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Surgical Technology, 1E Surgical Technology, 2E Delmar Delmar CHAPTER 1 ORIENTATION TO SURGICAL TECHNOLOGY CHAPTER 1 ORIENTATION TO SURGICAL TECHNOLOGY HISTORY OF SURGERY 4 HISTORY OF SURGERY 3 SURGERY TODAY 4 SURGERY TODAY 4 Surgical Specialties 4 Surgical Specialties 5 HISTORY OF SURGICAL TECHNOLOGY 6 HISTORY OF SURGICAL TECHNOLOGY 6 SURGICAL TECHNOLOGY AND SURGICAL TECHNOLOGISTS 6 FIELD OF SURGICAL TECHNOLOGY 8 Field of Surgical Technology 6 FIELD OF SURGICAL TECHNOLOGY 8 Surgical Technology Education and Certification 6 Surgical Technology Education and Certification 10 Surgical Technologist-Role(s) and Competencies 7 Roles and Competencies 11 Daily Roles in the Operating Room 7 Surgical Team Members 8 Job Descriptions for the Surgical Technologist 14 Job Descriptions for the Surgical Technologist 13 HEALTH CARE FACILITIES 14 HEALTH CARE FACILITIES 14 Hospital Organization 15 Hospital Organization 15 Financial Considerations and Reimbursement 17 Financial Considerations and Reimbursement 19 Organizations Related to Hospitals, Health Care, and Surgical Services 18 Organizations Related to Hospitals, Health Care, and Surgical Services 20 Hospital Departments and Interdepartmental Communication 18 Hospital Departments and Interdepartmental Communication 17 PERSONAL AND PROFESSIONAL RELATIONS 20 THE SURGICAL TECHNOLOGIST AS A PROFESSIONAL 11 Surgical Technologist’s Lifestyle 21 Surgical Technologist’s Lifestyle 12 Surgical Technologist as a Professional 21 Professionalism 11 NEW Working Conditions 8 NEW Personal Characteristics 8 NEW Career Opportunities 13

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Page 1: CHAPTER 1 - Brands Delmar - Cengage Learning  · Web viewchapter 1. orientation to surgical technology chapter 1. orientation to surgical technology history of surgery 4 history

Surgical Technology, 1E Surgical Technology, 2EDelmar Delmar

CHAPTER 1ORIENTATION TO SURGICAL TECHNOLOGY

CHAPTER 1ORIENTATION TO SURGICAL TECHNOLOGY

HISTORY OF SURGERY 4 HISTORY OF SURGERY 3SURGERY TODAY 4 SURGERY TODAY 4Surgical Specialties 4 Surgical Specialties 5HISTORY OF SURGICAL TECHNOLOGY

6 HISTORY OF SURGICAL TECHNOLOGY

6

SURGICAL TECHNOLOGY AND SURGICAL TECHNOLOGISTS

6 FIELD OF SURGICAL TECHNOLOGY 8

Field of Surgical Technology 6 FIELD OF SURGICAL TECHNOLOGY 8Surgical Technology Education and Certification

6 Surgical Technology Education and Certification

10

Surgical Technologist-Role(s) and Competencies

7 Roles and Competencies 11

Daily Roles in the Operating Room 7 Surgical Team Members 8Job Descriptions for the Surgical Technologist

14 Job Descriptions for the Surgical Technologist

13

HEALTH CARE FACILITIES 14 HEALTH CARE FACILITIES 14Hospital Organization 15 Hospital Organization 15Financial Considerations and Reimbursement

17 Financial Considerations and Reimbursement

19

Organizations Related to Hospitals, Health Care, and Surgical Services

18 Organizations Related to Hospitals, Health Care, and Surgical Services

20

Hospital Departments and Interdepartmental Communication

18 Hospital Departments and Interdepartmental Communication

17

PERSONAL AND PROFESSIONAL RELATIONS

20 THE SURGICAL TECHNOLOGIST AS A PROFESSIONAL

11

Surgical Technologist’s Lifestyle 21 Surgical Technologist’s Lifestyle 12Surgical Technologist as a Professional 21 Professionalism 11

NEW Working Conditions 8NEW Personal Characteristics 8NEW Career Opportunities 13

CHAPTER 2THE SURGICAL PATIENT

CHAPTER 3THE SURGICAL PATIENTCHAPTER 2*STANDARDS OF CONDUCTCHAPTER 4 *SPECIAL POPULATION

*Chapters 2 & 4 are new. They will be listed with entire contents separately at the end of the grid.

THE STSR AND THE SURGICAL PATIENT

25 THE STSR AND THE SURGICAL PATIENT

43

PHYSICAL, PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL NEEDS OF THE SURGICAL PATIENT

25 PHYSICAL, PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL NEEDS OF THE SURGICAL PATIENT

43

Understanding the Surgical Patient 26 Understanding the Surgical Patient 44Causes of Surgical Intervention 26 Causes of Surgical Intervention 44The Surgical Patient, a Human Being 26 The Surgical Patient, a Human Being 44Prioritizing Needs-Maslow’s Hierarchy 27 Prioritizing Needs-Maslow’s Hierarchy 45Select Basic Concepts in Developmental and Social Psychology

27 Life Stage Development: Select Basic Concepts

46

Cultural and Religious Influences 32 Cultural and Religious Influences 49PATIENT BILL OF RIGHTS: A FORMAL 41 AHA Patient’s Bill of Rights (Ch.2) 31

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VIEW OF THE PATIENT AS HUMANConsent for Surgery: A Basic Right 43 Consent for Surgery: A Basic Right (Ch.2) 27Principles of Documentation 45 Documentation (Ch.2) 45LEGAL AND ETHICAL CONSIDERATION

46 ETHICAL AND MORAL ISSUESElements of Ethical Decision Making (Ch.2)

3032

AST Code of Ethics 48 Professional Codes of Conduct (Ch.2) 34Specific Legal Considerations 48 Definitions of General Legal Terms

Definitions of Traditional Principles (Ch.2)2324

SPECIAL POPULATIONS 51 INTRODUCTION (Ch. 4) 57Pediatric Patients 51 Pediatric Patients (Ch. 4) 57Geriatric Patients 51 Geriatric Patients (Ch. 4) 69Other Special Populations: Trauma, HIV Positive, and Organ Donor/Recipient

53 Acquired Immunodeficiency SyndromeTrauma Patients (Ch. 4)

6871

SURGICAL PATIENT CARE: PUTTING IT ALL TOGETHER

54

Using the CARE Approach 54CHAPTER 3PHYSICAL ENVIRONMENT AND SAFETY STANDARDS

CHAPTER 5PHYSICAL ENVIRONMENT AND SAFETY STANDARDS

PHYSICAL DESIGN OF THE SURGERY DEPARTMENT

58 PHYSICAL DESIGN OF THE SURGERY DEPARTMENT

77

Areas of the OR 58 Areas of the OR 78Physical Components of the Operative Suite 59 Physical Components of the Operative Suite 79Substerile Area 64 Substerile Area 83Direct Support Services 64 Direct Support Services 83HAZARDS AND REGULATORY AGENCIES

66 HAZARDS AND REGULATORY AGENCIES

85

SAFETY CONSIDERATIONS 67 SAFETY CONSIDERATIONS 86Air-Handling System 67 Air-Handling System 86Surgical Lights 67 Surgical Lights 86Noise in the Operating Room 67 Noise in the Operating Room 86Ergonomics and Safety Considerations 67 Ergonomics and Safety Considerations 86Fire Hazards and Safety 68 Fire Hazards and Safety 87Electrical Hazards 69 Electrical Hazards 88Ionizing Radiation 70 Ionizing Radiation 89BIOLOGICAL HAZARDS AND SAFETY CONSIDERATIONS

71 BIOLOGICAL HAZARDS AND SAFETY CONSIDERATIONS

90

Universal Precautions 71 Universal Precautions 90Standard Precautions 71 Standard Precautions 90Laser and Electrosurgical Plume 74 Laser and Electrosurgical Plume 93Latex Allergy 74 Latex Allergy 94CHEMICAL HAZARDS AND SAFETY CONSIDERATIONS

75 CHEMICAL HAZARDS AND SAFETY CONSIDERATIONS

94

Waste Anesthetic Gases 75 Waste Anesthetic Gases 94Methyl Methacrylate 75 Methyl Methacrylate 95Formalin 75 Formalin 95Ethylene Oxide 75 Ethylene Oxide 95Glutaraldehyde 76 Glutaraldehyde 95CHAPTER 4ASEPSIS

