Table
of Contents
|
|
|
|
|
1 |
The Surgical
Technologist |
1 |
|
|
Introduction |
2 |
|
|
Historical
Evolution of the Profession |
2 |
|
|
AST: The
Association of Surgical Technologists |
3 |
|
|
Affiliated
Organizations |
3 |
|
|
Training and
Certification |
4 |
|
|
The Role of
the Surgical Technologist |
5 |
|
|
Other Perioperative Responsibilities |
6 |
|
|
Task
Integration |
7 |
|
|
Careers for
Certified Surgical Technologists |
7 |
|
|
Becoming a
Health Care Professional |
8 |
|
|
Personal
Attributes for Success |
9 |
|
2 |
Communication
and Teamwork |
13 |
|
|
Introduction |
14 |
|
|
Communication |
14 |
|
|
Cultural
Competence |
17 |
|
|
Professional
Communication Skills |
20 |
|
|
Stressors in
the Perioperative Environment |
21 |
|
|
Teamwork |
25 |
|
3 |
Law,
Documentation, and Professional Ethics |
30 |
|
|
Introduction |
31 |
|
|
Law and the
Surgical Technologist |
3 1 |
|
|
Institutional
Standards and Policy |
32 |
|
|
Professional
Standards and Practices |
33 |
|
|
Legal
Doctrines |
34 |
|
|
Negligence |
34 |
|
|
Intentional
Torts |
37 |
|
|
Documentation |
37 |
|
|
Risk
Management |
41 |
|
|
Ethics |
46 |
|
|
Ethical
Behavior in Health Care |
46 |
|
|
Combined
Ethical and Legal Concerns |
48 |
|
|
Ethical
Dilemmas |
48 |
|
|
Professional
Codes of Ethics |
49 |
|
|
Patients’
Rights |
49 |
|
4 |
The Health
Care Facility |
52 |
|
|
Introduction |
53 |
|
SECTION I |
THE PERIOPERATIVE ENVIRONMENT |
54 |
|
|
Principles of Operating Room Design |
54 |
|
|
Traffic Patterns |
54 |
|
|
The Surgical Suite |
55 |
|
|
Environmental Controls and Systems |
57 |
|
|
Work Areas |
58 |
|
SECTION II |
HEALTH CARE FACILITY DEPARTMENTS AND
FUNCTIONS |
60 |
|
|
Team Approach to Patient Care |
60 |
|
SECTION III |
HEALTH CARE ADMINISTRATION |
63 |
|
|
Health Care Providers |
63 |
|
|
Health Care Financing |
63 |
|
|
Management Structure |
64 |
|
|
Staff Roles |
65 |
|
5 |
Disaster
Preparedness and Response |
70 |
|
|
Introduction |
71 |
|
|
Classification
and Definition of Disasters |
72 |
|
|
Disaster
Management and Government Structures |
76 |
|
|
The Disaster
Cycle |
78 |
|
|
Ethical
Dilemmas in Disaster |
86 |
|
|
Resources
for Students and Instructors |
86 |
|
6 |
The Patient |
89 |
|
|
Introduction |
89 |
|
|
Fundamental
Human Needs—Maslow |
90 |
|
|
Therapeutic
Communication |
92 |
|
|
Cultural
Competence |
93 |
|
|
Spiritual
Needs of the Patient |
94 |
|
|
Special
Patient Populations |
94 |
|
7 |
Diagnostic
and Assessment Procedures |
103 |
|
|
Introduction |
104 |
|
|
Concepts
Related to Pathology |
104 |
|
|
Vital Signs |
105 |
|
|
Etectrocardiography |
109 |
|
|
Imaging
Procedures |
1 10 |
|
|
Blood Tests |
115 |
|
|
Urinaiysis |
117 |
|
|
Microbiological
Studies |
117 |
|
|
Pathological
Examination of Tissue |
117 |
|
|
Cancer Terms
and Concepts |
118 |
|
|
Nuclear
Medicine |
119 |
|
8 |
Environmental
Hazards |
121 |
|
|
Introduction |
122 |
|
|
Risk and
Safely |
122 |
|
|
Technical
Risks |
123 |
|
|
Chemical
Risks |
131 |
|
|
Biological
