Perioperative Care
65%of exam
Ancillary Duties
15%of exam
Basic Science
20%of exam
Quick Facts
- Exam
- CST
- Provider
- NBSTSA
- Questions
- 175
- Scored
- 150 scored
- Pretest
- 25 unscored
- Time
- 4 hours
- Pass
- 98 scored
- Format
- Multiple choice
Sterile vs Clean
Sterile
- No viable microbes
- Operative field
- Critical items
Clean
- Reduced bioburden
- Nonsterile areas
- Routine handling
Absence vs reduction
Safety Picker
- Wrong-site conflict→Stop time out(Team verify)
- Package compromised→Do not use
- Count incorrect→Notify surgeon
- Medication unlabeled→Remove/label now
- Specimen unclear→Verify source
- Implant mismatch→Do not open
Preoperative Setup
- Preference card
- Surgeon setup map
- Consent
- Procedure authorization
- Allergies
- Latex/drug risk
- PPE
- Barrier before opening
- Package check
- Integrity/indicator/date
- Skin prep
- Clean to dirty
- SCD
- VTE prevention
- Time out
- Final team pause
Preop vs Intraop
Preop
- Verify/setup
- Open field
- Position/drape
Intraop
- Maintain field
- Pass instruments
- Count/label
Prepare vs perform
Field Picker
- Need setup map→Preference card
- Opening wrapped set→Far flap first
- Prepping incision→Center outward
- Stoma in field→Stoma last
- Legs in lithotomy→Move together
- Draping patient→Incision outward
Sterile Field
- Sterile waist
- Table level up
- Edges
- One inch unsterile
- Moisture
- Strike-through risk
- Break
- Declare and correct
- Scrub
- Hands above elbows
- Gown front
- Chest to table
- Closed gloving
- Best first glove
- Draping
- Incision outward
Monopolar vs Bipolar
Monopolar
- Dispersive pad
- Current exits patient
- Broader use
Bipolar
- No pad
- Between tips
- Wet field safer
Pad vs tips
Positioning
- Supine
- Back lying
- Prone
- Eye pressure risk
- Lithotomy
- Legs move together
- Trendelenburg
- Head down
- Reverse Trendelenburg
- Head up
- Fowler
- Sitting
- Lateral
- Axillary roll
- Safety strap
- Above knees
Absorbable vs Nonabsorbable
Absorbable
- Temporary strength
- Body degrades
- Internal layers
Nonabsorbable
- Long-term support
- Body retains
- Skin/tendon/vessel
Temporary vs lasting
Intraoperative Flow
- Counts
- Baseline plus closure
- Sharps
- Neutral zone
- Specimen
- Verify and label
- Implant
- Size/type verified
- Meds
- Label on field
- Irrigation
- Fluid in/out
- Drains
- Prepare and connect
- Emergency
- Act by protocol
Mechanical vs Chemical
Mechanical
- Pressure/clamps
- Ligatures
- Bone wax
Chemical
- Topical agents
- Thrombin
- Oxidized cellulose
Physical vs agent
Instruments Sutures
- Hemostat
- Clamp vessels
- Forceps
- Grasp tissue
- Retractor
- Expose field
- Needle holder
- Drive needle
- Metz
- Delicate tissue scissors
- Mayo scissors
- Dense tissue/suture
- #10 blade
- Large skin incision
- #11 blade
- Stab incision
- Absorbable
- Temporary support
- Nonabsorbable
- Permanent support
Hemostasis
- Mechanical
- Pressure/clamps/ligature
- Thermal
- ESU/laser/ultrasonic
- Chemical
- Topical agents
- Surgicel
- Oxidized cellulose
- Gelfoam
- Gelatin sponge
- Thrombin
- Clot enzyme
- Bone wax
- Mechanical bone plug
- Epinephrine
- Vasoconstrictor
Postoperative Turnover
- Dressing
- Protect wound
- Transfer
- Team body mechanics
- QBL
- Measured blood loss
- Debrief
- Case closing review
