparation and passing 7. medication/ irrigation preparation and passing 8. monitoring the sterile field 9. anticipation 10. specimen management 11. counts 12. customizing the Mayo stand a. entry b. intraoperative c. exit B. specific variations 1. bowel technique 2. cancer technique 3. isolation technique ABDOMINAL INCISIONS UNIT OBJECTIVES

1. Identify the various tissue layers of the abdominal wall 2. Describe the creation and usage of the surgical incision. 3. Discuss the advantages and disadvantages of incision types UNIT OUTLINE: I. Anatomy of the abdominal wall A. abdominal regions B. tissues layers II. Abdominal incisions A. vertical 1. midline 2. paramedian B. oblique 1. lower oblique inguinal 2. lumbar (flank) 3. McBurney 4. subcostal (kocher-right subcostal) 5. thoraco-abdominal 6. chevron C. transverse 1. midabdominal 2. pfannenstiel 3. rocky davis EXPOSURE UNIT OBJECTIVES: 1. Describe principles of exposure. 2. Identify criteria used to select exposure devices. 3. Apply techniques for tissue exposure UNIT OUTLINE: I. Principles of retracting A. protecting underlying tissues B. provide wound exposure II. Selection of exposure devices A. tissue application 1. diseases affecting tissue durability B. depth of wound C. size of incision D. surgical procedure III. Types and uses of retractors A. hand held B. self-retaining 1. ratcheted 2. bed attachments C. traction suture D. vascular loops E. retracting bowel 1. moist laps F. wound protector bag G. bowel bag H. viscera retainer

UNIT XXXIV: HEMOSTASIS UNIT OBJECTIVES: 1. Analyze the principles of hemostasis. 2. Differentiate among various methods of hemostasis. 3. Assess special techniques of hemostasis. 4. Demonstrate surgical technologist’ role in hemostasis UNIT OUTLINE: I. Principles A. blood clotting mechanisms B. blood components C. monitoring blood loss II. Methods of hemostasis A. mechanical 1. hemostatic instruments 2. ligatures 3. pressure 4. bone wax 5. clip 6. tourniquet 7. sponges 8. pledgets 9. fibrin glues B. chemical 1. absorbable gelatin 2. absorbable collagen 3. oxidized cellulose 4. silver nitrate 5. epinephrine 6. thrombin 7. microfibrillar collagen C. thermal 1. electrosurgical unit 2. harmonic scalpel 3. argon beam coagulator 4. laser III. Techniques A. hypothermia B. hypotension CATHETERS AND DRAINS UNIT OBJECTIVES: 1. Compare and contrast the types and characteristics of various catheters and drainage devices. 2. Correlate the correct drainage device for each drain. 3. Compare and contrast the conceptual differences between gravity and vacuum drainage. 4. Prepare catheters and drains for intraoperative use. 5. Prepare anchoring devices for drains. UNIT OUTLINE: I. Concepts of catheter/ wound drainage A. exit for body fluid

1. intraoperatively 2. postoperatively B. introduction/ placement 1. end of the incision 2. "stab wound" 3. natural body orifice II. Catheters A. composition 1. latex/ rubber 2. PVC 3. silicone B. sizes 1. French sizing C. application 1. temporary 2. indwelling D. types 1. red rubber (Robinson) a. description b. uses (1). irrigation of ducts (2). temporary drainage of urine from the bladder 2. indwelling/ retention a. description (1) Foley (a). 2-way (b). 3-way (2). mushroom/ Pezzar/ Malecot (3). T-tube b. components (1). drainage portal (2). balloon portal (3). irrigation portal c. uses (1) long-term access or drainage of a hollow organ (2). irrigation of a hollow organ (3). drainage of common bile duct (CBD) during healing d. insertion technique (1). urinary catheterization (2). placement of a mushroom/Pezzer/Malcot catheter (3). T-tube e. difficult catheterization (1). Coude (2). Silicone with guide wire E. Preparation 1. lubrication F. Indwelling intravenous catheters 1. description a. broviac b. hickman c. groshong 2. components a. single lumen b. double lumen 3. uses a. infusion of nutrients, blood or medications 4. insertion techniques a. percutaneously

b. cut down c. into right atrium of heart III. Adapters A. types 1. catheter adapters 2. three in one connector B. uses IV. Collection devices A. gravity bedside drainage 1. urinary collection device 2. urometer B. bile bag V. Drains A. types 1. open a. concepts (1). not attached to a closed drainage system (2). drain by milking fluids along the surface into gauze (capillary action) (3). have an increased incidence of infection b. types (1) Penrose (2) cigarette 2. closed a. concepts (1). drain attached to a closed reservoir for fluid collection (2). drain by gravity or vacuum (3). have decreased incidence of infection b. types (1). gravity (a). urinary drainage (b). T-tube (c). mushroom/ Pezzer/ Malecot (2). vacuum (a). hemovac (b). Jackson-Pratt (c). autologous blood retrieval drainage systems (d). chest tube drainage system VI. Collection devices A. gauze B. bedside drain C. bile bag D. reservoir VII. Anchoring methods A. suture 1. nonabsorbable 2. cutting needle B. tape VIII. Urinary catheterization A. indications 1. specimen collection 2. retention 3. decompression of the urinary bladder 4. monitor urinary output 5. incontinence 6. keep urine from contact with surgical wound B. Considerations 1. duration of catheterization 2. physician's order 3. anatomical

a. female b. male 4. positioning and lighting 5. patient modesty 6. sterile technique C. Supplies 1. catheterization tray/ set 2. catheter a. temporary b. indwelling c. irrigating 3. urinary collection device D. Procedural steps 1. positioning 2. preparation 3. insertion 4. securing E. Monitoring urinary output 1. measurement 2. assessment 3. documentation IX. Safety precaution A. emptying contents 1. aseptic technique B. maintaining position of collection dexices 1. prevent back flow 2. prevent infections TISSUE APPROXIMATION UNIT OBJECTIVES: 1. Analyze and assess the factors that influence the closure of each wound layer. 2. Compare and contrast suture materials, suture sizing and suture coatings and analyze their significance. 3. Demonstrate proper suture selection, preparation, handling and cutting techniques 4. Diagram and describe needle points and needle bodies and demonstrate the proper placement, handling, loading and disposal of surgical needles. 5. Evaluate various applications of surgical stapling instruments and demonstrate proper assembly of stapling instrumentation. 6. Compare and contrast reusable and disposable surgical stapling instruments, and analyze the advantages and disadvantages of utilizing surgical staplers. 7. Compare and contrast biological adhesives and synthetic adhesives. 8. Analyze and evaluate various tissue repair and replacement materials, and assess the advantages and disadvantages of utilizing repair and replacement materials. 9. Interpret the specific applications of synthetic mesh, synthetic tissue replacement materials, and biological wound cover materials. 10. Compare and contrast the utilization of tissue transplants and xenograft biomaterials. 11. Describe tissue replacement materials. 12. Demonstrate knowledge of biological wound cover materials UNIT OUTLINE:

I. Sutures A. history of suture B. definitions 1. absorbable 2. nonabsorbable 3. monofilament 4. multifilament 5. synthetic 6. natural 7. tensile strength 8. ligate 9. ligature/tie/"stick tie"/suture ligature 10. continuous tie (ligature reel) 11. instrument tie 12. inert 13. capillarity 14. pliability 15. memory 16. tissue drag 17. elasticity 18. knot-security C. specifications for suture material 1. must be sterile 2. sterile technique applied in suture handling process 3. uniform tensile strength 4. uniform size 5. appropriate diameter 6. knot security 7. minimal foreign body tissue reaction D. selection of suture material 1. classifications of suture materials a. absorbable sutures vs. nonabsorbable (1). hydrolysis (2). enzymatic b. monofilament sutures vs. multifilament sutures c. natural vs. synthetic materials 2. surgeon selection of suture material a. biological characteristics of the suture material (1) absorbable vs. non-absorbable (2). capillary vs. non-capillary (3). inertness b. healing characteristics of tissue c. location/length of incision d. presence of absence of infection, contamination, and/or drainage e. patient characteristics f. physical characteristics of suture material g. surgeon preference E. Suture materials 1. natural absorbable suture a. materials (1). surgical gut (a). plain surgical gut (b). chromic surgical gut (2). collagen sutures b. handling characteristics of surgical gut and collagen (1). sealed in fluid filled packages (a). flammable (b). irritating to delicate tissues (c). use immediately after removal from

package handling c. applications 2. synthetic absorbable polymers a. materials (1). polydioxanone (PDS) (2). polyglecaprone 25 (Monocryl) (3). polyglyconate (Maxon) (4). polyglactin 910 (Vicryl) (5). polyglycolic acid (Dexon) (6). glycoside collected (Polysorb) (7). glycomer 631 (Biosyn) (8). poly(L-lactide/glycoside) (Panacryl) b. handling characteristics of synthetic absorbable polymers (1). expiration date on package (2). packaged and used dry c. applications 3. natural nonabsorbable sutures a. materials (1). silk (a). virgin (b). dermal silk (2). cotton (3). stainless steel b. handling characteristics (1). silk (2). cotton (3). stainless steel c. applications 4. synthetic nonabsorbable polymers a. materials (1). surgical nylon (a). monofilament 1). Ethilon 2). Dermalon 3). Monosof 4). Supramid (b). multifilament 1). Nurolon 2). Surgilon 3). Bralon 4). Supramid (2). polyester fiber (a). non-coated 1). Ticon 2). Dacron 3). Mersilene (b). coated 1). Ethibond 2). Ethiflex 3). Tevdek 4). Surgidac 5). Polydek (c). coatings 1). polybutilate 2). polytetrafluroethylene 3). silicone (d). coated / noncoated 1). Ticron (3). polybutester (Novofil) (4). polyethylene (Dermalene)

(5). polypropylene (Prolene, Surgipro, Surgilene) (6). polytetrafluroethylene (PTFE) (7). gore-tex (8). fiberwire

b. handling characteristics of synthetic nonabsorbable suture c. applications

F. suture preparation 1. loading and proper placement 2. cutting 3. estimating suture needs 4. sequence of usage 5. removal from package 6. straightening

G. packaging of suture materials 1. box 2. overwrap 3. primary packet 4. inner dispenser 5. color coding 6. labeling

H. suture size, material, color, and length 1. product code number 2. lot number 3. expiration date 4. needle a. shape b. quantity c. point geometry 5. number of strands 6. controlled release-swaged

I. Methods of suturing/suturing techniques 1. Halstead's principles

2. suturing techniques a. simple (1). continuous (running) (2). continuous running/locking (blanket stitch) (3). subcuticular stitch (4). purse-string suture b. interrupted (1). simple interrupted (2). interrupted horizontal mattress (3). interrupted vertical mattress (4). figure of eight (5). buried (6). retention (7). traction stitch 3. retention suture a. definition b. applications c. materials (1). suture materials (2). retention bridges, bolsters, and bumpers 4. endoscopic suturing a. applications b. methods (1). extracorporeal method (2). intracorporeal method (a). endo-loop (b). free hand (c). endo-stitch

5. accessory devices a. buttons and lead shots b. umbilical tape c. vessel loops d. adhesive skin closure tapes e. suture anchors 6. techniques for cutting suture material J. layer closure-abdominal wall 1. peritoneum 2. muscle 3. fascia 4. subcutaneous 5. subcuticular/skin K. surgical application L. alternative skin closure 1. wound zipper 2. adhesive skin closure strip 3. cyanoacrylate (Dermabond) II. Surgical needles A. needle characteristics 1. strong 2. rigid yet flexible 3. sharp 4. appropriate shape, size, and diameter 5. free from burrs and corrosion B. parts of a needle 1. point 2. body 3. eye C. needle points 1. shape a. cutting (1). conventional cutting (2). reverse cutting (3). side cutting b. taper (1). regular (2). tapercut (3). blunt (4). trocar 2. applications D. needle bodies 1. 1/4 circle 2. 3/8 circle 3. 1/2 circle 4. 5/8 circle 5. straight/ Keith E. eyed needles 1. French eye 2. split eye 3. "eyeless"/swaged a. single-armed attachment b. double-armed attachment c. permanently swaged needle attachment d. control release F. Needle holder selection and loading needles 1. proper size 2. proper length 3. proper position of the needle in holder 4. proper handing to surgeon

G. Needle accountability 1. hand needles on exchange basis to surgeon 2. inspect needles when returned by surgeon 3. use sharps container/ counter during case 4. terminal disposal at end of case H. Surgical specialty needles 1. biopsy needles 2. cannulated needles 3. diagnostic needles 4. medication/ injection needles 5. irrigation needles III Surgical stapling equipment A. Types of staplers 1. linear a. GIA/ linear with blade b. TA/ linear 2. intraluminal circular 3. ligating and dividing 4. fascia 5. skin 6. endoscopic B. reusable vs. disposable staplers 1. reusable staplers a. accuracy b. loading c. operation d. handling e. disassembled and cleaned 2. disposable staplers a. pre-assembled b. self-contained c. integral or reloadable staple cartridges d. materials 1. stainless steel, titanium, polysorb e. handling f. disposal C. Advantages 1. speed 2. accelerated wound healing 3. airtight and leak proof 4. placement through an endoscope D. Disadvantages 1. cost containment factors 2. errors in technique E. Applications 1. skin closure 2. fascial closure 3. division of tissue 4. biopsy/ resection 5. ligation 6. anastomosis 7. closure of organs IV. Ligating clips A. materials 1. stainless steel 2. titanium 3. tantalum 4. absorbable B. reusable vs. disposable 1. reusable

a. clip bar b. applicator c. applications V. Tissue adhesives A. biological adhesives 1. fibrin glue 2. autologous or homologous plasma 3. pooled-donor plasma B. synthetic adhesives 1. cyanoacrylate 2. methyl methacrylate VI. Tissue repair materials A. Biologic materials 1. cargile membrane 2. fascia lata B. synthetic meshes 1. advantages a. easily cut to size b. pliable c. porous and allow free drainage d. easily sutured e. fibrous tissue grows easily through openings 2. types a. polyester fiber mesh (Mersilene mesh) b. polyglactin 910 mesh (Vicryl mesh) c. polypropylene mesh (Prolene mesh, Marlex mesh) d. polytetrafluoroethylene (Gore-Tex soft tissue patch) e. ingrowth mesh (Surgisis) f. stainless steel mesh VII. Tissue replacement materials A. biologic wound cover 1. autograft 2. allograft 3. cryopreserved skin 4. amniotic membrane 5. xenograft a. porcine dermis b. artificial skin (apligraft) c. atriovenous shunts d. collagen e. corium B. biologic materials 1. bone a. bone grafts b. bone bank C. tissue transplants 1. human dura mater 2. human umbilical cord vein graft 3. genetically engineered/ grown D. xenograft bio-materials 1. atriovenous shunts 2. collagen 3. corium 4. human skin equivalent (Apligraft) E. synthetic materials 1. characteristics a. contour and conform to normal tissue b. stable c. adequate blood supply through and around d. viable and adequate tissue coverage

e. sterile f. compatible g. produce no or minimal tissue reaction 2. types a. carbon fiber b. metal c. methyl methacrylate d. polyester fiber e. polyethylene f. polytetrafluoroethylene g. silicone F. storage of tissue replacement materials 1. temperature settings SURGICAL DRESSINGS UNIT OBJECTIVES: 1. Evaluate the purposes of surgical dressings. 2. Analyze their importance to postoperative wound care.

3. Compare and contrast the most commonly used types of surgical and specialty dressings. 4. Acknowledge the importance of proper surgical dressing application techniques. 5. Apply proper principles of sterile technique and demonstrate the application of commonly used types of surgical and specialty dressings UNIT OUTLINE: I. Surgical dressings A. functions 1. protect incision from microbial contamination and injury 2. absorb drainage and secretions 3. provide aesthetic appeal 4. support the incision 5. provide pressure to reduce/ eliminate dead space 6. assist in hemostasis 7. provide pressure to prevent edema and hematoma formation 8. maintain moist environment allowing for destruction of microbes and preservation of new epithelial tissue B. types 1. primary 2. secondary C. materials 1. primary dressing a. nonadherant (1). Telfa (2). Adaptic (3). Xeroform (4). Vaseline gauze (5). povidone-iodine gauze (6). absorbent (7). sponges (8). Kerlix (9). rolled gauze/ Kling 2. secondary dressings a. absorbant (1). ABD

(2). stockinette b. supportive (1). Webril (2). ace bandage (3). casts/ splints 3. other dressing materials a. Op-site/ Bioclusive/ steri - strips b. liquid Collodion c. aerosol adhesive spray d. foams, gels, and hydrocolloids e. biological / skin grafts 4. skin preparation materials a. benzoin b. mastisol 5. methods to secure dressing materials a. tape (1) silk (2). paper (3). foam (4). elastoplast (5). plastic (6). cloth b. Montgomery straps c. tube gauze 6. specialty dressings a. stent dressings b. thyroid collar c. ostomy bags d. drain dressing e. bolster f. eye pad and shield g. perineal h. pressure i. tracheotomy j. wet to dry / wet to wet k. wound vac 7. packing a. plain NuGauze b. iodophor NuGauze (Iodoform) c. vaginal packing d. nasal packing 8. application techniques a. single material b. non-adherence, absorption, support c. occlusive d. semiocclusive e. non-occlusive POSTOPERATIVE CASE MANAGEMENT UNIT OBJECTIVES: 1. Perform postoperative case management duties in an organized and timely manner. 2. Apply standard precautions to the performance of postoperative case management activities. UNIT OUTLINE: I. Goals

A. care of the surgical patient B. reduce bioburden from the surgical intervention C. prevent nosocomial infections/ cross contamination in subsequent patients D. account for all items E. prepare items for decontamination/ terminal sterilization II. Process A. confine B. contain C. reduce/ eliminate III. Procedures A. drape removal 1. account for instruments, sharps, electrosurgical electrode on drapes 2. cover the wound with a dressing 3. roll contaminated drapes 4. discard contaminated drapes B. dismantle the sterile field 1. account for instruments outside the sterile field 2. account for light gloves/handles 3. sharps discarded according to hospital policy 4. isolate items that cannot be washer/sterilized or ultrasonically cleaned 5. instruments to the processing tray for preparation for terminal sterilization a. heavy instruments on bottom of tray b. sharps/delicate items protected c. all box locks opened d. all assembled instruments disassembled 6. linen in fluid-proof hamper 7. disposable drapes and supplies in plastic trash bag a. body substance contaminated items in biohazardous trash b. non-hazardous waste in regular trash C. remove gown/gloves 1. proper technique 2. handwashing WOUND HEALING UNIT OBJECTIVES:

1. Compare and contrast intentional, unintentional, and incidental/chronic wounds. 2. Analyze the mechanisms of wound healing, the inflammatory process, and the healing process. 3. Evaluate the classifications of surgical wounds, analyze factors that influence healing, and devise a plan to prevent postoperative wound infections. 4. Demonstrate basic wound care concepts and apply the principles of asepsis to the practice of sterile technique.

UNIT OUTLINE: I. Wound healing A. Historical background B. Definitions 1. adhesions 2. dehiscence 3. dead space 4. debridement

5. granuloma 6. collagen 7. evisceration 8. hemorrhage 9. scar / cicatrex - keloid 10. necrosis 11. trauma 12. hematoma 13. keloid 14. edema 15. seroma 16. exudates 17. granulation tissue 18. contracture 19. gangrene 20. serosanguinous 21. extravasation 22. trauma 23. tissue reaction 24. wound disruption C. Structure and function of the skin D. Types of wounds 1. intentional a. surgical site incision/excision b. chemical wounds c. occlusion banding

2. unintentional wounds a. traumatic injuries b. closed wounds c. open wounds d. simple wounds e. clean wounds f. complicated wounds g. delayed full-thickness injury h. contaminated wounds 3. incidental and chronic wounds a. pressure sores b. ulcers

E. Mechanism of wound healing 1. first intention/primary union 2. second intention/granulation 3. third intention/delayed primary closure 4. considerations / dead space - tensile strength - disease processes F. Inflammatory process 1. pain 2. heat 3. swelling 4. redness 5. loss of function G. Healing process 1. fibrinogen 2. fibroblasts 3. collagen 4. network of fibers 5. scar tissue H. Stages of wound healing 1. lag phase/inflammatory response phase 2. proliferation phase 3. maturation or differentiation phase

I. Factors influencing healing 1. physical condition a. general health (1) smoking (2) circulatory status (3) age (4) nutritional status (5) obesity (6) inflammatory and immune responses (7) disease b. related disease processes (1) hematology (2) fluid and electrolyte balance (3) immunosuppression (4) drug therapy (5) radiation (6) acute/chronic disease process (7) co-morbidity 2. surgical technique a. sterile technique b. tissue handling c. methods of hemostasis d. wound security e. tissue approximation f. dissection technique g. duration of surgery h. elimination of dead space i. length and direction of the incision J. Complications 1. hematoma/seroma 2. infection 3. wound distruption a. dehiscence b. herniation c. evisceration d. dead space e. tissue trauma f. wound tension 4. hemorrhage 5. sinus tract formation 6. fistula 7. scar/surgical cicatrix/keloid 8. adhesion 9. suture complications II. Surgical site infection (SSI) A. Incisional infection B. Deep wound infection C. Nosocomial infections 1. endogenous infection 2. exogenous infection III. Prevention of wound infections A. Reduce sources of contamination B. Standard precautions C. Principles of asepsis and practice of sterile technique D. Meticulous technique and wound closure E. Control endogenous infection F. Tissue perfusion G. Antibiotic therapy H. Wound drains I. Dressings

J. Wound irrigation IV. Basic wound care procedure A. Standard precautions B. Sterile technique 1. sterile supplies 2. sterile gloves C. Physician's orders D. Procedural steps 1. old dressings removed 2. sterile gloves donned 3. wound cleansed/ debridement a. sterile normal saline b. antiseptics c. wound cleaned before surrounding area d. wound care products and dressings applied and secured E. Wound classifications 1. Class a. I - clean b. II - clean-contaminated c. III - contaminated d. IV - dirty / infected EMPLOYABILITY SKILLS UNIT OBJECTIVES: 1. Assess current trends and employment opportunities for the surgical technologist. 2. Develop a plan of action to secure employment in the health care field. 3. Evaluate personal employability qualities and develop an employment strategy that includes positive characteristics. 4. Develop a professional resume. 5. Compare and contrast various types of employment/application correspondence. 6. Analyze various interview strategies. UNIT OUTLINE: I. Employment in the healthcare field A. Career information B. Current employment trends and opportunities C. Employment facilities and institutions D. Transition from student to employee II. Employability qualities A. Strong work ethic B. Ambition C. Communication skills (verbal and written) D. Motivation/initiative E. Honesty/integrity F. Dedication G. Flexibility/adaptability H. Conflict resolution I. Attendance and punctuality J. Personal appearance K. Commitment L. Dependability M. Competencies/skills N. Interpersonal skills O. Conscientiousness P. Understanding of policies/procedures

Q. Team mentality R. Accountability S. Willingness to serve on committees T. Commitment to continuing education U. Spirit of cooperation V. Moral and legal obligations III. Resume preparation A. Elements 1. purpose 2. presentation style 3. list qualifications 4. organized and neat 5. correct spelling, grammar, etc. 6. typed 7. length 8. electronic versus paper B. Content 1. identification (name/address) 2. career objective 3. education 4. work experience 5. outside activities and interests 6. achievements/honors 7. references available IV. Application correspondence A. Cover letter 1. position desired 2. education and experience summary 3. suggested contact and availability B. Professional reference letter 1. permission 2. factual information C. Thank you letter/appreciation 1. expresses appreciation for the interview 2. reemphasizes strongest qualifications 3. reiterates interest in the position D. Acceptance letter 1. acceptance of the position 2. confirms starting date and time E. Letter of refusal 1. refuse position 2. thanks individuals involved in interview process V. Employment application form A. Read employment application form first B. Neat C. Accurate D. Follow instructions E. Dates of education and work experience F. Reference information available VI. Interview strategies A. Prepare prior to interview 1. consult career books 2. seek out experts 3. gather information about the position and organization B. Appropriate attire C. Be punctual D. Be prepared E. Introduce yourself F. Demonstrate confidence G. Project a positive image

H. Make only positive or neutral comments I. Close the interview on a positive note J. Thank individuals involved in interview process VII. Resignation A. Notice 1. written 2. verbal B. Exit interview BIOPHYSICAL NEEDS OF THE PATIENT UNIT OBJECTIVES: 1. Discuss the basic physical and biological needs required to sustain life. 2. Describe patient and family response to hospitalization and surgical intervention. 3. Compare and contrast various spiritual and cultural needs of the surgical patient. 4. Demonstrate appropriate behavior in response to the needs manifested by the surgical patient. 5. Analyze and describe the potential psychological needs of the surgical patient. 6. List and describe potential sources of anxiety and fear in the surgical patient. 7. Identify and discuss the specific needs of pediatric, geriatric, and immunocompromised surgical patients. UNIT OUTLINE: I. Biological needs A. nutrition B. sleep C. regulation of body processes D. fluid balance E. O2/ CO2 exchange F. elimination of waste II. Psychological needs A. fear 1. unknown 2. shortened lifespan 3. anesthesia 4. death 5. pain 6. disfigurement/ mutilation 7. loss of self-control B. loss of security 1. financial 2. employment 3. house/ home C. family issues 1. incompetent personnel 2. idividualism a. self-image b. life roles III. Social needs IV. Spiritual needs A. supporting religious beliefs B. recognize religious faith C. visiting with clergy D. right to refuse treatment

V. cultural needs VI. Other considerations A. pediatrics 1. developmental level/ stages 2. biological differences B. geriatrics 1. developmental level/ stages 2. biological differences VII. Immunocompromised patient VIII. Other special patient populations PATIENT IDENTIFICATION UNIT OBJECTIVES: 1. State the purposes of proper identification. 2. Demonstrate the identification process for a surgical patient admitted to the surgical suite. UNIT OUTLINE: I. Patient identification A. purposes 1. correct patient 2. correct surgeon 3. correct procedure 4. correct location a. side b. site B. process 1. introduce self to patient 2. read patient ID band 3. compare patient ID band/patient chart with surgery schedule

4. request patient to verbally state name and pertinent information (if possible) a. name b. allergies

1. food 2. medication 3. adhesives 4. latex 5. prep solutions

c. procedure side/site d. surgeon

5. correct site surgery using time out a. preoperative verification process b. marking the surgical site c. alternative for site marking 1. patient wristband 2. combative patient d. process for emergency procedures

6. report discrepancies TRANSPORTATION UNIT OBJECTIVES: 1. Identify the methods of patient transportation.