Risks |
133 |
|
|
Musculoskeletal
Risks |
138 |
|
9 |
Microbes and
the Process of Infection |
143 |
|
|
Introduction |
144 |
|
|
Classification
of Organisms |
144 |
|
|
The Cell and
Its Components |
145 |
|
|
Tools for
Identifying Microbes |
148 |
|
|
The Process
of infection |
151 |
|
|
Disease
Prevention |
155 |
|
|
Microorganisms
and the Diseases They Cause |
155 |
|
|
Immunity |
166 |
|
10 |
The
Principles and Practice of Aseptic Technique |
172 |
|
|
Introduction |
173 |
|
|
Standards
and Recommendations |
173 |
|
|
Concepts and
Definitions |
174 |
|
|
The
Principles of Aseptic Technique |
174 |
|
|
Health and
Hygiene |
176 |
|
|
Surgical
Attire |
176 |
|
|
Hand Hygiene |
180 |
|
|
Gowning and
Gloving |
186 |
|
|
Opening a
Case |
192 |
|
|
Contamination
During Surgery |
195 |
|
|
Reality
Versus Standards |
195 |
|
|
Evidence-Based
Practice in Aseptic Technique |
195 |
|
11 |
Decontamination,
Sterilization, and Disinfection |
198 |
|
|
Introduction |
200 |
|
|
Standards
and Regulations |
200 |
|
|
Principles
of Decontamination, Sterilization, and Disinfection |
200 |
|
|
The
Principles of Reprocessing |
201 |
|
|
Decontamination |
204 |
|
|
Sorting and
Handling Following Decontamination |
207 |
|
|
Sterilization |
211 |
|
|
Disinfection |
220 |
|
|
Environmental
Disinfectants |
224 |
|
|
Historical
Highlights |
226 |
|
12 |
Surgical
Instruments |
229 |
|
|
Introduction |
229 |
|
|
Instrument
Names |
230 |
|
|
Instrument
Manufacturing |
230 |
|
|
Common Types
of Instruments by Function |
231 |
|
|
Use of
Instruments by Tissue Type |
243 |
|
|
Inspecting
Surgical Instruments |
245 |
|
13 |
Perioperative Pharmacology |
248 |
|
|
Introduction |
249 |
|
SECTION I |
PRINCIPLES OF PHARMACOLOGY |
249 |
|
|
Sources of Drugs |
249 |
|
|
Drug Information Resources |
250 |
|
|
Regulation of Drugs, Substances, and
Devices |
250 |
|
|
Drug Nomenclature |
252 |
|
|
Pharmaceutical Formulation |
252 |
|
|
Drug Labeling |
253 |
|
SECTION II |
THE MEDICATION PROCESS |
254 |
|
|
Preventing Drug Errors |
254 |
|
|
Prescriptions and Drug Orders |
256 |
|
|
Selection of Drugs |
256 |
|
|
Dispensing Drugs to the Sterile Field |
257 |
|
|
Medical Measurement Systems |
258 |
|
|
Delivery Devices |
260 |
|
|
Managing Drugs on the Sterile Field |
261 |
|
|
Drug Administration |
262 |
|
|
Assessment |
263 |
|
|
Documentation |
263 |
|
SECTION III |
DRUG ACTION |
264 |
|
|
Pharmacokinetics |
264 |
|
|
Pharmacodynamics |
265 |
|
SECTION IV |
SELECTED DRUG CATEGORIES |
265 |
|
|
Anti infective Agents |
265 |
|
|
Antineoplastic Agents |
267 |
|
|
Autonomic Drugs |
267 |
|
|
Blood and Blood Derivatives |
269 |
|
|
Blood Coagulation |
269 |
|
|
Cardiac Drugs |
270 |
|
|
Central Nervous System Agents |
270 |
|
|
Sedatives and Hypnotics |
273 |
|
|
Local Anesthetics |
273 |
|
|
Diagnostics |
274 |
|
|
Fluid Balance and Electrolytes |
274 |
|
|
Gastrointestinal Drugs |
276 |
|
|
Hormones and Synthetic Substitutes |
276 |
|
|
Emergency Drugs |
277 |
|
|
Drug Calculations |
277 |
|