CHAPTER 7ASEPSIS AND STERILE TECHNIQUE

HISTORY OF STERILIZATION 81 HISTORY OF STERILIZATION 130BASIC TERMINOLOGY 81 BASIC TERMINOLOGY 131PATHOGENS AND INFECTION 82 PATHOGENS AND INFECTION 131

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Infection 83 Infection 131Pathogens Associated with Surgical Site Infection

83 Pathogens Associated with Surgical Site Infection

132

Methods of Transmission 85 Methods of Transmission 135PRINCIPLES OF ASEPSIS AND STERILE TECHNIQUES

88 PRINCIPLES OF ASEPSIS 138

Principle 1: Sterile Field 88 Principle 1: Sterile Field 138Principle 2: Sterile Team Member Attire 89 Principle 2: Sterile Team Member Attire 139Principle 3: Movement in and around Sterile Field

90 Principle 3: Movement in and around Sterile Field

140

SURGICAL CONSCIENCE 91 SURGICAL CONSCIENCE 140CLEANING, DISINFECTION, AND STERILIZATION

91 CLEANING, DISINFECTION, AND STERILIZATION

141

Cleaning and Disinfection 92 Cleaning and Disinfection 142Disinfectant and Disinfectant/Sterilant Agents

96 Disinfectant and Disinfectant/Sterilant Agents

147

INSTRUMENT PREPARATION AND WRAPPING FOR STERILIZATION

100 INSTRUMENT PREPARATION AND WRAPPING FOR STERILIZATION

151

Instruments 100 Instruments 151Specific Procedural Trays 100 Specific Procedural Trays 151Instrument Sets 100 Instrument Sets 151PACKAGING FOR STERILIZATION AND STORAGE

101 PACKAGING FOR STERILIZATION AND STORAGE

152

Performance Standards of Packaging Material

101 Performance Standards of Packaging Material

152

Performance Characteristics 101 Performance Characteristics 152Types of Packaging Materials 102 Types of Packaging Materials 153General Principles of Packaging 104 General Principles of Packaging 155Sterilization 106 Sterilization 158Requirements and Essential Factors 107 Requirements and Essential FactorS 159Basic Components of a Steam Sterilizer 108 Basic Components of a Steam Sterilizer 160GAS STERILIZATION 110 GAS STERILIZATION 163Ethylene Oxide 111 Ethylene Oxide 163Alternative Gas Sterilization Methods 111 Alternative Gas Sterilization Methods 164LIQUID CHEMICAL STERILIZATION PROCESSES

112 LIQUID CHEMICAL STERILIZATION PROCESSES

165

IONIZING RADIATION 112 IONIZING RADIATION 165METHODS OF MONITORING THE STERILIZATION PROCESS

113 METHODS OF MONITORING THE STERILIZATION PROCESS

165

Mechanical Methods of Monitoring the Sterilization Process

113 Mechanical Methods of Monitoring the Sterilization Process

165

Chemical Methods of Monitoring the Sterilization Process

113 Chemical Methods of Monitoring the Sterilization Process

166

Biological Methods of Monitoring the Sterilization Process

113 Biological Methods of Monitoring the Sterilization Process

166

Bowie-Dick Test 114 Bowie-Dick Test 167EVENT-RELATED STERILITY 114 EVENT-RELATED STERILITY 167Environmental Decontamination 115 Environmental Decontamination 168Environmental Services 115 Environmental Services 168Case by Case 115 Case by Case 168Daily 115 Daily 168

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CHAPTER 5GENERAL PATIENT CARE AND SAFETY

CHAPTER 8GENERAL PATIENT CARE AND SAFETY

PREOPERATIVE PATIENT ROUTINES 119 PREOPERATIVE PATIENT ROUTINES 172Surgical Consent 119 Surgical Consent 173Preoperative Education 120 Preoperative Education 175Patient Possessions 120 Patient Possessions 175Evening/Morning before Surgery 121 Evening/Morning before Surgery 176Diet 122 Diet 177Makeup and Dress 122 Makeup and Dress 177Call to Operating Room 122 Call to Operating Room 177Family Visit 122 Family Visit 177Patient Identification 123 Patient Identification 177Transportation 123 Transportation 178TRANSFER AND POSITIONING 123 TRANSFER AND POSITIONING 179BASIC POSITIONING FOR SURGERY 124 BASIC POSITIONING FOR SURGERY 180Supine Position 125 Supine Position 181Trendelenburg Position 125 Trendelenburg Position 183Reverse Trendelenburg Position 125 Reverse Trendelenburg Position 184Fowler’s Position and Sitting Position 125 Fowler’s Position and Sitting Position 184Lithotomy Position 125 Lithotomy Position 185Prone Position 125 Prone Position 186Kraske (Jackknife Position) 127 Kraske (Jackknife Position) 188Lateral Position 127 Lateral Position 189Lateral Kidney Position 128 Kidney Position 190

NEW Sim’s Position 191THERMOREGULATORY DEVICES 128 THERMOREGULATORY DEVICES 191VITAL SIGNS 129 VITAL SIGNS 192Temperature 129 Temperature 192Pulse 130 Pulse 193Respiration 131 Respiration 194Blood Pressure 131 Blood Pressure 196URINARY CATHETERIZATION 133 URINARY CATHETERIZATION 199Indications 133 Indications 200Procedure 133 Procedure 200

NEW Considerations 200SKIN PREPARATION 134 SKIN PREPARATION 202Clean Areas and Contaminated Areas 136 SKIN PREPARATION 202Skin Preparation Setup 136 Skin Preparation Setup 203Perineal and Vaginal Preparations 138 Perineal and Vaginal Preparations 206Skin Marking 138 Skin Marking 206HEMOSTASIS AND BLOOD REPLACEMENT

139 HEMOSTASIS AND BLOOD REPLACEMENT

206

Factors Affecting Hemostasis 139 Factors Affecting Hemostasis 207Control of Bleeding during Surgery 139 Control of Bleeding during Surgery 207Mechanical Methods 140 Mechanical Methods 207THERMAL HEMOSTASIS 141 THERMAL HEMOSTASIS 209PHARMACOLOGICAL AGENTS 142 PHARMACOLOGICAL AGENTS 209Blood Loss 142 Blood Loss 210Blood Replacement 143 Blood Replacement 210CARDIOPULMONARY RESUSCITATION

144 CARDIOPULMONARY RESUSCITATION

211

Cardiac Arrest in the Surgical Setting 144 Cardiac Arrest in the Surgical Setting 212

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MALIGNANT HYPERTHERMIA 145 MALIGNANT HYPERTHERMIA 213Prevention 145 Prevention 213Treatment 145 Treatment 213EMERGENCY MEDICAL SERVICES 146 EMERGENCY MEDICAL SERVICES 213INDICATIONS OF EMERGENCY SITUATIONS

146 INDICATIONS OF EMERGENCY SITUATIONS

214

OBJECTIVES AND PRIORITIES IN ERMERGENCY SITUATIONS

146 OBJECTIVES AND PRIORITIES IN ERMERGENCY SITUATIONS

214

Syncope 147 Syncope 214Convulsions/Seizures 147 Convulsions/Seizures 215Management of Seizure 147 Management of Seizure 215Anaphylactic Reactions 147 Anaphylactic Reactions 215Clinical Manifestations of Impending Cardiac Arrest

148 Clinical Manifestations of Impending Cardiac Arrest

216

Hemolytic Transfusion Reactions 148 Hemolytic Transfusion Reactions 211CHAPTER 6SURGICAL PHARMACOLOGY AND ANESTHESIA

CHAPTER 9SURGICAL PHARMACOLOGY AND ANESTHESIA

PHARMACOLOGY 151 PHARMACOLOGY 219Drug Sources 151 Drug Sources 219Drug Forms 151 Drug Forms 220Drug Nomenclature 152 Drug Nomenclature 220Route of Administration 152 Route of Administration 221Drug Classifications 152 Drug Classifications 221Pharmacokinetics 153 Pharmacokinetics 221Pharmacodynamics 154 Pharmacodynamics 222DRUG-HANDLING TECHNIQUES 154 DRUG-HANDLING TECHNIQUES 223Medication Identification 155 Medication Identification 223Supplies for Medication Handling 156 Supplies for Medication Handling 225Transfer of a Medication to the Sterile Field 156 Transfer of a Medication to the Sterile Field 225Medications Commonly Used in the Operating Room

157 Medications Commonly Used in the Operating Room

226

HISTORY OF MODERN ANESTHESIA 160 HISTORY OF MODERN ANESTHESIA 229METHODS AND TECHNIQUES OF ANESTHETIC ADMINISTRATION

161 METHODS AND TECHNIQUES OF ANESTHETIC ADMINISTRATION

231

GENERAL ANESTHESIA 162 GENERAL ANESTHESIA 231Depth of General Anesthesia 162 Depth of General Anesthesia 231Phases of General Anesthesia 162 Phases of General Anesthesia 232Advantages of General Anesthesia 163 Advantages of General Anesthesia 232Risks and Complications Associated with General Anesthesia