2. Demonstrate the principles of safe transportation for each of the aforementioned methods. 3. Discuss the factors related to the family members and transportation of the patient. UNIT OUTLINE: I. Transportation A. methods 1. stretcher/cart/gurney 2. bed 3. wheelchair 4. crib/isolette 5. self- ambulation 6. wagon B. safety features 1. side rails 2. safety strap 3. wheel locks 4. intravenous (IV) stand/pole 5. oxygen holder C. patient safety principles 1. traction apparatus 2. drainage collection devices 3. ventilator 4. feet first 5. slowly and in full control 6. protect patient dignity 7. patient self-protection 8. placement of patient chart D. family considerations 1. explanations to family member(s) a. preoperative holding b. transferring patient to transportation device in hospital room c. transporting patient 2. accompany patient to preoperative holding a. elderly patient b. infant/child c. language barrier d. law enforcement for prisoner e. mentally disabled patient f. physically disabled patient TRANSFER UNIT OBJECTIVES: 1. Discuss methods of patient transfer. 2. Identify equipment utilized for safe transfer of the surgical patient. 3. Employ the principles of body mechanics when transferring the surgical patient. UNIT OUTLINE: I. Transfer A. methods 1. self-transfer 2. assisted four-person transfer B. equipment 1. transfer devices a. slider board

b. roller board c. backboard d. bariatric patient transfer devices e. lift sheet 2. safety strap C. principles 1. body mechanics 2. patient dignity 3. patient safety a. or table locked b. safety strap c. secure drains and tubes d. stretcher locked PREOPERATIVE ROUTINES ( Assistant circulator ) UNIT OBJECTIVES: 1. Describe and perform the physical preparation and care that the surgical patient may receive prior to the surgical procedure. 2. Evaluate the items on the pre-operative checklist. 3. Discuss the perioperative duties of the assistant circulator. 4. Discuss the OR documentation to be completed by the assistant circulator. 5. Demonstrate the duties of the assistant circulator including completion of documentation. UNIT OUTLINE: I. Patient physical preparation A. hair removal 1. depilatory 2. razor 3. clipper B. pre-shower 1. antiseptic wash C. enema D. medications II. Patient checklist A. NPO B. nail polish removal C. dentures D. voiding/ catheter E. jewelry removal F. baseline vital signs G. personal belongings H. prosthetics I. communication barriers (interpreter present) III. Preoperative assistant circulator duties A. Assist with positioning of OR furniture and equipment B. Assist with opening sterile supplies and instruments C Tie gowns D. Perform count E. Connect equipment F. Assist transferring patient from stretcher to OR table

G. Assist positioning patient IV. Intraoperative assistant circulator duties A. Monitor OR traffic B. Anticipate needs of sterile team C. Perform counts D. Specimen care E. Intraoperative documentation, e.g. pathology/specimen form; lab forms(s) V. Postoperative assistant circulator duties A. Dressing and drains B. Assist transferring patient from OR table to stretcher C. Documentation D. Assist with breakdown of OR REVIEW OF THE CHART UNIT OBJECTIVES: 1. Analyze laboratory reports in relationship to patient diagnosis and intervention. 2. Review the patient chart for completeness. UNIT OUTLINE: I. Review of the chart A. laboratory values 1. complete blood count (CBC) 2. urinalysis (UA) 3. blood chemistry/metabolic panel 4. prothrombin time/ partial thromboplastin time PT/PTT 5. type and crossmatch 6. drug toxicology/screening 7. patient specific(allergies) 8. consents(anesthesia and operative) 9. history and physical 10. pre-op check list 11. surgeons orders B. other diagnostic tests 1. electrocardiogram (ECG) 2. radiology C. diagnostic interventions D. other documentation 1. consent 2. pre-operative checklist 3. allergies a. medication b. food c. latex 4. history and physical exam CONSENT(Surgical) UNIT OBJECTIVES: 1. Analyze the procedure for obtaining informed surgical consent. 2. Analyze the legal concepts of obtaining informed consent. UNIT OUTLINE: I. Purpose A. protection of patient B. protection of hospital/facility/personnel

C. protection of physician II. Types A. medical B. surgical 1. operative procedure/examination 2. anesthesia administration 3. sterilization consent 4. blood administration C. specific 1. investigation device 2. specimen/limb disposal III. Informed consent A. understandable language B. no coercion/ intimidation C. proposed surgical procedure or treatment D. potential complications E. potential risks F. alternative therapies and relative risks IV. Contents of consent form A. patient name B. physician name C. procedure to be performed 1. medical terminology 2. lay terminology D. legal signature E. witness signature F. date/time of signatures V. Legal guidelines A. legal age of consent 1. of legal age 2. emancipated minor 3. previous child-bearing status B. legally competent C. mentally competent D. special concerns

1. illiteracy 2. sensory impairment 3. court order 4. emergency consent 5. alternate methods of obtaining consent a. telephone b. telegram c. consulting physicians d. administrative e. emergent situations f. life threatening circumstances g. minor without legal guardian

h. e-mail ANESTHESIA CONCEPTS UNIT OBJECTIVES: 1. Explain the necessity of each component of anesthesia preparation of the surgical patient. UNIT OUTLINE: I. Assessment A. ASA determination

B. choice of anesthesia administration II. Attaching monitoring devices A. electrocardiogram (ECG) B. pulse oximeter C. blood pressure cuff (sphygmomanometer) D. bispectral index monitor (BIS) E. temperature monitor F. other 1. central venous pressure (CVP) 2. Swan-Ganz line 3. arterial line III. Positioning for induction A. supine 1. OR table 2. stretcher B. lateral C. sitting IV. Thermoregulatory devices A. hyper/hypothermia blanket B. warmed air device V. Intravenous access A. peripheral B. central VI. Team Roles A. provider B. circulator C. scrub role one D. scrub role two POSITIONING UNIT OBJECTIVES:

1. Analyze the use, components, and aides utilized to achieve various surgical positions 2. Detail the sections and functions of the OR table 3. Perform basic positioning. UNIT OUTLINE: I. Factors A. anesthesia types B. surgeon's preference C. patient considerations D. physiological and anatomical consideration E. safety F. procedure/ incision site II. OR table A. function B. accessories C. additional supplies III. Positions A. supine (dorsal recumbent) 1. Trendelenburg 2. reverse Trendelenburg 3. Fowler's/ semi-Fowler's 4. lithotomy

B. lateral 1. kidney

2. Sims' C. prone 1. Kraske/ jackknife 2. knee-chest SKIN PREPARATION UNIT OBJECTIVES: 1. Contrast and compare different types of skin preparations. 2. Contrast and compare different chemical agents used for skin preparation. 3. Describe the steps and rationales for surgical skin preparation. UNIT OUTLINE: I. Concepts A. purpose B. mechanical cleansing/bathing/showering C. hair removal 1. orders 2. timing 3. area 4. techniques a. shaving b. clippers c. depilatory cream II. Skin prep A. mechanical cleansing B. pressure C. friction 1. chemical antisepsis 2. supplies D. basins for antiseptic soap and/ or solution E. applicators 1. gauze 2. sponges 3. cotton tip swab 4. other applicators F. towels for drying G. sterile gloves H. pads to collect excess prep solution I. solutions 1. chlorhexidine gluconate 2. iodine and iodophors 3. alcohol (Isopropyl 70%) 4. hexachlorophene 5. parachlorometaxylenol (PCMX) J. procedure 1. assemble necessary equipment 2. establish a sterile field 3. prepare solutions 4. expose the site to be prepped 5. provide adequate lighting

6. place protective pads/ drapes 7. don sterile gloves 8. wet the applicator with scrub solution 9. scrub the skin

a. circular motion b. start at the incision point and working toward the periphery c. discard the sponge after reaching the periphery and obtain a new one to continue d. scrub for a minimum of five minutes or according to hospital policy 10. dry the area 11. apply paint solution a. use gauze sponge sticks b. work from the incision line outward toward the periphery 12. considerations a. the umbilicus is considered contaminated b. stomas, skin ulcers, sinuses and open wounds are considered contaminated c. areas of high microbial counts (axilla, groin, hair line, etc) are considered contaminated and are prepped last with each sponge d. perineal preps e. skin grafts (donor and recipient sites) f. eyes 1. eyebrows - never shaved 2. eyelashes 3. orbit 4. trauma 5. cancer Multiple procedures g. post-op removal of solutions 13. documentation a. skin condition(post-op/pre-op) b. hair removal technique c. prep solutions d. person performing the prep 14. safety concerns a. allergy b. burn from warm prep solution c. chemical burn d. flammability e. pooling of solution f. skin site mark visible URINARY CATHETERIZATION UNIT OBJECTIVES:

1. List the indications for urinary catheterizations. 2. Discuss the basic considerations for urinary catheterizations. 3. List the supplies required to perform urinary catheterization. 4. Demonstrate urinary catheterization (simulation may be used). 5. Discuss the principles of monitoring urine output.

UNIT OUTLINE: I. Indications A. specimen collection B. urine retention C. decompression of the bladder

D. monitor output E. incontinenece F. control bleeding G. keep urine from contact with surgical wound H. prevent trauma I. promote healing J. provide visualization II. Considerations A. physician's order B. male/female anatomy C. positioning and lighting D. patient modesty E. sterile technique F. duration of catheterization G. size of catheter III. Supplies A. catheter set/tray B. catheter 1. indwelling 2. irrigating 3. temporary C. urine collection devices IV. Procedural steps A. preparation of supplies B. insertion C. securing D. positioning 1. below hip level 2. patient position changes V. monitoring urine output A. measurement B. assessment C. documentation VI. safety and patient risks A. patient positioning injuries B. trauma to bladder or urethra C. urinary tract infection (UTI) HOMEOSTASIS UNIT OBJECTIVES: 1. Describe the homeostatic parameters monitored in the OR setting. 2. Perform basic monitoring of patient homeostatic parameters. UNIT OUTLINE: I. Vital signs A. Common measurements B. Blood pressure C. Pulse D. Respiration E. Temperature F. Techniques G. Equipment H. Sites I. Principles J. Recording

K. Values II. Hemodynamics A. Common measurements B. Mean arterial pressure C. Central venous pressure D. Arterial blood pressure E. Techniques F. Equipment G. Sites H. Principles I. Recording J. Values K. Replacement interventions L. Autotransfusion M. Donated blood products N. Blood volume expanders III. Monitoring A. Common measurements B. Electrocardiogram C. Blood gases D. Other E. Techniques F. Equipment G. Sites H. Principles I. Recording J. Values IV. Thermoregulatory devices A. Techniques B. Equipment C. Sites D. Principles E. Recording F. Values EMERGENCY PROCEDURES UNIT OBJECTIVES: 1. Perform duties within their scope of practice related to emergencies in the OR setting. 2. Describe the emergency procedures carried out in the OR setting. 3. Be CPR certified. UNIT OUTLINE: I. Malignant hyperthermia A. etiology B. clinical manifestations C. management D. clinical intervention E. pharmacological interventions F. prevention II. Cardiac arrest A. etiology B. clinical manifestations C. management D. clinical intervention

1. CPR 2. AED / defibrillator E. pharmacological interventions F. prevention III. hemolytic reaction A. etiology B. clinical manifestations C. management D. clinical interventions E. pharmacological interventions F. prevention IV. anaphylactic reaction A. etiology B. clinical manifestations C. management D. clinical intervention E. pharmacological interventions F. prevention V. hemorrhage A. prevention B. management MONITORING THE STERILE FIELD UNIT OBJECTIVES: 1. Initiate the beginning steps for the intraoperative phase of a surgical procedure. 2. Monitor the sterile field and assess the needs of the surgical team. 3. Provide for the needs of the sterile team members. UNIT OUTLINE: I. Assistant circulating duties A. tie gowns of sterile team members B. assist in moving furniture into position. C. attach distal ends of suction tubing, electrosurgical active electrode, and other equipment to units D. observe for breaks in sterile technique E. monitor the traffic in the operating room during the surgical procedure F. provide for the needs of sterile team members 1. anticipate needs of surgical team and provide items as needed 2. perform sponge, needle, and instrument counts SURGICAL WOUND CLASSIFICATION UNIT OBJECTIVES

1. Analyze the classifications of surgical wounds. 2. Distinguish surgical procedures that fit the various categories.

UNIT OUTLINE: I. Wound classifications according to their degree of microbial contamination A. Class I: Clean B. Class II: Clean contaminated C. Class III: Contaminated D. Class IV: Dirty/infected II. Examples of surgical procedures that fall into each category

DOCUMENTATION UNIT OBJECTIVES: 1. Evaluate the common sources of documentation utilized in the operating room. 2. Judge the importance and impact of proper documentation. 3. Analyze the recommended practices and legal elements of proper documentation. UNIT OUTLINE: I. Documentation concepts A. definition B. documentation of patient care 1. observation of patient responses (routine and individualized) 2. plan of care 3. implementation of patient care interventions 4. outcomes and evaluation II. Documents and forms A. intraoperative record B. consent form 1. surgical 2. anesthesia 3. sterilization 4. special procedure C. incident reports D. patient charge forms E. count forms F. pathology/laboratory forms G. patient medical record H. anesthesia record I. birth/death certificates III. Aspects of proper documentation A. legal standards B. legal permanent record C. patient charge forms IV. Legal elements of proper documentation A. recommended practices 1. standard terminology and abbreviations 2. correct spelling 3. factual information not personal opinions 4. legible documentation 5. correction of errors 6. legal signature of reporter 7. completed in a timely manner V. Documentation A. perioperative documentation 1. patient care information 2. laboratory results 3. surgical reports SPECIMEN CARE UNIT OBJECTIVES: 1. Define specimen 2. Assess methods of obtaining specimens. 3. Describe the handling of tissue specimens. 4. Identify types of containers.

5. Describe the procedure for specimen labeling and transfer to appropriate department. 6. Evaluate the care given to specific types of specimens.

7. Discuss areas for specimen storage. 8. Describe procedure for validating specimen with surgeon and circulator.

UNIT OUTLINE: I. Definition of specimen II. Methods of obtaining specimen A. needle aspiration B. incisional biopsy C. excisional biopsy III. Specimen handling A. on field 1. keep moist 2. careful handling 3. orientation of specimen (markings) 4. tiny specimens 5. multiple specimens a. right and left b. staging 6. validating specimen with surgeon a. receiving specimen from surgeon b. transferring to circulator B. off field 1. label properly 2. proper container 3. proper solution a. fixative b. preservative C. special considerations 1. cord blood 2. muscle biopsy 3. placenta 4. radioactive material IV. Containers A. sterile B. nonsterile C. specific V. Specimen labeling A. departmental policy B. date and time C. patient's name D. patient's hospital number E. diagnosis F. surgeon G. exact specimen title H. precise test required I. proper specimen identification J. logging VI. Specific types of specimens and their care A. frozen sections B. fresh specimens C. permanent sections D. stones E. body fluids or washings F. cytologic smears G. cultures H. amputated limbs I. embryo/ fetus

J. tissue bank K. foreign bodies L. legal evidence 1. bullet 2. clothing 3. DNA 4. prosthesis M. chain of custody VII. Specimen storage/ transfer A. room temperature in department B. refrigerator C. direct transfer to lab D. transfer to X-ray VIII. Incidents A. incorrect labeling B. loss of specimen PACU - POST-ANESTHESIA CARE UNIT UNIT OBJECTIVES: 1. Analyze the immediate postoperative care of the surgical patient. 2. Describe potential postoperative discomforts and complications. 3. List necessary equipment in the postanesthesia care unit (PACU). UNIT OUTLINE: I. Postoperative patient care A. Airway maintenance B. Monitor vital signs C. Note skin condition D. Check IV, dressing, catheters, drains E. Postoperative discomforts 1. pain 2. nausea and vomiting 3. thirst 4. abdominal distention 5. urinary retention F. Postoperative complications 1. hemorrhage 2. shock 3. respiratory issues 4. pulmonary embolus 5. deep vein thrombosis II. Equipment A. Bedside 1. airway 2. oxygen 3. suction 4. monitors 5. stethoscope 6. emesis basin 7. sphygmomanometer 8. electrocardiogram 9. bed pan / urinal 10. pulse oximeter B. Immediate access / Departmental supplies and equipment 1. tracheotomy tray 2. crash cart and defibrillator 3. IV equipment

4. dressings 5. glucometer 6. malignant hyperthermia cart III. Standards, policies and criteria for patient discharge A. Institutional discharge policy 1. institutional guidelines 2. patient evaluation 3. written post-operative and follow-up instructions 4. discharge options 5. transportation DISCHARGE PLANNING UNIT OBJECTIVES: 1. Assess the standards and policies to promote patient satisfaction in the perioperative setting. 2. Apply the various assessment methods to optimize quality patient care to promote safe discharge from the facility. 3. Develop a plan to education patients regarding the anticipated recovery process.

4. Determine ways to proficiently manage patients to minimize costs to the patient, medical facility, and third party payers.

UNIT OUTLINE: I. Standards and policies of the patient discharge A. Accrediting and provider organizations B. Institutional discharge policy 1. institutional guidelines a. written protocols 2. patient evaluation a. assessment 3. responsible adult a. assist with activities of daily living b. ensure patient complies with postop instructions c. monitor the patient's progress and recovery 4. written post-operative and follow up instructions a. format (1) make them reader friendly (2) understandable b. content: specific treatment instructions, medications, activity, referrals, therapeutic diet instructions (SMART) (1) medications (a) name, purpose, dosage (2) activity restrictions (a) procedural specific information (3) diet and elimination (a) restrictions (4) surgical side effects (a) anticipated sequelae of surgery (5) possible complications and symptoms (a) signs and symptoms indicative of postoperative complications (6) treatment and tests (a) patient responsible procedures 1) incision dressing changes and supplies (b) postoperative tests

(7) access to post discharge care (a) surgeon's phone number (b) emergency care facility name, phone number and address (8) follow-up care (a) postoperative return visit to surgeon (b) postoperative phone calls 5. written transfer agreement a. unanticipated hospital admission b. admission plan and implementation 6. discharge options a. transportation (1) responsible adult b. extended observations (1) patient did not meet critical discharge criteria c. discharge against medical advice (AMA) (1) patient must sign AMA release II. Recovery from anesthesia III. Critical readiness criteria for discharge A. Vital signs B. respiratory status C. Reflexes D. Mental status - cognition E. Surgical consideration 1. bleeding 2. extremity circulation F. Pain 1. etiology 2. pain prophylaxis 3. pain management G. Nausea and vomiting 1. postoperative nausea and vomiting (PONV) 2. patient evaluation 3. postoperative management of nausea and vomiting H. Oral intake I. Voiding J. Anesthesia considerations 1. side effects 2. malignant hyperthermia 3. regional anesthesia K. Ambulation RISK MANAGEMENT AND LIABILLITY UNIT OBJECTIVES: 1. Evaluate the role of the risk management department in the health care facility. 2. Assess errors that may occur in the operating room and devise a plan for investigation, correction and notification. 3. Interpret prevention, correction, and documentation techniques that may positively impact risk management issues. 4. Compare and contrast professional liability insurance policies. UNIT OUTLINE: I. Risk management objectives A. minimize risks to patients and hospital employees B. avoid or control financial loss

C. identify actual or potential causes of patient and employee accidents D. implement programs, policies, and procedures to eliminate or reduce occurrences E. efforts of hospital to collect and utilize data to decrease harm to patients and staff or damage to property

II. Errors in the operating room A. physician error B. failure of equipment or medical device (Safe Medical Devices Act)

C. errors made by surgical team members III. Administrative practice A. written policies and procedures B. regulations, laws, recommendations enforced C. monitoring devices used in hazardous areas as recommended by regulatory agency D. employee health services E. protective attire and safety equipment (standard precautions) IV. Prevention practices A. routine preventative maintenance for all equipment B. professional development/continuing education programs for employees C. employees must wear personal protective equipment, as appropriate (standard precautions)

D. employees must know the location and use of emergency equipment E. employees must follow hospital policies and procedures F. continuity of patient care and safety

V. Interventions A. unsafe conditions reported immediately B. faulty or malfunctioning equipment or device should be removed from service immediately C. any patient or employee injury should be reported and medical attention sought as soon as possible D. proper documentation of incident VI. Documentation A. incident report/ sentinel event report B. occupational risks communicated to employees C. witnesses D. document facts not opinions VII. Insurance A. hospital insurance coverage (liability) B. malpractice insurance (professional liability) C. amount of coverage/cost of coverage D. extent of insurance coverage provision LEGAL ISSUES UNIT OBJECTIVES: 1. Analyze major concepts inherent in professional practice law. 2. Interpret the legal responsibilities of the surgical technologist and other surgical team members. 3. Compare and contrast major criminal and civil liabilities and the consequences for these acts. 4. Assess the resources that aid the surgical technologist in interpreting and following professional standards of conduct. UNIT OUTLINE: I. Legal terminology A. law 1. statutory 2. common B. liability 1. corporate

2. personal C. torts 1. define 2. intentional a. civil assault b. civil battery c. false imprisonment d. defamation e. invasion of privacy 3. unintentional a. negligence (1) standard / duty of care (2) dereliction/ failure to meet the standard of care (3) foreseeability of harm existed (4) omission or commission of an act (5) actual damages occurred

D. malpractice 1. deposition 2. plaintiff 3. defendant 4. subpoena 5. jury 6. perjury 7. trial II. Legal doctrines A. doctrine of personal liability B. doctrine of respondeat superior C. doctrine of borrowed servant D. doctrine of res ipsa loquitur E. doctrine of foreseeability F. informed consent 1. "patient's right to know" 2. preparation of informed consents 3. verification of informed consents 4. legality of informed consents G. tradition principles 1. Aeger Primo 2. primum non nocere III. Legal risks and responsibilities on the job A. hospital policies B. legal risks related to reduced staffing C. witnessing and signing documents D. legal responsibility for patient safety E. legal risks related to medications F. documentation G. event/ incident reports H. employee rights I. risk management J. advance directives IV. Professional standards of conduct A. federal law B. federal agencies C. state law and regulations D. hospital policy E. legal precedent F. professional agencies G. AST Code of Ethics H. AST Recommended Standards of Practice I. core curriculums for surgical technology and surgical assisting J. private agencies

V. Credentialing A. registration B. certification C. licensure D. accreditation VI. Operating room incidents/sentinel events A. harm secondary to use of defective equipment/instruments B. exceeding authority or accepted functions; violations of hospital policy C. loss of or damage to patient's property D. abandonment of a patient E. patient misidentification F. lack of informed consent G. documentation errors H. harm secondary to major break in sterile technique I. improper identification or loss of specimen J. burns secondary to improper use of electrosurgical device K. incorrect drugs or incorrect administration L. injury related to incorrect positioning or padding M. falls resulting in patient injury N. retained foreign bodies secondary to incorrect instrument/ sponge counts O. incorrect procedure performed P. failure to observe critical events and take appropriate action Q. invasion of privacy R. assault and battery S. defamation T. breach of confidentiality ETHICAL AND MORAL ISSUES UNIT OBJECTIVES: 1. Analyze the American Hospital Association's (AHA) Patient's Bill of Rights. 2. Develop an increased sensitivity to the influence of ethics in professional practice. 3. Analyze the role of morality during ethical decision making. 4. Cite examples of ethical situations and problems in the health professions. 5. Analyze the key elements related to developing a surgical conscience. 6. Apply principles of problem solving in ethical decision making. UNIT OUTLINE: I. AHA Patient's Bill of Rights A. Tenets 1. The patient is a consumer 2. Hospital services are purchased to meet health needs. B. Bill of Rights 1. Receive considerate and respectful care. 2. Obtain from physician complete information concerning diagnosis, treatment, and prognosis in easily understood terms. 3. Receive from physician information necessary to give informed consent prior to procedure or treatment, including risks, length of incapacitation, and medical alternatives available.

4. Refuse treatment as allowed by law and be informed of the medical consequences of his/her action. 5. Receive every consideration of privacy concerning his/her medical program. 6. Expect that all communications and records are treated as confidential. 7. Expect that the hospital make a reasonable response to his/her request for services or to be transferred to another medical facility after being informed of

need for transfer. 8. Obtain any information of the relationship of his/her hospital to other institutions insofar as his/her care is concerned. 9. Be advised if the hospital proposes to engage in or perform human experimentation affecting his/her care or treatment, having the right to refuse to participate in such research projects. 10. Expect reasonable continuity of care, know availability of appointment times and physicians, and be informed by the physician or his/her delegate of continuing health care requirements following discharge. 11. Examine and receive an explanation of his/her bill regardless of source of payment. 12. Know what hospital rules and regulations apply to his/her conduct as a patient. II. Elements of ethical decision making A. personal values B. ethical principles C. accountability D. responsibility E. religious and cultural beliefs F. morality G. moral dilemmas H. corporate integrity I. ethical decision-making (problem-solving) III. Surgical conscience A. Concepts 1. professional honesty 2. personal moral integrity 3. confidentiality 4. nondiscriminatory treatment of all patients 5. commitment to cost containment 6. principles of asepsis/ sterile technique B. Barriers 1. stress 2. peer apathy 3. other IV. Ethical conflicts in clinical practice A. Patient's Bill of Rights B. Right-to-die 1. assisted suicide 2. end-of-life decisions C. Organ donation and transplantation D. HIV/ AIDS E. Genetic engineering F. Human experimentation G. Abortion and reproductive technology H. Good Samaritan Law I. Gender reassignment J. Refusal of treatment HEALTH AND WELLNESS UNIT OBJECTIVES: 1. List and define the five components of physical health (cardiopulmonary, muscular strength, muscular endurance, flexibility, and body composition). 2. Discuss and describe food sources of energy and the metabolic processes involved, and relate both of these to wellness and disease. 3. Differentiate internal and external sources of stress, and the effect of stress on various body systems. 4. Compare and contrast alternative healing methodologies, including mental

health and spiritual attunement. UNIT OUTLINE: I. Physical health A. cardiopulmonary health B. muscular strength C. muscular endurance D. flexibility E. body composition II. Physical activity A. work B. home C. exercise III. Nutrition and metabolism A. nutrition 1. intake a. food (1) carbohydrates (2) proteins (3) fats b. water c. vitamins and minerals (1) water-soluble (2) fat-soluble (3) essential minerals 2. output (normal) a. urine b. feces c. perspiration B. metabolism 1. catabolism 2. anabolism IV. Stress A. definition B. types 1. external/ internal 2. physical/psychological C. stress reduction techniques 1. relaxation/meditation 2. exercise 3. biofeedback 4. defense mechanisms V. Alternative healing methodologies A. acupuncture B. herbal remedies C. aroma therapy D. touch therapy E. massage therapy F. music therapy G. other PATIENT CARE CONCEPTS DEATH AND DYING UNIT OBJECTIVES: 1. Evaluate attitudes, beliefs and classifications regarding death and dying. 2. Compare and contrast responses to the process of death and various

coping mechanisms. 3. Debate quality of life vs. quantity of life. 4. Trace the steps that are implemented when a patient death occurs in the operating room. UNIT OUTLINE: I. Death and dying A. Perceptions of death and dying 1. religious beliefs 2. cultural beliefs 3. attitudes of family members 4. attitudes of caregivers 5. ethnicity beliefs B. Classifications of death 1. accidental 2. terminal 3. prolonged (chronic) 4. sudden C. Responses to loss/grief (Kubler-Ross) 1. anger 2. denial 3. depression 4. bargaining 5. acceptance D. Quality of life vs. quantity of life 1. palliative procedures 2. therapeutic procedures 3. life-support systems 4. life-sustaining therapy 5. euthanasia 6. right to die 7. advanced directives a. living will b. durable power of attorney 8. do not resuscitate (DNR) a. medical b. surgical E. Death of a patient in the operating room 1. notification of family and significant others 2. notification of perioperative manager 3. notification of chaplain/clergy 4. preparation of the body for family viewing 5. forensic issues and coroner's cases 6. postmortem patient care 7. state law and hospital policy F. Coping strategies 1. empathy 2. grieving process 3. share feelings with others 4. fears 5. team effort 6. support groups for staff members and bereaved families 7. chaplain/clergy G. Organ procurement and transplantation 1. organ procurement a. establishing death b. consent for procurement c. procurement team d. types

(1) procurement on life support (2) procurement without life support 2. transplantation H. Definitions of death 1. cardiac 2. higher brain 3. whole brain BIOPSYCHOSOCIAL NEEDS OF THE PATIENT UNIT OBJECTIVES:

1. Discuss the basic physical and biological needs required to sustain life. 2. Compare and contrast various spiritual and cultural needs of the surgical patient.

3. Demonstrate appropriate behavior in response to the needs manifested by the surgical patient

4. Analyze and describe the potential psychological needs of the surgical patient and family

5. List and describe potential sources of anxiety and fears of the surgical patient. 6. Identify and discuss the specific needs of the special populations.

UNIT OUTLINE: I. Maslow’s Hierarchy of Needs.

A. physical and physiological needs B. psychological needs C. social needs D. spiritual needs E. cultural needs

II. Special populations A. pediatrics B. geriatrics C. bariatrics D. immunocompromised patient E. diabetic patient F. pregnant patient G. physically challenged patient H. mentally challenged patient 1. disabilities (Down’s syndrome. Etc.) 2. post-tramatic stress syndrome (PTSD) I. isolation patient J. trauma patient K. language barriers L. substance abuse patient ALL – HAZARDS PREPARATION UNIT OBJECTIVES:

1. Describe disasters or public health emergencies that impact public health including the different types (e.g. natural, unintentional, and terrorist events) along with the general health, safety and security risks. 2. Describe the all-hazards framework. 3. Explain key components of personal, family, institutional, community and regional disaster preparation and

planning as related to the following: a. available informational resources b. special needs of individuals c. precautions and actions for protection d. detection

e. immediate response f. short term interventions g. long term interventions

4. Describe communication strategies and procedures used in a disaster including barriers to communicating and disseminating health information, and reporting systems and procedures for contacting family, coworkers, and local authorities. 5. Describe the purpose and relevance of disaster support services including rationale for integration and coordination of all systems: a. national response framework (NRF) b. national incident management systems (NIMS) c. hospital incident command system (HICS) 6. Describe the potential impact of mass casualties on the clinical and public health resources including infection control precautions, personal protective equipment, and decontamination procedures. 7. Explain the role of triage as a basis for prioritizing or rationing health care services for victims. 8. Describe the possible medical and mental health consequences, interventions, and solutions for managing those affected including the psychological, emotional, cultural, religious, and forensic considerations for management of mass fatalities and the resources, supplies and services available.

a. immediate care b. mass fatality management c. mass evacuation d. mass sheltering e. prolonged sheltering

9. Explain both the basic life-saving and life-support principals and procedures that can be used at a disaster scene. 10. Describe issues relevant to the management of individuals of all ages, populations, and communities affected by a disaster or public health emergency:

a. moral b. ethical c. legal d. regulatory 11. Describe the support roles of the surgical technologist in a disaster. UNIT OUTLINE: I. General indicators and epidemiological clues of a disaster A. natural disasters 1. avalanche 2. earthquake 3. emerging infectious disease a. epidemic b. pandemic 4. flood 5. heat wave 6. hurricane 7. storms a. tropical b. winter 8. tornado 9. tsunami 10. volcano 11. wildfires B. manmade disasters 1. chemical release 2. explosion 3. infrastructure incidents 4. radiation release 5. transportation accident 6. terrorism

C. combination disaster 1. natural – manmade disaster II. Disaster planning (personal, healthcare facility, LEMA) A. family and personal protection 1. research recommended procedures for local emergencies 2. create family plans for each type emergency 3. communication a. no technology available b. designate meeting places c. out-of-town relative as “communication center” d. emergency contact information available 1. wallet 4. go bag 5. essential supplies in home 6. provisions for pet(s) B. national incident management system (NIMS) 1. local emergency operations plan (EOP) 2. all-hazards plan C. incident command systems (ICS) 1. incident commander 2. unified command 3. chain of command 4. ICS organization a. command group 1. four reporting groups a. operations b. planning c. logistics d. finance and administration D. hospital emergency operations plans 1. components of plan a. scalable 1. patient surge b. mitigation c. preparedness d. response e. recovery 2. evacuating a medical facility a. evacuation plans b. moving patients c. medical records d. refrigerated medical supplies 3. hospital incident command system (HICS) a. clarify roles and responsibilities b. job action sheets 4. healthcare worker responsibilities a. personal responsibilities b. department role c. chain of command d. knowledge of hospital signals/codes during emergency e. procedures for communication E. medical office and stand-alone out-patient surgery centers 1. procedures for communication 2. evacuation procedures a. central meeting place b. methods for accounting for all personnel 3. methods for protecting patient health records 4. coordinate plan with local and regional health department 5. coordinate plan with local and regional hospitals 6. procedures to expand operations

a. care for non-routine patients b. high volume of patients c. provide beds/stretchers F. local emergency management agencies (LEMA) 1. lead coordinating responsibility 2. emergency operations center (EOC) III. National disaster planning A. federal emergency management agency (FEMA) B. national response framework (NRF) C. national disaster medical system (NDMS) 1. disaster medical assistance teams (DMAT) 2. disaster mortuary operations response team (DMORT) 3. national pharmacy response teams (NPRT) IV. Immediate response to an all-hazards event A. mitigation 1. reduce potential for casualties a. electrical hazards b. chemical hazards c. fire and explosive hazards d. infrastructure hazards e. biological hazards f. radiological hazards 2. create safe zones 3. evacuation orders 4. storage of potential hazardous items 5. communication with LEMA 6. law enforcement a. mandates, e.g. curfew orders, no entry to hazardous zone/area 7. security of family B. response 1. set up incident command site 2. establish methods for communication 3. set up triage area 4. set up decontamination area 5. prepare for special needs patients 6. point of distribution site (POD) a. strategic national stockpile (SNS) 1. push packs C. risk communication with public 1. strategies for disseminating health information to populations 2. barriers to communication with populations V. Infection control precautions A. controlling contamination 1. standard precautions 2. personal protective equipment (PPE) a. protective clothing b. eye and face protection c. hand protection d. medical masks e. respirators f. hand washing without water B. decontamination patient procedures VI. Triage A. triage procedures 1. simple triage and rapid treatment (START) 2. surgical technologist in supporting role a. basic lifesaving procedures b. first aid c. transport patients

VII. Issues during a disaster A. relevant moral and ethical issues B. availability of health services for all populations during a disaster C. legal issues D. regulatory issues VIII. Support roles of the surgical technologist during a disaster A. DMAT B. evacuation teams C. specialty surgical teams, e.g. burn team D. support triage role of a surgical technologist during a disaster E. transport patients F. volunteer 1. preregistration a. emergency system for the advance registration of volunteer health professionals (ESAR-VHP) 2. community emergency response team (CERT)


COURSE: Surgical Procedures COURSE DESCRIPTION: This course is an in-depth look at basic surgical procedures and an exploration of intermediate and advanced surgical procedures. Concepts and principles are reinforced through complementary clinical assignments in operating rooms in local hospitals. PRE-REQUISITES: Admission into the Surgical Technology Program TEXTS: Price, Frey, Junge, Surgical Technology for the Surgical Technologist, Delmar-Thomson Learning, 2004. STST Study Guide

Phillips, Berry & Kohn’s Operating Room Technique, Mosby, 2004 TEACHING METHODOLOGIES: Lecture, discussion, classroom demonstrations, student presentations, clinical experiences, visual aids, and self study METHODS OF EVALUATION: Examinations, oral presentation EXPECTED OUTCOMES: The student will: 1. Discuss the relevant anatomy and physiology. 2. Describe the pathology that prompts surgical intervention and related terms. 3. Discuss any special preoperative diagnostic procedures/tests. 4. Discuss any special preoperative preparation procedures. 5. Identify the names and uses of special instruments, supplies, and drugs. 6. Identify the names and uses of special equipment. 7. Discuss the intra-operative preparation of the patient. 8. Define and give an overview of the surgical procedure. 9. Discuss the purpose and expected outcomes of the surgery.