14 |
Anesthesia
and Physiological Monitoring |
280 |
|
|
Introduction |
281 |
|
|
Important
Anesthesia Concepts |
282 |
|
|
Anesthesia
Personnel |
282 |
|
|
Preoperative
Evaluation of the Patient |
283 |
|
|
Anesthesia
Selection |
285 |
|
|
Immediate
Preoperative Preparation of the Patient |
285 |
|
|
Physiological
Monitoring During Surgery |
286 |
|
|
Methods of
Anesthesia |
289 |
|
|
Airway
Management |
291 |
|
|
Phases of
General Anesthesia |
294 |
|
|
Dissociative Anesthesia |
295 |
|
|
Conscious
Sedation |
295 |
|
|
Regional
Anesthesia |
295 |
|
|
Emergencies |
299 |
|
|
Historical
Highlights |
302 |
|
15 |
Postanesthesia Recovery |
305 |
|
|
Introduction |
305 |
|
|
PACU
Facility |
305 |
|
|
PACU
Procedures |
306 |
|
|
Psychosocial
Care |
309 |
|
|
Postoperative
Complications |
310 |
|
|
Elements of
Discharge Planning |
312 |
|
|
Unanticipated
PACU Outcome |
313 |
|
16 |
Death and
Dying |
316 |
|
|
Introduction |
316 |
|
|
Defining the
End of Life |
317 |
|
|
Models of
Death and Dying |
317 |
|
|
Support and
Comfort for the Dying and Bereaved Patient |
317 |
|
|
Ethical
Considerations in Death and Dying |
318 |
|
|
Cultural
Responses to Death and Dying |
319 |
|
|
Death in the
Clinical Setting |
319 |
|
|
General
Postmortem Procedures |
320 |
|
|
Health
Professionals Confronting Death |
321 |
|
17 |
Physics and
Information Technology |
324 |
|
|
Introduction |
325 |
|
|
Technology
and Medicine |
325 |
|
SECTION I |
PHYSICS |
326 |
|
|
Matter |
326 |
|
|
Motion |
327 |
|
|
Energy |
328 |
|
|
Electricity |
330 |
|
|
Light |
333 |
|
|
Heat |
334 |
|
|
Sound |
334 |
|
SECTION II |
INFORMATION TECHNOLOGY |
336 |
|
|
Computers in the Perioperative
Environment |
336 |
|
|
Computer Learning Tools |
336 |
|
|
How Computers Work |
336 |
|
|
Computer Terms and language |
336 |
|
|
Hardware (Physical Components) |
336 |
|
|
Basic Computer Use |
337 |
|
|
Computer Networks |
342 |
|
18 |
Energy
Sources in Surgery |
345 |
|
|
Introduction |
347 |
|
|
Electrical
Energy |
347 |
|
|
Electrical
Hazards in Minimally Invasive Surgery |
354 |
|
|
Kinetic
Energy |
355 |
|
|
Cold Thermal
Energy |
355 |
|
|
Laser Energy |
355 |
|
19 |
Moving,
Handling, and Positioning the Surgical Patient |
362 |
|
|
Introduction |
363 |
|
|
Patient
Identification |
363 |
|
|
Principles
of Safe Patient Transport and Transfer |
364 |
|
|
Communication
with Families |
364 |
|
SECTION I |
TRANSFERRING AND
TRANSPORTING THE PATIENT |
364 |
|
|
Safe Moving and Handling for Health
Care Providers |
364 |
|
|
Transferring Ambulatory and
Wheelchair-Assisted Patients |
366 |
|
|
Transporting Patients |
368 |
|
|
Lateral Transfers |
369 |
|
|
Special Patient Populations |
371 |
|
SECTION II |
POSITIONING THE
SURGICAL PATIENT |
373 |
|
|
Duties of the Surgical Technologist |
373 |
|
|
General Operating Table |
373 |
|
|
Preventing Patient Injury During
Positioning |
374 |
|
|
Positioning the Pregnant Patient |
381 |
|
|
Surgical Positions |
381 |
|
|
Historical Highlights |
388 |
|
20 |