- Sharps disposal
- Puncture container
- Room turnover
- Clean reset
- Unused supplies
- Return appropriately
- Abnormal finding
- Report immediately
RACE
Rescue Alarm Contain Extinguish
CI vs BI
CI
- Chemical change
- Exposure evidence
- No sterility proof
BI
- Live spores
- Lethality challenge
- Strongest monitor
Exposure vs kill
Sterility Picker
- Sterile tissue contact→Sterilization(Critical)
- Mucous contact→HLD minimum(Semicritical)
- Intact skin contact→Low disinfection(Noncritical)
- Need spore proof→BI
- Need exposure proof→CI
- Need air removal→Bowie-Dick
Admin Safety
- Preference card
- Update changes
- Cost control
- Open when needed
- Fire triangle
- Fuel/oxygen/ignition
- RACE
- Rescue alarm contain extinguish
- PASS
- Pull aim squeeze sweep
- Laser
- Eye/smoke hazard
- ESU
- Burn risk
- Ethics
- Patient-first conduct
PASS
Pull Aim Squeeze Sweep
Critical vs Semicritical
Critical
- Sterile tissue
- Vascular system
- Sterilize
Semicritical
- Mucous membrane
- Nonintact skin
- HLD minimum
Sterilize vs HLD
Sterilization
- Decon
- Dirty first step
- Enzymatic
- Breaks organic soil
- Inspection
- Clean/function check
- CI
- Process exposure
- BI
- Spore challenge
- Bowie-Dick
- Air removal
- Steam
- Moist heat
- EtO
- Aeration required
- H2O2
- Low-temp option
Spaulding
Critical Semi Noncritical
Fire Triangle
Fuel Oxygen Ignition
Amide Locals
Two i's usually amide
General vs MAC
General
- Unconscious
- Airway controlled
- Full anesthesia
MAC
- Sedated
- Monitored anesthesia
- May respond
Unconscious vs sedated
Surgical Anatomy
- Calot
- Cystic duct/artery
- Hesselbach
- Direct hernia triangle
- Femoral triangle
- Vascular access
- McBurney
- Appendix point
- RLN
- Thyroid danger nerve
- Circle Willis
- Cerebral collateral
- Treitz
- Duodenojejunal landmark
- Retroperitoneal
- Posterior abdominal organs
Microbiology
- Bioburden
- Microbial load
- Biofilm
- Protected microbial layer
- Spores
- Most resistant form
- SSI
- Surgical site infection
- Clean wound
- Class I
- Dirty wound
- Class IV
- Halsted
- Gentle tissue handling
- Sepsis
- Systemic infection response
Pharmacology
- General
- Unconscious anesthesia
- Local
- Site numbness
- Block
- Regional nerve anesthesia
- MAC
- Monitored sedation
- Lidocaine
- Amide local
- Bupivacaine
- Long-acting local
- Heparin
- Anticoagulant
- Protamine
- Heparin reversal
- Dantrolene
- MH antidote
- Succinylcholine
- MH trigger
Common Traps
Indicator vs sterility
CI shows exposure ≠ BI challenges lethality
Prep direction
Incision to periphery ≠ Stoma last
Lithotomy legs
Raise together ≠ Lower together
Count discrepancy
Notify surgeon ≠ Do not ignore
Sterile edge
Table top sterile ≠ Edges unsterile
Medication safety
Verify aloud ≠ Label immediately
Monopolar pad
Needs dispersive pad ≠ Avoid bony prominences
Skin prep
Reduce microbes ≠ Cannot sterilize skin
Last Minute
- 1.Weights: 65 / 15 / 20
- 2.Items: 97 / 23 / 30
- 3.Intraop: 68 scored items
- 4.Pass: 98 of 150
- 5.Time: 175 in 4 hours
- 6.Time out: stop all activity
- 7.Counts: setup and closure
- 8.CI exposure; BI lethality
- 9.Sterile tissue requires sterilization
- 10.Meds verified and labeled
- 11.Lithotomy legs move together
- 12.Skin prep center outward
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