10. Discuss the immediate post-operative care and possible complications. 11. Describe the pathophysiology that prompts surgical intervention and related terms. 12. Discuss any preoperative diagnostic procedures/tests. 13. Discuss any special preoperative preparation procedures. 14. Discuss special considerations for the surgical intervention. 15. Identify the names and uses of special instruments, supplies, and drugs. 16. Identify the names and uses of special equipment. 17. Discuss the intra-operative preparation of the patient. 18. Define and give an overview of the surgical procedure. 19. Discuss the purpose and expected outcomes of the surgery.

20. Discuss the immediate post-operative care and possible complications. 21. Describe the pathophysiology which prompts surgical intervention for each advanced procedure. 22. Discuss the special considerations for patients undergoing advanced interventions. 23. Give an overview of the advanced surgical interventions. 24. Describe the pathophysiology which prompts surgical intervention for each related surgical intervention. 25. Discuss the special considerations for patients undergoing related surgical interventions. 26. Give an overview of the related surgical interventions.

27. Assess the anatomy, physiology and pathophysiology of the colon. 28. Analyze the diagnostic and surgical interventions for a patient undergoing colon resection. 29. Plan the intraoperative course for a patient undergoing colon resection. 30. Assemble supplies, equipment and instrumentation needed for the procedure. 31. Choose the appropriate patient position.

32. Identify the incision used for the procedure. 33. Analyze the procedural steps for colon resection. 34. Describe the care of the specimen. 35. Discuss the postoperative considerations for a patient undergoing colon resection.

36. Assess the pathophysiology of the biliary tree. 37. Analyze various diagnostic interventions for a patient undergoing a common bile duct exploration with choledochoscopy. 38. Plan the intraoperative course for a patient undergoing a common bile duct exploration with choledochoscopy. 38. Assemble supplies, equipment and instrumentation needed for the procedure. 39. Choose the appropriate patient position. 40. Identify the incision used for the procedure. 41. Analyze the procedural steps for a common bile duct exploration with choledochoscopy. 42. Describe the care of the specimen.

43. Assess the pathophysiology of the urinary bladder 44. Analyze an overview of the surgical intervention of a patient undergoing ureteroileocutaneous diversion.

45. Assess the anatomy, physiology, and pathophysiology of the female reproductive system. 46. Analyze the diagnostic and surgical interventions for a patient undergoing Cesarean section. 47. Plan the intraoperative course for a patient undergoing Cesarean section. 48. Assemble supplies, equipment, and instrumentation needed for the procedure. 49. Choose the appropriate patient position. 50. Identify the incision used for the procedure. 51. Analyze the procedural steps for a Cesarean section. 52. Describe the care of the specimen. 53. Discuss the postoperative considerations for a patient undergoing Cesarean section.

54. Assess the anatomy, physiology and pathophysiology of the pharynx. 55. Analyze the diagnostic and surgical interventions for a patient undergoing tonsillectomy and adenoidectomy. 56. Plan the intraoperative course for a patient undergoing tonsillectomy and adenoidectomy.

57. Assemble supplies, equipment and instrumentation needed for the procedure. 58. Choose the appropriate patient position. 59. Identify the incision used for the procedure. 60. analyze the procedural steps for tonsillectomy and adenoidectomy. 61. Describe the care of the specimen. 62. Discuss the postoperative considerations for a patient undergoing tonsillectomy and adenoidectomy.

63. Assess the anatomy, physiology and pathophysiology of the male genitourinary system. 64. Analyze the diagnostic and surgical interventions for a patient undergoing TURP. 65. Plan the intraoperative course for a patient undergoing TURP. 66. Assemble supplies, equipment and instrumentation needed for the procedure. 67. Chose the appropriate patient position. 68. Identify the incision used for the procedure. 69. Analyze the procedural steps for TURP. 70. Describe the care of the specimen. 71. Discuss the postoperative considerations for a patient undergoing TURP. 72. Assess the anatomy, physiology and pathophysiology of the foot. 73. Analyze the diagnostic and surgical interventions related to a patient undergoing bunionectomy with hammertoe correction. 74. Plan the intraoperative course for a patient undergoing bunionectomy with hammertoe correction. 75. Assemble supplies, equipment and instrumentation needed for the procedure. 76. Choose the appropriate patient position. 77. Identify the incision used for the procedure. 78. Analyze the procedural steps for a bunionectomy with hammertoe correction.

79. Describe the care of the specimen. 80. Discuss the postoperative considerations for a patient undergoing bunionectomy with hammertoe correction. 81. Assess the anatomy, physiology, and pathophysiology of the eye. 82. Analyze the diagnostic and surgical interventions related to a patient undergoing cataract extraction. 83. Plan the intraoperative course for a patient undergoing cataract extraction. 84. Assemble supplies, equipment, and instrumentation needed for the procedure. 85. Choose the appropriate patient position. 86. Identify the incision used for the procedure. 87. Analyze the procedural steps for a cataract extraction. 88. Describe the care of the specimen. 89. Discuss the postoperative considerations for a patient undergoing cataract extraction. 90. Assess the anatomy, physiology and pathophysiology of the thoracic/pleural cavities. 91. Analyze the diagnostic and surgical interventions for a patient undergoing

thoracoscopy. 92. Plan the intraoperative course for the patient undergoing thoracoscopy. 93. Assemble supplies, equipment and instrumentation needed for the procedure. 94. Choose the appropriate patient position. 95. Identify the incision used for the procedure. 96. Analyze the procedural steps for thoracoscopy. 97. Describe the care of the specimen. 98. Discuss the postoperative considerations for a patient undergoing thoracoscopy. 99. Assess the anatomy, physiology, and pathophysiology of the vasculature of the head and neck. 100. Analyze the diagnostic and surgical interventions for a patient undergoing carotid endarterectomy. 101. Plan the intraoperative course for a patient undergoing carotid endarterectomy. 102. Assemble supplies, equipment and instrumentation needed for the procedure. 103. Choose the appropriate patient position. 104. Identify the incision used for the procedure. 105. Analyze the procedural steps for a carotid endarterectomy. 106. Describe the care of the specimen. 107. Discuss the postoperative considerations for a patient undergoing carotid endarterectomy.

108. Assess the anatomy, physiology and pathophysiology of the brain and central nervous system.

109. Analyze the diagnostic and surgical interventions for a patient undergoing craniotomy for tumor excision. 110. Plan the intraoperative course for a patient undergoing craniotomy for tumor excision. 111. Assemble supplies, equipment and instrumentation needed for the procedure. 112. Choose the appropriate patient position. 113. Identify the incision used for the procedure. 114. Analyze the procedural steps for a craniotomy for tumor excision. 115. Describe the care of the specimen. 116. Discuss the postoperative considerations for a patient undergoing craniotomy for

tumor excision. Clinical Objectives - Upon completion of the clinical experience, the student will: 1. Recognize common and specialized surgical instruments and equipment and their uses. 2. Demonstrate principles of self-accountability by adhering to strict sterile technique when scrubbing, gowning, gloving, and when working in the sterile field. 3. Become familiar with numerous surgical procedures. 4. Demonstrate increased knowledge of anatomy and physiology by choosing appropriate instruments, equipment and supplies.

5. Perform clinical assignments with efficiency and good organization. 6. Demonstrate good attention, observation and communication skills during surgical procedures 7. Function as a team member by showing consideration for and cooperation with the OR staff. BASIC SURGICAL INTERVENTIONS UNIT OBJECTIVES: 1. Discuss the relevant anatomy and physiology. 2. Describe the pathology that prompts surgical intervention and related terms. 3. Discuss any special preoperative diagnostic procedures/tests. 4. Discuss any special preoperative preparation procedures. 5. Identify the names and uses of special instruments, supplies, and drugs. 6. Identify the names and uses of special equipment. 7. Discuss the intra-operative preparation of the patient. 8. Define and give an overview of the surgical procedure. 9. Discuss the purpose and expected outcomes of the surgery.

10. Discuss the immediate post-operative care and possible complications. UNIT OUTLINE: FOR EACH PROCEDURE I. Anatomy II. Physiology III. Pathyophysiology IV. Diagnostic intervention A. Diagnostic exams B. Preoperative testing V. Surgical intervention A. Special considerations (e.g. patient factors, room set-up, etc) B. Anesthesia C. Position/ positioning aids D. Skin prep E. Draping F. Time out G. Incision H. Supplies 1. Routine 2. Specialty 3. Suture 4. Medications 5. Catheters/drains I. Equipment J. Instrumentation K. Procedural steps L. Counts 1. Initial 2. Closure M. Dressing materials N. Specimen care 1. intra-op 2. post-op O. Postoperative destination VI. Postoperative patient care considerations VII. Prognosis VIII. Complications IX. Wound classification/management INTERMEDIATE SURGICAL INTERVENTIONS

UNIT OBJECTIVES: 1. Describe the pathophysiology that prompts surgical intervention and related terms. 2. Discuss any preoperative diagnostic procedures/tests. 3. Discuss any special preoperative preparation procedures. 4. Discuss special considerations for the surgical intervention. 5. Identify the names and uses of special instruments, supplies, and drugs. 6. Identify the names and uses of special equipment. 7. Discuss the intra-operative preparation of the patient. 8. Define and give an overview of the surgical procedure. 9. Discuss the purpose and expected outcomes of the surgery.

10. Discuss the immediate post-operative care and possible complications. UNIT OUTLINE: I. Pathophysiology II. Diagnostic intervention III. Surgical intervention A. special considerations (e.g. patient factors, room set-up, etc.) B. position/positioning C. incision D. supplies E. equipment F. instrumentation G. procedural steps H. counts I. specimen care IV. Complications ADVANCED SURGICAL INTERVENTIONS UNIT OBJECTIVES:

1. Describe the pathophysiology which prompts surgical intervention for each advanced procedure. 2. Discuss the special considerations for patients undergoing advanced interventions. 3. Give an overview of the advanced surgical interventions.

UNIT OUTLINE: I. Pathophysiology II. Surgical intervention A. special considerations (e.g. patient factors, room set-up, etc.) RELATED SURGICAL INTERVENTIONS UNIT OBJECTIVES:

1. Describe the pathophysiology which prompts surgical intervention for each related surgical intervention. 2. Discuss the special considerations for patients undergoing related surgical interventions. 3. Give an overview of the related surgical interventions.

DEFINTION: When instruction is provided in the basic, intermediate, and the advanced

procedures outlined in the curriculum, the learner should be able to apply that information to the understanding of the related procedures. CORE PROCEDURES UNIT I GENERAL SURGERY PROCEDURE LIST

A. Endoscopic 1. choledochoscopy 2. colonoscopy 3. endoscopic retrograde cholangiopancreatoscopy (ERCP) 4. esophagoscopy 5. sigmoidoscopy

B. Bastic Interventions 1. colectomy 2. colostomy 3. endoscopic inguinal herniorrhaphy 4. laparoscopic umbilical herniorrhaphy 5. laparoscopic appendectomy 6. laparoscopic cholecystectomy

7. modified radical mastectomy with axillary node dissection 8. open cholecystectomy with cholangiogram

C. Intermediate Interventions 1. common bile duct exploration (CBDE) 2. gastrectomy 3. laparoscopic Nissen fundoplication 4. lumpectomy (breast) with sentinel node biopsy 5. vagotomy/pyloroplasty D. Advanced Interventions

1. abdominoperineal resection (Miles resection) 2. esophagectomy 3. liver resection (transplant) 4. Whipple procedure E. Related Surgical Interventions

1. endoscopic (minimally invasive) a. colonoscopy b. laparoscopic inguinal herniorrhaphy (spigelian) c. endoscopic retrograde cholangiopancreatoscopy (ERCP) d. esophagogastroduodenoscopy (EGD) e. esophagoscopy f. laparoscopic appendectomy g. laparoscopic cholecystectomy h. sigmoidoscopy

i. laparoscopic splenectomy 2. General surgery 1. anoplasty 2. appendectomy 3. Billroth I 4. Billroth II 5. breast biopsy with needle localization a. sentinel nobe 6. cholecystoduodenostomy 7. cholecystojejunostomy 8. choledochoduodenostomy 9. choledochojejunostomy 10. excision of gynecomastia 11. excision of lipoma 12. excision of Zender's diverticulum 13. exploratory laparotomy 14. femoral herniorrhaphy

15. fissure/fistula repair 16. gastrectomy 17. gastrostomy 18. ileostomy 19. incision and drainage (I&D) of an abscess 20. incisional herniorrphaphy 21. insertion of infusion catheters/ports 22. liver biopsy 23. liver resection 24. muscle biopsy 25. pilonidal cystecotmy 26. rectal polypectomy 27. Roux-en-y 28. small bowel resection 29. sphincterotomy 30. spigelian herniorrhaphy 31. umbilical herniorrhaphy 32. ventral herniorrhaphy 33. hemorrhoidectomy 34. splenectomy 35. cholecystectomy UNIT II: COLON RESECTION UNIT OBJECTIVES: 1. Assess the anatomy, physiology and pathophysiology of the colon. 2. Analyze the diagnostic and surgical interventions for a patient undergoing colon resection. 3. Plan the intraoperative course for a patient undergoing colon resection. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for colon resection. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing colon resection. UNIT OUTLINE: I. Anatomy A. normal regional anatomy 1. bowel wall a. serosa b. submucosa c. mucosa 2. structure a. haustra b. taenia coli c. epiploi appendices d. goblet cells 3. points of fixation a. mesentery b. hepatic (right colic) flexure c. splenic (left colic) flexure d. sigmoid mesocolon 4. segments a. ileocecal valve b. cecum c. vermiform appendix d. ascending colon

e. transverse colon f. descending colon g. sigmoid colon h. rectum/ anus 5. vascular supply a. superior mesenteric artery (1) ileocolic artery (2) right colic artery (3) middle colic artery b. inferior mesenteric artery (1) left colic artery (2) sigmoid artery (3) superior rectal artery 6. nerve supply a. celiac plexus b. vagus nerve c. nervi erigentes d. presacral plexus 7. lymphatic supply a. intramural (1) submucosal tissue (2) muscular layer of the bowel b. extramural (1) epicolic glands (2) pericolic glands (3) intermediate group (4) mesenteric artery glands II. Physiology A. absorption B. storage C. peristalsis D. valsalva mechanism III. Pathophysiology A. pseudomembranous enterocolitis B. polyps 1. morphology a. nonmalignant b. malignant 2. shapes a. sessile mucosal b. adenomatous pedunculated 3. types a. polypoid adenoma b. villous adenoma c. mucous polyp d. pseudopolyposis of the colon e. familial polyposis C. mechanical lesions 1. large bowel obstruction a. band/adhesion b. malignancy 2. volvulus 3. intussusception 4. fecal impaction D. trauma 1. blunt 2. penetrating E. inflammatory 1. diverticulosis/diverticulitis 2. ulcerative colitis

3. Crohn's disease F. vascular 1. ischemic colitis 2. vascular occlusion/infarction 3. A-V malformation IV. Diagnostic interventions A. diagnostic exams 1. barium enema 2. IVP - if renal involvement suspected 3. CT scan/MRI 4. sigmoidoscopy/colonoscopy 5. hemoccult/guaiac B. preoperative testing 1. blood work a. CBC b. electrolytes c. PT/PTT 2. urinalysis 3. chest X-ray 4. ECG 5. medical history V. Surgical intervention A. special considerations 1. intestinal antisepsis/bowel prep 2. chemical agents a. antibiotic therapy b. mechanical agents (1) diet (2) hyperosmolar solutions (3) lavage 3. concepts of "bowel technique" B. anesthesia 1. types a. epidural pain control b. general 2. patient monitoring a. routine - vital signs, BIS, CO2 b. hemodynamic c. urinary output (Foley) d. DVT prophylaxis e. intraopeerative temperature maintenance C. position/positioning aids 1. dorsal recumbent 2. modified lithotomy 3. safety strap 4. arm boards 5. stirrups a. Allen b. knee-crutch c. string, candy-cane D. skin prep 1. stoma marking 2. routine abdominal 3. perineal prep E. draping 1. wound towels/clips 2. fenestrated laparotomy sheet 3. lithotomy a. under buttocks sheet b. leggings

F. incisions 1. vertical midline 2. parpmedian 3. stoma site G. supplies 1. routine a. basic laparotomy pack b. prep tray c. # 10 knife blades d. laparotomy sheet e. laparotomy sponges f. basin set 2. specialty a. Penrose drain (to provide traction) 3. suture a. surgeon's preference (1) hemostasis (2) mesenteric (3) bowel (4) abdominal wall closure (5) stoma b. stapling devices (1) ligating and dividing staplers (2) internal anastomosis staplers (3) terminal end staplers (4) end-to-end circular staplers (5) purse string devices 4. medications 5. catheters/drains a. urinary (1) intraoperatively (a) fluid intake/output monitoring (b) decompress bladder b. closed wound drainage system H. equipment 1. headlight/light source 2. electorsurgical unit (ESU) 3. harmonic scalpel I. instrumentation 1. general abdominal instrumentation 2. abdominal retractor system 3. bowel clamps 4. other a. end to end circular staplers sizers b. suction/tips (1) Poole (2) Yankauer J. procedural steps 1. bowel resection a. the abdominal wall is incised using the skin knife

b. the incision is extended down to the level of the anterior fascia using the deep knife or electrosurgical pencil; hemostasis is achieved with hemostatic forceps or the electrosurgical unit

c. the incision is extended through the fascia layer with Mayo scissors or the electrosurgical unit; a Kelly Richardson retractor is used for exposure d. the muscle layer is separated bluntly along it fibers e. the parietal peritoneum is opened; toothed forceps or hemostats are used to lift the tissue off the viscera; incision is accomplished with deep knife or scissors; a Kelly

Richardson retractor is used for exposure f. the abdominal cavity is explored and the pathology is identified g. the peritoneum is incised lateral to the colonic segment using electrosurgical pencil or Metzenbaum scissors; retractors and moist lap sponges used for exposure h. the areas for resection/anastomosis are identified; the mesentery is opened and a Penrose drain or hernia/umbilical tape may be placed to encircle the bowel segment i. the mesentery is cross clamped with two Kelly hemostatic forceps and the tissue is cut with Mayo scissors; hemostasis is achieved with sutures of the surgeon's preference or division and hemostasis is accomplished using the internal anastomosis stapling device j. "bowel technique" is used to isolate any instrument/supply which contacts bowel mucosa or luminal contents k. the bowel segments are transected using either non-crushing bowel clamps on the non-specimen side with incision accomplished with the knife or use of the internal anastomosis stapling device with cutting bar l. the bowel segments are anastomosed (1) by hand (end-to-end) (a) traction sutures are placed to align the

mesenteric borders; non-absorbable, interrupted mattress stitches are used and tagged with hemostats (b) the serosa layer of the posterior wall of the bowel is closed; non-absorbable, interrupted mattress stitches are used (c) starting on the middle posterior wall of the mucosa layer, the mucosa layer is closed using absorbable, running stitch - double armed or two, single-armed stitches (d) the serosa layer of the anterior wall of the bowel is closed in the same fashion as the posterior wall

(2) mechanical (side-to-side) (a) a small colotomy is made in the staple line across the lumen of each bowel loop (b) one arm of the internal anastomosis stapler is placed into each bowel loop; the device is closed and fired (c) Allis clamps are used to grasp each side of

the colotomy created by the stapler (d) the terminal end stapler is applied and the excess bowel is trimmed with the skin knife or scissors

(3) mechanical (end-to-end) (a) a running, purse-string stitch of non-absorbable, monfilament suture is

placed around the end of each bowel loop (b) a colotomy is performed close to the anastomosis site (c) the end-to-end circular stapler is introduced; the jaw is opened, and the purse-string sutures are tightened and secured around the anvil of the stapler (d) the stapler is fired; opened slightly, rotated through the anastomosis site, and removed

(e) the "ring" specimens of the end-to-end circular stapler are checked for integrity of the anastomosis (f) Allis clamps are placed along the colostomy and a terminal end stapler is applied to close the colostomy; excess bowel is trimmed with the skin knife or scissors

m. the mesenteric defect is closed with an absorbable running suture

n. the abdominal cavity is irrigated with copious amounts of saline for irrigation o. the abdominal incision is closed

(1) the fascia later is closed with two, long-term absorbable running sutures of the surgeon's preference (2) if the incision involves the umbilicus, the fascia of the umbilicus is closed with interrupted long-term absorbable or non-absorbable sutures (3) retention sutures may be placed (4) the subcutaneous layer may be closed with an absorbable, interrupted suture of the surgeon's choice (5) the skin is closed with staples or interrupted mattress sutures of the surgeon's choice

2. colostomy formation a. the stoma site is marked pre-operatively, with the patient

standing, if possible b. an incision is made at the stoma site following the protocol for entering the abdominal cavity previously detailed c. the loop of bowel is brought out through the incision d. the fascia may be partially closed with an absorbable, interrupted suture e. the bowel loop is secured to the skin f. closed bowel loop (1) a bridge is sutured to the skin with a non-absorbable suture on a cutting needle

(2) the stoma is matured within 24 hours as detailed below g. open bowel loop (1) the bowel edge may be clamped for 12-24 hours, or immediately sutured to the skin using an absorbable suture with a tapercut needle h. mucous fistula (1) matured at the time of surgery (refer to open bowel loop)

3. laparoscopic assisted bowel resection a. the hepatic/splenic flexure may be taken down laparoscopically by means of the harmonic scalpel, ESU, or endo-shears b. mesenteric division may be accomplished by use of the harmonic scalpel c. the anastomosis is performed extracorporeally through a small abdominal incision

K. counts 1. initial - sponges, sharps and instruments 2. closure - sponges, sharps and instrument a. hollow organ b. cavity c. skin L. dressing materials 1. routine abdominal

2. stoma a. Vaseline gauze b. stoma appliance M. specimen care 1. bowel segment a. frozen section b. permanent section c. circular stapler specimens N. postoperative destination 1. PACU 2. ICU VI. Postoperative patient care considerations A. stoma management VII. Prognosis A. according to tumor/disease progression 1. benign/ malignant 2. primary/localized 3. metastasis to mesentery 4. metastasis to distant tissues VIII. complications A. DVT (deep vein thrombosis) B. short-gut syndrome C. infection D. ischemic bowel/mesenteric infarction E. anastomosis rupture F. hemorrhage IX. Wound classification/ management A. Class II - controlled spillage B. Class III - uncontrolled spillage C. Class IV - frank pus/infection UNIT III: COMMON BILE DUCT EXPLORATION WITH CHOLEDOCHOSCOPY UNIT OBJECTIVES:

1. Assess the pathophysiology of the biliary tree. 2. Analyze various diagnostic interventions for a patient undergoing a common bile duct exploration with choledochoscopy. 3. Plan the intraoperative course for a patient undergoing a common bile duct exploration with choledochoscopy. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for a common bile duct exploration with choledochoscopy. 8. Describe the care of the specimen.

UNIT OUTLINE: I. Pathology A. cholelithiasis B. common bile duct obstruction II. Diagnostic intervention A. exams 1. routine radiography 2. ultrasonography 3. CT scans 4. nuclear imaging 5. endoscopic retrograde cholangiopancreatography (ERCP) 6. intraoperative cholangiogram

III. Surgical intervention A. special considerations 1. evaluate the patient for allergies to contrast media if an intraoperative cholangiogram is to be performed B. position/positioning aids 1. supine 2. small pad may be placed under right upper quadrant for better exposure

3. scout film may be performed to check the position of the x-ray cassette C. incision 1. right subcostal 2. right paramedian or midline may be used D. supplies 1. cholangiocath 2. two 30cc syringes 3. injectable saline 4. contrast media 5. balloon-tipped biliary catheter 6. 1000cc bag 0.9% normal saline 7. sterile IV tubing 8. pressure bag E. equipment 1. electrosurgical unit (ESU) 2. OR table with radiographic attachment 3. OR table with image-intensification attachment 4. fluoroscopy unit 5. lead aprons and shields 6. rigid or flexible fiberoptic choledochoscope 7. light source 8. light cable 9. video camera and viewing screen F. instrumentation 1. basic laparotomy set 2. Harrington retractor 3. biliary instruments a. common duct dilators b. common duct probes c. common duct scoops d. Randall stone forceps e. cystic duct clamp (Swenson) f. flexible stone forceps or basket

G. procedural steps 1. subcostal incision made from epigastrium laterally and obliquely to lower costal margin

2. routine opening of the abdomen 3. laparotomy sponges are used to wall off surrounding organs 4. Deaver or Harrington retractor may be used to gently retract the liver upward 5. ring or pean forceps may be used on the gallbladder for gentle retraction

6. gallbladder may be drained by a trocar connected to suction then clamp placed over the opening in the gallbladder 7. thin peritoneal fold is removed from the cystic duct and common bile ducts using long Metzenbaum scissor and blunt dissection with a small dissecting sponge mounted on a stick(instrument) 8. cystic duct, cystic artery, hepatic ducts and common bile duct are identified 9. ducts are palpated for stones and stones may be milked back into the gallbladder 10. intraoperative cholangiogram and exploration of the common bile duct will be performed at this time.