Surgical Skin Prep and Draping |
390 |
|
|
Introduction |
390 |
|
|
Patient
Hygiene Before Surgery |
391 |
|
|
Urinary Carheterization |
391 |
|
|
Surgical
Skin Prep |
394 |
|
|
Standard
Prep Sites |
398 |
|
|
Draping the
Surgical Site |
404 |
|
|
Draping
Techniques of the Surgical Site |
406 |
|
|
How to Drape
Equipment |
410 |
|
|
Removing
Drapes |
410 |
|
21 |
Case
Planning and Intraoperative Routines |
412 |
|
|
Introduction |
413 |
|
|
Surgical
Techniques |
413 |
|
|
Surgical
Case Plan |
416 |
|
|
Preoperative
Case Preparation |
418 |
|
|
Opening a Cose |
419 |
|
|
Intraoperative Sterile Setup |
421 |
|
|
The Count |
424 |
|
|
Lost and
Retained Items |
426 |
|
|
Starting the
Case |
427 |
|
|
Management
of Sufgical Specimens |
433 |
|
|
Wound
Closure |
437 |
|
|
End of
Surgery |
438 |
|
|
Historical
Highlights |
438 |
|
22 |
Management
of the Surgical Wound |
441 |
|
|
Introduction |
442 |
|
|
The Role of
the Surgical Technologist in Wound Management |
442 |
|
|
Halstead’s
Principles of Surgery |
442 |
|
|
Preventing
Injury |
443 |
|
|
Wound
Irrigation |
443 |
|
|
Retraction |
444 |
|
|
Hemostasis |
444 |
|
|
Thermal and
High-Frequency Coagulation |
447 |
|
|
Pneumatic
Tourniquet |
447 |
|
|
Autotransfusion |
448 |
|
|
Surgical
Sponges |
449 |
|
|
Sutures |
450 |
|
|
Surgical
Needles |
454 |
|
|
Suture
Storage, Packaging, and Dispensing |
458 |
|
|
Suturing
Techniques |
459 |
|
|
Specialty
Uses of Suture |
462 |
|
|
Suture
Handling Techniques |
463 |
|
|
Tissue
Implants |
466 |
|
|
Synthetic
Implants |
467 |
|
|
Wound
Drainage |
468 |
|
|
Dressings |
469 |
|
|
Simple and
Composite Dressings |
471 |
|
|
Wound
Healing and Complications |
473 |
|
|
Wound
Complications |
475 |
|
23 |
General Surgery |
481 |
|
|
Introduction |
482 |
|
SECTION I |
THE ABDOMEN |
483 |
|
|
Structure and Regions of the Abdomen |
483 |
|
|
Abdominal Wall Hernias |
485 |
|
|
Case Planning |
485 |
|
|
Surgical Procedures |
488 |
|
SECTION II |
GASTROINTESTINAL
SURGERY |
492 |
|
|
Surgical Anatomy |
492 |
|
|
Diagnostic Procedures |
493 |
|
|
Case Planning |
493 |
|
|
Techniques in Gastrointestinal Surgery |
495 |
|
|
Surgical Procedures |
496 |
|
SECTION III |
SURGERY OF THE BILIARY
SYSTEM, LIVER, PANCREAS, AND SPLEEN |
518 |
|
|
Surgical Anatomy |
518 |
|
|
Diagnostic Procedures |
519 |
|
|
Case Planning |
520 |
|
|
Surgical Procedures |
520 |
|
SECTION IV |
BREAST SURGERY |
528 |
|
|
Surgical Anatomy |
528 |
|
|
Breast Cancer |
529 |
|
|
Case Planning |
530 |
|
|
Surgical Procedures |
530 |
|
24 |
Minimally Invasive Endoscopic
and Robotic-Assisted Surgery |
535 |
|
|
Introduction |
536 |
|
SECTION I |
MINIMALLY INVASIVE
SURGERY |
537 |
|
|
Principles of Minimally invasive
Surgery |
537 |
|
|
Advantages and Disadvantages of
Minimally Invasive Surgery |
539 |
|
|
Preoperative Preparation and Patient
Safety |
539 |
|
|
Techniques and Equipment Used in
Minimally Invasive Surgery |
541 |
|
|
Flexible Endoscopy |
555 |
|
|
Reprocessing Endoscopes and
Instruments |
557 |
|