163 Risks and Complications Associated with General Anesthesia

232

Anesthetic Agents 165 Anesthetic Agents 235Adjuncts to General Anesthesia 170 Adjuncts to General Anesthesia 240Anesthesia Equipment 171 Anesthesia Equipment 241NERVE CONDUCTION BLOCKADE 174 NERVE CONDUCTION BLOCKADE 244Nerve Conduction Blocking Agents 174 Nerve Conduction Blocking Agents 244Topical Anesthesia 175 Topical Anesthesia 246Local Anesthesia 176 Local Anesthesia 246Regional Anesthesia 176 Regional Anesthesia 246Epidural Anesthesia 178 Epidural Anesthesia 249NONTRADITIONAL ANESTHESIA OPTIONS

179 NONTRADITIONAL ANESTHESIA OPTIONS

249

TEAM MEMBER ROLES DURING ANESTHESIA ADMINISTRATION

179 TEAM MEMBER ROLES DURING ANESTHESIA ADMINISTRATION

249

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Preoperative Visits 180 Preoperative Visits 250Preoperative Routine-All Types of Anesthesia

180 Preoperative Routine-All Types of Anesthesia

250

Postanesthesia Care 184 Postanesthesia Care 253CHAPTER 7INSTRUMENTATION, EQUIPMENT, AND SUPPLIES

CHAPTER 10INSTRUMENTATION, EQUIPMENT, AND SUPPLIES

INSTRUMENTATION 188 INSTRUMENTATION 259Classifications 188 Classifications 259Care and Handling 193 Instrument Care and Handling 264Types of Instrument Sets 193 Types of Instrument Sets 265SPECIALTY EQUIPMENT 196 SPECIALTY EQUIPMENT 269Endoscopes 196 Endoscopes 269Power Tools 197 Power Tools 270Lasers 197 Lasers 270Microscopes 200 Microscopes 273Video Monitors, Recorders, and Cameras 200 Video Monitors, Recorders, and Cameras 273Fiber-optic Headlights and Light Sources 201 Fiber-optic Headlamps and Light Sources 274Irrigation/Aspiration (IA) Units 201 Irrigation/Aspiration Units 274Cryotherapy Units 201 Cryotherapy Units 274Insufflators 201 Insufflators 274Nerve Stimulators 201 Nerve Stimulators 274ACCESSORY EQUIPMENT 202 ACCESSORY EQUIPMENT 275Suction Systems 202 Suction Systems 275Electrosurgical Unit 202 Electrosurgical Unit 275Lights 204 Lights 278Pneumatic Tourniquets 205 Pneumatic Tourniquets 279

NEW Sequential Compression Devices 280SUPPLIES 206 SUPPLIES 280Drapes 206 Drapes 280Sterile Packs 207 Sterile Packs 282Sponges and Dressings 207 Sponges and Dressings 282Catheters, Tubes, and Drains 209 Catheters, Tubes, and Drains 285Nonsuture Needles 211 Nonsuture Needles 288Irrigators and Syringes 212 Irrigators and Syringes 289CHAPTER 8WOUND HEALING, SUTURES, NEEDLES, AND STAPLING DEVICES

CHAPTER 11WOUND HEALING, SUTURES, NEEDLES, AND STAPLING DEVICES

INTRODUCTION 215 INTRODUCTION 292TYPES OF WOUNDS 215 TYPES OF WOUNDS 292Surgical Wound 215 Surgical Wound 292Traumatic Wound 215 Traumatic Wound 293Chronic Wound 216 Chronic Wound 294INFLAMMATORY PROCESS 216 INFLAMMATORY PROCESS 294TYPES OF WOUND HEALING 216 TYPES OF WOUND HEALING 294First Intention (Primary Union) 216 First Intention (Primary Union) 294Phases of Wound Healing by First Intention 216 Phases of Wound Healing by First Intention 295Second Intention (Granulation) 217 Second Intention (Granulation) 295Third Intention (Delayed Primary Closure) 217 Third Intention (Delayed Primary Closure) 295FACTORS INFLUENCING WOUND HEALING

218 FACTORS INFLUENCING WOUND HEALING

295

COMPLICATIONS OF THE HEALING WOUND

218 COMPLICATIONS OF THE HEALING WOUND

296

Intraoperative Wound Care 219 Intraoperative Wound Care 297

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Postoperative Wound Care 220 Postoperative Wound Care 298SUTURE 221 SUTURE 298History 221 History 298Types of Suture Material 222 Types of Suture Material 299Suture Sizes 222 Suture Sizes 300General Factors Affecting Choice of Suture 222 General Factors Affecting Choice of Suture 300Characteristics of Common Sutures 223 Characteristics of Common Sutures 300Packaging of Suture 225 Packaging of Suture 303Ligatures 226 Ligatures 303Ligating Methods 226 Ligating Methods 303Suture for the Procedure 227 Suture for the Procedure 304Layer Closure 228 Layer Closure 305Endoscopic Suture 229 Endoscopic Suture 307Suturing Techniques 229 Suturing Techniques 307Accessory Devices 231 Accessory Devices 309STAPLING DEVICES 232 STAPLING DEVICES 310Types of Staplers 233 Types of Staplers 312Meshes or Fabrics 234 Meshes or Fabrics 313NEEDLES 234 NEEDLES 314Needle Eye 235 Needle Eye 314Needle Point 235 Needle Point 315Needle Bodies 236 Needle Bodies 315CHAPTER 9THE SURGICAL TECHNOLOGIS IN THE SCRUB ROLE (CASE MANAGEMENT)

CHAPTER 12 SURGICAL CASE MANAGEMENT

OPERATING ROOM ATTIRE 239 Attire 323Clothing 239 Scrub Suit 323Head Coverings 240 Hair Cover 324Masks 240 Mask 324Shoe Covers 240 Shoe Covers 325Gloves 241 Nonsterile Glove

Sterile Gloves325326

Surgical Gown 241 Sterile Gown 326Protective Eyewear 242 Protective Eyewear 325Other Protective Attire 242 Other Protective Attire 326DAILY ROUTINES 242 Preparing the OR 327Furniture Setup 242 OR Setup 327ESTABLISHING THE STERILE FIELD 243 Creating and Maintaining the Sterile Field 329Opening Sterile Supplies 243 Opening Sterile Supplies 330The Surgical Scrub 246 Scrubbing and Donning Sterile Attire 333Hand Drying and Donning the Surgical Gown

248 Self-Drying and Gowning 335

Closed Gloving Technique for Gowning and Gloving

251 Closed Gloving 338

Open Glove Technique When Not Gowned 251 Open Gloving 340Gowning and Gloving Another Team Member

254 Turning the Gown 339

Turning Gown 254 Turning the Gown 339Gown Removal 255 Gown and Glove Removal 364BACK TABLE SETUP 255 ORGANIZING THE BACK TABLE 341Some Basic Principles of Back Table Setup 256 ORGANIZING THE BACK TABLE 341THE MAYO STAND 258 Organizing the Mayo Stand 346DRAPING THE SURGICAL PATIENT 260 Draping the Surgical Patient 346

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General Principles of Draping 260 Draping the Surgical Patient 346INTRAOPERATIVE ACTIVITIES OF THE STSR

265 INTRAOPERATIVE CASE MANAGEMENT

353

Using the APOS Approach During the Intraoperative Phase

265 General Principles 353

Case Management: Principles, Techniques, Considerations

267

Principles of Practice 267 INTRODUCTION 318Technique of Practice: Passing Instruments 268 Passing the Instruments (and Other

Supplies)356

Counts 270 Counting 359Medications and Solutions in the Sterile Field

270 Medication Handling 360

Dressing Application 271 Dressing Application 361Communication 271 Intraoperative Communication 355Postoperative Routines 272 POSTOPERATIVE CASE

MANAGEMENT363

NEW Applied Theory 319NEW Positioning of the Sterile Team Members and the Furniture

353

NEW Progression of the Surgical Procedure 361NEW Preservation of the Sterile Field 363NEW Drape Removal 363NEW Immediate Postoperative Care 364NEW Patient Transfer and Transportation 364NEW Breakdown of the Setup 365NEW The Operating Room Cycle 365NEW The Instrument Cycle 366

