Have you ever wondered what it's like to be in the operating room, elbow to elbow with
surgeons, using the latest in cutting edge surgical technology to save lives? You've
seen it on TV shows, but perhaps never stepped in the OR yourself. It seems mysterious, intense,
even a little intimidating. Here's what to expect when you first enter the operating
room. Dr. Jubbal, MedSchoolInsiders.com.
For many medical students and aspiring surgeons, the first time you enter the operating room
will be in your third year, during your clerkship rotations. The common theme of your third
year of medical school is that you want to learn, be helpful, and not get in the way.
This is most apparent in the operating room, where it's difficult to help and easy to get
in the way. When you enter the operating room, always
introduce yourself, and usually it's best practice to write your name on the whiteboard.
This is because the circulating nurse needs to chart in the computer who all was in the
room. Do your best to not get in the way. Your first
few times in the OR, you may be confused by all the moving pieces. That's fine, as long
as you don't slow other people down in doing their job.
Avoid being on your phone. Even if you're trying to be useful or studious, it looks
like you're texting and not paying attention. Surgery is often high stress, and there will
be moments of high tension where you may be yelled at or not like how someone talks to
you. Don't beat yourself up, and don't take it personally. It's more often a reflection
of the situation or the character of the individual, and surgery tends to have a higher proportion
of more abrasive personality types. Your aim as a medical trainee is to learn,
and you should be asking questions, but timing is critical. You don't want to be the annoying
student that asks too many questions, and you also don't want to be the student who
asks questions at inappropriate moments. During times of high stress and tension, refrain
from asking questions and allow the various members of the surgical team to resolve the
situation. The more you work with a particular surgeon and other members of the surgical
team, the more you'll get a feeling for what is and is not appropriate. Timing is important,
as you don't want to interrupt their focus during moments of higher acuity.
It's also viewed favorably by all members of the surgical team when you firmly, but
with surgical precision, press on both the like and subscribe buttons of this video.
Not too hard as to cause unnecessary tissue damage, and not too gently, otherwise it's
as if no intervention ever occurred. The single most important thing is that you
don't contaminate the sterile field. Doing so won't make you any friends.
The purpose of creating a sterile field around the surgical site is to reduce the number
of microbes and therefore the risk of infection and complications.
How do they decide where to draw the line on sterility? Well, making the whole operating
room sterile isn't practical, nor does it confer improved infection risk. On the other
hand, sterilizing only the immediate area of the incision would still introduce microbes
from movement and touching surrounding unsterilized structures.
For this reason, the sterile field generally includes the drapes over the patient, down
to about your waist height. If you're scrubbed in, meaning you are wearing a surgical gown
and gloves, then your hands and arms, and anterior torso from your chest down to your
waist are in the sterile field too. If a sterile object makes contact with a non-sterile
object, we call that contaminating the sterile field. If your nose is itchy and you're scrubbed
in, too bad, as touching it will contaminate the sterile field. You'll have to wait for
it to pass, as touching your face, glasses, mask, or anything that isn't sterile is a
big no-no. If your mask is fogging up or you're having issues seeing, then ask one of the
nurses who isn't scrubbed in to help make adjustments.
Standing by the operating table, your hands should either be resting on the drapes on
top of the patient, or you should hold your hands in front of you. Do not drop your hands
below your waist or to your sides, as doing so would contaminate them.
If you're going to sneeze and you're standing at the sterile field, then take a step or
two back and sneeze directly into your mask, facing toward the sterile field. Do not raise
your arm to cover your mouth, as that would contaminate your sterile sleeves, and do not
turn to the sides, as doing so will allow microbes to escape from the sides of your
mask and toward the surgical field. The first time you're in the operating room,
you likely won't be scrubbed in, meaning you'll just be wearing regular scrubs and no part
of you will be considered sterile. In this case, you always want to maintain a safe distance
from the sterile field as to not contaminate it.
Surgery is still very much an old boys' club, and even as a student there will be several
unspoken expectations of you, and you should always come prepared.
If it's your first time and you're not scrubbing in, still make sure you wear a mask and eye
protection. Everyone inside the operating room must wear a mask to reduce airborne microbes,
and once you see fluids squirt around, you'll understand why eye protection is paramount.
If you are scrubbing in, make sure you know proper scrub technique and follow it closely.
To reduce interruptions, use the bathroom prior to entering the surgical suite. It's
generally frowned upon to excuse yourself to use the bathroom, particularly if you're
scrubbed in, and even more so if it's a shorter case. It shows you simply weren't prepared.
You should also avoid chugging a gallon of water right before surgery for obvious reasons.
In line with reducing interruptions, put your phone on silent or vibrate, as you don't want
to distract the surgeon while your Drake ringtone blasts at max volume.
Complications and unexpected delays in the operating room are common, and you should
be prepared to stick around longer than expected. No food is allowed in the operating room,
so be sure to fuel yourself ahead of time. If you're a medical student rotating on the
surgical service, be ready to be pimped, meaning quizzed by your residents or attending. You
should absolutely know the patient, why the surgery is indicated, the nature of the surgery,
the anatomy you'll be seeing intraoperatively, and other relevant details. Expectations will
vary depending on your stage in training and whether or not you're pursuing a surgical
specialty for residency. A third year medical student on their first day in the OR will
have different expectations than a fourth year who is doing a plastic surgery sub-internship
and hoping to match into the field. After a few cases in the OR, you should start
to form an understanding of how things work. The room is prepared, the patient is rolled
in, anesthesia begun, time out is performed, and the first incision is made. After the
incision is closed, the site is properly bandaged or dressed, the patient is woken up and extubated,
transferred to a hospital bed, and wheeled out to post-op.
Depending on whether or not you're scrubbed in, there will be different tasks you can
help with. By being attentive and observant, it won't be difficult to figure out where
to be useful. If you're not scrubbed in, you can help the
patient get transferred to the operating room table, grab supplies from the back supply
room, help gown others who are scrubbing in, pull up imaging on the TV screen if the surgeon
needs to reference something while operating, and anything else you're asked of. After closing,
you can grab the gurney, which is usually outside the room, transfer the patient, and
so on. If you are scrubbed in, do your best to not
get in the way, don't contaminate the sterile field, and get great at retracting, since
you'll be doing a lot of it. Retracting is when you help hold back organs or tissues,
usually with one of many tools, allowing the surgeon to more easily view and operate on
the exposed area. You may need to suction, apply pressure, cut sutures, and do other
minor tasks too. By first demonstrating proficiency in these basic tasks, you'll then be allowed
to close, meaning suture the incision, and even do other simple techniques with the scalpel
or bovie. Also understand that each surgeon will have
different preferences. Some will appreciate you helping to drape the patient, while others
are more particular and would prefer you stay out of the way. When it comes to cutting suture,
if you cut the tails too long, then there's excess material in the patient which can lead
to inflammation and increased risk of infection. If you cut the tails too short, then there's
a higher risk of the knot failing. The running joke amongst medical students is that you'll
always cut too long or too short, but never just right. That's fine, just do your best
to learn the surgeon's preferences and take all feedback in stride.
If you found anything in this video helpful, let me know with a thumbs up and if you want
to see more like this, tap that subscribe button firmly and with surgical precision.
If you enjoyed this, check out my video explaining the various members of the surgical team.
And if you want me to cover something else about surgery or the operating room, let me
know with a comment down below. Much love, and I'll see you guys there.