SECTION II |
ROBOTIC
SURGERY |
558 |
|
|
Principles of Robotic Surgery |
558 |
|
|
Robotic Movement |
558 |
|
|
Classification of Robots |
558 |
|
|
da Vinci
Surgical System |
558 |
|
|
Advantages and Disadvantages of
Robotic Surgery |
559 |
|
|
Training for Robotics |
560 |
|
|
Surgical Specialties and Robotics |
560 |
|
|
Components of the Robotic System:
Structure and Purpose |
560 |
|
|
da Vinci
Instruments |
562 |
|
|
Setup and Sequence for Robotic Surgery |
563 |
|
|
Special Roles of the Surgical Team |
565 |
|
25 |
Gynecological
and Obstetrical Surgery |
569 |
|
|
Introduction |
570 |
|
SECTION
I |
GYNECOLOGICAL
AND REPRODUCTIVE SURGERY |
570 |
|
|
Surgical Anatomy |
570 |
|
|
Ovarian (Menstrual) Cycle |
573 |
|
|
Diagnostic Procedures |
573 |
|
|
Psychosocial Considerations |
574 |
|
|
Case Planning |
575 |
|
|
Surgical Techniques in Gynecological
and Reproductive Surgery |
577 |
|
|
Abdominal Procedures |
578 |
|
|
Transcervical Procedures |
588 |
|
|
Transvaginal and Vulvar Procedures |
593 |
|
SECTION
II |
OPERATIVE
OBSTETRICAL PROCEDURES |
599 |
|
|
Introduction |
599 |
|
|
Stages of Pregnancy |
599 |
|
|
Complications of Pregnancy |
599 |
|
|
Diagnostic Tests |
602 |
|
|
Normal Vaginal Delivery |
603 |
|
|
Immediate Postpartum Care |
603 |
|
|
Newborn Care |
603 |
|
|
Obstetrical Procedures |
604 |
|
26 |
Genitourinary
Surgery |
609 |
|
|
Introduction |
610 |
|
|
Surgical
Anatomy |
610 |
|
|
Reproductive
Structures of the Male |
613 |
|
|
Kidney
Dialysis |
614 |
|
|
Diagnostic
Tests |
615 |
|
|
Imaging
Studies |
615 |
|
|
Case
Planning |
617 |
|
|
Techniques
in Transurethral Surgery |
623 |
|
|
Transurethral
(Cystoscopic) Procedures |
625 |
|
|
Surgery of
the Male External Genitalia |
628 |
|
|
Surgery of
the Bladder and Ureters |
636 |
|
|
Urinary
Incontinence |
637 |
|
|
Prostate
Procedures |
640 |
|
|
Surgery of
the Ureter and Kidney |
646 |
|
27 |
Ophthalmic
Surgery |
652 |
|
|
Introduction |
652 |
|
|
Surgical
Anatomy |
653 |
|
|
Refraction |
656 |
|
|
Diagnostic
Testing |
656 |
|
|
Case
Planning |
656 |
|
|
Surgical
Techniques in Eye Surgery |
665 |
|
|
Role of the
Scrubbed Surgical Technologist |
666 |
|
|
Surgical
Procedures |
667 |
|
28 |
Surgery of
the Ear, Nose, Pharynx, and Larynx |
685 |
|
SECTION
I |
THE
EAR |
685 |
|
|
Introduction |
685 |
|
|
Surgical Anatomy |
686 |
|
|
Sound Transmission in the Ear |
687 |
|
|
Diagnostic Procedures |
687 |
|
|
Case Planning |
687 |
|
|
Surgical Procedures |
690 |
|
SECTION II |
THE
NASAL CAVITY, OROPHARVNX, AND
LARYNX |
695 |
|
|
Introduction |
695 |
|
|
Surgical Anatomy |
695 |
|
|
Diagnostic Tests |
696 |
|
|
Case Planning |
697 |
|
|
Nasal Procedures |
702 |
|
SECTION
III |
THE
NECK |
709 |
|
|
Introduction |
709 |
|
|
Surgical Anatomy |
709 |
|
|
Case Planning |
711 |
|
|
Surgical Procedures |
712 |
|
29 |
Oral and
Maxillofacial Surgery |
724 |
|
|
Introduction |
724 |
|
|
Surgical
Anatomy |
724 |
|
|
Diagnostic
Procedures |
725 |
|
|
Case
Planning |
725 |
|
|
Surgical
Procedures of the Face |