CHAPTER 10DIAGNOSTIC PROCEDURES

CHAPTER 13DIAGNOSTIC PROCEDURES

SOURCES OF PATIENT DATA 278 SOURCES OF PATIENT DATA 371History and Physical Examination 278 History and Physical Examination 371Diagnostic Imaging 278 Diagnostic Imaging 371Laboratory Reports 285 Laboratory Reports 378Electrodiagnostic Studies 288 Electrodiagnostic Studies 381Pulmonary Diagnosis 289 Pulmonary Diagnosis 382Endoscopy 289 Endoscopy 383Plethysmography and Phleborheography 289 Plethysmography and Phleborheography 383INDICATIONS FOR SURGERY 289 INDICATIONS FOR SURGERY 383CHAPTER 11GENERAL SURGERY

CHAPTER 14GENERAL SURGERY

ANATOMY 292 ANATOMY 386Abdominal Cavity: General Dimensions 292 Abdominal Cavity: General Dimensions 386Surface Features 293 Surface Features 386Abdominal Musculature 293 Abdominal Musculature 387Peritoneum 293 Peritoneum 387Retroperitoneum 293 Retroperitoneum 388Alimentary Canal 293 Alimentary Canal 388Esophagus 293 Esophagus 388Stomach 294 Stomach 389Small Intestine 295 Small Intestine 390Mesentery 296 Mesentery 391Colon 297 Colon 391Rectum 299 Rectum 393

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Anus 299 Anus 393Omenta 299 Omenta 394Pancreas 299 Pancreas 394Spleen 300 Spleen 395Liver 301 Liver 395Biliary Tract 301 Biliary Tract 396GENERAL SURGERY INSTRUMENTATION

303 GENERAL SURGERY INSTRUMENTATION

397

General Surgery: Minor Set 303 General Surgery: Minor Set 397Local Excision Instruments 303 Local Excision Instruments 399Biliary Instruments 303 Biliary Instruments 399Intestinal Instruments 303 Intestinal Instruments 400Other General Instruments 303 Other General Instruments 400ROOM SETUP 307 ROOM SETUP 400POSITIONING 307 POSITIONING 400DRAPING 307 DRAPING 400INCISIONS 307 INCISIONS 402SURGERY OF THE ABDOMINAL WALL 310 SURGERY OF THE ABDOMINAL

WALL: HERNIAS404

Specific Anatomic Features of the Groin Area

310 Specific Anatomic Features of the Groin Area

404

Hernias 310 Hernias 405Hernia Repair 312 Hernia Repair 405SURGERY OF THE ALIMENTARY CANAL

313 SURGERY OF THE ALIMENTARY CANAL

407

Surgery of the Esophagus 313 Surgery of the Esophagus 408Gastric Surgery 318 Gastric Surgery 408Pathological Conditions of the Stomach 318 Pathological Conditions of the Stomach 408Procedures Related to Gastric Secretion, Ulcers, and Neoplasm

320 Procedures Related to Gastric Secretion, Ulcers, and Neoplasm

416

Procedures for Morbid Obesity 321 Procedures for Morbid Obesity 416Surgery of the Small Bowel 321 Surgery of the Small Bowel 416Appendectomy 325 Appendectomy 420Colon Surgery 326 Colon Surgery 425STOMAS 330 STOMAS 427Anorectal Surgery 330 Anorectal Surgery 427Hemorrhoid Ligation and Excision 333 Hemorrhoid Ligation and Excision 430Surgery of the Liver and Biliary Tract 333 Surgery of the Liver and Biliary Tract 430Common Bile Duct Exploration 342 Common Bile Duct Exploration 439SURGERY OF THE PANCREAS AND SPLEEN

349 SURGERY OF THE PANCREAS AND SPLEEN

447

Select Pathology of the Pancreas 349 Select Pathology of the Pancreas 447Draining Pancreatic Cysts 349 Draining Pancreatic Cysts 448Pancreatic Resection 350 Pancreatic Resection 448Whipple Pancreaticoduodenectomy 350 Whipple Pancreaticoduodenectomy 448Surgery of the Spleen 353 Surgery of the Spleen 452VASCULAR AND OTHER PROCEDURES

356 VASCULAR AND OTHER PROCEDURES

454

Treating Varicose Veins 356 Treating Varicose Veins 454Vascular Access Procedures 356 Vascular Access Procedures 455Muscle and Nerve Biopsies 357 Muscle and Nerve Biopsies 456Incision and Drainage 357 Incision and Drainage 456Excision of Lesion 358 Excision of Lesion 456Endoscopy 358 Endoscopy 457

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BREAST SURGERY 358 BREAST SURGERY 457Breast Anatomy 358 Breast Anatomy 457Breast and Axilla: Pathology and Diagnosis 358 Breast and Axilla: Pathology and Diagnosis 457Breast Surgery (Noncosmetic) 359 Breast Surgery (Noncosmetic) 457SURGERY OF THE THYROID AND PARATHYROID

361 SURGERY OF THE THYROID AND PARATHYROID

461

Anatomy of the Thyroid and Parathyroid 362 Anatomy of the Thyroid and Parathyroid 461Pathological Conditions of the Thyroid and Parathyroid Glands

363 Pathological Conditions of the Thyroid and Parathyroid Glands

461

Thyroidectomy 363 Thyroidectomy 461TRACHEOTOMY 363 TRACHEOTOMY 461Indications for a Tracheotomy 366 Indications for a Tracheotomy 461Illustrative Procedure: Tracheotomy 367 Illustrative Procedure: Tracheotomy 467CHAPTER 12OBSTETRIC AND GYNOCOLOGICAL SURGERY

CHAPTER 15OBSTETRIC AND GYNOCOLOGICAL SURGERY

INTRODUCTION TO OBSTETRIC AND GYNOCOLOGICAL SURGERY

376 INTRODUCTION TO OBSTETRIC AND GYNOCOLOGICAL SURGERY

478

ANATOMY 376 ANATOMY 478The Pelvis 376 The Pelvis 478External Genitalia 377 External Genitalia 481Vagina 377 Vagina 481Uterus 379 Uterus 482Fallopian Tubes 380 Fallopian Tubes 483Ovaries 380 Ovaries 483PREGNANCY-A SPECIAL CONDITION 381 PREGNANCY-A SPECIAL CONDITION 485Select Key Terms in Labor and Delivery 381 Select Key Terms in Labor and Delivery 486Labor 381 Labor 486SPECIAL INSTRUMENTATION, SUPPLIES, DRUGS, AND EQUIPMENT IN OBSTETRIC AND GYNOCOLOGICAL SURGERY

383 SPECIAL INSTRUMENTATION, DRUGS, EQUIPMENT, AND SUPPLIES IN OBSTETRIC AND GYNOCOLOGICAL SURGERY

487

Instrumentation 383 Instrumentation 487Equipment 384 Equipment 494Supplies 390 Supplies 494

NEW Drugs 487ROOM SETUP AND BASIC PATIENT POSITIONING AND DRAPING

390 OR SETUP AND BASIC PATIENT POSITIONING AND DRAPING

494

SURGICAL PROCEDURES: OBSTETRICS AND FERTILITY RELATED

391 SURGICAL PROCEDURES: OBSTETRICS AND FERTILITY RELATED

494

Pathology and Surgical Conditions: Obstetrics and Fertility Related

391 Pathology and Surgical Conditions: Obstetrics and Fertility Related

494

Vaginal Delivery 392 Vaginal Delivery 495Cesarean Section 394 Cesarean Section 497Sterilization Procedures 399 Tubal Occlusion (Sterilization) Procedures 503Tuboplasty 400 Tuboplasty 504Laproscopic Resection of Unruptured Tubal Pregnancy

403 Laproscopic Resection of Unruptured Tubal Pregnancy

507

SURGICAL PROCEDURES: GYNECOLOGICAL PROCEDURES

406 SURGICAL PROCEDURES: GYNECOLOGICAL PROCEDURES

510

Gynecological Pathology 406 Gynecological Pathology 510SURGICAL INTERVENTION OVERVIEW

406 SURGICAL INTERVENTION OVERVIEW

510

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Abdominal Incisions for Gynecological Surgery

406 Abdominal Incisions for Gynecological Surgery

510

Surgical Intervention: Laparoscopy 411 Surgical Intervention: Laparoscopy 515Basic Colposcopy 414 Basic Colposcopy 518Hysteroscopy 416 Hysteroscopy 518Marsupialization of Bartholin’s Gland Cyst 417 Marsupialization of Bartholin’s Gland Cyst 521Simple Vulvectomy 419 Simple Vulvectomy 521Anterior and Posterior Repair (Colporrhaphy)

423 Anterior and Posterior Repair (Colporrhaphy)

524

Cervical Biopsy, Cryotherapy, Laser Treatment, LEEP, and Conization

429 Cervical Biopsy, Cryotherapy, Laser Treatment, LEEP, and Conization

533

Dilation and Curettage 431 Dilation and Curettage 535Myomectomy 434 Myomectomy 538Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy

436 Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy (TAH-BSO)

542

Vaginal and Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

441 Vaginal and Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

546

Radical Cancer Surgery: Total Pelvic Exenteration

442 Radical Cancer Surgery: Total Pelvic Exenteration

547

CHAPTER 13OPHTHALMIC SURGERY

CHAPTER 16OPHTHALMIC SURGERY

ANATOMY OF THE EYE 448 ANATOMY OF THE EYE 554Orbit 448 Orbit 554Extrinsic Muscles 448 Extrinsic Muscles 555Lacrimal System 449 Lacrimal System 555Globe 449 Globe

Cavities and Chambers of the Eye556558

OPHTHALMIC SURGICAL PATHOLOGY

451 OPHTHALMIC SURGICAL PATHOLOGY

558

Cataract 451 Cataract 558Small Retinal Detachment 451 Small Retinal Detachment 558Large Retinal Detachment 452 Large Retinal Detachment 558Vitreous Hemorrhage 452 Vitreous Hemorrhage 558Proliferative Vitreoretinopathy (PVR) 452 Proliferative Vitreoretinopathy (PVR) 559Traction Retinal Detachment 452 Traction Retinal Detachment 559Epiretinal Membarane 452 Epiretinal Membarane 559Corneal Pathology 452 Corneal Pathology 559Chalazion 452 Chalazion 559Dacryocystitis 452 Dacryocystitis 559Strabismus 452 Strabismus 559

NEW Glaucoma 558NEW Pterygium 559

SPECIAL CONSIDERATIONS IN OPHTHALMIC SURGERY

453 SPECIAL CONSIDERATIONS IN OPHTHALMIC SURGERY

560

Special Equipment 453 Special Equipment 560Instruments 453 Instruments 561SURGICAL INTERVENTION 454 SURGICAL INTERVENTION 562Strabismus Correction: Recession/Resection

454 Strabismus Correction: Recession/Resection

563

Adjustable Suture Surgery 457 Adjustable Suture Surgery 566Scleral Buckle 458 Scleral Buckle 567Enucleation and Evisceration of the Eye (Traditional Approach)

462 Enucleation and Evisceration of the Eye (Traditional Approach)

571

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Keratoplasty (Corneal Transplant) 464 Keratoplasty (Corneal Transplant) 573Cataract Extraction 468 Cataract Extraction 577Phacoemulsification 470 Phacoemulsification 580Vitrectomy 470 Vitrectomy 580

Surgical repair of Ptosis 562Iridectomy 563Trabeculoplasty 563NEW OPTHALMIC MEDICATIONS 560

CHAPTER 14OTORHINOLARYNGOLOGIC SURGERY

CHAPTER 17OTORHINOLARYNGOLOGIC SURGERY

ANATOMY OF THE EAR 476 ANATOMY OF THE EAR 587Outer Ear 476 Outer Ear 587Middle Ear 476 Middle Ear 588Inner Ear 476 Inner Ear 588PATHOLOGY OF THE EAR 477 PATHOLOGY OF THE EAR 589Pathology Affecting the Outer Ear 477 Pathology Affecting the Outer Ear 589Pathology Affecting the Middle Ear 478 Pathology Affecting the Middle Ear 589Pathology Affecting the Inner Ear 478 Pathology Affecting the Inner Ear 590Diagnostic Procedures/Tests for the Ear 479 Diagnostic Procedures/Tests for the Ear 590SPECIAL PREOPERATIVE CONSIDERATIONS

479 PREOPERATIVE CONSIDERATIONS 591

SPECIAL INSTRUMENTS, SUPPLIES, DRUGS

480 SPECIAL INSTRUMENTS, SUPPLIES, DRUGS

592

INTRAOPERATIVE PREPARATION 480EAR PROCEDURES 480 EAR PROCEDURES 592Myringotomy 480 Myringotomy 592Myringoplasty/Tympanoplasty 484 Myringoplasty/Tympanoplasty 596Mastoidectomy 487 Mastoidectomy 600Stapedectomy 487 Stapedectomy 600Stapedotomy 488 Stapedotomy 600Cochlear Implants 488 Cochlear Implants 601ANATOMY OF THE NOSE AND SINUSES

488 ANATOMY OF THE NOSE AND SINUSES

601

External Nose 488 External Nose 601Internal Nose 488 Internal Nose 601Paranasal Sinuses 489 Paranasal Sinuses 602Blood Supply to the Nose 490 Blood Supply to the Nose 602Olfaction 490 Olfaction 603PATHOLOGY OF THE NOSE AND PARANASAL SINUSES

490 PATHOLOGY OF THE NOSE AND PARANASAL SINUSES

603

Rhinitis/Sinusitis 490 Rhinitis/Sinusitis 603Nasal Polyps 491 Nasal Polyps 604Hypertrophied Turbinates Hypertrophied Turbinates 604Deviated Nasal Septum 491 Deviated Nasal Septum 604Septal Perforation 491 Septal Perforation 604Epistaxis 492 Epistaxis 604DIAGNOSTIC PROCEDURES 492 DIAGNOSTIC PROCEDURES 605Direct Vision 492 Direct Vision 605Mirror Examination 492 Mirror Examination 605Radiography 492 Radiography 605SPECIAL PREOPERATIVE CONSIDERATIONS

492 PREOPERATIVE CONSIDERATIONS 605

SPECIAL INSTRUMENTS, SUPPLIES, 493 SPECIAL INSTRUMENTS, SUPPLIES, 606

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AND DRUGS AND DRUGSINTRAOPERATIVE PREPARATION 496NASAL PROCEDURES 496 NASAL PROCEDURES 609Submucous Resection (SMR) 496 Submucous Resection (SMR) 609Polypectomy 499 Polypectomy 612Intranasal Antrostomy 499 Intranasal Antrostomy 612Removal of Foreign Body 499 Removal of Foreign Body 612Internal Maxillary Artery Ligation 500 Internal Maxillary Artery Ligation 613Sinus Procedures 500 Sinus Procedures 613Caldwell-Luc 500 Caldwell-Luc 613Ethmoidectomy 502 Ethmoidectomy 615Sphenoidectomy 502 Sphenoidectomy 616Drainage of the Frontal Sinus 503 Drainage of the Frontal Sinus 616Sinus Endoscopy 503 Sinus Endoscopy 616ANATOMY OF THE UPPER AERODIGESTIVE TRACT

505 ANATOMY OF THE UPPER AERODIGESTIVE TRACT

618

Pharynx 505 Pharynx 618Larynx 506 Larynx 620Trachea 507 Trachea 621Bronchi and Lungs 507 Bronchi and Lungs 621Esophagus 507 Esophagus 621PATHOLOGY AFFECTING THE UPPER AERODIGESTIVE TRACT

508 PATHOLOGY AFFECTING THE UPPER AERODIGESTIVE TRACT

621

Pharyngitis 508 Pharyngitis 621Epiglottis 508 Epiglottis 622Tonsillitis 508 Tonsillitis 622Sleep Apnea 509 Sleep Apnea 623Laryngitis 509 Laryngitis 623Polypoid Corditis or Vocal Cord Polyps 510 Polypoid Corditis or Vocal Cord Polyps 623Vocal Cord Nodules 510 Vocal Cord Nodules 623Vocal Cord Granulomas 510 Vocal Cord Granulomas 623Laryngeal Neoplasms 510 Laryngeal Neoplasms 624Tracheitis and Bronchitis 510 Tracheitis and Bronchitis 624Laryngotracheobronchitis (Croup) 510 Laryngotracheobronchitis (Croup) 624Foreign Bodies 511 Foreign Bodies 624PATHOLOGY AFFECTING THE ESOPHAGUS

511 PATHOLOGY AFFECTING THE ESOPHAGUS

624

Esophagitis 511 Esophagitis 624Ulceration of the Esophagus 511 Ulceration of the Esophagus 624Neoplasms Affecting the Esophagus 511 Neoplasms Affecting the Esophagus 624Foreign Bodies 511 Foreign Bodies 625Zenker’s Diverticulum 511 Zenker’s Diverticulum 625DIAGNOSTIC PROCEDURES/TESTS 511 DIAGNOSTIC PROCEDURES/TESTS 625Direct Visualization 511 Direct Visualization 625Indirect Visualization 512 Indirect Visualization 625Laboratory Tests 512 Laboratory Tests 625Radiological Examinations 512 Radiological Examinations 625Videostroboscopy 512 Videostroboscopy 626Polysomnography 512 Polysomnography 626Multiple Sleep Latency Test (MSLT) 512 Multiple Sleep Latency Test (MSLT) 626SPECIAL PREOPERATIVE CONSIDERATIONS