11. two syringes are prepared according to the surgeon's preference Note: frequently the surgeon wishes to have the contrast media diluted half strength - the surgical technologist would prepare on syringe with half injectable saline and halft contrast media and a second syringe with injectable saline - both syringes should be properly labeled 12. the cholangiocath is prepared by attaching the syringe containing the injectable saline and filling the catheter Note: all air bubbles must be removed from both the syringe and catheter as they may be interpreted as stones on the x-ray 13. the cystic duct and common bile duct are identified and two traction sutures may be placed through the wall of the duct 14. a small incision is made in either duct with a # 15 or # 11 blade on a #7 knife handle 15. the cholangiocath is then inserted into the duct while the assistant injects saline 16. the cholangiocath is held in place by a ring-jawed forceps or by tying, suturing, or applying a clip to the catheter 17. in preparation for the x-ray, all instruments and radiopaque sponges are removed from the field 18. the field is covered with a sterile drape before the x-ray tube or C-arm is positioned over the patient 19. lead aprons and shields are utilized for the protection of the patient and personnel 20. the surgeon then injects the previously prepared contrast media and alerts the radiology technologist to take the appropriate x-rays which are developed immediately 21. the surgeon then studies the x-rays and may elect to take additional x-rays or to explore the common bile duct for stones 22. curved stone forceps (Randall), malleable scoops (Mayo), balloon catheters (Fogarty), stone baskets, and common duct dilators (Bakes) may be used for the common duct exploration 23. if a biliary balloon is used, the catheter is threaded into the duct past the stone, the balloon is inflated with injectable saline, and the catheter withdrawn bringing the stone with it 24. a choledochoscope may be used to explore the biliary system and may take the place of the operative cholangiogram 25. the flexible scope is inserted into the common bile duct 26. sterile IV tubing is passed from the sterile field and the circulator attaches it to a bag of IV saline, which is in a pressure bag - the surgical technologist attaches the end to the irrigating channel 27. normal saline is injected continuously under pressure through the irrigating channel to provide distention of the biliary tract 28. a flexible sotne forceps or basket or balloon-tipped catheter may be inserted through the instrument channel of the scope to remove the stone 29. following exploration of the common bile duct, a T-tube may be inserted as a stent for the common bile duct and to provide drainage postoperatively

H. counts 1. initial 2. closure I. specimen care 1. stones will be sent to pathology in a dry container

2. several stones may be returned to the patient after pathologic examination if requested IV. Complications A. hemorrhage B. wound infection C. atelectasis D. ileus

E. injury to nearby structures F. retained stones G. stricture of the common bile duct H. dislodgment of the T-tube UNIT IV: ILEAL CONDUIT (URETEROILEOCUTANEOUS DIVERSION) UNIT OBJECTIVES: 1. Assess the pathophysiology of the urinary bladder 2. Analyze an overview of the surgical intervention of a patient undergoing ureteroileocutaneous diversion. UNIT OUTLINE: I. Pathophysiology A. malignancy of the bladder B. severe stricture of the distal ureter C. interstitial cystitis D. neurogenic bladder II. Surgical intervention A. special considerations 1. do not inadvertently remove ileostomy site markings when performing the skin prep 2. patient will require an enterosotomal consult and the patient or

caregiver must be able to care for the urinary collection device 3. in some cases, prior to cystectomy, the surgeon may treat the patient with radiation to decrease the tumor size. This may negatively affect the tissue at the operative site 4. patient will require full bowel prep 5. positioning variation: Patient generally is placed in the supine position with arms extended on arm boards. The patient may be placed in the low lithotomy position, which would require additional drapes, and positioning aids. Position will be according to the surgeon's preference. 6. the urologist may request a general surgeon and/or a gynecologist to assist with the procedure 7. the bladder will be decompressed with a Foley catheter. The Foley m may be inserted from the sterile field, and the entire drainage system may be required to remain sterile throughout the procedure 8. pathologist will be required to examine specimens for frozen section 9. preoperative radiographic films should be available in the operating room 10. surgeon may request ureteral stents

B. procedural overview 1. the ileal conduit is performed to divert urine flow to an isolated loop of bowel

2. this procedure is usually performed in conjunction with a cystectomy. Cystectomy may be performed before or after this procedure, depending on the patient's diagnosis and condition 3. the distal ileum is exposed and a segment that is approximately 15cm is divided. Proximal and distal ileum continuity is re-established. The mesentery is closed over the intervening mesentery of the isolated loop, and the proximal end of the isolated loop is closed 4. the ureters are implanted into an isolated segment of terminal ileum near its proximal end 5. most often, the distal end of the ileal loop is brought out to the selected stoma site, usually the right lower quadrant of the lower abdomen. The stoma site is usually marked with methylene blue or a surgical marking pen. The goal is to create a round stoma, without

wrinkles, that does not allow urine leakage under the collection device 6. gastrointestinal stapling devices may be utilized to perform the intestinal anastomoses and the closure of the proximal end of the isolated loop 7. the stoma is sutured to the skin, the abdominal wound is closed, and dressings are applied 8. A urine collection appliance is secured over the stoma before the patient leaves the operating room 9. wound drainage is optional 10. some surgeons prefer to catheterize the stoma site to prevent urine contact with the external tissues until the stoma has matured 11. a more difficult surgical option is the continent urinary reservoir constructed of ileum without the use of the ileocecal region. (Kock Pouch). Continent diversion requires the following: a reservoir, an antireflux mechanism, and a catheterizable stoma that will not leak. Continence is achieved by utilizing reconfigured bowel to serve as the holding area for the urine. The valve mechanism is created within construction of a nipple valve attached to the skin. The reservoir is emptied by periodic catheterization of an abdominal stoma 12. stents may be placed in the ureters for the immediate postoperative period 13. mesh may be utilized to serve as a strut to prevent parastomal herniation and to anchor the base of the nipple to the abdominal wall

UNIT V OBSTETRICS AND GYNECOLOGIC SURGERY A. Endoscopic 1. colposcopy 2. hysteroscopy B. Basic Interventions

1. Cesarean section 2. laparoscopic assisted vaginal hysterectomy (LAVH) 3. laparoscopy 4. operative laparoscopy with oophorectomy 5. total abdominal hysterectomy with bilateral salpingo-oophrectomy 6. vaginal hysterectomy

C. Intermediate Interventions 1. cervical cone biopsy 2. ectopic pregnancy resolution 3. endometrial ablation 4. vulvectomy 5. dilation and curettage(D&C) D. Advanced Interventions

1. micro-tubal reanastomosis 2. uterine balloon therapy 3. Wertheim procedure (pelvic exenteration) E. Related Surgical Interventions 1. endoscopic

a. colposcopy b. hysteroscopy c. laparoscopic assisted vaginal hysterectomy (LAVH) d. laparoscopy e. tubal ligation/sterilization (tuboplasty) f. hysterectomy (robotic - assisted) 2. obstetric and gynecologic a. ablation of condylomata b. Bartholin cystectomy c. cerclage

d. episotomy (episotomy repair) e. loop electrosurgical excision procedure (LEEP) f. myomectomy g. oophorectomy h. ovarian cystectomy i. placement of radiation therapy device j. salpingectomy k. vaginoplasty (labioplasty/A&P repairs)

UNIT VI: CESAREAN SECTION UNIT OBJECTIVES:

1. Assess the anatomy, physiology, and pathophysiology of the female reproductive system. 2. Analyze the diagnostic and surgical interventions for a patient undergoing Cesarean section. 3. Plan the intraoperative course for a patient undergoing Cesarean section. 4. Assemble supplies, equipment, and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for a Cesarean section. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing Cesarean section.

UNIT OUTLINE I. Anatomy A. pelvis 1. ileum 2. ischium 3. symphysis pubis 4. sacrum 5. coccyx B. pelvic floor 1. levator ani muscle 2. iliococcygeal 3. pubococcygeal 4. puborectalis 5. pelvic fascia C. pelvic cavity 1. uterus a. tissue layers (1) endometrium (2) myometrium (3) peritoneal or pelvic peritoneum/serous layer b. uterine vasculature (1) uterine artery and veins c. cervix (1) internal os (2) external os

d. ligaments (1) broad (2) cardinal (anteriorly) (3) pubic (posteriorly) (4) sacral (5) round (6) uterosacral (7) infundibulopelvic (suspensory ligament)

2. fallopian tubes (oviducts) a. fimbria b. infundibulum

c. ampulla d. mesosalpinx 3. ovaries a. ovarian ligament b. ovarian vasculature c. cortex d. medulla e. ova 4. vagina a. vaginal mucosa 5. external genitalia a. vulva b. mons pubis c. labia majora d. labia minora e. clitoris f. Bartholin's glands g. vestibule h. uretheral meatus i. vascularization and innervation (1) pudendal artery and nerve D. vascular, nerve and lymphatic supply of the pelvic cavity 1. blood supply a. internal iliac artery b. common iliac artery c. ovarian artery d. superior rectal artery e. median sacral artery 2. nerve supply a. autonomic nervous system (1) superior hypogastric plexus (presacral nerve) 3. lymphatic supply a. iliac nodes b. preaortic nodes c. inguinal nodes 4. tissue layers of the abdominal wall and internal structures a. skin b. subcutaneous c. fascia d. muscle e. peritoneum f. bladder peritoneum g. uterus h. amniotic sac (if still intact) II. Physiology A. uterus 1. houses fetal tissues during growth and development 2. menstruation B. fallopian tubes C. ovaries 1. ova maturation 2. hormone production a. estrogen b. progesterone c. human chorionic gonadotropin D. vagina III Pathophysiology A. repeat Cesarean Section B. cephalopelvic disproportion (CPD) = "dystocia" C. malpresentation

D. fetal distress E. failure to progress F. maternal hemorrhage 1. placenta previa 2. abruptio placentae G. maternal medical problems 1. diabetes 2. toxemia (preeclampsia) 3. hypertension not controlled by medication 4. pelvic tumor obstructing the passages 5. fibroids blocking the outlet 6. invasive cervical cancer 7. active genital herpes 8. repaired vesicovaginal fistula or urinary sling operation

H. prolonged labor I. failed induction J. conjoined twins K. death of the mother near term L. major congenital fetal anomalies M. immune thrombocytopenia N. prior vaginal colporrhaphy O. large vulvar condylomata P. prolapsed cord Q. previous pelvic surgery R. trauma S. common 1. cardiac disease 2. multiple pregnancy 3. breech presentation IV. Diagnostic intervention A. diagnostic exams 1. previous medical history 2. ultrasound 3. fetal monitoring 4. vaginal cultures 5. scalp pH B. preoperative testing 1. CBC 2. urinalysis V. Surgical intervention A. special considerations 1. if general anesthetic utilized, all preparations done prior to induction a. Foley catheter insertion b. skin prep c. draping d. suction/ electrosurgical unit connection e. counts f. gowning and gloving of all sterile team members 2. three closing counts will be necessary because the uterus is a hollow organ B. anesthesia 1. types a. epidural b. spinal c. general d. local (rare) 2. patient monitoring a. fetal (1) Doppler b. maternal (1) routine - vitals, etc

(2) hemodynamic (3) urinary output (Foley) (4) temperature maintenance C. positioning/ positioning aids 1. supine with wedge under right side 2. safety strap placement 3. arm boards D. skin prep 1. routine abdominal E. draping 1. wound towels/clips 2. fenestrated sheet with pouch for fluid collection F. incision 1. skin a. midline b. Pfannenstiel (low transverse) G. supplies 1. routine a. Cesarean section pack b. prep tray c. # 10 knife blades d. skin marker e. basin set f. laparotomy sponges 2. specialty a. bulb syringe (one per infant b. cord blood/pH kits ( one of each per infant) c. cord clamps (two per infant d. DeLee suction device e. additional suction tubing 3. suture a. surgeons preference (1) hemostasis (2) closure of uterus (3) bladder flap (4) closure of abdominal wall 4. medications a. may use oxytocic (1) oxytocin (2) prostaglandins (3) methergine 5. catheters / drains a. Foley catheter b. closed wound drains (1) Jackson-Pratt with reservoir (not common) H. equipment 1. electrosurgical unite (ESU) 2. radiant warmer for neonate (one per infant) 3. hypo/hyperthermia unit 4. fetal monitoring device a. ultrasound b. Doppler I. instrumentation 1. Cesarean section set 2. surgeon's preference for bladder blade a. DeLee b. Richardson c. Balfour blade 3. delivery forceps (if not routine in instrument set) 4. suction/tips

a. Poole tip b. Yankauer tip c. DeLee section device 5. bandage scissors (if not routine in instrument set) J. procedural tips 1. abdominal wall incision a. instruments (1) knife blade/handle (a) skin knife (b) deep knife (c) uterine knife (#10 blade on #3 handle) (2) Russian or toothed forceps (3) retractors of surgeon's choice (Richardson etc.) 2. intraoperative intervention a. abdomen entered (1) moist laps (2) Kelly or Richardson retractors b. parietal peritoneum dissected (1) Metzenbaum scissors (2) Russian forceps c. uterine incision scored lengthwise (1) new knife blade/handle d. incision carried bilaterally with blunt or sharp dissection (1) bandage scissors e. amniotic sac encountered and ruptured (1) Allis clamp f. obstetrician delivers infant g. cord is clamped (1) cord clamps (2) peans (3) Kelly's h. infant suctioned (1) DeLee suction (2) bulb syringe i. neonate passed to pediatrician/neonate team j. cord blood sample collected (1) cord blood tube k. placenta delivered and inspected (1) cord pH drawn (if needed) (a) cord pH kit l. clean uterine cavity (1) dry lap sponges m. oxytocin uterine injection (1) oxytocin 3. tissue approximation a. uterus (1) single or multiple closure (2) imbricating stitch b. bladder flap c. peritoneum d. muscle e. fascia f. subcutaneous g. skin K. counts 1. initial - instruments, sponges, and sharps 2. closure - instruments, sponges, and sharps a. uterus b. peritoneum c. skin

L. dressing materials 1. Telfa 2. 4x4 gauze 3. abdominal pad (ABD) 4. tape 5. perineal pad M. specimen care 1. placenta 2. cord blood 3. cord gasses 4. neonate N. postoperative destination 1. PACU 2. postpartum ward VI. Postoperative patient care considerations A. psychosocial 1. allow maternal/neonatal bonding 2. address neonatal care issues (e.g. breast feeding) 3. adoption circumstances B. neonate 1. prognosis depends on nonsurgical factors VII. Prognosis A. maternal 1. return to normal activities within 4-6 weeks 2. increased risk of future Cesarean section with subsequent pregnancy B. neonate 1. prognosis depends on non-surgical factors VIII. Coomplications A. bleeding B. infection C. injury to adjacent organs D. Cesarean section weakens musculature and may result in future Cesarean section IX. Wound classification/management A. Cesarean section is considered a clean/contaminated procedure because the reproductive tract is entered. B. additional factors, such as, intrauterine infection, may affect wound classification UNIT VII OTORHINOLARYNGOLOGIC A. Endoscopic 1. microlaryngoscopy 2. triple endoscopy (laryngoscopy, bronchoscopy and esophagoscopy) 3. endoscopic sinus surgery (FESS) B. Basic Interventions 1. myringotomy

2. septoplasty 3. sinuscopy

4. temporomandibular joint arthroplasty 5. thyroidectomy 6. tonsillectomy and adenoidectomy (T&A) C. Intermediate Interventions

1. Caldwell-Luc 2. tracheotomy/tracheostomy 3. tympanoplasty II 4. uvulopapatopharyngoplasty (UPPP) D. Advanced Interventions

1. laryngectomy 2. mastoidectomy 3. radical neck dissection (glossectomy andmandibulectomy) 4. tympanoplasty

E. Related Surgical Interventions 1. endoscopic

a. microlaryngoscopy b. sinuscopy c. temporomandibular joint (TMJ) arthroscopy d. triple endoscopy (laryngoscopy, bronchoscopy, and esophagoscopy) 2. otorhinolaryngologic a. glossectomy b. mandibulectomy c. nasal antrostomy d. nasal polypectomy e. parathyroidectomy f. parotidectomy g. salivary duct stone excision/sialolithotomy h. sphenoidectomy i. stapedectomy j. turbinectomy k. cochlear implant l. choanal atresia UNIT VIII: TONSILLECTOMY AND ADENOIDECTOMY (T&A) UNIT OBJECTIVES: 1. Assess the anatomy, physiology and pathophysiology of the pharynx. 2. Analyze the diagnostic and surgical interventions for a patient undergoing tonsillectomy and adenoidectomy. 3. Plan the intraoperative course for a patient undergoing tonsillectomy and

adenoidectomy. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. analyze the procedural steps for tonsillectomy and adenoidectomy. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing tonsillectomy and adenoidectomy.

UNIT OUTLINE: I. Anatomy A. pharynx 1. nasopharynx a. Eustachian tubes b. pharyngeal tonsils 2. oropharynx a. palatine tonsils b. lingual tonsils c. palatine pillars (1) anterior (2) posterior d. uvula 3. laryngopharynx II. Physiology A. normal respiration B. normal deglutition III. Pathophysiology A. recurrent tonsillitis B. peritonsillar abscess C. tonsillar (pharyngeal/palatine) hypertrophy

D. cancer IV. Diagnostic intervention A. diagnostic exams

1. history of repeated tonsillitis, dysphagia, snoring, pharyngeal obstruction and/or middle ear infections 2. visual examination 3. culture and sensitivity

B. preoperative testing 1. CBC V. Surgical intervention A. special considerations 1. OR table may be turned 90o if surgeon prefers to be at the head of the table 2. in a combination procedure, some surgeons prefer to perform the Tonsillectomy first while others will remove the adenoids first

3. pharyngeal surgery is not considered sterile - use the best technique possible 4. equipment adjustments will be necessary and OR arrangement will be affected by the surgeon's preference to stand at the patient's side or head; or sit at the head of the table 5. generally performed on pediatric patients 6. adult patients are typically administered local anesthesia and placed in the sitting position

B. anesthesia 1. general a. pediatric mask induction b. oral endotracheal tube is used c. lubricate and protect the eyes C. position/positioning aids 1. supine with neck hyperextended a. roll placed under the shoulders b. arms tucked at sides c. elbow pads d. safety strap e. donut or foam headrest may be used for stabilization

f. for the comfort of the surgeon, a small patient may be placed closer to the side of the operating table at which the surgeon will be standing

D. skin prep 1. none needed E. draping 1. none required 2. a head wrap and/or cover sheet may be used F. incision 1. peritonsillar G. supplies 1. routine a. 1/2 sheet x 2 b. 4/4 x-ray detectable sponges c. towels d. gowns e. gloves f. suction tubing g. electrosurgical pencil with extension h. small basin 2. specialty a. tonsil sponges b. #12 knife blade c. insulated suction cautery apparatus d. syringe for irrigation of nasopharynx (available)

e. additional supplies will be necessary if local anesthesia is planned (control syringe, tonsil style injection needle)

3. suture

a. 2-0 plain on a heavy, tapered 5/8 curve needle 4. medications a. local anesthetic of surgeon's choice, if necessary 5. catheters/drains H. equipment 1. sitting stool if surgeon prefers to sit 2. headlamp 3. electrosurgical unit 4. harmonic scalpel 5. suction apparatus I. instrumentation 1. T&A instrument set J. procedural steps 1. self-retaining mouth gag is inserted and tongue depressor is placed 2. tonsil is grasped with an Allis or tenaculum 3. mucosa of the anterior pillar is incised

4. tonsil is dissected free of it mucosa using a Hurd elevator, Metzenbaum scissors, electrosurgical pencil or the harmonic scalpel 5. tonsil may be removed with a snare, guillotine or cauterized from its fossa 6. following amputation of the tonsil, pressure may be applied with a tonsil sponge 7. hemostasis is achieved with the electrocautery, harmonic scalpel or suture 8. the procedure is repeated on the contralateral tonsil 9. the uvula is retracted to expose the nasopharynx 10. the adenoids are removed with an adenotom, curette or punch 11. pressure is applied to control bleeding 12. hemostasis is achieved 13. the nasopharynx may be irrigated to ensure that all clots and tissue have been removed 14. final inspection of all sites is performed and hemostasis verified 15. retractors are removed 16. closure is not needed

K. counts 1. initial - sponges, sharps 2. closure - sponges, sharps a. performed prior to removal of retractors L. dressing materials 1. none needed M. specimen care

1. according to facility policy and surgeon's preference; specimens may be kept separate or sent together

N. postoperative destingation 1. PACU 2. home when discharge criteria is met VI. Postoperative patient care considerations A. once extubated, the patient should be placed on his or her side to prevent aspiration B. elevate the head of the bed slightly to reduce postoperative swelling C. provide cold fluids to aid in comfort and prevent swelling VII. Prognosis A. patient is expected to return to normal activities within 2 weeks B. incidents of "sore throats" and ear infections should be greatly reduced VIII. Complications

A. bleeding is the most common postoperative complication and can occur up to 10 days after surgery B. infection IX. Wound classification/management A. Class II wound due to entry of upper aerodigestive tract B. increase class if inflammation or infection is present

UNIT IX: GENITOURINARY A. Endoscopic 1. cystoscopy 2. nephroscopy 3. ureteroscopy B. Basic Interventions 1. nephrectomy 2. orchiopexy/orchidopexy 3. suprapubic prostatectomy 4. transurethral resection of the prostate (TURP) 5. prostatectomy (laparoscopic - laparoscopic robotic assisted) 6. prostate seeding 7. hydrocelectomy 8. orchiectomy C. Intermediate Interventions 1. cystectomy 2. hypospadius repair

3. Marshall Marchetti Krantz procedure (suspension TVT/sling) 4. ureteropyelolithotomy 5. urethrovesical angle repositioning 6. vasovasotomy 7. circumcision 8. epispadius repair 9. penectomy D. Advanced Interventions

1. adrenalectomy 2. cystectomy with creation of ileal conduit 3. insertion of penile implants 4. kidney transplantation 5. ureteral reimplantation E. Related Surgical Interventions 1. cystoscopy 2. nephroscopy 3. ureteroscopy 4. TUR-BT UNIT X: TRANSURETHERAL RESECTION OF THE PROSTATE (TURP) UNIT OBJECTIVES: 1. Assess the anatomy, physiology and pathophysiology of the male genitourinary system. 2. Analyze the diagnostic and surgical interventions for a patient undergoing TURP. 3. Plan the intraoperative course for a patient undergoing TURP. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Chose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for TURP. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing TURP. UNIT OUTLINE: I. Anatomy A. organs

1. urinary bladder a. location (1) pelvic cavity (2) behind symphysis pubis (3) superior fascia of the urogenital diaphragm b. trigone 2. vas deferens a. ampullae of the vas 3. seminal vesicles 4. ureters 5. urethra 6. bulbourethral gland 7. prostate a. prostatic urethra b. capsule c. prostatic sheath (fascial sheath) d. prostatic venous plexus e. prostatic utricle f. lobes (intra-urethral and extraurethral) (1) anterior lobe (2) median lobe (3) lateral lobes (4) posterior lobe 8. lymphatics 9. penis a. membranous urethra b. penile urethra c. sphincter d. corpus cavernosum e. corpus spongiosum f. corona of gland g. navicular fossa of urethra h. glans penis i. external meatus B. vascular supply 1. branch of hypogastric artery 2. superior vesical artery and vein 3. inferior vesical artery and vein 4. middle vesical artery and vein 5. pudendal artery and vein 6. internal spermatic arteries and veins 7. deep dorsal vein of penis 8. superficial dorsal vein of the penis 9. dorsal artery 10. middle rectal artery C. nerve supply D. dorsal nerves of the penis E. lymphatic supply 1. obturator 2. external iliac lymph nodes II. Physiology A. accessory male sex organ B. secretion of alkaline fluid (sperm nourishment and motility) III. Pathophysiology A. prostatic enlargement 1. benigh prostatic hypertrophy/hyperplasia (BPH) 2. bladder outlet obstruction B. carcinoma of the prostate

IV. Diagnostic intervention A. annual digital prostate examination/digital rectal examination (DRE)

B. prostate-specific antigen (PSA) C. PSA II (free total serum PSA) D. prostatic acid phosphatase level (PAP) E. transrectal aspiration F. core biopsy G. prostatic ultrasonography H. bone scan and skeletal survey (if biopsy results are positive for malignancy) I. CT scan/MRI J. KUB x-ray V. Surgical intervention A. special considerations 1. TURP is generally performed in the "cysto" room 2. preoperative radiographic films should be available in the cysto room

3. the surgical technologist is not generally required to "scrub in" for this procedure, but a sterile field must be created and maintained. In many facilities it is acceptable to don sterile gloves to perform tasks related to the procedure 4. the surgical technologist may assist the circulator sterile case preparation 5. for obese patients: additional positioning aides may be required, additional staff may be required to assist with positioning 6. the amount of time required for a TURP varies and is directly related to the size of the prostate gland. Operating time can range from 30 minutes to three hours.

B. anesthesia 1. regional 2. general C. position/positioning aids 1. litotomy 2. cystoscopy table 3. stirrups a. specific to the cystoscopy table and are removable b. generally, padded knee supports can be utilized to support the popliteal space in a padded knee-crutch stirrup 4. safety straps 5. armboard or draw sheet to tuck arms D. skin prep 1. cleanse entire pubic area including penis, scrotum and perineum a. retract foreskin if present E. draping 1. cystocsopy drape 2. surgeon may request an O'Connor shield 3. leggings F. incision 1. none G. supplies 1. routine a. cysto pack b. prep tray c. basin set 2. specialty a. isotonic (nonhemolytic irrigant (e.g. sorbitol, glycine) b. disposable irrigation system c. 50-60cc syringe d. lubricant, water-soluble e. Toomey syringe f. Ellik or McCarthy evacuator 3. suture 4. medications 5. catheters/drains

a. Foley catheter (22 - 24 Fr.) with 30cc balloon, two or three-way catheter

b. urinary drainage system H. equipment 1. electrosurgical unit 2. fiberoptic light source 3. camera and video equipment, if requested I. instrumentation 1. cystoscope 2. fiberoptic light cord 3. electorsurgical cord 4. resectoscope (complete with sheath and obturator) 5. resectoscope sheath with corresponding obturator 6. cutting loops 7. telescope 8. working elements 9. urethral dilators/Van Buren sounds 10. biopsy forceps J. procedural steps 1. urethra is lubricated with water-soluble jelly, and if necessary is

dilated or a meatotomy is performed 2. the irrigation tubing, fiberoptic light cord, cautery cable are connected 3. preliminary cystoscopy may be performed to assess the hypertrophy and to inspect the bladder 4. cystoscope is removed and lubricated resectoscope is inserted 5. resectoscope may be inserted under direct visualization, or a camera/video system may be utilized 6. a loop electrode is used to resect the enlarged prostate tissue 7. resection generally begins with the middle lobe to the crossing fibers of the bladder neck. This technique opens the prostatic urethra proximally to facilitate the remainder of the resection. 8. the bladder is continuously irrigated 9. the surgeon will intermittently remove tissue fragments by utilizing the Ellik or McCarthy evacuator. A Toomey syringe may also be requested. 10. the urethra, bladder, and prostatic fossa are inspected for debris and any bleeding. Total removal of all fragments of tissue is desired. 11. hemostasis is achieved by using a blade or ball style electrode prior to the removal of instrumentation 12. a Foley catheter (22 - 24 Fr.) two or three-way, with a 30cc balloon is inserted and the balloon is inflated with water 13. the catheter may be manually irrigated to assess hemostasis 14. bladder drainage should be clear or slightly tinged with blood 15. traction may be applied to the Foley by securing the catheter to the external portion of the patient's thigh. This technique is often helpful

in reducing bleeding K. counts 1. generally omitted on TURP L. dressing materials 1. none M. specimen care 1. prostatic tissue/curetting N. postoperative destination 1. PACU VI. Postoperative patient care considerations A. blood for serum electrolytes, hematocrit, and hemoglobin is drawn postoperatively if operative time is greater than 1 hour or if blood loss is significant B. the patient remains hospitalized for several days until drainage from catheter is clear, the catheter is removed, and the patient is able to void

VII. Prognosis A. prognosis depends on tissue diagnosis and location of carcinoma within the prostate gland VIII. Complications A. infection B. hemorrhage C. urethral stricture D. urethral stricture may lead to retrograde ejaculation and urinary retention E. fluid-load shifts F. impotence G. intraperitoneal extravasation of fluid H. hyponatremia I. hypervolemia IX. Wound classification/management A. TURP is considered a Class II clean-contaminated procedure because the genitourinary tract is entered. UNIT XI: ORTHOPEDIC A. Basic Interventions 1. bunionectomy with hammer toe correction

2. carpal tunnel release 3. knee arthroscopy

4. lumbar laminectomy 5. open reduction internal fixation (ORIF) of the femur 6. shoulder arthroscopy 7. total hip arthroplasty B. Intermediate Interventions 1. bipolar hip replacement 2. femoral rodding 3. lower extremity amputation (below the knee/above the knee - BK/AK) 4. metacarpal phalangeal joint (MPJ) arthroplasty 5. tenorrhaphy 6. triple arthrodesis C. Advanced Interventions 1. anterior cruciate ligament (ACL) reconstruction 2. limb reattachment 3. open reduction internal fixation (ORIF) pelvic fracture 4. total hip arthroplasty 5. total knee arthroplasty D. Related Surgical Interventions 1. endoscopic a. knee arthroscopy b. shoulder arthroscopy 2. orthopedic a. Achilles tendon repair b. Bankart procedure (open/arthroscopic) c. Bristow procedure d. DeQuervain's contracture release e. Dupuytren's contracture release f. Putti Platte procedure g. total ankle arthroplasty h. total elbow arthroplasty i. total shoulder arthroplasty j. ulnar nerve transposition k. acromioplasty (open) l. acromioplasty (arthroscopic) m. ORIF (radius) n. external fixator (radius)

UNIT XII: BUNIONECTOMY WITH HAMMERTOE CORRECTION UNIT OBJECTIVES: 1. Assess the anatomy, physiology and pathophysiology of the foot. 2. Analyze the diagnostic and surgical interventions related to a patient undergoing bunionectomy with hammertoe correction. 3. Plan the intraoperative course for a patient undergoing bunionectomy with hammertoe correction. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for a bunionectomy with hammertoe correction. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing bunionectomy with hammertoe correction. UNIT OUTLINE: I. Anatomy A. bones of the ankle and foot 1. posterior half of the foot a. tarsus/tarsal bones (1) talus (2) calcaneus (3) cuboid (4) cuneiforms (3) b. joints (1) tibiofibular (a) structure: fibrous, syndemosis (b) function: synarthrotic (2) ankle (a) structure: synovial, hinge (b) diarthrotic, gliding (3) intertarsal (a) structure: synovial, plane (b) function: diarthrotic, gliding (4) tarsometatarsal (a) structure: synovial, plane (b) function: diarthrotic, gliding 2. Mid-section of foot a. metatarsus/ metatarsal bones (5) (1) first (medial) (2) second (3) third (4) fourth (5) fifth (lateral) b. joints (1) metatarsophalangeal (a) structure: synovial, condyloid (b) function: diathrotic 3. Anterior section of foot a. bones/phalanges (14) (1) great toe (2) (2) digits 2-5 b. joints (1) interphalangeal (a) structure: synovial, hinge (b) function: diathrotic