729 |
|
|
Oral Surgery
Procedures |
734 |
|
|
Orthognathic Procedures |
734 |
|
30 |
Plastic and
Reconstructive Surgery |
737 |
|
|
Introduction |
738 |
|
|
Surgical
Anatomy |
738 |
|
|
Case
Planning |
739 |
|
|
Techniques
in Plastic and Reconstructive Surgery |
742 |
|
|
Surgical
Procedures |
743 |
|
31 |
Orthopedic
Surgery |
761 |
|
|
Introduction |
762 |
|
|
Surgical
Anatomy |
762 |
|
|
Diagnostic
Procedures |
770 |
|
|
Case
Planning |
772 |
|
|
Fracture
Pathology |
775 |
|
|
Orthopedic
Technology and Instrumentation |
780 |
|
|
Surgical
Approaches to the Shoulder and Arm |
798 |
|
|
Surgical
Approaches to the Wrist and Hand |
809 |
|
|
Surgical
Approaches to the Hip and Pelvis |
814 |
|
|
Surgical
Approaches to the Knee and Lower Leg |
821 |
|
|
Surgical
Approaches to the Foot |
831 |
|
32 |
Peripheral
Vascular Surgery |
836 |
|
|
Introduction |
837 |
|
|
Surgical
Anatomy |
837 |
|
|
Diagnostic
Procedures |
843 |
|
|
Case
Planning |
844 |
|
|
Techniques
in Vascular Surgery |
849 |
|
|
Surgical
Procedures |
849 |
|
33 |
Thoracic and
Pulmonary Surgery |
870 |
|
|
Introduction |
870 |
|
|
Surgical
Anatomy |
871 |
|
|
Diagnostic
Tests |
874 |
|
|
Case
Planning |
875 |
|
|
Surgical
Procedures |
878 |
|
|
Thoracoscopy (Video-Assisted Thoracoscopic
Surgery) |
880 |
|
34 |
Cardiac Surgery |
892 |
|
|
Introduction |
892 |
|
|
Surgical
Anatomy |
893 |
|
|
Diagnostic
Procedures |
895 |
|
|
Case
Planning |
897 |
|
|
Surgical
Procedures |
903 |
|
|
Heart
Failure |
923 |
|
35 |
Pediatric Surgery |
930 |
|
|
Introduction |
930 |
|
|
Physiological
and Anatomical Considerations |
931 |
|
|
Pathology |
932 |
|
|
Case
Planning |
938 |
|
|
Surgical
Procedures |
941 |
|
|
Neural Tube
Defects |
960 |
|
36 |
Neurosurgery |
966 |
|
|
Introduction |
966 |
|
|
Surgical
Anatomy |
966 |
|
|
Diagnostic
Procedures |
975 |
|
|
Case
Planning |
977 |
|
|
Cranial
Procedures |
986 |
|
|
Spinal
Procedures |
1004 |
|
|
Neurosurgical
Pain Management |
1015 |
|
|
Peripheral
Nerve Procedures |
1017 |
|
37 |
Emergency Trauma Surgery |
1020 |
|
|
Introduction |
1021 |
|
|
Trauma
Systems |
1021 |
|
|
Trauma
Injuries |
1022 |
|
|
Trauma
Pathophysiology |
1022 |
|
|
ATLS
Principles of Trauma Management |
1025 |
|
|
Management
of Forensic Evidence |
1026 |
|
|
Damage
Control Surgery |
1026 |
|
|
Case
Planning for Trauma Surgery |
1027 |
|
|
Preoperative
Care of the Patient |
1028 |
|
|
Opening a
Case and Sterile Setup |
1029 |
|
|
Managing the
Sterile Field in Emergency Trauma |
1029 |
|
|
Laparotomy with Staged Closure |
1030 |
|
|
Orthopedic
Trauma |
1033 |
|
|
Thoracic
Injury |
1035 |
|
|
Major
Peripheral Vascular Trauma |
1039 |
|
|
Injuries of
the Brain and Spinal Cord |
1040 |
|
Appendix A |
American Hospital Association
Guideline for Patient Rights |
1044 |
|
Appendix B |
Drugs and Substances Associated with
Surgery |
1046 |
|
Appendix C |
Contents of Crash Cart |
1053 |
|
Appendix D |
Common Pathology by System |
1054 |
|
|
Glossary |
1061 |
|
|
Index |
1031 |
|
|
|
|