512 PREOPERATIVE CONSIDERATIONS 626

SPECIAL INSTRUMENTS, SUPPLIES, 513 SPECIAL INSTRUMENTS, SUPPLIES, 626

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DRUGS DRUGSINTRAOPERATIVE PREPARATION 514AERODIGESTIVE TRACT PROCEDURES

514 AERODIGESTIVE TRACT PROCEDURES

628

Adenoidectomy 514 Adenoidectomy 628Tonsillectomy 514 Tonsillectomy 628Incision and Drainage of a Peritonsellar Abscess

517 Incision and Drainage of a Peritonsellar Abscess

631

Uvulopalatopharyngoplasty 517 Uvulopalatopharyngoplasty 631Laryngoscopy 519 Laryngoscopy 633Bronchoscopy 521 Bronchoscopy 636Esophagoscopy 522 Esophagoscopy 636Panendoscopy 522 Panendoscopy 636Radical Neck Dissection with Mandibulectomy

522 Radical Neck Dissection with Mandibulectomy

636

CHAPTER 15ORAL AND MAXILLOFACIAL SURGERY

CHAPTER 18ORAL AND MAXILLOFACIAL SURGERY

ANATOMY OF THE ORAL CAVITY 530 ANATOMY OF THE ORAL CAVITY 645Lips 530 Lips 645Teeth 530 Teeth 645Palate 530 Palate 646Cheeks 530 Cheeks 646Tongue 530 Tongue 646ANATOMY OF THE FACE AND CRANIUM

531 ANATOMY OF THE FACE AND CRANIUM

646

Orbit 532 Orbit 647Facial Muscles and Innervation 532 Facial Muscles and Innervation 647EMBRYOLOGICAL EVELOPMENT OF THE FACE

533 EMBRYOLOGICAL EVELOPMENT OF THE FACE

648

PATHOLOGY OF THE ORAL CAVITY 533 PATHOLOGY OF THE ORAL CAVITY 649Mouth 533 Mouth 649Jaw Bones 534 Jaw Bones 649Mandibular Fractures 534 Mandibular Fractures 649Frontal Fractures 535 Frontal Fractures 650Orbital Fractures 535 Orbital Fractures 650Zygomatic Fractures 535 Zygomatic Fractures 650Midfacial Fractures 536 Midfacial Fractures 651Craniofacial Deformities 536 Craniofacial Deformities 651DIAGNOSTIC TESTS 536 DIAGNOSTIC TESTS 651ORAL PROCEDURES: GENERAL CONSIDERATIONS

537 ORAL PROCEDURES: GENERAL CONSIDERATIONS

652

Tooth Extraction 538 Tooth Extraction/Odontectomy 653Tooth Restoration 541 Tooth Restoration 657Implantation 541 Implantation 657MAXILLOFACIAL PROCEDURES: GENERAL CONSIDERATIONS

541 MAXILLOFACIAL PROCEDURES: GENERAL CONSIDERATIONS

658

Graft Materials 542 Graft Materials 658Repair of Mandibular/Maxillary Fractures 543 Repair of Mandibular/Maxillary Fractures 659Application of Arch Bars 543 Application of Arch Bars 659Wire Fixation 546 Wire Fixation 662Plate and Screw Fixation of Mandibular Fracture

546 Plate and Screw Fixation of Mandibular Fracture

663

Frontal Fracture Repair 549 Frontal Fracture Repair 666

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Orbital Floor Fracture Repair 550 Orbital Floor Fracture Repair 667Reduction of Zygomatic Fractures 553 Reduction of Zygomatic Fractures 670Le Fort I Fracture Repair 554 Le Fort I Fracture Repair 671Le Fort II and III Fracture Repair 557 Le Fort II and III Fracture Repair 675Craniofacial Reconstruction 557 Craniofacial Reconstruction 675Correction of Retrognathism or Prognathism 560 Correction of Retrognathism or

Prognathism679

Temporomandibular Joint Procedures 561 Temporomandibular Joint Procedures 682CHAPTER 16PLASTIC AND RECONSTRUCTIVE SURGERY

CHAPTER 19PLASTIC AND RECONSTRUCTIVE SURGERY

ANATOMY 567 ANATOMY 685Skin and Underlying Structures 567 Skin and Underlying Structures 685Palate 568 Palate 687Nose 570 Nose 687Hand 570 Hand 687Breast 575 Breast 694SURGICAL PATHOLOGY 575 SURGICAL PATHOLOGY 694Pathology Affecting the Skin 575 Pathology Affecting the Skin 694Cleft Lip and Palate 577 Cleft Lip and Palate 696Pathology Affecting the Hand 578 Pathology Affecting the Hand 697Pathology Affecting the Breast 581 Pathology Affecting the Breast 701DIAGNOSTIC PROCEDURES AND TESTS

582 DIAGNOSTIC PROCEDURES AND TESTS

701

SPECIAL INSTRUMENTATION, SUPPLIES, DRUGS, AND EQUIPMENT

582 SPECIAL INSTRUMENTATION, SUPPLIES, DRUGS, AND EQUIPMENT

701

Nasal Set 582 Nasal Set 701Dermatome 583 Dermatome 702Mesh Graft Device Mesh Graft Device 704SURGICAL INTERVENTION 584 SURGICAL INTERVENTION 704Rhytidectomy 584 Rhytidectomy 704Blepharoplasy 586 Blepharoplasy 706Suction Lipectomy 587 Suction Lipectomy 707Abdominoplasy 588 Abdominoplasy 708Skin Grafts 589 Skin Grafts 709Cheiloplasty and Palatoplasy 592 Cheiloplasty and Palatoplasy 713Rhinoplasty 593 Rhinoplasty 714Hand Surgery 595 Hand Surgery 716Mammoplasty 602 Mammoplasty 723

NEW Dermabrasion 713NEW Scar Revision 713

CHAPTER 17GENITOURNARY SURGERY

CHAPTER 20GENITOURNARY SURGERY

ANATOMY 611 ANATOMY 732Suprarenal (Adrenal) Glands 611 Suprarenal Glands 732Kidneys 611 Kidneys 732Ureters 614 Ureters 735Urinary Bladder 615 Urinary Bladder 736Male Reproductive System 615 Male Reproductive System 737PATHOLOGY AFFECTING THE ADRENAL GLANDS

617 PATHOLOGY AFFECTING THE ADRENAL GLANDS

739

Cushing’s Syndrome 617 Cushing’s Syndrome 739Adrenal Insufficiency (Addison’s Disease) 617 Adrenal Insufficiency (Addison’s Disease) 739Pheochromocytoma 618 Pheochromocytoma 739

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PATHOLOGY AFFECTING THE URINARY SYSTEM

618 PATHOLOGY AFFECTING THE URINARY SYSTEM

739

Bladder Tumors 618 Bladder Tumors 739Urinary Calculi 618 Urinary Calculi 740Kidney Disorders 619 Kidney Disorders 740PATHOLOGY AFFECTING THE MALE REPRODUCTIVE SYSTEM

621 PATHOLOGY AFFECTING THE MALE REPRODUCTIVE SYSTEM

743

Phimosis 621 Phimosis 743Hypospadias/Epispadias 621 Hypospadias/Epispadias 743Benign Prostatic Hyperplasia 622 Benign Prostatic Hypertrophy 743Cancer of the Prostate 622 Cancer of the Prostate 744Cryptorchidism 622 Cryptorchidism 744Testicular Torsion 622 Testicular Torsion 744Testicular Cancer 622 Testicular Cancer 744Trauma to the Genitourinary System 623 Trauma to the Genitourinary System 745DIAGNOSTIC PROCEDURES/TESTS 623 DIAGNOSTIC PROCEDURES/TESTS 745History and Physical 623 History and Physical 745Laboratory Findings 623 Laboratory Findings 745Radiological Findings 629 Radiological Findings 751Biopsy 630 Biopsy 751Endoscopy 630 Endoscopy 751SPECIAL EQUIPMENT, INSTRUMENTS, SUPPLIES, DRUGS

631 SPECIAL EQUIPMENT, INSTRUMENTS, SUPPLIES, DRUGS

751

PREOPERATIVE AND INTRAOPERATIVE PREPARATION

632 PREOPERATIVE AND INTRAOPERATIVE PREPARATION

752

Incisional Options 633 Incisional Options 754SURGICAL PROCEDURES 635 SURGICAL PROCEDURES 757Adrenalectomy 636 Adrenalectomy 757Nephrectomy 637 Nephrectomy 757Renal Transplant 641 Renal Transplant 762Stone Removal 642 Stone Removal 763Cystostomy 643 Cystostomy 764Cystectomy/Ileal Conduit 645 Cystectomy/Ileal Conduit 766Procedures for Stress Incontinence Affecting Women