B. Muscles of the ankle and foot 1. dorsum a. extensor digitorum brevis (1) origin: calcaneus (2) insertion: proximal phalanx of big toe (3) action: toe extension (4) nerve supply: deep peroneal nerve 2. sole a. first layer (superficial) (1) flexor digitorum brevis (a) origin: tuber calcanei (b) insertion: middle phalanx of toes 2-4 (c) action: toe flexion (d) nerve supply: tibial nerve (2) abductor hallucis (a) origin: calcanei/flexor retinaculum (b) insertion: proximal phalanx of great toes medially (c) action: abducts big toe (d) nerve supply: tibial nerve (3) abductor digiti minimi (a) origin: calcanei (b) insertion: lateral side of proximal phalanx of little toe (c) action: abducts little toe (d) nerve supply: tibial nerve b. second layer (1) flexor accessories (a) origin: medial and lateral sides of calcaneous (b) insertion: tendon of flexor digitorum longus (c) action: straightens oblique pull of flexor digitorum longus

(d) nerve supply: tibial nerve (2) lumbricals (a) origin: each tendon of flexor digitorum longus

(b) insertion: medial side of proximal phalanx of toes 2-5 (c) action: flexion at metatarsophalangeal joint and extension at interphalangeal joint (d) nerve supply: medial and lateral plantar nerve

c. third layer (1) flexor hallucis brevis (a) origin: cuboid (b) insertion: both sides of proximal phalanx of great toe (c) action: flexion of great toe at metatarsophalangeal joint

(d) nerve supply: medial plantar branch of tibial nerve

(2) adductor hallucis (a) origin: bases of metatarsals 2-4 (b) insertion: base of proximal phalanx of great toe, laterally

(c) action: maintain transverse arch of foot; weak ` adductor of great toe

(d) nerve supply: lateral plantar branch of tibial nerve (3) flexotr digit minimi brevis (a) origin: base of metatarsal 5 and tendon of peroneus longus (b) insertion: base of proximal phalanx of toe 5 (c) action: flexion of little toe at

metatarsophalangeal joint (d) nerve supply: lateral plantar branch of tibial nerve

II. Physiology A. movements of the ankle 1. dorsiflexion 2. plantarflexion B. arches of the foot 1. weight bearing capabilities of foot 2. shock absorbers 3. propelling body during movement 4. types a. longitudinal b. medial c. lateral d. transverse III. Pathophysiology A. hallux valgus 1. lateral deviation of great toe 2. metatarsals 3. sesamoids 4. bursa 5. etiology a. poorly fitting shoes b. degenerative arthritic changes c. flat feet

B. hammer toe 1. deformity of toes 2. most commonly the second toe 3. proximal phalanx is permanently flexed 4. middle phalanx is plantar flexed 5. distal phalanx flexed or extended 6. etiology a. weakness of lumbrical and interossei muscles IV. Diagnostic intervention A. diagnostic exams 1. AP and lateral x-rays B. preoperative testing 1. CBC with differential 2. urinalysis 3. chest x-ray 4. ECG 5. medical history V. Surgical intervention A. special considerations 1. room set up a. surgeon at foot, on affected side b. surgical technologist at foot c. back table at foot d. no Mayo stand e. tourniquet at head, non-operative side 2. team members a. surgeon b. surgical assistant c. surgical technologist in scrub role d. circulator e. anesthesia provider 3. patient factors a. size

b. level of cooperation c. anxiety d. awake patient e. other 4. Indications a. pain (1) dorsomedial aspect of first metatarsal head (2) directly over the exostosis (3) painful plantar callus 5. goals of surgery a. cosmesis: correct the deformity b. reconstruction: resect abnormal components c. function: normal or near-normal range of motion 6. methods a. Keller procedure - partial resection of proximal phalanx b. McBride procedure - tendon transfer to lateral portion of metatarsal neck c. Mitchell procedure - osteotomy of first metatarsal d. Chevron procedure - v-shaped osteotomy e. Mayo procedure - partial resection of the first metatarsal head B. Anesthesia 1. general 2. spinal 3. ankle block C. position/positioning aids 1. supine 2. tourniquet placement 3. pad pressure points D. skin prep 1. routine orthopedic prep 2. foot, ankle, entire leg below knee 3. povidone iodine 4. foot holder E. draping 1. stockinette 2. impervious split sheet 3. extremity drape F. incision 1. buncioncetomy a. dorosomedial aspect of the metatarsal head 2. hammer toe correction a. elliptical, over the proximal phalanx G. supplies 1. routine

a. minor orthopedic surgery pack b. prep tray c. #15 knife blades d. skin marker e. basin set f. x-ray detectable sponges g. impervious stockinette h. bulb syringe i. irrigation solution j. Esmarch bandage or ace bandage k. electrosurgical pencil 2. specialty a Ioban incise drape b. kling c. steri-strips d. webril 4" e. ace bandage 4"

f. plaster splint g. 0.045 0r 0.062 Kirschner wires x 4 3. suture a. surgeon's preference 4. medications 5. catheters/drains H. equipment 1. tourniquet and cuff 2. nitrogen power source 3. electrosurgical unit I. instrumentation 1. power micro sagittal saw and blades 2. power wire driver 3. minor ortho set or hand and foot set (light bone tray) 4. soft tissue set 5. small rongeurs 6. small osteotomes 7. small curettes 8. pin cutter 9. bandage scissors 10. Frazer suction 11. small self-retaining retractor J. procedural steps 1. bunionectomy (Keller) a. as Emarch bandage is used for exsanguinations of the extremity b. webril is wrapped around the tourniquet site c. the tourniquet is placed and inflated: the time is noted

d. a midline incision is made with a #15 blade from the neck of the proximal phalanx over the first metatarsal

e. hemostasis is maintained with electrosurgical pencil f. dissection is carried down through the joint capsule

g. using Metzenbaum scissors, a flap is created to expose the exostosis on the dorsomedial aspect of the first metatarsal head

h. additional exposure is achieved with Senn retractors i. all soft tissue attachments are removed from the base of the proximal phalanx j. proximal third of the proximal phalanx is resected with an oscillating saw

k. Kirschner wires are used to maintain alignment of the toe (1) desired gauge Kirschner wire is loaded in the power wire driver

(2) wires are driven into the center of the medullary canal of the phalanx, then to the metatarsal head, neck and shaft (3) 1-2 wires may be used (4) a pin cutter is used to cut the excess wire (5) a pin cap may be placed on the exposed end of the wire

l. the tourniquet is deflated and the time is noted m. the wounds is irrigated and the capsule is closed with an absorbable suture n. the skin is closed with a non-absorbable suture, such as nylon

o. the incision is covered with sterile gauze dressings (1) Webril is applied, followed by a posterior plaster splint

(2) the toe is splinted in approximately five degrees of flexion and slight varus position 2. Hammer toe correction

a. an elliptical incision is made with a # 15 blade, over the proximal interphalangeal joint, approximately 5mm wide and 3mm long b. dissection is carried down into the capsule with Metzenbaum scissors c. hemostasis is maintained with electrosurgical cautery pencil d. the distal third of the proximal phalanx and the proximal interphalangeal joint is exposed with Senn retractors e. a small rongeur or micro saw is used to resect the distal third of the proximal phalanx

f. a rongeur or rasp is used to debride the remaining portion of the distal proximal phalanx g. Kirschner wires are used for alignment (1) the desired gauge Kirschner wire is loaded in the power wire driver (2) the wires are driven into the center of the medullary canal of the phalanx, then to the metatarsal head, neck and shaft (3) 1-2 wires may be used (4) a pin cutter is used to cut the excess wire (5) a pin cap may be placed on the exposed end of the wire h. the wound is irrigated and closed with a non-absorbable suture i. the skin is closed with a non-absorbable suture, such as nylon j. dressings are applied

K. Counts 1. initial - sponges and sharps 2. closure - sponges and sharps L. Dressing materials 1. steri-strips 2. 4x4 gauze 3. Webril 4" 4. Ace bandage 4" 5. casting materials M. Specimen care 1. properly identified as resected bone, with location noted 2. properly labeled upon verification of patient name, number and site/side

3. fixed with formalin and processed as a routine specimen N. Postoperative patient care considerations 1. the patient is taken to PACU 2. the patient is discharged within 3-10 hours, depending on the ability to ambulate VI. Postoperative patient care considerations A. diet as tolerated when taken by mouth B. the patient is restricted to total bed rest for the first 48 hours, and then crutches must be used

C. neurovascular checks are done every two hours for the first 24 hours, or until discharge D. the extremity is kept elevated and ice packs are applied E. antibiotics are administered for seven days F. analgesics are administered as needed G. a physical therapist is consulted to demonstrate range of motion exercises, and to assist the patient with walking in a boot cast or with crutches. H. a postoperative check is scheduled for approximately ten days I. a bunion shoe is used for six weeks J. Kirschner wires are removed in approximately four to six weeks.

VII. Prognosis A. prognosis is good following bunionectomy; however there is a chance of recurrence VIII. Complications A. Hallux varus B. necrosis of wound edges C. paresthesias D. limited range of motion E. infection F. hematoma IX. Wound classification/ management A. bunionectomy is considered a clean procedure B. close postoperative follow up by surgeon to avoid an significant complications

C. patient should follow discharge instructions, and perform the assigned range of motion exercises to prevent avoidable complications

D. incision should be watched for signs of infection

SPECIALTY PROCEDURES UNIT XIII: OPHTHALMIC A. Basic Interventions 1. cataract extraction 2. entropion/ ectropion repair 3. recession and resection (R&R) B. Intermediate Interventions 1. enucleation 2. keratoplasty (corneal transplant) 3. scleral buckle C. Advanced Interventions 1. vitrectomy 2. chalazion excision 3. dacryocystorhinostomy 4. iridectomy 5. laceration repairs 6. strabismus correction (recession and resection) UNIT XIV: CATARACT EXTRACTION UNIT OBJECTIVES:

1. Assess the anatomy, physiology, and pathophysiology of the eye. 2. Analyze the diagnostic and surgical interventions related to a patient undergoing cataract extraction. 3. Plan the intraoperative course for a patient undergoing cataract extraction. 4. Assemble supplies, equipment, and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for a cataract extraction. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing cataract extraction. UNIT OUTLINE: I. Anatomy A. external structures of the eye 1. eyelids 2. conjunctiva 3. cornea 4. sclera 5. extraocular muscles 6. lacrimal apparatus 7. bony orbit B. internal structures of the eye 1. anterior segment a. iris b. pupil c. crystalline lens (1) capsular membrane (2) cortex (3) nucleus d. suspensory ligaments e. ciliary body f. anterior chamber g. posterior chamber 2. posterior segment

a. choroids b. retina c. vitreous d. optic nerve e. optic disc f. macula lutea g. fovea centralis C. associated anatomical structures 1. blood supply a. ophthalmic artery b. central retinal artery c. posterior ciliary arteries 2. infraorbital artery 3. innervation a. sensory b. motor II. Physiology A. function of the eye 1. organ of vision 2. refraction of light a. optics b. accommodation c. phototransduction B. fluid dynamics 1. aqueous 2. vitreous 3. lacrimal fluid III. Pathophysiology A. nuclear subcapsular cataract B. cortical cataract C. congenital cataract D. traumatic cataract E. other IV. Diagnostic intervention A. diagnostic exams 1. physical signs and symptoms 2. visual acuity testing 3. ophthalmoscopy 4. slit lamp biomicroscopy 5. axial biometry 6. keratometry B. preoperative testing 1. blood work a. CBC b. blood glucose c. serum potassium d. serum enzymes 2. urinalysis 3. chest x-ray

4. ECG 5. medical history

V. Surgical intervention A. special considerations 1. room set up a. surgeon at head b. technologist stands/sits c. Mayo placement d. Phaco machine placement e. microscope placement 2. team members

a. surgeon b. surgical assistant c. surgical technologist d. circulator e. anesthesia provider 3. patient factors a. age b. may be awake c. level of cooperation d. anxiety level e. alterations in mentation f. alterations in respiratory/cardiac function g. pronounced eyebrow 4. indications a. restore clear vision 5. methods a. extracapsular cataract extraction (ECCE) b. phacoemulsification c. intracapsular cataract extraction (ICCE) 6. other a. patient may be awake (1) keep room quiet (2) provide reassurance to patient b. lint-free drapes, sponges and supplies must be used c. be aware of your surroundings, avoid bumping or touching the microscope d. lenses are ordered specifically for each patient, locate lenses and verify sizes prior to incision e. patient may have fears related to the possible loss of vision following surgery

f. powder-free gloves are worn to prevent introduction of foreign materials into the eye g. all sterile team members will wipe hands with moistened gauze prior to procedure h. do not handle IOL with gloved hands, use forceps i. instrument wipes should be used instead of gauze to clean the tips of the microsurgical instruments.

B. anesthesia 1. general 2. local infiltration 3. topical (intraocular instillation) 4. peribulbar block 5. retrobulbar block 6. monitored anesthesia care (MAC) C. position/positioning aids 1. supine 2. special stabilization of head a. donut b. tape across forehead 3. wrist rest 4. eye cart versus OR table D. skin prep 1. solutions a. povidine iodine 2. area of prep a. eyelids of operative eye b. lashes c. eyebrows d. surrounding skin e. lid margins

f. evert lids g. cotton tip applicators moistened with prep solution h. irrigate with bulb syringe E. draping 1. special considerations a. lint free b. adequate air exchange 2. types of drapes a. one-piece fenestrated, self adherent section around eye b. double thickness head sheet, two towels, large drape, self adherent plastic eye drape (3M 1020) F. incision 1. types a. limbic b. clear corneal 2. size determination a. ECCE/phacoemulsification b. foldable IOL c. non-foldable IOL G. supplies 1. routine a. custom ophthalmic pack b. prep tray c. basin set 2. specialty a. wet field cautery b. disposable cautery c. intraocular lenses d. instrument wipes e. micro blades f. diamond knife g. powder free gloves h. 5cc syringe i. TB syringes j. 27 gauge cannulas k. 18 gauge needle l. cellulose spears (sponges) m. labels n. disposable blades o. phacoemulsification tubing pack p. microscope drape 3. suture a. surgeon's preference 4. medications a. anesthetic b. additives to anesthetic c. miotic agent d. mydriatic agent e. irrigation solution (1) 500cc bottle balanced salt solution (BSS) for infusion (2) 10cc or 15cc bottle BSS for irrigation f. viscoelastic agent g. anti-infective agent h. anti-inflammatory agent i. lubricant j. other 5. catheters/drains H. equipment 1. small back table 2. phaco machine

3. Mayo stand 4. stool for surgeon 5. microscope 6. Honan cuff 7. Shiatzu tonometer I. instrumentation 1. cataract instruments 2. phaco handpiece 3. cystotome handle 4. irrigation and aspiration (I&A) handpiece J. procedural steps 1. ECCE/phacoemulsification a. a self-retaining or spring type, eye speculum is placed in the

operative eye b. a small limbic incision is made and a flaps is dissected superiorly c. the limbal site is cleaned using a beaver blade d. hemostasis is obtained with cautery e. incision into the eye is carried out with a keratome or sharp micro knife f. the anterior lens capsule is opened with a cystotome or capsulorhexis forceps g. a viscoelastic agent, irrigating solution, or air may be injected into the anterior chamber, to maintain chamber depth h. the lens nucleus is loosened from the cortex with a cyclodialysis spatula or a cystotome i. the surgeon for proper vacuum control checks the ultrasonic handpiece (phaco), which has been previously primed and tuned j. the ultrasonic handpiece is introduced into the eye; the surgeon operates the handpiece with foot control to operate in the desired mode k. the lens nucleus is emulsified with the phaco handpiece l. the cortex is removed with the irrigation-aspiration handpiece m. with a keratome, the incision is enlarged to facilitate implantation of the intraocular lens into the posterior capsule n. if a foldable intraocular lens is to be used, the incision will be enlarged to 3.2mm o. if a rigid intraocular lens is to be used, the incision will be enlarged to 5.1mm p. Miochol may be injected immediately following implantation of IOL, to construct pupil and aid in stabilization of IOL q. a viscoelastic agent may be injected to protect the corneal endothelium and reshape the anterior chamber r. a keyhole or sector iridectomy may be performed if postoperative increased intraocular pressure is suspected, or if the patient has a history of glaucoma s. the corneoscleral wound is closed with a 10-0 non-absorbable suture, usually nylon t. the conjunctival flap is closed with suture or bipolar micro cautery u. anti-inflammatory ointment is placed in the cul-de-sac, and a topical agent to reduce intraocular pressure may be administered v. an eye pad and fox shield is applied

2. clear cornea method a. a self-retaining or spring type, eye speculum is placed in the

operative eye b. a 1-mm wide, stab incision is made at the 5o'clock position in a left eye or the 11 o'clock position in a right eye; this incision

enters the anterior chamber c. one ml of unpreserved lidocaine is injected into the anterior chamber

d. a viscoelastic agent is injected into the anterior chamber e. a caliper is used to mark a 3mm area on the temporal aspect of the cornea. A vertical incision, between 0.3 and 4.0 mm in depth, is made with a diamond knife f. a diamond keratome is used to carry the incision through to the anterior chamber, 2.6mm in length g. a capsulorrhexis is performed h. hydrodissection and hydrodelineation is performed by

injecting BSS via a 30-gauge cannula i. using the phaco handpiece and a cyclodialysis spatula, the nucleus is divided into quadrants, and phacoemulsification of the nucleus is carried out j. irrigation-aspiration is then used to remove the remaining cortex k. the surgeon may elect to polish the posterior capsule, using the Kratz capsule polisher l. viscoelastic material is injected into the capsular bag, in preparation for IOL implantation m. a keratome is used to widen the incision, to accommodate the IOL n. a foldable, posterior chamber IOL is prepared for insertion o. the lens is folded using a lens folding forceps, and inserted into the capsular bag p. the IOL is positioned with a Sinskey hook or a Kuglen hook q. irrigation-aspiration is used to remove excess viscoelastic material r. BSSmay be injected to re-form the anterior chamber s. being a no-stitch procedure, wound closure is not performed; however, a 10-0 nylon suture is needed for leakage t. an agent to reduce intraocular pressure and a steroid/anti- infective combination may be administered u. the eye is not patched

K. counts 1. initial - sponges and sharps 2. closure - sponges and sharps L. dressing materials 1. eye pad 2. eye shield 3. tape M. specimen care 1. properly identified as crystalline lens 2. properly labeled after verifying patient name, number, and site/side 3. fixed with formalin and processed as routine specimen N. postoperative destination 1. PACU 2. the patient is discharged to home when able to ambulate VI. Postoperative patient care considerations A. patient may be kept in PACU from 2-4 hours, if local or topical anesthesia B. patient recovery time varies with general anesthesia C. patient must be able to ambulate with assistance prior to discharge D. discharge instructions are given; patient understanding of instructions is verified - including signs and symptoms of complications E. corrective devices 1. intraocular lens(es) 2. glasses 3. contact lenses VII. Prognosis

A. patients that undergo cataract extraction, without any additional eye conditions, such as macular degeneration or diabetes, have a high probability of noticing a significant improvement in vision B. those patients that undergo cataract extraction for other reasons, such as traumatic, or congenital cataracts, may have a lower chance for significant visual improvement C. those patients with retinal or vascular problems are likely have less success with vision improvement D. close postoperative follow-up by the surgeon to maintain intraocular pressure and to monitor visual improvement E. patients should avoid straining, heavy lifting or bending for a few weeks following surgery - to avoid placing increased pressure on the incision site

VIII. Complications A. infection B. lens displacement C. retinal hemorrhage D. corneal edema E. increased intraocular pressure F. glaucoma G. blindness H. vitreous loss I. posterior capsular opacification IX. Wound classification/ management A. cataract extraction is considered a clean procedure UNIT XV: ORAL AND MAXILLOFACIAL A. Basic Interventions 1. LeFort I B. Intermediate Interventions 1. LeFort II 2. odontectomy 3. open reduction internal fixation (ORIF) maxillary/mandibular fractures 4. orbital fracture reduction/stabilization (ORIF) C. Advanced Interventions 1. craniofacial reconstruction 2. LeFort III D. Related Surgical Interventions 1. arch bar application 2. dental extraction 3. dental implants 4. orthognathic procedures 5. zygomatic fracture management 6. cleft repair (lip) 7. cleft repair (palate) UNIT XVI: PLASTIC AND RECONSTRUCTIVE A. Basic Interventions 1. breast reconstruction 2. rhytidectomy 3. skin grafting(full thickness and split thickness) B. Intermediate Interventions 1. abdominoplasty 2. cleft lip/palate repair 3. microvascular pedicle graft C. Related Surgical Interventions

1. blepharoplasty 2. breast augmentation 3. breast reduction 4. cheiloplasty 5. dermabrasion 6. excision nevus/basal cell carcinoma/squamous cell carcinoma 7. mastopexy 8. mentoplasty 9. otoplasty 10. palatoplasty 11. rhinoplasty 12. scar revision 13. suction lipectomy 14. brow lift 15. malar implants 16. mammoplasty (nipple reconstruction and tram flap) 17. trauma repairs 18. radial dysplasia 19. release of polydactyly 20. release of syndactyly UNIT XVII: CARDIOTHORACIC A. Endoscopic 1. bronchoscopy 2. mediastinoscopy (node biopsy) B. Basic Interventions 1. thoracoscopy (video assisted) 2. thoracostomy 3. thoracotomy - pulmonary wedge resection 4. thoracotomy - lobectomy 5. thoracotomy - pectus excavatum repair 6. thoracotomy - pulmonary embolism C. Intermediate Interventions 1. cervical rib resection 2. coronary angioplasty 3. decortication of the lung 4. pacemaker insertion 5. pericardectomy D. Advanced Interventions 1. aortic/mitral valve replacement 2. batista procedure 3. coronary artery bypass graft (CABG) 4. lung transplantation 5. lung volume reduction procedure 6. MID-CABG 7. pneumonectomy 8. aortic arch aneurysm repair 9. transmyocardial revascularization 10. ventricular aneurysm repair 11. ventricular assistive device (VAD) insertion 12. atrial/ventricular septal defect repair 13. closure of patent ductus arteriosus 14. coronary artery bypass graft - intraaoritc ballon pump 15. coronary artery bypass graft - ventricular assistive device (VAD) insertion 16. heart transplant 17. repair of coarctation of the aorta 18. tetralogy of fallot repair E. Related Surgical Interventions 1. annuloplasty

2. lobectomy 3. lung biopsy 4. mitral valve commissurotomy 5. scalene node biopsy 6. thoracoplasty 7. thymectomy 8. decortication of the lung UNIT XVIII: THORACOSCOPY UNIT OBJECTIVES: 1. Assess the anatomy, physiology and pathophysiology of the thoracic/pleural cavities. 2. Analyze the diagnostic and surgical interventions for a patient undergoing

thoracoscopy. 3. Plan the intraoperative course for the patient undergoing thoracoscopy. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for thoracoscopy. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing thoracoscopy.

UNIT OUTLINE: I. Anatomy A. sternum 1. manubrium 2. middle body or gladiolus 3. xyphoid process B. costal cartilages C. thoracic vertebrae D. ribs 1. twelve thoracic ribs 2. seven true ribs 3. three false ribs 4. two floating ribs E. diaphragm F. three divisions of thoracic cavity 1. right pleural cavity a. right lung (1) three lobes: superior, middle, inferior (2) oblique and horizontal fissure 2. left pleural cavity a. left lung (1) two lobes: superior and inferior (2) oblique fissure 3. mediastinum a. esophagus b. trachea c. thymus d. lymph nodes e. heart f. cardiac vessels G. structures of the lung 1. bronchi 2. bronchioles 3. alveoli 4. hilum H. pleura

1. parietal pleura 2. visceral pleura 3. pleural space a. serous or pleural fluid I. associated structures/organs 1. eleven external intercostals muscles 2. eleven internal intercostals muscles 3. sternocleidomastoid 4. scalenes 5. external oblique muscle 6. internal oblique muscle 7. transverses abdominis muscle 8. rectus abdominis muscles 9. pulmonary arteries 10. pulmonary veins 11. lymphatic vessels 12. pulmonary plexuses 13. vagus nerve 14. intercostals nerve 15. thoracic outlet II. Physiology A. functions of the thorax 1. respiration a. exchange carbon dioxide for oxygen b. inspiration c. expiration d. vital capacity e. residual volume 2. protection a. lungs b. heart c. cardiac vessels d. bronchial vessels III. Pathopysiology A. cysts B. blebs C. effusions D. tumors E. lesions IV. Diagnostic interventions A. diagnostic exams 1. patient history a. frequency of coughing b. increase in sputum production c. recurrent hemoptysis d. malaise e. shortness of breath f. substernal chest discomfort g. weight loss h. poor appetite i. adequacy of nutrition j. hypoxia k. smoking l. alcohol intake m. exercise B. physical 1. pulmonary assessment function (deep breathing) 2. palpation 3. assessment of skin condition 4. assessment of patient's general condition

5. diagnostic tests 6. chest x-ray 7. pulmonary function tests 8. ventilation studies 9. perfusion studies 10. computerized tomographic (CT) of chest 11. magnetic resonance imaging (MRI) of chest C. laboratory studies 1. sputum analysis 2. cytology reports 3. arterial blood gases D. other diagnostic invasive procedures 1. bronchoscopy 2. mediastinoscopy V. Surgical intervention A. special considerations 1. video tower at head of bed 2. x-rays in OR 3. Foley catheter (surgeon's preference) 4. prepared for open thoracotoomy 5. video equipment set up a. checked prior to starting procedure 6. scope lens kept warm prior to starting procedure B. anesthesia 1. general a. double-lumen endotracheal tube to facilitate single lung inflation C. position/positioning aids 1. lateral 2. positioning devices a. overhead armboard b. axillary roll c. gel pad (1) elbows (2) wrists d. donut (1) head (2) ankle e. pillow between the legs f. kidney rests (if beanbag is not used) g. tape (1) across hips (2) across shoulders h. safety strap (if tape is not used) D. skin prep 1. solutions a. betadine b. Hibiclens 2. boundaries a. anterior; midline (sternum) b. distal: level of iliac crest c. posterior: midline of back (vertebrae) d. posterior: close to elbow of upper arm E. draping 1. four towels to square off incision site a. four perforating towel clips 2. transverse laparotomy sheet 3. variations a. 3/4 sheet x 2 b. lower sheet placed at level of lower towel c. upper sheet placed at level of upper towel

d. laparoscopy sheet e. thoracoscopy sheet F. incision 1. 5 cm stab skin incision 2. made over intercostals space 3. factors determining site of incision a. anatomical area to be viewed b. location of lesion or other pathology c. surgeon's preference G. supplies 1. routine a. back table pack: variations (1) basic (2) laparoscopy b. prep tray c. # 15 knife blades d. basin set e. x-ray detectable sponges f. electrosurgical pencil g. suction apparatus 2. specialty a. lens defogger b. 10cc syringe c. 18g. hypodermic needle d. 21g. hypodermic needle 3. suture a. 4-0 Vicryl or other absorbable suture on small cutting needle 4. medications a. local anesthetic: variations (surgeon's preference) (1) reasons for use (a) hemostasis (b) postoperative pain relief (2) 0.25% Marcine with epinephrine (1:100,000) (3) 1% lidocaine with epinephrine (1:100,000) 5. catheters/drains a. chest tube (1) adult: 28 - 32 Fr. (2) pediatric: 12 - 16 Fr. b. pleur-evac closed water-seal drainage system c. Foley catheter H. equipment 1. video monitor 2. video cassette recorder 3. light source 4. electrosurgical unit 5. Nd: YAG laser (optional) 6. suction 7. defibrillation unit available a. sterile internal paddles 8. printer I. instrumentation 1. 5mm and 10mm 00 thorascope 2. 5mm and 10mm 300 thorascope 3. camera 4. fiberoptic light cord 5. endoscopic instruments a. scissors (1) curved (2) straight b. graspers

(1) toothed (2) smooth c. dissectors (1) spatula tip (2) blunt tip d. endoscopic lung retractors e. endoscopic hemoclip appliers f. endoscopic linear staplers g. endoscopic Pennington h. endoscopic suture ligators and carriers i. endoscopic Babcock's j. trocars (1) 10-12mm blunt (2) 10-12mm sharp (3) reducers k. sets (1) major set (2) vascular set (3) emergency chest set J. procedural steps 1. local anesthetic injected into incisional site

2. 1.5 to 2cm stab incision made in skin with #15 knife blade over the intercostal space, usually between the fourth and seventh space 3. cautery used to carry incision through intercostal space to control bleeding 4. lung deflated

5. 10 mm trocar placed into pleural space 6. thoracoscope introduced through trocar into pleural cavity 7. diagnosis is made visually or procedure to be performed is decided upon by surgeon

8. 18g. needle placed through chest wall to determine sites for second and third incisions 9. if necessary, second and third lateral stab incisions created 10. endoscopic instruments introduced according to procedure to be performed; trocars not required for insertion of instruments 11. after procedure is complete, instruments, thoracoscope, and trocar removed 12. chest tube inserted and hooked up to a closed water-seal drainage system 13. subcuticular closure with absorbable suture, typically 4-0 Vicryl on small cutting needle

K. counts 1. hospital policy 2. surgeon's preference L. dressing materials 1. steri-strips 2. 2x2 gauze with tape M. specimen care 1. contingent upon procedure a. lymph node b. cysts c. blebs d. biopsy of tumor mass e. biopsy of lung tissue f. wedge resection N. postoperative destingation 1. PACU VI. Postoperative patient care considerations VII. Prognosis A. depends on pathological condition B. shorter recovery time for minimally invasive surgery (MIS) VIII. Complications A. atelectasis B. pneumonia C. respiratory insufficiency D. pneumothorax

E. hemopneumothorax F. pulmonary embolism G. subcutaneous emphysema H. mediastinal shift I. acute pulmonary edema J. infection IX. Wound classification/management A. Class I: Clean 1. incision made under ideal conditions 2. should be no break in sterile technique 3. primary closure 4. no wound drain 5. no entry to respiratory tract UNIT XIX: PERIPHERAL VASCULAR A. Basic Interventions 1. angioscopy 2. aortofemoral bypass 3. arteriovenous (AV) fistula/shunt creation/insertion 4. carotid endarectomy B. Intermediate Interventions 1. femoropopliteal bypass 2. Greenfield filter insertion 3. popliteal in-situ graft 4. venous access device implantation 5. aortofemoral bypass C. Advanced Interventions 1. abdominal aortic aneurysmectomy with graft insertion D. Related Surgical Interventions 1. angioplasty - endograft and endostent insertion 2. axillogemoral bypass 3. embolectomy 4. femorofemoral bypass 5. veing ligation/stripping 6. vena cava device UNIT XX: CAROTID ENDARECTOMY UNIT OBJECTIVES:

1. Assess the anatomy, physiology, and pathophysiology of the vasculature of the head and neck. 2. Analyze the diagnostic and surgical interventions for a patient undergoing carotid endarterectomy. 3. Plan the intraoperative course for a patient undergoing carotid endarterectomy. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for a carotid endarterectomy. 8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing carotid endarterectomy.

UNIT OUTLINE: I. Anatomy A. vessels 1. arteries a. aorta (1) ascending

(2) aortic arch (a) innominate (b) left common carotid (c) left subclavian (3) descending thoracic aorta (4) abdominal aorta (5) common carotid arteries (a) carotid bifurcation (b) external carotid 1) superior thyroid 2) lingual 3) facial 4) occipital 5) superficial temporal 6) maxillary (c) internal carotid 1) ophthalmic 2) anterior cerebral 3) anterior communicating 4) middle cerebral 5) subclavian 6) vertebral 7) basilar 8) posterior cerebral 9) posterior communicating 10) arterial circle 2. Veins a. superior vena cava (1) left brachiocephalic (2) right brachiocephalic b. inferior vena cava (1) dural sinuses (2) ophthalmic (3) internal jugular (4) external jugular (5) vertebrals B. bony landmarks of the neck 1. spinous processes 2. hyoid bone 3. laryngeal prominence 4. cricoid cartilage 5. jugular notch C. muscles of the neck 1. sternocleidomastoid 2. trapezius 3. sternohyoid 4. platysma II. Physiology A. carotid body 1. chemoreceptors a. arterial pO2 b. arterial pH

2. baroreceptors a. blood pressure III. Pathophysiology A. stroke with minimal to moderate neurological deficit B. transient ischemic attack C. Amaurosis fugax D. central retinal artery occlusion

E. asymptomatic high-grade stenosis F. vertebrobasilar transient ischemic attack G. stroke in evolution IV. Diagnostic intervention A. diagnostic exams 1. physical signs and symptoms 2. Doppler evaluation 3. cardiovascular evaluation 4. neurological evaluation 5. arteriography 6. MRI 7. CT scan B. preoperative testing 1. blood work

a. CBC b. electrolytes c. type and cross match d. hematocrit e. hemoglobin f. platelets g. coagulation studies 2. urinalysis 3. chest x-ray 4. ECG 5. medical history V. Surgical intervention A. special considerations 1. room set up a. surgeon stands on affected side b. placement of the Mayo stand 2. team members a. surgeon b. surgical assistant c. surgical technologist in the scrub role d. circulator e. anesthesia provider 3. patient factors a. anxiety level b. possibility of stroke during case c. alterations in respiratory/cardiac function d. alterations in level of mentation e. may be awake for observation of neurological deficits during procedure 4. methods a. carotid endarterectomy with shunt b. carotid endarterectomy without shunt 5. Other a. sterile set up is maintained until the patient leaves the room, in the event that reoperation is

necessary b. lessening the likelihood of neurological deficit is a major concern during surgery

c. EEG is used during general anesthesia to further monitor cerebral perfusion d. some controversy exists over the use of the shunt (1) opponents (a) possibility of dislodging debris with placement

(b) increased difficulty in suturing patch (c) increased operating time

(2) advocates (a) increased cerebral perfusion (b) less hurried procedure for surgeon e. regardless of how scheduled, always have shunt available in room f. always have heparin flush ready to use on field

B. anesthesia 1. general 2. cervical block C. position/positioning aids 1. supine 2. head supported and turned away from operative site 3. neck slightly hyperextended 4. roll between scapulas D. skin prep 1. povidone iodine 2. area of prep a. incision site outward b. to middle ear c. to clavicle at midline d. includes posterior neck e. lower leg may be prepped in case of vein patch E. draping 1. split sheet and bar drape 2. fenestrated drape F. incision 1. vertical incision is made over the anterior border of the sternocleidomastoid muscle 2. length of incision is based on location and size of plaque G. supplies 1. routine a. basic pack b. prep tray c. #13 and #11 knife blades d. basin set e. x-ray detectable sponges f. bulb syringe g. electrosurgical pencil 2. specialty a. vessel loops b. hemoclips c. suture boots d. shunt e. cotton tipped applicators f. vascular patch g. 10 cc syringes 3. suture a. vascular suture of surgeon's choice (double-armed 6-0 Prolene, silk) 4. medications a. IV heparin sulfate b. protamine sulfate c. thrombin d. normal saline e. hemostatic (Gelfoam, surgicel) 5. catheters/drains a. Jackson-Pratt H. equipment 1. large back table 2. Mayo stand 3. electrosurgical unit I. instrumentation 1. vascular instrument set 2. vascular instrument extras 3. shunting instruments J. procedural steps 1. incision is made with a # 15 blade over area of plaque 2. a weitlaner self-retaining retractor is placed for exposure

3. soft tissue dissection is carried out with Metzenbaum scissors to expose the area of the carotid artery and its bifurcation 4. hemostasis is carried out with cautery 5. vessel loops are placed around the vessel 6. anesthesia provider administers heparin, systemically 7. the external, common, and internal carotid arteries are clamped 8. arteriotomy is made with a #11 blade and extended with Potts scissors 9. if a shunt is used the following steps will be followed a. the shunt (Javid or Argyle) is flushed with heparin b. shunt is first inserted into the internal carotid (distal) and then the common carotid (proximal) artery c. the shunt is held in place with shunt clamps 10. plaque is dissected free (freer, Penfield elevators) 11. fine forceps or mosquito forceps may be used to remove plaque from the intima 12. heparin irrigation is used often during procedure to remove loose remnants of plaque 13. arteriotomy is closed with a running stitch, using 6-0 prolene, with or without a patch (PTFE) or vein graft (saphenous vein) 14. before the arteriotomy is completely closed, the shunt clamps are released and the shunt is removed 15. the occluding vessel clamps are always removed in the following order: a. external carotid clamp b. common carotid clamp c. internal carotid clamp 16. additional interrupted sutures are placed to control any leakage 17. surgicel may be used for hemostasis 18. a drain (Jackson-Pratt) is placed a. separate stab incision with a #15 blade b. drain placed and anchored during incision closure 19. the fascia and muscles are closed in either a continuous or interrupted fashion 20. skin is closed with an absorbable suture (4-0 Vicryl) or with staples 21. gauze dressing is applied and secured with tape

K. counts 1. initial - sponges and sharps 2. closure - sponges and sharps L. dressing materials 1. 4x4 gauze M. specimen care 1. properly identified a plaque 2. proper labeled upper verification of patient name, number, site/side N. postoperative destination 1. the patient is taken to phase I PACU 2. depending on the cardiopulmonary status, the patient may be taken to ICU VI. Postoperative patient care considerations A. flexion and turning the patient's head are avoided, to decrease the incidence of kinking the artery, bleeding,

and thrombosis B. the head is elevated 20 degrees C. blood pressure is monitored D. neurological status is assessed every hour VII. Prognosis A. prognosis is affected by other medical conditions 1. hypertension 2. recent myocardial infarction (MI) 3. organ dysfunction 4. studies have shown good results with regard to mortality begin at a case volume of about 15 procedures per year

VIII. Complications A. stroke B. embolus C. infection D. myocardial infarction E. cranial nerve injury F. hematoma IX. Wound classification/management A. carotid endarterectomy is a clean procedure UNIT XXI: NEUROSURGICAL A. Endoscopic 1. ventriculoscopy B. Basic Interventions 1. cervical discectomy 2. craniotomy - aneurysm repair 3. craniotomy - hematoma evacuation 4. craniotomy - tumor excision 5. lumbar discectomy 6. lumbar discoscopy 7. ventriculoperitoneal (V/P) shunt placement C. Intermediate Interventions 1. cranioplasty 2. rhizotomy 3. craniotomy - craniosynostosis

D. Advanced Interventions 1. acoustic neuroma resection 2. anterior thoracic/lumbar discectomy 3. arteriovenous malformation (AVM) repair 4. posterior fossa craniectomy 5. spinal fixation 6. spinal tumor excision 7. stereotactic procedures 8. transsphenoidal hypophysectomy 9. laminectomy - cervical posterior/anterior 10. laminectomy - thoracic 11. laminectomy - lumbar minimally invasive E. Related Surgical Interventions 1. chordotomy 2. ulnar nerve transposition 3. carpal tunnel release UNIT XXII: CRANIOTOMY - TUMOR EXCISION UNIT OBJECTIVES: 1. Assess the anatomy, physiology and pathophysiology of the brain and central

nervous system. 2. Analyze the diagnostic and surgical interventions for a patient undergoing craniotomy for tumor excision. 3. Plan the intraoperative course for a patient undergoing craniotomy for tumor excision. 4. Assemble supplies, equipment and instrumentation needed for the procedure. 5. Choose the appropriate patient position. 6. Identify the incision used for the procedure. 7. Analyze the procedural steps for a craniotomy for tumor excision.

8. Describe the care of the specimen. 9. Discuss the postoperative considerations for a patient undergoing craniotomy for tumor excision.

UNIT OUTLINE: I. Anatomy A. divisions of the nervous system 1. central nervous system 2. peripheral nervous system B. cranium 1. frontal bone 2. parietal bone 3. occipital bone 4. temporal bone 5. sphenoid bone 6. ethmoid bone C. meninges 1. dura mater 2. arachnoid mater 3. pia mater D. tentorium cerebelli E. falx cerebelli F. brain 1. gray matter 2. white matter 3. cerebral cortex 4. cerebrum a. hemispheres b. lobes (1) frontal (2) temporal (3) parietal (4) occipital c. corpus callosum d. anterior commissure e. posterior commissure f. sulci g. gyri h. fissures (1) Rolando (2) Sylvius 5. ventricles and cerebral spinal fluid a. lateral b. third c. fourth d. foramen of Monro e. aquaduct of Sylvius f. central canal g. subarachnoid space h. choroids plexuses 6. basal ganglia 7. limbic system 8. diencephalons a. thalamus b. hypothalamus c. posterior pituitary gland d. pineal gland 9. mesencephalon 10. pituitary gland

11. brain stem a. medulla oblongata b. pons c. midbrain G. blood supply 1. Circle of Willis 2. internal carotid artery 3. anterior cerebral artery 4. middle cerebral artery 5. vertebral artery 6. basilar artery 7. posterior cerebral artery 8. posterior communicating artery 9. anterior communicating artery H. cerebellum 1. hemispheres 2. vermis 3. cerebellar peduncles I. cranial nerves 1. olfactory 2. optic 3. oculomotor 4. trochlear

5. trigeminal 6. abducens 7. facial 8. vestibulocochlear 9. glossopharyngeal 10. vagus 11. accessory 12. hypoglossal

II. Physiology A. function of the brain 1. cerebral cortex a. sensory (1) interpretation of sensory impulses b. motor (1) control muscular movement (2) association (3) memory (4) emotions (5) reasoning (6) will (7) judgment (8) personality traits (9) intelligence III. Pathophysiology A. intracranial neoplasms 1. glioma 2. astrocytoma, grades I and II 3. astrocytoma, grades III and IV 4. oligodendroglioma 5. ependymoma 6. medulloblastoma 7. meningioma 8. acoustic neuroma 9. craniopharyngioma 10. hemangioblastoma IV. Diagnostic interventions A. diagnostic exams

1. patient history a. headaches b. seizures c. hemiparesis d. aphasia e. ataxia or other motor disturbances f. nausea g. visual field difects h. dysphasia i. mood disorders j. memory disturbances k. loss of sensation or other sensory disturbances l. loss of cognitive abilities 2. physical a. complete neurological examination b. funduscopic examination 3. ECG 4. chest x-ray 5. skull x-rays 6. electroencephalogram (EEG) 7. CT scan 8. MRI 9. metastatic work-up 10. infectious disease work-up 11. laboratory studies a. CBC b. chemistry profile c. PT/PTT 12. other diagnostic invasive procedures a. cerebral angiogram V. Surgical intervention A. special considerations 1. patient a. understands procedure (if cognitive or conscious) b. understands outcomes and prognosis c. understands postoperative instructions 2. family a. understands procedure b. understands outcomes and prognosis 3. surgeon stands at the head of the OR table 4. surgical technologist typically stands at a Mayo or Mayfield table

situated over the patient's torso 5. equipment is situated according to the position of the table, which is turned according to the side of the head, that is operated on 6. be sure CT or MRI scans, arteriorgrams, or plain film studies are in the room before the procedure begins 7. be sure saline irrigation is always body temperature. Always test the temperature of the saline before handing it to the surgeon a. keep close track of the amount of irrigation used. 8. remember that the key to doing a good job is to understand why things are done the way they are, rather than just memorizing the steps 9. always test drills and saws before the procedure 10. surgical should be cut into strips and postage stamp size squares. Microsurgical and vascular procedures may require smaller cuts. 11. Gelfoam is typically cut into postage stamp-size squares and 1"x3" strips, placed into a container, and covered with topical thrombin mixed and poured by the circulator 12. Frazier suction tips are easily clogged with debris. A 10cc syringe filled with saline and attached to the proximal port completely flushes

debris out of the tube 13. know how to drape microscopes, ultrasound devices and C-arms. Wounds should be protected from nonsterile overhead X-ray units with sterile towels 14. For emergency cranial procedures, think about what you will be doing first and prepare the items necessary to do those things. Decide what you will need to quickly get into the head and control hemorrhage. 15. small dural needles and cottonoids are easily lost. Keep close track of them 16. make sure that the Mayfield horseshoe headrest and pin fixation devices are locked into place and the handle is secured with tape to prevent slippage 17. as usual, the surgical technologist and the back table should remain sterile until the patient has safely left the room 18. care must be taken not to drop the head when removing it from the pin fixation device 19. operative personnel should take precautions when moving the patient to the transport stretcher or ICU bed. The patient will have monitoring lines, urinary catheter and drainage bag, wound drains, or other important lines that can easily be dislodged

B. anesthesia 1. general C. position/positioning aids 1. position a. determined by approach 2. devices a. pin fixation headrest b. horseshoe headrest c. donut d. pillows e. chest rolls D. skin prep 1. the area around the incision site should be shaved with an electric

razor and straight or safety razor 2. hair should be saved for the patient in a plastic bag 3. eyes and ears should be protected from prep solution 4. after the initial prep with iodophor scrub by the circulator, the surgeon may paint from a sterile Mayo stand with alcohol and/or iodophor paint

E. draping

1. wound towels may be stapled or sutured in place 2. placement of the craniotomy drape with built-in adhesive over the fenestration and drainage bag 3. drape may be used to cover Mayfield table over the patient's torso F. Incision 1. according to location of pathology 2. approach options a. stereotactic b. craniotomy (bone flap) c. craniectomy d. transphenoidal G. supplies 1. routine a. basic pack b. prep tray c. blades (#10, #11, #15) d. basin set

e. laparotomy sponges f. raytec sponges g. gloves h. electrosurgical pencil i. bulb syringes 2. specialty a. drapes: towels, craniotomy drapes b. control syringe c. hypodermic needles d. bipolar cord for attachment to bipolar bayonet forceps e. suction tubing (2) f. radiopaque cottnoid strips of various sizes g. Raney scalp clips (for scalp gun or manual applicators) h. hemostatic clips (MRI compatible) i. rubber bands for Dandy clamps j. cotton balls k. telfa for specimen m. ultrasound wand drape 3. suture a. 4-0silk, 4-0 Nurolon b. closure suture of surgeon's preference 4. medications a. hemostatic agents (Gelfoam with topical thrombin, Surgicel,

Avitene) b. antibiotic irrigation c. xylocaine 1% with epinephrine

5. catheters/drains a. Hemovac drain H. equipment 1. monopolar and bipolar electrosurgical units 2. fiberoptic headlight and light source (optional) 3. operating microscope and/or loupes (optional) 4. CUSA (optional) 5. CO2 or Nd:YAG laser (optional) 6. ultrasound machine and attachments (optional) 7. two suction systems 8. nitrogen source for power equipment 9. Mayfield overhead table 10. autotransfusion machine (optional) 11. temperature monitoring device I. instrumentation 1. craniotomy set or basic neurological set 2. microsurgical instruments (optional) 3. Anspach or Midas Rex power instruments with attachments, or cranial perforator and craniotome 4. air drill with bits and burrs J. procedural steps 1. With digital pressure applied to each side of the marked incision line

for hemostasis, a shaped incision is performed and Raney scalp clips are applied over the upper skin edges 2. Dandy hemostatic clamps may be placed onto the lower skin edges and secured with rubber bands around the handles 3. The galea and periosteum are incised by electrocautery, and the cranium is explosed 4. After hemostasis has been achieved, the scalp flap is dissected away from the cranium, folded backwards over a laparotomy sponge, and secured to the drape for retraction 5. Muscle and periosteum are stripped away from the cranium with a periosteal elevator and retracted 6. Two or more burr holes are made into the cranium with an air-

powered burr, such as the Midas Rex, or an electric, battery, or air- powered cranial perforator. Occasionally burr holes are drilled manually with a Hudson brace and D'Errico bit 7. After the holes are drilled, they may be enlarged with a double-action rongeur or Kerrison rongeur. Any bleeding from the edges of the burr holes is controlled by bone wax and neurosurgical patty. 8. A small, straight bone curette is used to carve away the inner table and expose the dura. 9. The dura around the burr hole is separated from the cranium by a # 3 Penfield dissector to prevent tearing of the dura mater when the flap is turned. 10. The cranium between the burr holes is cut with an electric battery, or air-powered craniotome saw with dural guard attachment. Occasionally, the cranium is manually cut with a Gigli saw 11. after each burr hole has been connected, the bone flap is carefully lifted away from the dura with a periosteal elevator 12. If muscle has been left attached, the bone flap is covered with a moistened laparotomy pad and retracted in a manner similar to the scalp flap; otherwise, it is removed. 13. Bleeding around the bone edges is controlled with bone wax, and bleeding from the dura is controlled with bipolar cautery and thrombin-impregnated Gelfoam 14. Holes may be drilled along the edges of the cranial defect for epidural tacking to prevent postoperative epidural dead space 15. Dural traction may be necessary to pull the dura away from the brain surface before incising 16. A small incision is made into the dura 17. Cottonoid patties are placed under the dura with bayonet forceps as the dura is incised to protect delicate brain tissue underneath, and 4-0 dural traction sutures are placed along the dural edges and tagged with mosquito hemostats for retraction 18. Brain spoons are placed and held manually or attached to the Leyla- Yasargil sefl-retaining retractor 19. After the bone flap is turned and the dura is opened in the usual manner, the tumor is exposed 20. If the tumor is a benigh and accessible, such as a meningioma, blood vessels to the tumor are identified and clipped or coagulated with bipolar coagulation 21. The tumor capsule is then internally decompressed with Cavitron ultrasonic aspirator (CUSA), cautery loops, and/or bipolar coagulation 22. After decompression, the tumor capsule is dissected with division of vascular and arachnoid attachments as they are encountered 23. Involved dura and bone is removed when possible. Any dural defects are reconstructed with a free graft of periosteum or fascia. 24. If the tumor is malignant, it is biopsied and decompressed 25. Hemostasis is achieved with warm saline irrigation, Surgicel, thrombin-impregnated Gelfoam, and bipolar cautery 26. The Midas Rex or small air drill is used to place holes at strategic locations along the edges of the cranial defect and the bone flap, and the flap is secured to the cranium with titanium plates and screws. Some surgeons may prefer to wire the bone flap to the cranium with stainless steel wire. 27. A Hemovac drain is placed in the epicranium and brought up through the scalp through a small stab wound. The wound is closed in layers

K. counts 1. initial - sponges, cottonoids, and sharps 2. closing - sponges, cottonoids, and sharps L. dressing materials

1. Adaptic or Xeroform 2. 4x4's 3. Kerlix M. specimen care 1. pieces of the tumor are removed for biopsy, and passed off the sterile field to the circulator. The frozen section is transported to the laboratory as is 2. the frozen and permanent specimens should be properly labeled after verifying patient name, number and site/side 3. the permanent specimen is fixed with formalin and processed as a routine specimen N. postoperative destination 1. surgical ICU or PACU VI. Postoperative patient care considerations A. patient recovery time varies with neurological condition and general anesthesia time VII. Prognosis A. prognosis depends upon the pathological situation and the preoperative condition of the patient VIII. Complications A. Complications that may occur postoperatively include wound infection,

meningitis, neurological deficits related to the pathological condition, or intraoperative damage to vital structures, subdural or epidural hematoma, or intracerebral hemorrhage B. Postoperative bleeding and intracranial pressure is monitored closely by ICU or recovery room personnel through Hemovac drainage and attention to neurological signs. If bleeding is deemed excessive, the patient is returned to the operating room and the wound is reopened for hemorrhage control C. Postoperative infections can be potentially fatal. The surgical technologist must pay close attention to sterile technique at all times to decrease the risk of infection of the surgical wound.

IX. Wound classification/management A. Class I: Clean 1. incision made under ideal conditions 2. should be no break in sterile technique 3. primary closure 4. wound drain used UNIT XXIII: SPECIAL CONSIDERATIONS/POPULATIONS A. geriatric patient B. immunocompromised patient C. mentally challenged patient D. pediatric patient

1. Related pediatric congenital defects a. atrial/ventricular septal defects b. bladder extrophy c. branchial cleft cyst d. choanal atresia e. coarctation of the aorta f. craniosynostosis g. diaphragmatic hernia h. gastroschisis i. Hirschsprung's disease j. imperforate anus k. intussusception l. myelomeningocele m. omphalocele

n. patent ductus arteriosus o. pectus excavatum p. pyloromyotomy q. syndactylism r. Tetrology of Fallot s. thyroglossal duct cyst t. tracheoesophageal fistula u. volvulus v. Wilms' tumor E. physically impaired patient F. trauma patient

CARVER CAREER AND TECHNICAL EDUCATION CENTER

SURGICAL TECHNOLOGY PROGRAM COURSE: LABS COURSE DESCRIPITON: Labs are the practical application of performing the tasks of a surgical technologist student entering the clinical rotation. PREREQUISITES: Admission to the surgical technology program. TEXT: Frey, Ross Surgical Technology for the Surgical Technologist, Delmar-Thomson Learning, 2008. Surgical Technology for the Surgical Technologist Study Guide to accompany text. SPECIAL RESCOURCES: Phillips, Berry & Kohn’s Operating Room Technique, Mosby, 2007 TEACHING METHODOLOGIES: Attend demonstration by instructor, practice procedure with partner. METHODS OF EVALUATION: Pass / Fail skilled competencies. EXPECTED OUTCOMES: The student will: 1. Assemble necessary equipment and supplies 2. Maintain a surgical conscience at all times 3. Perform all tasks maintaining sterile / asepsis technique 4. Recognize any breaks in sterile technique 5. Correct any breaks in sterile technique 6. Anticipate needs of lab instructors 7. Function independently in the lab surgical setting GRADING FORMAT: The student must pass all competencies with 100% accuracy. Failure to do so by the start of the clinical rotation, will result in termination from the surgical technology program. SURGICAL TECHNOLOGIST IN THE FIRST SCRUB ROLE (STSR) UNIT OUTLINE: I. Preoperative A. donning of O.R. attire B. basic handwash C. back table 1. open sterile pack 2. arrange supplies and instruments 3. assemble a balfour abdominal retractor D. open a sterile basin on ringstand E. instrument set 1. open wrapped set 2. open container system 3. remove instrument set from container system F. open sterile supplies 1. small wrapped package placed onto sterile field 2. small wrapped package secured by surgical technologist 3. peel pack G. pour sterile solution H. surgical scrub I. gown and glove self J. mayo stand set-up

1. drape 2. arrange instruments and supplies 3. construct a sponge stick 4. load and unload scalpel blade on scalpel handle K. suture and ties 1. transfer suture packets to the sterile back table 2. straighten sutures 3. cut ties in ¼, 1/3, and ½ lengths L. fill bulb syringe M. draw up medications 1. vial held by circulator 2. receive medication(s) onto sterile field 3. label medications N. gown and glove another person O. drape patient 1. laparotomy 2. vagina 3. extremity – leg and arm

II. Intraoperative A. recognize, prepare, and pass instruments B. suture and ties 1. load and pass NH swaged needle – right and left handed 2. load free needle onto NH – thread, pass and reload 3. tag and cut suture 4. pass ties – free hand and instrument C. contaminated sterile attire 1. re-glove 2. re-gown III. Postoperative A. dressings 1. assemble and apply abdominal dressings 2. assemble and apply a Montgomery strap dressing B. connect ostomy bag to stoma site C. drains 1. connect hemovac 2. connect jackson – pratt 3. connect chest tube to drainage system D. remove sterile gown and gloves E. disinfecting O.R. 1. end of case – room turn over (20 minutes) 2. terminal IV. Perioperative A. sponge, sharp, and instrument counts

ASSISTANT CIRCULATOR ROLE (STSR II) UNIT OUTLINE: A. turn and tie sterile gown B. transporting patient 1. prepare patient stretcher 2. transport patient from ward room to pre-op holding or O.R. C. transperring patient

1. stretcher to O.R. table 2. O.R. table to stretcher D. taking vital signs 1. temperature 2. pulse 3. respirations 4. blood pressure E. electrosurgery 1. position grounding pad 2. connect bovie pencil cord to ESU 3. complete ESU check list F. sellick’s maneuver (cricoid pressure) G. positioning patient 1. supine 2. lateral 3. prone H. urinary catheterization 1. straight catheter – male and female 2. foley catheter – male and female I. position pneumatic tourniquet cuff J. patient skin prep 1. abdomen 2. vagina 3. extremity K. connect suction L. documentation 1. lab test requisition 2. pathology – specimen DISINFECTION AND STERILIZATION UNIT OUTLINE: A. hand wash instruments B. disinfect an endoscope C. assemble an instrument set D. packaging items for sterilization 1. peel pack 2. container system 3. envelope fold and square fold wrap E. operate steam sterilizer 1. flash 2. routine F. operate sterrad/steris system

CARVER CAREER AND TECHNICAL EDUCATION CENTER

Surgical Technology Program The Surgical Technology Program is designed to produce a graduate who is prepared to enter the profession with a minimum of orientation to the workplace. The Surgical Technology Program offered is an eleven-month certificate program. Students must complete a minimum of 1250 hours, 500 academic and 750 lab / clinical hours.

This handbook is to be used in conjunction with the school's Adult Student Handbook. If there is a conflict in requirements etc., between the two handbooks, this program handbook overrides the general school handbook.