650 Procedures for Stress Incontinence Affecting Women

771

Transurethral Endoscopy of the Genitourinary Tract

653 Transurethral Endoscopy of the Genitourinary Tract

774

Circumcision 655 Circumcision 776Orchiectomy 657 Orchiectomy 778Orchiopexy 657 Orchiopexy 778Vasectomy 660 Vasectomy 783Vasovasostomy 660 Vasovasostomy 784Prostatectomy 660 Prostatectomy 784

NEW Hydrocelectomy 781NEW Varicocelectomy 781NEW Hypospadias Repair 782NEW Insertion of Inflatable Penile Prosthesis

782

CHAPTER 18 ORTHOPEDIC SURGERY

CHAPTER 21ORTHOPEDIC SURGERY

BONE AND BONE TISSUE 669 BONE AND BONE TISSUE 792Bone Tissue 670 Bone Tissue 792Types of Bones 671 Types of Bones 794Types of Joints 672 Types of Joints 794

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Bone Growth and Bone Cells 673 Bone Growth and Bone Cells 797Intramembranous Bones 674 Intramembranous Bones 798Endochondral Bone 674 Endochondral Bone 798Mineral Storage 674 Mineral Storage 798Factors That Affect Bone Growth 675 Factors That Affect Bone Growth 798Clinical and Bone Landmark Terms 675 Clinical and Bone Landmark Terms 798PATHOLOGY 676 PATHOLOGY 798Types of Fractures 676 Types of Fractures 805Normal Bone Healing 676 Normal Bone Healing 805Pathological Bone Healing 682 Pathological Bone Healing 806Diagnostic Terms and Procedures 684 Diagnostic Terms and Procedures 808THE SKELETON 685 THE SKELETON 808The Skull 685 The Skull 808Vertebral Column 688 Vertebral Column 811Bones of the Thoracic Region 689 Bones of the Thoracic Region 812Clavicles 689 Clavicles 812Scapula 689 Scapula 812Pectoral Girdle 689 Pectoral Girdle 812Humerus 690 Humerus 812Radius and Ulna 690 Radius and Ulna 813Hand and Wrist 690 Hand and Wrist 814Pelvis 691 Pelvis 814Hip and Femur 692 Hip and Femur 814Tibia and Fibula 692 Tibia and Fibula 814Ankle and Foot 694 Ankle and Foot 816EQUIPMENT 695 EQUIPMENT 818Positioning Devices 695 Positioning Devices 818Pneumatic Tourniquets 696 Pneumatic Tourniquets 819Traction 696 Traction 819Lasers 696 Lasers 819Radiography 696 Radiography 819Air Flow 696 Air Flow 820Continuous Passive Range-of-Motion Machines (CPM)

696 Continuous Passive Range-of-Motion Machines

820

Transcutaneous Electrical Nerve Stimulation (TENS)

696 Transcutaneous Electrical Nerve Stimulation

820

Electrical Stimulation of Bone 697 Electrical Stimulation of Bone 820Saws, Drills, and Reamers 697 Saws, Drills, and Reamers 820Arthroscopic Equipment 697 Arthroscopic Equipment 820SUPPLIES 697 SUPPLIES 821Implants 697 Implants 821Suture 698 Suture 821Polymethyl Methacrylate (PMMA) 698 Methyl Methacrylate 821Pharmacology 698 Pharmacology 821PROCEDURES 699 PROCEDURES 822Bone Grafting 699 Bone Grafting 822Knee Arthroscopy 700 Knee Arthroscopy 824Arthroscopic Repair of Meniscal Tear 703 Arthroscopic Repair of Meniscal Tear 827Endoscopic Carpal Tunnel Release 706 Endoscopic Carpal Tunnel Release 832Colle’s Fracture 709 Colle’s Fracture 835Open Reduction-Internal Fixation (ORIF) of the Humerus

713 Open Reduction-Internal Fixation (ORIF) of the Humerus

842

Repair of the Rotator Cuff 716 Repair of the Rotator Cuff 846

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Total Hip Arthroplasty 720 Total Hip Arthroplasty 852NEW Arthroscopic Anterior Cruciate Ligament Repair

830

NEW Above-the-Knee Amputation 832NEW Metacarpal Phalangeal Joint Arthroplasty

840

NEW Triple Arthrodesis 840NEW Achilles Tendon Repair 841NEW Bunionectomy 842NEW Shoulder Joint Arthroscopy 845NEW Acromioplasty 846NEW Internal Fixation of Femoral Shaft Fracture

851

NEW Total Hip Arthroplasty 853NEW Total Knee Arthroplasty 859

CHAPTER 19CARDIOTHORACIC SURGERY

CHAPTER 22CARDIOTHORACIC SURGERY

ANATOMY OF THE CHEST 729 ANATOMY OF THE CHEST 864The Thorax 729 The Thorax 864The Trachea 730 The Trachea 866The Bronchial Tree 730 The Bronchial Tree 866The Lungs 731 The Lungs 867ANATOMY AND PHYSIOLOGY OF THE HEART

732 ANATOMY AND PHYSIOLOGY OF THE HEART

868

Location of the Heart 733 Location of the Heart 868Coverings of the Heart 733 Coverings of the Heart 869The Heart Wall 733 The Heart Wall 869The Heart Chambers 733 The Heart Chambers 869The Heart Valves 733 The Heart Valves 869Blood Flow Through the Heart 735 Blood Flow Through the Heart 870Blood Supply for the Heart 735 Blood Supply for the Heart 871The Cardiac Cycle 735 The Cardiac Cycle 871Cardiac Output 736 Cardiac Output 872Cardiac Conduction 736 Cardiac Conduction 872Anatomical Development of the Heart 736 Anatomical Development of the Heart 872OPERATIVE PATHOLOGY 738 OPERATIVE PATHOLOGY 873The Chest Wall 738 The Chest Wall 873The Mediastinum 739 The Mediastinum 873The Lungs 739 The Lungs 874Thoracic Trauma 739 Thoracic Trauma 875Thoracic Outlet Syndrome 741 Thoracic Outlet Syndrome 877Thoracic Aortic Aneurysm 741 Thoracic Aortic Aneurysm 877Coronary Artery Disease 742 Coronary Artery Disease 879Valvular Disease 745 Valvular Disease 881Cardiomyopathy 746 Cardiomyopathy 882Cardiac Dysrythmias 746 Cardiac Dysrythmias 882Congenital Heart Defects 748 Congenital Heart Defects 884DIAGNOSTIC PROCEDURES: THORAX 750 DIAGNOSTIC PROCEDURES: THORAX 887Bronchoscopy 750 Bronchoscopy 887Mediastinoscopy 751 Mediastinoscopy 887Thoracoscopy 751 Thoracoscopy 887Thoracentesis 751 Thoracentesis 889DIAGNOSTIC PROCEDURES: 751 DIAGNOSTIC PROCEDURES: 889

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CARDIAC CARDIACRadiological Studies 753 Radiological Studies 889SURGICAL INTERVENTION: THORACIC

753 SURGICAL INTERVENTION: THORACIC

889

Special Preoperative Considerations 753 Special Preoperative Considerations 889Special Instrumentation, Supplies, Drugs, and Equipment

753 Special Instrumentation, Supplies, Drugs, and Equipment

889

Patient Preparation 754 Patient Preparation 890Thoracoscopy 755 Thoracoscopy 892Scalene/Supraclavicular Node Biopsy 758 Scalene/Supraclavicular Node Biopsy 895Thoracotomy for Upper Lobectomy 758 Thoracotomy for Upper Lobectomy 895Thoracotomy for Right Pneuonectomy 762 Thoracotomy for Right Pneuonectomy 899Thoracotomy for Wedge Resection or Segmentectomy

762 Thoracotomy for Wedge Resection or Segmentectomy

899

Decortication of Lung 762 Decortication of Lung 899SURGICAL INTERVENTION: CARDIAC (ADULT)

763 SURGICAL INTERVENTION: CARDIAC (ADULT)

900

Preoperative Considerations 763 Preoperative Considerations 900Patient Preparation 764 Patient Preparation 901Techniques of Cardiopulmonary Bypass (CPB)