COURSE LIST First Semester

Surgical Technology (Theory) Medical Terminology Anatomy and Physiology Microbiology Surgical Pharmacology Lab

Second Semester

Lab Clinical Rotation (M-TH 6:45 A.M. to 3:15 P.M. & Fri. 6:45 A.M. to 11:00 A.M.) Class every Friday 12:30 P.M. to 2:30 P.M. Surgical Procedures National Certification group study

SURGICAL TECHNOLOGY COURSE OUTLINE The outline is based on full days. All daily activities include the use of small groups, visual-aids, power points, white board, and internet when applicable. Half days will be used as a teach re-teach day. TIME Day 1 Orientation: Carver Career Center and Surgical Technology Handbook 8A–2:30P Day 2 Microbiology: Chapters 1&2, read – Q&A 8A–9A Surgical Technology: Chapter 1, read and complete workbook exercises – Q&A 9A–11A Pharmacology: Chapter 1, read and complete workbook exercises – Q&A 11:30A–12:30P A&P: Chapter 1&2, read and completer workbook exercises – Q&A 12:30P–1:30P Medical Terminology: Chapter 1, read and complete workbook exercises – Q&A 1:30P–2:30P Day 3 Microbiology: Chapters 1&2, read – Q&A 8A–9A Surgical Technology: Chapter 1, read and complete workbook exercises – Q&A 9A–11A Pharmacology: Chapter 1, read and complete workbook exercises – Q&A 11:30A–12:30P A&P: Chapter 1&2, read and complete workbook exercises – Q&A 12:30P–1:30P Medical Terminology: Chapter 1, read and complete workbook exercises – Q&A 1:30P–2:30P Day 4 Microbiology: Chapters 1&2, lecture – outline – Q&A 8A–9A Surgical Technology: Chapter 1, read and complete workbook exercises – Q&A 9A–11A Pharmacology: Chapter 1, read and complete workbook exercises – Q&A 11:30A–12:30P A&P: Chapter 1&2, read and completer workbook exercises – Q&A 12:30P–1:30P Medical Terminology: Chapter 1, read and complete workbook exercises – Q&A 1:30P–2:30P Day 5 Microbiology: Chapters 1&2, outline – review game – Q&A 8A–9A Surgical Technology: Chapter 1, lecture – outline – Q&A 9A–11A Pharmacology: Chapter 1, read and complete workbook exercises – Q&A 11:30P–12:30P A&P: Chapter 1&2, read and completer workbook exercises – Q&A 12:30P–1:30P Medical Terminology: Chapter 1, read and complete workbook exercises – Q&A 1:30P–2:30P Day 6 Microbiology: Chapters 1&2, TEST 8A–9A Surgical Technology: Chapter 1, outline – review game – Q&A 9A–11A Pharmacology: Chapter 1, lecture – outline – Q&A 11:30A–12:30P A&P: Chapter 1&2, read and complete workbook exercises – Q&A 12:30P–1:30P Medical Terminology: Chapter 1, read and complete workbook exercises – Q&A 1:30P–2:30P Day 7 Microbiology: Chapters 3&4, read – Q&A 8A–9A Surgical Technology: Chapter 1, TEST 9A–11A Pharmacology: Chapter 1, outline – review game – Q&A 11:30A–12:30P A&P: Chapter 1&2, lecture – outline – Q&A 12:30P–1:30P Medical Terminology: Chapter 1, read and complete workbook exercises – Q&A 1:30P–2:30P Day 8 Microbiology: Chapters 3&4, read – Q&A 8A–9A Surgical Technology: Chapter 2, read and complete workbook exercises – Q&A 9A–11A Pharmacology: Chapter 1, TEST 11:30A–12:30P

A&P: Chapters 1&2, outline – review game – Q&A 12:30P–1:30P Medical Terminology: lecture – outline – Q&A 1:30P–2:30P Day 9 Microbiology: Chapters 3&4, lecture – outline – Q&A 8A–9A Surgical Technology: Chapter 2, read and complete workbook exercises – Q&A 9A–11A Pharmacology: Chapter 2, read and complete workbook exercises – Q&A 11:30A–12:30P A&P: Chapters 1&2, TEST 12:30P–1:30P Medical Terminology: Chapter 1, outline – review game – Q&A 1:30P–2:30P Day 10 Microbiology: Chapters 3&4, outline – review game – Q&A 8A–9A Surgical Technology: Chapter 2, lecture – outline – Q&A 9A–11A Pharmacology: Chapter 2, read and complete workbook exercises – Q&A 11:30A–12:30P A&P: Chapters 3&4, read and complete workbook exercises – Q&A 12:30P–1:30P Medical Terminology: Chapter 1, TEST 1:30P–2:30P Day 11 Microbiology: Chapters 3&4, TEST 8A–9A Surgical Technology: Chapter 2, outline – review game – Q&A 9A–11A Pharmacology: Chapter 2, lecture – outline – Q&A 11:30A–12:30P A&P: Chapter 3&4, read and complete workbook exercises – Q&A 12:30P–1:30P Medical Terminology: Chapter 2, read and complete workbook exercises – Q&A 1:30P–2:30P Day 12 Microbiology: Chapters 5&6, read – Q&A 8A–9A Surgical Technology: Chapter 2, TEST 9A–11A Pharmacology: Chapter 2, outline – review game – Q&A 11:30A–12:30P A&P: Chapter 3&4, lecture – outline – Q&A 12:30P–1:30P Medical Terminology: Chapter 2, read and complete workbook exercises – Q&A 1:30P–2:30P Day 13 Microbiology: Chapters 5&6, read – Q&A 8A–9A Surgical Technology: Chapter 3, read and complete workbook exercises – Q&A 9A–11A Pharmacology: Chapter 2, TEST 11:30A–12:30P A&P: Chapters 3&4, outline – review game – Q&A 12:30P–1:30P Medical Terminology: Chapter 2, lecture – outline – Q&A 1:30P–2:30P Day 14 Microbiology: Chapters 5&6, lecture – outline – Q&A 8A–9A Surgical Technology: Chapter 3, read and complete workbook exercises – Q&A 9A–11A Pharmacology: Chapter 3, read and complete workbook exercises – Q&A 11:30A–12:30P A&P: Chapters 3&4, TEST 12:30P–1:30P Medical Terminology: Chapter 2, outline – review game – Q&A 1:30P–2:30P Day 15 Microbiology: Chapters 5&6, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 3, lecture – outline – Q&A 9A – 11A Pharmacology: Chapter 3, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 5&6, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 2, TEST 1:30P – 2:30P Day 16 Microbiology: Chapters 5&6, TEST 8A – 9A Surgical Technology: Chapter 3, outline – review game – Q&A 9A – 11A Pharmacology: Chapter 3, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 5&6, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 2, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 17

Microbiology: Chapters 7&8, read – Q&A 8A – 9A Surgical Technology: Chapter 3, TEST 9A – 11A Pharmacology: Chapter 3, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 5&6, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 2, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 18 Microbiology: Chapters 7&8, read – Q&A 8A – 9A Surgical Technology: Chapter 4, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 3, TEST 11:30A – 12:30P A&P: Chapters 5&6, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 2, lecture – outline – Q&A 1:30P – 2:30P Day 19 Microbiology: Chapters 7&8, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 4, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 4, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 5&6, TEST 12:30P – 1:30P Medical Terminology: Chapter 2, outline – review game – Q&A 1:30P – 2:30P Day 20 Microbiology: Chapters 7&8, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 4, lecture – outline – Q&A 9A – 11A Pharmacology: Chapter 4, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 7, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 2, TEST 1:30P – 2:30P Day 21 Microbiology: Chapters 7&8, TEST 8A – 9A Surgical Technology: Chapter 4, outline – review game – Q&A 9A – 11A Pharmacology: Chapter 4, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 7, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 3, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 22 Microbiology: Chapters 9&10, read – Q&A 8A – 9A Surgical Technology: Chapter 4, TEST 9A – 11A Pharmacology: Chapter 4, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 7, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 3, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 23 Microbiology: Chapters 9&10, read – Q&A 8A – 9A Surgical Technology: Chapter 5, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 4, TEST 11:30A – 12:30P A&P: Chapters 7, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 3, lecture – outline – Q&A 1:30P – 2:30P Day 24 Microbiology: Chapters 9&10, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 5, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 5, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 7, TEST 12:30P – 1:30P Medical Terminology: Chapter 3, outline – review game – Q&A 1:30P – 2:30P Day 25 Microbiology: Chapters 9&10, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 5, lecture – outline – Q&A 9A – 11A Pharmacology: Chapter 5, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 8, read and complete workbook exercises – Q&A 12:30P – 1:30P

Medical Terminology: Chapter 3, TEST 1:30P – 2:30P Day 26 Microbiology: Chapters 9&10, TEST 8A – 9A Surgical Technology: Chapter 5, outline – review game – Q&A 9A – 11A Pharmacology: Chapter 5, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 8, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 4, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 27 Microbiology: Chapters 11&12, read – Q&A 8A – 9A Surgical Technology: Chapter 5, TEST 9A – 11A Pharmacology: Chapter 5, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 8, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 4, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 28 Microbiology: Chapters 11&12, read – Q&A 8A – 9A Surgical Technology: Chapter 6, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 5, TEST 11:30A – 12:30P A&P: Chapters 8, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 4, lecture – outline – Q&A 1:30P – 2:30P Day 29 Microbiology: Chapters 11&12, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 6, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 6, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 8, TEST 12:30P – 1:30P Medical Terminology: Chapter 4, outline – review game – Q&A 1:30P – 2:30P Day 30 Microbiology: Chapters 11&12, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 6, lecture – outline – Q&A 9A – 11A Pharmacology: Chapter 6, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 9, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 4, TEST 1:30P – 2:30P Day 31 Microbiology: Chapters 11&12, TEST 8A – 9A Surgical Technology: Chapter 6, outline – review game – Q&A 9A – 11A Pharmacology: Chapter 6, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 9, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 5, read and complete workbook exercises – Q&A 1:30P – 2:30P Day32 Microbiology: Chapters 13&14, read – Q&A 8A – 9A Surgical Technology: Chapter 6, TEST 9A – 11A Pharmacology: Chapter 6, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 9, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 5, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 33 Microbiology: Chapters 13&14, read – Q&A 8A – 9A Surgical Technology: Technological Sciences, Computers – lecture outline – Q&A 9A – 11A Pharmacology: Chapter 6, TEST 11:30A – 12:30P A&P: Chapters 9, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 5, lecture – outline – Q&A 1:30P – 2:30P Day 34 Microbiology: Chapters 13&14, lecture – outline – Q&A 8A – 9A

Surgical Technology: Technological Sciences, Computers–outline review game – Q&A 9A – 11A Pharmacology: Chapter 7, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 9, TEST 12:30P – 1:30P Medical Terminology: Chapter 5, outline – review game – Q&A 1:30P – 2:30P Day 35 Microbiology: Chapters 13&14, outline – review game – Q&A 8A – 9A Surgical Technology: Technological Sciences, Computers TEST 9A – 11A Pharmacology: Chapter 7, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 10&11, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 5, TEST 1:30P – 2:30P Day 36 Microbiology: Chapters 13&14, TEST 8A – 9A Surgical Technology: Technological Sciences, Electricity – lecture outline – Q&A 9A – 11:00A Pharmacology: Chapter 7, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 10&11, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 6, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 37 Microbiology: Chapters 15&16, read – Q&A 8A – 9A Surgical Technology: Technological Sciences, Electricity–outline review game– Q&A 9A – 11A Pharmacology: Chapter 7, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 10&11, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 6, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 38 Microbiology: Chapters 15&16, read – Q&A 8A – 9A Surgical Technology: Technological Sciences, Electricity TEST outline – Q&A 9A – 11A Pharmacology: Chapter 7, TEST 11:30A – 12:30P A&P: Chapters 10&11, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 6, lecture – outline – Q&A 1:30P – 2:30P Day 39 Microbiology: Chapters 15&16, lecture – outline – Q&A 8A – 9A Surgical Technology: Technological Sciences, Physics – outline lecture – Q&A 9A – 11A Pharmacology: Chapter 8, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 10&11, TEST 12:30P – 1:30P Medical Terminology: Chapter 6, outline – review game – Q&A 1:30P – 2:30P Day 40 Microbiology: Chapters 15&16, outline – review game – Q&A 8A – 9A Surgical Technology: Technological Sciences, Physics – outline review game – Q&A 9A – 11A Pharmacology: Chapter 8, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 12&13, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 6, TEST 1:30P – 2:30P Day 41 Microbiology: Chapters 15&16, TEST 8A – 9A Surgical Technology: Technological Sciences, Physics TEST 9A – 11:00A Pharmacology: Chapter 8, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 12&13, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 7, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 42 Microbiology: Chapters 17&18, read – Q&A 8A – 9A Surgical Technology: Technological Sciences, Robotics – outline lecture – Q&A 9A – 11A Pharmacology: Chapter 8, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 12&13, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 7, read and complete workbook exercises – Q&A 1:30P – 2:30P

Day 43 Microbiology: Chapters 17&18, read – Q&A 8A – 9A Surgical Technology: Technological Sciences, Robotics–outline review game – Q&A 9A – 11A Pharmacology: Chapter 8, TEST 11:30A – 12:30P A&P: Chapters 12&13, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 7, lecture – outline – Q&A 1:30P – 2:30P Day 44 Microbiology: Chapters 17&18, lecture – outline – Q&A 8A – 9A Surgical Technology: Technological Sciences, Robotics TEST 9A – 11A Pharmacology: Chapter 9, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 12&13, TEST 12:30P – 1:30P Medical Terminology: Chapter 7, outline – review game – Q&A 1:30P – 2:30P Day 45 Microbiology: Chapters 17&18, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 7, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 9, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 14, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 7, TEST 1:30P – 2:30P Day 46 Microbiology: Chapters 17&18, TEST 8A – 9A Surgical Technology: Chapter 7, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 9, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 14, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 8, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 47 Microbiology: Chapters 19-22, read – Q&A 8A – 9A Surgical Technology: Chapter 7, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 9, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 14, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 8, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 48 Microbiology: Chapters 19-22, read – Q&A 8A – 9A Surgical Technology: Chapter 7, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 9, TEST 11:30A – 12:30P A&P: Chapters 14, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 8, lecture – outline – Q&A 1:30P – 2:30P Day 49 Microbiology: Chapters 19-22, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 7, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 10, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 14, TEST 12:30P – 1:30P Medical Terminology: Chapter 8, outline – review game – Q&A 1:30P – 2:30P Day 50 Microbiology: Chapters 19-22, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 7, lecture – outline – Q&A 9A – 11A Pharmacology: Chapter 10, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 15, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 8, TEST 1:30P – 2:30P Day 51 Microbiology: Chapters 19-22, TEST 8A – 9A Surgical Technology: Chapter 7, outline – review game – Q&A 9A – 11A

Pharmacology: Chapter 10, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 15, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 9, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 52 Microbiology: Chapters 23-24, read – Q&A 8A – 9A Surgical Technology: Chapter 7, TEST 9A – 11A Pharmacology: Chapter 10, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 15, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 9, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 53 Microbiology: Chapters 23-24, read – Q&A 8A – 9A Surgical Technology: Chapter 8, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 10, TEST 11:30A – 12:30P A&P: Chapter 15, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 9, lecture – outline – Q&A 1:30P – 2:30P Day 54 Microbiology: Chapters 23-24, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 8, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 11, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 15, TEST 12:30P – 1:30P Medical Terminology: Chapter 9, outline – review game – Q&A 1:30P – 2:30P Day 55 Microbiology: Chapters 23-24, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 8, lecture – outline – Q&A 9A – 11A Pharmacology: Chapter 11, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 16-19, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 9, TEST 1:30P – 2:30P Day 56 Microbiology: Chapters 23-24, TEST 8A – 9A Surgical Technology: Chapter 8, outline – review game – Q&A 9A – 11A Pharmacology: Chapter 11, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 16-19, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 10, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 57 Microbiology: Chapters 25-29, read – Q&A 8A – 9A Surgical Technology: Chapter 8, TEST 9A – 11A Pharmacology: Chapter 11, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 16-19, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 10, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 58 Microbiology: Chapters 25-29, read – Q&A 8A – 9A Surgical Technology: Chapter 9, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 11, TEST 11:30A – 12:30P A&P: Chapters 16-19, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 10, lecture – outline – Q&A 1:30P – 2:30P Day 59 Microbiology: Chapters 25-29, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 9, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 12-16, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 16-19, TEST 12:30P – 1:30P Medical Terminology: Chapter 10, outline – review game – Q&A 1:30P – 2:30P

Day 60 Microbiology: Chapters 25-29, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 9, lecture – outline – Q&A 9A – 11A Pharmacology: Chapter 12-16, read and complete workbook exercises – Q&A 11:30A – 12:30P A&P: Chapters 20-22, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 10, TEST 1:30P – 2:30P Day 61 Microbiology: Chapters 25-29, TEST 8A – 9A Surgical Technology: Chapter 9, outline – review game – Q&A 9A – 11A Pharmacology: Chapter 12-16, lecture – outline – Q&A 11:30A – 12:30P A&P: Chapter 20-22, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 11, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 62 Microbiology: Chapters 30-33, read – Q&A 8A – 9A Surgical Technology: Chapter 9, TEST 9A – 11A Pharmacology: Chapter 12-16, outline – review game – Q&A 11:30A – 12:30P A&P: Chapter 20-22, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 11, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 63 Microbiology: Chapters 30-33, read – Q&A 8A – 9A Surgical Technology: Chapter 10, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter 12-16, TEST 11:30A – 12:30P A&P: Chapters 20-22, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 11, lecture – outline – Q&A 1:30P – 2:30P Day 64 Microbiology: Chapters 30-33, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 10, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Final review 11:30A – 12:30P A&P: Chapters 20-22, TEST 12:30P – 1:30P Medical Terminology: Chapter 11, outline – review game – Q&A 1:30P – 2:30P Day 65 Microbiology: Chapters 30-33, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 10, lecture – outline – Q&A 9A – 11A Pharmacology: Final review 11:30A – 12:30P A&P: Chapters 23-25, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 11, TEST 1:30P – 2:30P Day 66 Microbiology: Chapters 30-33, TEST 8A – 9A Surgical Technology: Chapter 10, outline – review game – Q&A 9A – 11A Pharmacology: Chapter Final review 11:30A – 12:30P A&P: Chapter 23-25, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 12, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 67 Microbiology: Chapters 34-37, read – Q&A 8A – 9A Surgical Technology: Chapter 10, TEST 9A – 11A Pharmacology: Chapter Final review 11:30A – 12:30P A&P: Chapter 23-25, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 12, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 68 Microbiology: Chapters 34-37, read – Q&A 8A – 9A Surgical Technology: Chapter 11, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Chapter Final review 11:30A – 12:30P

A&P: Chapters 23-25, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 12, lecture – outline – Q&A 1:30P – 2:30P Day 69 Microbiology: Chapters 34-37, lecture – outline – Q&A 8A – 9A Surgical Technology: Chapter 11, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: Final review 11:30A – 12:30P A&P: Chapters 23-25, TEST 12:30P – 1:30P Medical Terminology: Chapter 12, outline – review game – Q&A 1:30P – 2:30P Day 70 Microbiology: Chapters 34-37, outline – review game – Q&A 8A – 9A Surgical Technology: Chapter 11, lecture – outline – Q&A 9A – 11A Pharmacology: Final review 11:30A – 12:30P A&P: Chapters 26-27, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 12, TEST 1:30P – 2:30P Day 71 Microbiology: Chapters 34-37, TEST 8A – 9A Surgical Technology: Chapter 11, outline – review game – Q&A 9A – 11A Pharmacology: Chapter Final review 11:30A – 12:30P A&P: Chapter 26-27, read and complete workbook exercises – Q&A 12:30P – 1:30P Medical Terminology: Chapter 13, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 72 Microbiology: Final review 8A – 9A Surgical Technology: Chapter 11, TEST 9A – 11A Pharmacology: Chapter Final review 11:30A – 12:30P A&P: Chapter 26-27, lecture – outline – Q&A 12:30P – 1:30P Medical Terminology: Chapter 13, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 73 Microbiology: Final review 8A – 9A Surgical Technology: Chapter 12, read and complete workbook exercises – Q&A 9A – 11A Pharmacology: FINAL TEST 11:30A – 12:30P A&P: Chapters 26-27, outline – review game – Q&A 12:30P – 1:30P Medical Terminology: Chapter 13, lecture – outline – Q&A 1:30P – 2:30P Day 74 Microbiology: Final review 8A – 9A Surgical Technology: Chapter 12, read and complete workbook exercises – Q&A 9A – 11A Instrumentation: review 11:30A – 12:30P A&P: Chapters 26-27, TEST 12:30P – 1:30P Medical Terminology: Chapter 13, outline – review game – Q&A 1:30P – 2:30P Day 75 Microbiology: Final review 8A – 9A Surgical Technology: Chapter 12, lecture – outline – Q&A 9A – 11A Instrumentation: review 11:30A – 12:30P A&P: Final review 12:30P – 1:30P Medical Terminology: Chapter 13, TEST 1:30P – 2:30P Day 76 Microbiology: Final review 8A – 9A Surgical Technology: Chapter 12, outline – review game – Q&A 9A – 11A Instrumentation: TEST 11:30A – 12:30P A&P: Final review 12:30P – 1:30P Medical Terminology: Chapter 14, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 77

Microbiology: Final review 8A – 9A Surgical Technology: Chapter 12, TEST 9A – 11A Instrumentation: review 11:30A – 12:30P A&P: Final review 12:30P – 1:30P Medical Terminology: Chapter 14, read and complete workbook exercises – Q&A 1:30P – 2:30P Day 78 Microbiology: Final review 8A – 9A Surgical Technology: Ch. 13 read and complete workbook exercises 9A – 11A Instrumentation: TEST 11:30A – 12:30P A&P: Final review 12:30P – 1:30P Medical Terminology: Chapter 14, lecture – outline – Q&A 1:30P – 2:30P Day 79 Microbiology: Final review 8A – 9A Surgical Technology: Chapter 13, read and complete workbook exercises – Q&A 9A – 11A Instrumentation: review 11:30A – 12:30P A&P: Final review 12:30P – 1:30P Medical Terminology: Chapter 14, outline – review game – Q&A 1:30P – 2:30P Day 80 Microbiology: Final TEST 8A – 9A Surgical Technology: Chapter 13, lecture – outline – Q&A 9A – 11A Instrumentation: TEST 11:30A – 12:30P A&P: Final review 12:30P – 1:30P Medical Terminology: Chapter 14, TEST 1:30P – 2:30 Day 81 Surgical Technology: Chapter 13, outline – review game – Q&A 8A – 10A Instrumentation: review 10A – 11A A&P: Final review 11:30A – 12:30P Medical Terminology: Final review 12:30P – 1:30 P Labs: Skill 7-1 1:30P – 2:30P Day 82 Surgical Technology: Chapter 13, outline – review game – Q&A 8A – 10A Instrumentation: review 10A – 11A A&P: Final review 11:30A – 12:30P Medical Terminology: Final review 12:30P – 1:30 P Labs: Skill 7-1 1:30P – 2:30P Day 83 Instrumentation: TEST 8A – 9A A&P: Final TEST 9A – 10A Medical Terminology: Final review 10A – 11A Labs: Skill 7-1, 7-2 11:30A – 2:30P Day 84 Medical Terminology: Final review 8A – 9A Labs: Skill 7-2 9A – 2:30P Day 85 Instrumentation: TEST 8A – 9A Medical Terminology: Final review 9A – 10A Labs: Skill 8-1, 8-2 10A – 2:30P Day 86 Medical Terminology: Final review 8A – 9A Labs: Skill 9-1 – 9-5 9A – 2:30P Day 87 Medical Terminology: Final review 8A – 9A

Labs: Skill 9-1 – 9-5 9A – 2:30P Day 88 Medical Terminology: Final review 8A – 9A Labs: Skill 10-1 – 10-5 9A – 2:30P Day 89 Medical Terminology: Final review 8A – 9A Labs: Skill 10-1 – 10-5 9A – 2:30P Day 90 Medical Terminology: Final Test 8A – 9A Labs: Skill 11-1, 11-2 9A – 2:30P Day 91 Labs 8A – 2:30P They will consist of pass/fail skill assessments 7-1, 7-2, 8-1, 8-2, 9-1 – 9-5 10-1 – 10-5, 11-1, 11-2, 12-1 – 12-14. For skill assessments refer to Surgical Technology work book. Day 92 Labs 8A – 2:30P They will consist of pass/fail skill assessments 7-1, 7-2, 8-1, 8-2, 9-1 – 9-5 10-1 – 10-5, 11-1, 11-2, 12-1 – 12-14. For skill assessments refer to Surgical Technology work book. Day 93 Labs 8A – 2:30P They will consist of pass/fail skill assessments 7-1, 7-2, 8-1, 8-2, 9-1 – 9-5 10-1 – 10-5, 11-1, 11-2, 12-1 – 12-14. For skill assessments refer to Surgical Technology work book. Day 94 Labs 8A – 2:30P They will consist of pass/fail skill assessments 7-1, 7-2, 8-1, 8-2, 9-1 – 9-5 10-1 – 10-5, 11-1, 11-2, 12-1 – 12-14. For skill assessments refer to Surgical Technology work book. Day 95 Labs 8A – 2:30P They will consist of pass/fail skill assessments 7-1, 7-2, 8-1, 8-2, 9-1 – 9-5 10-1 – 10-5, 11-1, 11-2, 12-1 – 12-14. For skill assessments refer to Surgical Technology work book. Day 96 Labs 8A – 2:30P They will consist of pass/fail skill assessments 7-1, 7-2, 8-1, 8-2, 9-1 – 9-5 10-1 – 10-5, 11-1, 11-2, 12-1 – 12-14. For skill assessments refer to Surgical Technology work book. Day 97 Labs 8A – 2:30P They will consist of pass/fail skill assessments 7-1, 7-2, 8-1, 8-2, 9-1 – 9-5 10-1 – 10-5, 11-1, 11-2, 12-1 – 12-14. For skill assessments refer to Surgical Technology work book. Day 98 – 187 Clinical Rotation 6:45A – 3:15P The Friday of each week during the clinical rotation will be a half day. Students will report to Carver Career Center at 12:30P – 2:30P for Surgical Procedures

Day 188 Preparation for Certification 8A – 2:30P Day 189 Preparation for Certification 8A – 2:30P Day 190 Program surveys and questionnaires 8A – 10A Preparation for Certification 10A – 2:30P Day 191 Preparation for Certification 8A – 2:30P Day 192 Preparation for Certification 8A – 2:30P Day 193 Preparation for Certification 8A – 2:30P Day 194 Preparation for Certification 8A – 2:30P Day 195 Preparation for Certification 8A – 2:30P Day 196 Preparation for Certification 8A – 2:30P Day 197 Preparation for Certification 8A – 2:30P Day 198 Graduation Pending

SECTION A

ATTENDANCE Attendance in this program is very important, and nowhere more important than in clinical. Absences in the clinical are a signal to a potential employer that you are not interested in what you are doing, and that you would not be a reliable employee. When employers ask about students, they ask about attendance. Absence from class and clinical could affect your job marketability. You will be allowed no more than six days absent. Of those six days, only three days can be a clinical absence. More than three clinical absences will result in termination from the program; more than six absences will also result in termination from the program. All clinical absences must be made up. The procedure to appeal a termination is in the Carver Adult Student Handbook. Please note that if you are successful appealing your termination, there is a $50.00 re-enrollment fee. When you are going to be absent from class, you must call the school between 6:30 am and 8:00 am. The number is 348-1965; ask for extension 110 (this is my extension). Failure to call in before 8am will result in first occurrence, a written warning for the second occurrence termination without appeal. PUNCTUALITY Being late to class is disruptive and annoying to those who were on time. If you have to be late, please enter the classroom as quietly as possible and take the closest empty seat to the door. If there is a reason you must be chronically late, please speak to me about that situation. Each tardy counts as 1/4 of an absence; hence, four tardies count as one absence. DRESS CODE Please refer to the dress code on page 20 of the Adult Student Handbook. You will not be required to buy or wear uniforms for your clinical experience because OSHA regulations stipulate that scrubs worn in the operating room must be discarded before leaving the area and cleaned by the hospital. Therefore, you should not be removing scrubs from any clinical area. Follow the dress code in the Adult Student Handbook when. Dressing to go to the clinical area, remember that you want people to perceive you as a professional. TRANSPORTATION It is the responsibility of the student to provide his or her own transportation to class, lab, and clinical sites. DRUG TESTING OF STUDENTS FOLLOWING ADMISSION The student understands and agrees that he/she may be requested to submit to random drug screening during the course of the academic year. Screening may be requested at any time during the program length. CELL PHONES AND BEEPERS You are not allowed to have cell phones in class, lab, or clinical. Violations may and can result in termination. SMOKING Smoking is permitted only in designated areas. You are not to ask for a smoke break. SUBSTANCE ABUSE & SEXUAL HARASSEMENT Refer to Carver's Adult Student Handbook. Violations will not be tolerated and will result in immediate termination. EVALUATIONS

Your progress in the Surgical Technology program will be evaluated quarterly and at the end of each semester. A surgicaltechnology instructor will have a conference with the student at these times. GRADING The grading scale is as follows: 93 – 100 A 85 – 92 B 75 – 84 C 74 - Below Academic Termination SUCCESSFUL COMPLETION OF THE SURGICAL TECHNOLOGY COURSES IS A GRADE OF "C" OR BETTER. ANYTHING BELOW A "C" IS UNACCEPTABLE AND WILL RESULT IN SUSPENSION FROM THE PROGRAM. THE COURSE MAY BE REPEATED UNTIL SUCCESSFULLY COMPLETED. IF THE COURSE IS A PRE-REQUISITE TO OTHER SURGICAL TECHNOLOGY COURSES, THE STUDENT MUST WAIT UNTIL SUCCESSFUL COMPLETION TO PROGRESS IN THE PROGRAM. IT IS IMPORTANT THAT YOU ARE SUCCESSFUL IN THE CLINICAL PORTION OF THE PROGRAM AS WELL AS THE ACADEMIC PORTION. IF YOU’RE CLINICAL EVALUATIONS ARE CONSISTENTLY UNSATISFACTORY AND/OR THE COMMENTS FROM YOUR PRECEPTORS INDICATE PROBLEMS, YOU MAY BE ASKED TO RE-EVALUATE YOUR CAREER GOALS AND TO CONSIDER RESIGNING FROM THE PROGRAM OR BE TERMINATED. IF YOU DECIDE TO LEAVE THE SURGICAL TECHNOLOGY PROGRAM If you decide that surgical technology does not meet your career goals, you must write a letter withdrawing from the program. See page 18 of the Carver Adult Student Handbook about refunds. ACADEMIC DISHONESTY All forms of academic dishonesty, including but not limited to, cheating on tests, plagiarism, collusion, and falsification of information will call for discipline up to and including termination from the program. Cheating on test is defined to include the following:

Copying from another student's test paper Using materials during a test not authorized by the person giving the test Collaborating with any other person during a test without permission Knowingly obtaining, using, buying, selling, transporting, or soliciting in whole or in part the contents of any

un-administered test Bribing any other person to obtain tests or information about tests Substituting for another student, or permitting any other person to substitute for oneself

"Plagiarism" is the appropriation of any other person's work and the unacknowledged incorporation of that work in one's own work offered for credit. This is not limited to just the written word. Beware of downloading information from the Internet. Copyright laws apply to this material also. "Collusion" is the unauthorized collaboration with any other person in preparing work offered for credit. CLASS RULES All assignments are to be turned in on straight edged paper. If the assignment requires more than one sheet, the sheets are to be bound with a staple. Failure to do so will result in a ten-point deduction from the grade. All work must be done in pencil, blue, or black ink. Tape recording is allowed, if it is not disruptive to the class.

NO VISITORS OR CHILDREN ALLOWED IN CLASS/LAB/CLINICAL No jewelry, including body piercing, can be worn in lab or clinic. Please review the Dress Code Policy. REMINDER No visible tattoos during clinic. Please avoid additional tattoos and piercings once you have begun the Surgical Technology program. Hospital policies are such that tattoos and piercings are not allowed, having such can and will adversely affect your potential for employment. COMPLETION OF THE SURGICAL TECHNOLOGY PROGRAM Completion of the academic portion of the program does not guarantee completion of the surgical technology program. There are some people who do well in the academic portion, but who are unable to progress in the clinical portion. If you are unable to progress in the clinical portion of the program, you will be asked to re-evaluate your career goals and consider resigning from the program. It is important that you are successful in the clinical portion of the program as well as the academic portion. If you clinical evaluations are unsatisfactory and/or the comments from your preceptors indicate problems, you will be asked to re-evaluate your career goals and consider resigning from the program. TO COMPLETE THE REQUIRMENTS FOR GRADUATINON YOU MUST SIT FOR YOUR NATIONAL CERTIFICATION.

SECTION B ABSENCES FROM CLINICALS

Remember that you have only 6 (six) absences PER YEAR. Of those absences only 3(three) can be a clinical absence. If you must be absent from clinical, you must: 1. Notify your clinical site by 7:00 am - please make note of the person's name that you speak with. If a coordinator comes to me and tells me that you did not call in, if you have a name, then you have proof that you called. 2. Notify me, at 348-1965 ext.110, between 6:30am and 7am. If I do not answer, leave a message on the answering machine. Failure to report your absence to me or your clinical site may result in your termination from the program. 3. The missed days must be made up. All clinical days missed have to be made up with in three weeks of the missed day. Failure to do so may result in termination. 4. Failure to call in will result in: 1st occurrence – written warning 2nd occurrence – termination without appeal You can accumulate two occurrences of failure to call in for one absence. If you do not call your clinical site by 7am and me by 7am, that is two occurrences of not calling in. 5. Nine tardies during the clinical rotation can and may result in termination. 6. Three tardies during a two week rotation may and can result in termination. LEAVING THE CLINICAL SITE The student will not leave the clinical site except when prior arrangements have been made with the instructor and your Clinical Site Coordinator. 1st occurrence – termination without appeal SAFE AND PROFESSIONAL CLINICAL PRACTICE Safe clinical practices are behaviors that the student demonstrates which do not threaten or violate the physical, biological, or emotional safety of the patient assigned to her/his care. Professional practices are behaviors, which are demonstrated by the student, which are appropriate to the student-instructor, student-personnel or student-patient interactions. These may be taken to be safe practice and reflect positively upon the Surgical Technology program and on Carver Career Center Violations of these standards can have serious repercussions up to and including termination from the Surgical Technology program. TRANSPORTATION

The student is responsible for providing his/her own transportation to and from the clinical site. This includes parking arrangements. TELEPHONE POLICY Personal phone calls are not to be made or accepted at the clinical site except for emergencies. Pay telephones are used for personal calls during your break. Cell phone usage during clinical time may result in termination. HOSPITAL POLICY AND PROCEDURES A clinical site has the right to refuse a student clinical time if the student violates the policies of the hospital as they apply to the student's clinical rotation. If the student is denied a clinical site due to an offense that would have resulted in termination or suspension of an employee for the same offense, this will result in termination from the program. ATTENDANCE POLICY FOR ADVERSE WEATHER Students who are scheduled for clinical rotations will follow the schedule of the clinical site and will report to their assigned site; unless your instructor or the Clinical Site Coordinator advise the student not to report. If the governor declares a state of emergency, do not go to clinical. DRESS CODE IN CLINICAL Keep jewelry to a minimum while in clinical. Rings, bracelets, and watches will have to be removed once you begin scrubbing. These items can become easily lost or forgotten in a scrub pocket. I recommend that you do not wear earrings to the clinical area; if you must wear them, they should be small studs - no danglers - that will easily fit under your scrub hat. Strong perfumes and aftershaves are not to be worn in the clinical area or the classroom. Many people, your patients as well as your co-workers, have allergies to scents. It is most uncomfortable to be around someone with a strong scent. You will be required to wear a nametag while at the clinical site. If you lose your name tag, please let me know so that we can order you a new one. There will be a $20.00 fee for a new name tag. Shoes should be purchased for use in the OR only (not to be worn to or from the clinical site). Purchase shoes that give you good support and that are comfortable. Your shoes should also protect your feet. This means that you should not wear open-toed shoes. Remember that you will be standing for long periods of time. Protective eyewear must be worn during all surgical procedures. OSHA requires facilities to provide these as well as other personal protective equipment. But, in order to get eyewear that is comfortable and fits well, you may want to purchase your own.Fingernails should be short and unpolished. Hair should be kept in such a manner that it can be easily contained under the surgical cap. Good personal hygiene is mandatory for the surgical technologist. NO VISIBLE PEIRCINGS OR TATOOS. EVALUATIONS You will be given a daily evaluation form for each clinical experience. It is your responsibility to get these filled out and signed by your preceptor. The evaluation will then be returned to me, scored, and entered as part of your grade. Evaluations should be left with your preceptor. Mr. McIntyre will pick up the evaluations from the clinical sites weekly. Evaluations will be discussed with the student on a need to know basis for educational purposes only. All evaluations will be kept in strict confidentiality between the instructor and preceptor. CONFIDENTIALITY

Every patient has a right to her/his privacy. As a healthcare worker, it is your responsibility to maintain that privacy. No part of any patient's chart should be copied or printed out of the computer. You need to be especially careful of discussing patients in public areas (cafeteria, restroom, walking in hallways, etc.). Someone could recognize his/her loved one in your overheard conversation. Every patient should be treated with respect. Watch your conversation in the operating room. There are many reported cases of patients having recalled everything that was said while under a general anesthetic. Do not speak of the patient in a derogatory manner because that could be the conversation that a patient recalls. Just because others are doing it is no reason for you to do it. With the new HIPPA regulations, all clinical sites are very conscious of the patient's privacy. Failure to do so will result in termination. FREE TIME IN CLINICAL Hopefully, this will not happen often. If for some reason your assigned area does not have something to do or you have a long wait between cases, go looking for another experience. Observe in another room or look for somewhere else to scrub if you have enough time or help someone else clean up after his/her case. Find something to do other than sit in the lounge. You are not to be sitting in the lounge or "hanging out" at a control desk. Tell your preceptor where you are going when you go to look for another experience; that way if a case should come up she/he will know where to find you so that you can return to your assignment. EATING During clinical you will be provided one half hour for a lunch break. You should take no more than that half hour. Cafeterias and snack areas are provided at each clinical site. You are NOT to leave the clinical site during your lunch break. PERSONAL POSSESSIONS Locker space is very tight at some clinical sites. You cannot be assured of having a locker to put you possessions in. It would be best if you only brought the absolute essentials to clinical. Do not bring valuables and large sums of money. Neither Carver nor the clinical site will be responsible for lost or stolen items. CLINICAL LOG You are to maintain a log of your clinical experiences. Once you start scrubbing, your log should include the cases you scrubbed, the doctor with whom you scrubbed, and whether you were the first scrub (passing instruments) or the second scrub (observing and holding retractors). We will periodically review you log and make recommendations on what cases you need to scrub. It is important that you keep an accurate record of what you have scrubbed; this will be helpful in filling out your application for certification. PROBLEMS AT A CLINICAL SITE Anytime a problem arises, the student should immediately discuss the situation with your Clinical Site Coordinator and also with me. Do not try to handle the problem on your own. Your Clinical Site Coordinator and I are there to help you in any way we can. REASONS FOR TERMINATION FROM THE PROGRAM The following situations may lead to termination from the surgical technology program: 1. Breaks – During your clinical experience the ONLY break you are permitted is a 30 (thirty) minute lunch break. You are not to ask for a “smoke” break at any time. If I receive reports of you taking breaks or taking longer than thirty minutes for lunch, you may be terminated.

2. “Disappearing” – Your preceptor is to know where you are at all times. If I receive reports of you disappearing and or not telling the preceptor where you are going, will result in termination. 3. If I come to your clinical site and cannot find you, you may be terminated. 4. If I come to your clinical site and find you sitting in the lounge, you may be terminated. 5. Leaving the clinical site early or without notifying the clinical site coordinator and the instructor before leaving early will result in termination. 6. If logs and procedure sheets are not turned in and completed on the assigned date: 1st occurrence – verbal warning 2nd occurrence – written warning 3rd occurrence – termination without appeal

CLINICAL CASE REQUIREMENTS

Surgical Specialty

Total # of Cases Required

Minimum # of First Scrub Cases Required

Maximum # of Second Scrub Cases That Can be Applied Towards 120 Case

General Surgery 30 (2) 20 (2) 10

Surgical Specialties: Cardiothoracic ENT EYE GU Neuro Ob-GYN Oral/Maxillofacial Orthopedics Peripheral vascular Plastics Procurement/Transplant

90 (3) 60 (3) 30

Diagnostic Endoscopy: Bronchoscopy Colonoscopy Cystoscopy EGD ERCP Esophagoscopy Laryngoscopy Panendoscopy Sinoscopy Ureteroscopy

10 diagnostic endoscopy cases may be applied toward the second scrub cases (5)

Labor and Delivery 5 vaginal delivery cases may be applied toward the second scrub cases (5)

Totals 120 (1&7) 80 40

1. The total number of cases the student must complete is 120. 2. Students are required to complete 30 cases in General Surgery. Twenty of the cases must be in the First Scrub Role. 3. Students are required to complete 90 cases in various surgical specialties. Sixty

Of the cases must be in the First Scrub Role and evenly distributed between a Minimum of 5 surgical specialties. However, 15 is the maximum number of Cases that can be counted in any one surgical specialty. 4. The surgical technology program will verify through the surgical rotation and document the students’ progression in First and Second Scrubbing surgical procedures of increased complexity as he/she moves towards entry level graduate abilities. 5. Diagnostic endoscopy cases and vaginal delivery cases are not mandatory. But Up to 10 diagnostic endoscopic cases and 5 vaginal delivery cases can be counted towards the maximum number of Second Scrub Role cases. 6. Observation cases must be documented, but do not count towards the 120 required Cases. 7. Cases will be counted according to surgical specialty. FIRST SCRUB ROLE CRITERIA 1. Verify supplies and equipment needed for the surgical procedure. 2. Set up the sterile field with instruments, supplies, equipment, medication(s) and Solutions needed for the procedure. 3. Perform counts with the circulator prior to the procedure and before the incision is closed. 4. Pass instruments and supplies to the sterile surgical team members during the Procedure. 5. Maintain sterile technique as measured by recognized breaks in technique and demonstrate knowledge of how to correct with appropriate technique. SECOND SCRUB ROLE CRITERIA 1. Sponging 2. Suctioning 3. Cutting suture 4. Holding retractors 5. Manipulating endoscopic camera OBSEVATION ROLE CRITERIA 1. Not meeting the criteria for First or Second Scrub Role. 2. Assisting the Circulator 3. In the O.R. sweet not at the sterile field WORK POLICY All student activities associated with the curriculum, especially while students are completing his or her clinical rotations, will beeducation in nature. Students will not be receiving any monetary remuneration during this education experience, nor will he or she be substituted for hired staff personnel within the clinical institution, in the capacity of a surgical technologist. PRECEPTOR EVALUATIONS Preceptor evaluations will be discussed with the student on a need to know basis for instructional purposes only. Theconfidentiality between your preceptors, instructor, and patients will and cannot be breached. At no time will a studenthave access to his/her evaluations. STUDENT RESPONSIBILITIES

The philosophy of the Carver Career Center Surgical Technology Program states, “under the guidance of the faculty, the student assumes responsibility for his/her own learning”. It is necessary for the student to complete reading assignments,submit written work when due, and be prepared in class discussion and clinical conference(s). Academic success is directly tied to the participation in the above learning activities. MISSION STATEMENT The mission of the Surgical Technology Program at Carver Career Center is to provide quality education to produce entry level, professional, and compassionate surgical technologists and to promote lifelong learning through continuing education. PROGRAM PHILOSOPHY The Surgical Technology Department Faculty of Carver Career Center believes that: Health is the state of optimum well-being for man. Health is relative and constantly changing. Due to this changing state, theSurgical Technologist practices in the unique role of restoring optimum health and alleviating suffering by aiding surgicalintervention. In fulfilling this role, the Surgical Technologist works closely with the patient, surgeon, and other operating room professionals in the operative care of the surgical patient. Surgical Technology practice is not limited to the physical setting of the operating room. It is also utilized in other health careareas and facilities. These areas and facilities include, but are not limited to Labor and Delivery, Emergency Room,Central/Sterile Processing, Ambulatory Surgical Facilities, and private physician’s offices. The educational environment of the Surgical Technology Program at Carver Career Center considers individual differences whichaffect learning ability, and provides motivation to continue to learn and adapt in the changing surgical environment. The faculty believes and individual’s ability to learn is based on past experiences and personal potential, which permits learning to occur at different rates and levels. Learning takes place most readily when material is covered in logical sequence and progresses indifficulty from simple to complex. Under the guidance of the faculty, the student should assume responsibility for much of their own learning. The faculty believes that Surgical Technology education should reflect the student’s development of skills and theoretical knowledge essential for restoring optimum health and alleviating suffering in the operative setting.

CLINICAL DO'S, DON'TS AND REMINDERS DO'S -arrive on time -show interest in clinical activities -ask questions -seek opportunities to become involved -willingly accept activities assigned to you for completion -accept instruction from surgical technologists, nurses, surgeons and surgical residence -coordinate any change of a clinical schedule with the Clinical Coordinator and your instructor -call into clinical sites by the assigned time if you are ill or are going to be late -follow all policies and procedures of your clinical site -have your preceptor complete and sign evaluation sheet -complete your clinical log sheet -discuss clinical concerns with the Clinical Coordinator and the instructor DON'TS -don't fail to call your clinical site by start time, if you are going to be late -don't fail to call your clinical site one half hour before start time, if you are ill or unable to attend -don't stand around with your hands in your pockets or in a corner -don't sit in the lounge listening to the local gossip -don't leave clinical site early unless approved by the Clinical Coordinator and the instructor -don't refuse to carry out a reasonable workload -don't disregard dress code REMEMBER -make a good impression, surgery personnel are looking at you as a potential employee -all experiences are not gained at each site -some sites are slower paced than others -you are assigned to a preceptor for instruction and experience -the clinical affiliates are using their time and resources to help train you -you are at a clinical site because the program was invited in, the site has no obligation -you are not only representing yourself in the clinical area, you are also representing Carver Career Center and the Surgical Technology program.

Accreditation Review Council on Education in Surgical Technology and Surgical Assisting

2013 Core Curriculum for Surgical Technology, 6e (CCST6e) Implementation Approval Report

[Note: An electronic version of this form and applicable ARC/STSA standardized forms are available online at

www.arcstsa.org/index.php/educators/educators-surgical-technology/st-forms-and-facts/#stforms. This form should be submitted when filing documentation for approval of compliance with implementation of the CCST6e. The comprehensive curriculum implementation approval submission

should include a copy of this completed report and supporting documentation, as indicated.

Sponsoring Institution Carver Career Center

City, State Charleston, WV

Program ID# 2947

Program Director John McIntyre, CST

Date of Submission 4-25-13

1. Please indicate the start date and on-time completion/anticipated graduation date for the first cohort (class) of students instructed

using the CCST6e. [Note: All components (didactic, laboratory and clinical) components of the CCST6e must be implemented at the samtime for the first cohort noted below – programs implementing only the clinical component of the CCST6e are not compliant with the Standards.]

First CCST6e Implementation Cohort

Start Date July 29, 2013 On-Time Completion/Anticipated Graduation Date June 13, 2014

2. Has the program’s sequencing changed with implementation of the CCST6e? YES NO X

If YES, please submit an ARC/STSA Curriculum Sequencing (C-1) Form.

3. Has the program’s master curriculum list changed with implementation of the CCST6e? YES NO X

If YES, please submit an updated master curriculum list. This document can be from pages in the institutional catalog, program brochure or other official program document.

4. Have any of the program’s course syllabi changed with implementation of the CCST6e? YES X NO

5. Please submit one (1) clinical course syllabus and/or other program publication (page, webpage, brochure, syllabus, etc.) that clearly indicates the minimum required, detailed clinical case requirement for program completion indicated in the CCST6e.

6. Please submit an ARC/STSA Curriculum Comparison Form – 6e [CCST6e].

This report and applicable supporting documentation must be submitted as one (1) single, “seamless”, digital/electronic copy of all required documentation- documentation consisting of 20 pages or less can be submitted via email attachment to [email protected]. - documentation in excess of 20 pages should be submitted on a CD-ROM, DVD or external drive (electronic drive or “thumb” drive)].

Please note that submissions that include multiple files within the electronic copy will be returned to the program for revision, which may delay the program’s document review.

This report and applicable supporting documentation is due to the ARC/STSA on or before January 31, 2013*. Programs electing to voluntarily implement the CCST6e prior to January 1, 2013 should submit this report prior to voluntary implementation.

Please contact the ARC/STSA office at 303-694-9262 or [email protected] with any questions or for further assistance.

*Please Note: Submission of this report after January 31, 2013 will incur an automatic $250 late fee.

Healthcare SciencesAnatomy & Physiology

Organization of the Human Body 6

Cells 8

Tissues 9

Organs 10

Integumentary System 11

Skeletal System 13

Muscular System 15

Nervous System 18

Sensory System 22

Circulatory System - Blood 24

Cardiovascular System 26

Circulatory System - Peripheral Vascular 28

Lymphatic System 30

Respiratory System 31

Digestive System 33

Genitourinary System 40

Reproductive System 42

Endocrine System 46

Pharmacology and Anesthesia

Definition of Anesthesia 50

Assessment to Determine Anesthesia Choice 55

Surgical Team Roles During Administration 56

Preoperative Medication of the Patient 56

General Anesthesia 57

Local Anesthesia 60

Complications of Anesthesia 60

Alternative Anesthesia Methods 60

Medication Measurements 50

Terminology 51

Medications 52

Care and Handling of Medications and Solutions 53

Medications Used in Surgery 54

Medical Terminology

Rules for Combining Forms 71

Prefix, Suffix, Direction, Amount, and Color 63

Medical Terms Components by System - Integumentary System 68

Medical Terms Components by System - Musculoskeletal System 66

Medical Terms Components by System - Nervous System 68

Medical Terms Components by System - Sensory System 69

Medical Terms Components by System - Circulatory System-Blood 70

Medical Terms Components by System - Cardiovascular System 67

Medical Terms Components by System - Lymphatic System 70

Medical Terms Components by System - Respiratory System 66

Medical Terms Components by System - Digestive System 65

Medical Terms Components by System - Genitourinary System 67

Medical Terms Components by System - Reproductive System 67/68

Medical Terms Components by System - Endocrine System 71

Abbreviations 71

Microbiology

Introduction to Microbiology 75

Cell 75

Introduction to Microscopy 75

Staining Methods 77

Culture Media 77

Nomenclature of Microbiology 77

Host-Microbe Relationships 77

Types of Microorganisms 78

Common Causative Agents 79

Immunology 80

Process of Infection 81

Pathophysiology

Introduction to Disease 7

Tumors 11

Fluid and hemodynamic Disorders 13

Inflammation and Infection 12

Surgically Treatable Diseases and Disorders 12

Technological Sciences

Electricity 107

Information Technology 106

Robotics 109

Patient care concepts

Biopsychosocial needs of the patient 152

Death and dying 175

Surgical Technology

PreoperativeNon-Sterile

Attire 120

Preoperative Physical Preparation of the Patient 156

Patient identification 153

Transportation 154

Review of the chart 156

Surgical Consent 157

Transfer 155

Positioning 159

Urinary catheterization 161

Skin preparation 159

Equipment 122

Instrumentation 123

Sterile

Asepsis and sterile technique 110

Hand Hygiene and Surgical Scrub 128

Gowning and gloving 129

Surgical Counts 130

Draping 131

Intraoperative: Sterile

Specimen care 166

Abdominal incisions 132

Hemostasis 134

Exposure 133

Catheters and drains 134

Wound closure 137

Surgical dressings 145

Wound healing 147

Tissue Replacement Materials 144

Emergency Patient Situations 163

Postoperative

Postanesthesia Care Unit (PACU) 167

Methods of Disinfection and Sterilization 113

Sterile Storage and Distribution 119

Environmental Disinfection of the OR 118

Perioperative Case Management

Perioperative Case Management 126

Assistant Circulator Role

Assistant Circulator Role 155

Surgical Procedures - Didactic

General Surgery

Appendectomy - Open 188

Appendectomy - Laparoscopic 188

Breast Biopsy - Sentinel Node Biopsy 187

Breast biopsy - Needle Localization 188

Modified Radical Mastectomy w/ Axillary Node Dissection 187

Cholecystectomy -Open 188

Cholecystectomy - Laparoscopic 188

Cholecystectomy w/ Cholangiogram 187

Colon Resection w/ Colostomy 188

Colon Resection w/o Colostomy 188

Gastrectomy w/ Gastrostomy 187/188

Gastrectomy w/o Gastrostomy 188

Hemorrhoidectomy 188

Herniorrhaphy - Open - Incisional 188

Herniorrhaphy - Laparoscopic - Incisional 188

Herniorrhaphy - Open - Inguinal 188

Herniorrhaphy - Laparoscopic - Inguinal 188

Herniorrhaphy - Open - Umbilical 188

Herniorrhaphy - Laparoscopic - Umbilical 187

Laparoscopic Nissen Fundoplication 187

Liver Resection 187

Splenectomy - Open 188

Splenectomy - Laparoscopic 188

Thyroidectomy 206

Pancreaticoduodenectomy (Whipple Procedure) 187

Obstetrics and Gynecologic Procedures

Cervical Biopsy 199

Cervical Cerclage (Shirodkar's Procedure 200

Dilation and Curettage (D&C) 200

Hysteroscopy 199

Cesarean Section 199

Endometrial Ablation 199

Hysterectomy - Laparoscopic 200

Hysterectomy - Robotic-Assisted 200

Hysterectomy - Total Abdominal 199

Hysterectomy - Vaginal 199

Myomectomy 200

Uterine Radiation Seeding 84

Oophorectomy 200

Ectopic Pregnancy 199

Salpingectomy 200

Sterilization Procedures 200

Tuboplasty 200

Labioplasty 200

Perineal Laceration 200

Vulvectomy 199

Ablation of Condylomata 200

Marsupialization of Bartholin's Gland (Cystectomy) 200

Anterior and Posterior Repair (Colporrhaphy) 200

Diagnostic Laparoscopy 200

Total Pelvic Exenteration 200

Wertheim Procedure 200

Genitourinary

Nephrectomy 210

Kidney Transplant 210

Wilm's Tumor Excision (Adrenalectomy) 210

Ureteroscopy 210

Ureteropyelithotomy 210

TUR-BT 210

Cystectomy w/ Creation of Ileal Conduit 210

Suspension (TVT/Sling) 210

TURP 210

Prostatectomy - Laparoscopic w/ Robot 210

Prostatectomy - Suprapubic 210

Prostate Seeding 210

Circumcision 210

Epispadius Repair 210

Hypospadius Repair 210

Penile Implant Insertion 210

Penectomy 210

Hydrocelectomy 210

Orchiopexy 210

Orchiectomy 210

Otorhinolaryngologic

Cochlear Implant 207

Mastoidectomy 207

Myringotomy 207

Stapedectomy 207

Tympanoplasty 207

Choanal Atresia 207

Endoscopic Sinus Surgery (FESS) 207

Nasal Antrostomy 207

Nasal Polypectomy 207

Septoplasty 207

Turbinectomy 207

Laryngectomy 207

Parotidectomy 207

Radical Neck Dissection - Glossectomy 207

Radical neck Dissection - Mandibulectomy 207

Temporomandibular Joint Arthroplasty (TMJ) 207

Tonsillectomy and Adenoidectomy 207

Tracheotomy and Tracheostomy 207

Uvulopalatopharyngoplasty 207

Orthopedic

Acromioplasty - Open 215

Acromioplasty - Arthroscopic 215

Shoulder - Arthroscopy 215

Bankart Procedure - Open 215

Bankart Procedure - Arthroscopic 215

Shoulder - Total Arthroplasty 215

Radius ORIF 215

Radius - External Fixator 215

Hip - Total Arthroplasty 215

Hip - ORIF 214

Femur - Femoral Shaft Fracture 214

Knee - Arthroscopy 215

Anterior Cruciate Ligament Repair (ACL) 214

Amputation - Above-the-Knee 214

Amputation - Below the-Knee 214

Knee - Total Arthroplasty 215

Achilles Tendon Repair 215

Triple Arthrodesis 214

Bunionectomy 214

Oral and Maxillofacial

Maxillary and Mandibular Fractures - ORIF 228

Maxillary and Mandibular Fractures - Arch Bar Application 228

Cleft Repair - Lip 229

Cleft Repair - Palate 229

Odontectomy/Tooth Extraction 228

Maxillary Fractures - LeForte I 228

Maxillary Fractures - LeForte II 228

Maxillary Fractures - LeForte III 228

ORIF Orbital Fracture 228

Plastic and Reconstructive

Blepharoplasty 113

Brow Lift 113

Cheiloplasty/Palatoplasty 113

Malar Implants 113

Mentoplasty 229

Otoplasty 229

Rhinoplasty 229

Rhytidectomy 229

Breast Augmentation 229

Mastopexy 229

Mammoplasty - Nipple Reconstruction 229

Mammoplasty - TRAM Flap 229

Abdominoplasty 229

Suction Lipectomy 229

Superficial Lesion/Neoplasm 229

Skin Graft - Full-Thickness (FTSG) 229

Skin Graft - Split-Thickness (STSG) 229

Microvascular Pedicle Graft 229

Scar Revision 229

Dupuytren's Contracture 215

Traumatic Injury Repairs 229

Radial Dysplasia 229

Release of Polydactyly 229

Release of Syndactyly 229

Ophthalmic

Chalazion Excision 222

Dacryocystorhinostomy 222

Entropion/Ectropion Repair 221

Enucleation 221

Extracapsular Cataract Excision 221

Iridectomy 222

Keratoplasty 222

Laceration Repairs 222

Scleral Buckle 222

Strabismus Correction - Recession & Resection 221

Vitrectomy 222

Cardiothoracic

Bronchoscopy 229

Mediastinoscopy - Lymph Node Biopsy 229

Thoracoscopy - Video=Assisted Thoracoscopy 229

Thoracotomy - Lobectomy 229

Thoracotomy - Pneumonectomy 230

Thoracotomy - Decortication of the Lung 230

Thoracotomy - Lung Transplant 230

Thoracotomy - Pectus Excavatum Repair 229

Thoracotomy - Pulmonary Embolism 229

Aortic/Mitral Valve Replacement 230

Atrial/Ventricular Septal Defect Repair 230

Closure of Patent Ductus Arteriosus 230

Coronary Artery Bypass Graft - Intraaortic Balloon Pump 230

Coronary Artery Bypass Graft - Minimally Invasive Direct (MID-CABG) 230

Coronary Artery Bypass Graft - Off-Pump CABG 230

Coronary Artery Bypass Graft - Ventricular Assistive Device (VAD) Insertion 230

Heart Transplant 230

Repair of Coarctation of the Aorta 230

Tetralogy of Fallot Repair 230

Ventricular Aneurysm Repair 230

Peripheral Vascular

Abdominal Aortic Aneurysm w/ Graft Insertion 236

Angioplasty - Endograft Placement 236

Angioplasty - Endostent Insertion 236

Angioscopy 236

AV Shunts and Bypass - Aortofemoral Bypass 236

AV Shunts and Bypass - Arteriovenous Fistula and Shunt 236

AV Shunts and Bypass - Femoropopliteal Bypass 236

Carotid Endarterectomy 236

Embolectomy 236

Vena Cava Device 236

Vein Ligation and Stripping 236

Venous Access Device 236

Neurosurgical

Carpal Tunnel Release 241

Laminectomy - Cervical - Anterior 241

Laminectomy - Cervical - Posterior 241

Laminectomy - Thoracic 241

Laminectomy - Lumbar - Minimally Invasive 241

Laminectomy - Lumbar - Spinal Fusion 241

Craniotomy - Aneurysm Repair 241

Craniotomy - Cranioplasty 241

Craniotomy - Craniosynostosis Repair 241

Rhizotomy 241

Stereotactic Procedures 241

Transphenoidal Hypophysectomy 241

Ulnar Nerve Transposition 241

Ventriculoperitoneal Shunt Placement 241

Ventriculoscopy 241

Surgical Rotation Case Requirements

General Surgery 275

Surgical Specialties 275

Diagnostic Endoscopy 275

Labor & Delivery 275

First and Second Scrub Role and Observation Definitions 276

Professional PracticeProfessionalism

Professional Management 103/104

Employability skills 150

Communication Skills and Teamwork 96/98

Ethical and Moral Issues 173

Legal Issues, Documentation & Risk Management165/170/

171Healthcare Facility Information

Healthcare Facility Organization and Management 157

Physical Environment 173

All-Hazards Preparation 231

Summative Lab Skills Assessment

Surgical Technologist in the Scrub Role 250

Surgical Technologist in the Assistant Circulator Role 252

Disinfection and Sterilization 252

The Program Director verifies that the curriculum offered as detailed above meets or exceeds the content requirements of the Core Curriculum for Surgical Technology, 6e . Program Director Signature

(For electronic submission, printed name = electronic signature)

Date of Signature

Carver Career Center

Topic Surgical P

roce

dures

Lab

Surgical T

echno

logy

Hand

boo

k

SCHOOL NAME SUBMISSION DATE April 25, 2013 Please enter data in "yellow" areas only - all other areas are "locked". Rows 1-3 and Columns A-G are "frozen" - this information is always

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the program's graduation requirements in columns to the right. [NOTE: Please do NOT include General Education courses unless they are used to demonstrate Core Curriculum - ST content instruction.] 2. Please list the syllabus page where the content area is located in the program's Master Curriculum.

PROGRAM SYLLABUS IDENTIFICATION

Ana

tomy and

Phy

siology

Pharmac

ology

Med

ical T

erm

inology

Microbiology

Surgical T

echno

logy