765 Techniques of Cardiopulmonary Bypass 901

Mechanical Circulatory Assistance 767 Mechanical Circulatory Assistance 904Coronary Artery Bypass Grafting (CABG) 769 Coronary Artery Bypass Grafting 905Aortic Valve Replacement 774 Aortic Valve Replacement 911Mitral Valve Replacement 778 Mitral Valve Replacement 916Thoracic Aortic Aneurysmectomy (TAA) 779 Thoracic Aortic Aneurysmectomy 917Pericardictomy/Pericardial Window 781 Pericardictomy/Pericardial Window 918Heart Transplantation 781 Heart Transplantation 919Permanent Pacemaker Insertion 782 Permanent Pacemaker Insertion 920Percutaneous Transluminal Coronary Angioplasty (PTCA)

783 Percutaneous Transluminal Coronary Angioplasty

921

SURGICAL INTERVENTION: CARDIAC (PEDIATRIC)

784 SURGICAL INTERVENTION: CARDIAC (PEDIATRIC)

921

Special Preoperative Preparation 784 Special Preoperative Preparation 922Atrial Septal Defect 784 Atrial Septal Defect 922Ventricular Septal Defect 785 Ventricular Septal Defect 922Patent Ductus Arteriosus 785 Patent Ductus Arteriosus 923Correction of Aortic Coarctation 785 Correction of Aortic Coarctation 924Procedure for Correction of Tetralogy of Fallot

787 Procedure for Correction of Tetralogy of Fallot

924

Procedure for Correction of Transposition of the Great Arteries

787 Procedure for Correction of Transposition of the Great Arteries

925

CHAPTER 20PERIPHERAL VASCULAR SURGERY

CHAPTER 23PERIPHERAL VASCULAR SURGERY

PERIPHERAL VASCULAR SURGERY 790 PERIPHERAL VASCULAR SURGERY 928SURGICAL ANATOMY 790 SURGICAL ANATOMY 928Blood Vessels 790 Blood Vessels 928Blood Pressure 791 Blood Pressure 930The Arterial System 793 The Arterial System 931The Venous System 795 The Venous System 933OPERATIVE PATHOLOGY AND DIAGNOSIS

796 OPERATIVE PATHOLOGY AND DIAGNOSIS

934

Arterial Embolism 796 Arterial Embolism 935Arteriosclerosis Obliterans 797 Arteriosclerosis Obliterans 935

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Aneurysms of the Abdominal Aorta 797 Aneurysms of the Abdominal Aorta 936SURGICAL INTERVENTIONS 799 SURGICAL INTERVENTIONS 937Peripheral Vessel Angioplasty 799 Peripheral Vessel Angioplasty 937Bypass Grafting and Endarterectomy 800 Bypass Grafting and Endarterectomy 939Features of Peripheral Vascular Procedure 802 Features of Peripheral Vascular Procedure 940Aortofemoral Bypass 803 Aortofemoral Bypass 943Abdominal Aortic Aneurysmectomy 806 Abdominal Aortic Aneurysmectomy 947Femoropopliteal Bypass 810 Femoropopliteal Bypass 950Femorofemoral Bypass 813 Femorofemoral Bypass 954Axillofemoral Bypass 815 Axillofemoral Bypass 956Carotid Endarterectomy 818 Carotid Endarterectomy 959CHAPTER 21NEUROSURGERY

CHAPTER 24NEUROSURGERY

SURGICAL ANATOMY 825 SURGICAL ANATOMY 966Divisions of the Nervous System 825 Divisions of the Nervous System 966Cranium 825 Cranium 966Vertebral Column 831 Vertebral Column 973Blood Supply 833 Blood Supply 974Cranial Nerves 833 Cranial Nerves 974Spinal Nerves 833 Spinal Nerves 974NEUROSURGICAL PATHOLOGY 834 NEUROSURGICAL PATHOLOGY 976Cervical Spine 835 Cervical Spine 976Thoracic Spine 836 Thoracic Spine 977Lumbar Spine 836 Lumbar Spine 978Neoplasms 837 Neoplasms 979Head Injury 838 Head Injury 980Spinal Cord Injury 840 Spinal Cord Injury 982Cerebrovascular Disease 840 Cerebrovascular Disease 982Congenital Abnormalities 841 Congenital Abnormalities 983INFECTION 842 INFECTION 984Abscess 842 Abscess 984Spinal Tumors 843 Spinal Tumors 985Peripheral Nerve Disorders 843 Peripheral Nerve Disorders 985NEUROSURGICAL PROCEDURES 844 NEUROSURGICAL PROCEDURES 986Special Instrumentation, Supplies, Drugs, and Equipment

844 Special Instrumentation, Supplies, Drugs, and Equipment

986

Patient Preparation 848 Patient Preparation 990Craniotomy 849 Craniotomy 991Craniectomy 858 Craniectomy 1001Ventriculoperitoneal and Ventriculoatrial Shunt

862 Ventriculoperitoneal and Ventriculoatrial Shunt

1005

Transphenoidal Hypophysectomy 865 Transphenoidal Hypophysectomy 1008Stereotactic Procedure 868 Stereotactic Procedure 1011Cranioplasty 869 Cranioplasty 1012Spinal Procedures 869 Spinal Procedures 1012Peripheral Nerve Procedure 876 Peripheral Nerve Procedure 1020

NEW ADVANCES IN NEUROSURGERY 1022NEW Intraoperative MRI 1022NEW Three-Dimensional Reconstruction 1022NEW Radiosurgery 1022NEW Minimall Invasive Techniques 1022NEW Stereotaxis 1022NEW Intraoperative Ultrasound 1023

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NEW Brain Mapping 1023NEW Endoscopic Neurosrgery 1023NEW Deep Brain Stimulation 1023

APPENDIX A: COMMON PREFIXES AND SUFFIXES

881 APPENDIX B: COMMON PREFIXES AND SUFFIXES

1036

APPENDIX B: MEASUREMENTS 884 APPENDIX C: MEASUREMENTS 1039INDEX 886 Not Ready

NEW APPENDIX A: ANATOMY PLATES

1025

NEW CHAPTERSCHAPTER 2STANDARDS OF CONDUCTLEGAL ISSUES 23Definitions of General Legal Terms 23Definitions of Traditional Principles 24Torts 25Consent for Surgery: A Basic Right 27Documentation 29Event/Incident Reports 30Advance Directives 30ETHICAL AND MORAL ISSUES 30Moral Principles 31Bioethics 31AHA Patient’s Bill of Rights 31Elements of Ethical Decision Making 32Professional Codes of Conduct 34Surgical Conscience 34SCOPE OF PRACTICE 34Job Descriptions and Competencies 35Credentialing 36Accreditation 36Core Curricula for Surgical Technology and Surgical Assisting

36

Career Development 36Clinical Ladder Program 37RISK MANAGEMENT AND LIABILITY 38Medical Errors 38Safe Medical Device Act 39Malpractice Insurance 39CHAPTER 4SPECIAL POPULATIONSINTRODUCTION 57PEDIATRIC PATIENTS 57Monitoring the Pediatric Patient 59Shock 60Fluids and Electrolytes 60Infection 61Metabolic and Nutritional Responses 61Trauma 61PATIENTS WITH OBESITY 62Review of Surgical Considerations 64

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Specific Considerations of Bariatric Surgery 64PATIENTS WITH DIABETES 64Complications Associated with Diabetes 65Care of the Patient with Diabetes in Surgery 66PREGNANT PATIENTS 66Considerations when Caring for Pregnant Patients

67

Anesthesia 67Intraoperative Considerations for the Surgical Technologist

67

IMMUNOCOMPROMISED PATIENTS 68Acquired Immunodeficiency Syndrome 68Considerations for the Surgical Team Members

68

PATIENTS WITH DISABILITIES 69GERIATRIC PATIENTS 69TRAUMA PATIENTS 71THE “GOLDEN HOUR” AND TRAUMA PATIENTS

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KINEMATICS 71Blunt Trauma 71Penetrating Trauma 72TRAUMA SCORING 72CONSIDERATIONS FOR THE SURGICAL TECHNOLOGIST

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Preservation of Evidence 72Hypothermia 73Infection 73PREPARATION OF THE CASE 73CHAPTER 6BIOMEDICAL SCIENCEINTRODUCTION 99COMPUTERS 99Surgical Applications 99Hardware 100Software 103Word Processing 104Graphics 105Internet Basics 106ELECTRICITY 107Surgical Applications 107Basic Principles of Electricity 108PHYSICS 112Medical and Surgical Applications 112Mechanics 113Nuclear Physics 122Gravity 122SURGICAL ROBOTS 122Terminology 123Design 123Remote Manipulation 124Geometry 124Hearing and Vision 125

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Decontamination and Sterilization of Robotic Components

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Clinical Applications 125THE OR OF THE FUTURE 125Surgical Planning and Rehearsal 125Surface-Based Registration 126ROLE OF THE SURGICAL TECHNOLOGIST

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