Discussion in 'Clinical Rotations' started by dust, Jul 3, 2006.
Anyone know a good website or something to quickly get a handle on the various surgical instruments?
The only one you need to know is Richardson.
Just watch and learn when you scrub in. The common ones are of course the richardson, all the pickups, army-navy, sweetheart retractors, right angle clamps, etc. You'll get to know them well since you'll probably be the one holding them for an hour plus on each case. haha
It's not designed for education, and the pictures are a little small, but vendors' sites like this one can be helpful for learning the names of various instruments:
I think there's a chapter in Surgical Recall with that stuff in it.
First, "tweezer" is no longer a word in your vocabulary. Throw it out. Burn it out of your mind.
The only thing missing is the Kelly clamp
The two golden rules of surgery that's not in any Surgery Recall book.
Never Never touch anything on the Mayo stand w/o the scrub nurse's permission. As you do more surgeries with the same OR staff, they will learn to trust you more (aka your hands won't be flying around contaminating everything) they will ease up and let you do more stuff.
Learn how to correctly cut with the suture scissor. For some strange reason, med students forget basic skills while scrubbed in.
Additional advice: learn how to open and close those various instruments with the lock on the handles with one hand (i.e., hemostat, Kelly, etc). The last thing you want to do is yank and struggle to open the hemostat while it is clamped onto a blood vessel and the attending or resident is trying to tie it off.
Acutally, page 5 of surgical recall 4th edition:
"Never touch or take instruments from the mayo tray unless explicitly given permission to do so."
"can I grab things off the mayo tray?" "No. Ask the scrub nurse/tech."
You also will find out that different surgeons use varying names for each of the instruments, sometimes to the point of calling them the wrong name altogether. There are surgeons that call hemostats mosquitoes and kellys hemostats, but when they ask for a kelly, they seem satisfied when they get a "hemostat". Some instruments really do have multiple names, like Parkers/Goulets, Right Angles/Army-Navys, Malleables/Ribbons, the list goes on. Forceps can also be called fingers. It very much depends on who is talking about what.
Yep. Heres another peanuts = Kitners. Where I work, mosquitoes are small hemostats...usually used by ENTs.
Peanuts also = pushers, but to others, spongesticks = pushers. Schnidt = tonsil clamp = long hemostat = half-right angle. LOL, we could go on and on with this.
that's all you need. you'll learn some of the basic intsruments after the first few surgeries.
When I was a medical student and president of the Student Surgical Society, we made our own PowerPoint presentation of the most common surgical instruments, how to handle them and their common uses. With the help of one of the scrub nurses, we photographed things like major lap tray, minor procedure tray, plastics tray with each instrument named it's use.
If you can enlist of a scrub nurse or a surgical technician (equally nice at my medical school) you might be able to take your digital camera and get what you need. Otherwise, consult the book "Basic Surgical Technique" which has a pretty good listing of different instruments and their uses.
That's a great idea. Mind if I steal it?
Know what a kocher is
Know how to hold an army/navy
Never cut suture with the metz
That will get your through a surgical rotation without getting yelled at.
To impress you need to pay attention.
Oh...and dont eat Junior Mints while scrubbed in.
"Who's going to turn down a Junior Mint? It's chocolate, it's peppermint, it's delicious. It's very refreshing."
Yeah, I remember not knowing what a "Coker" or "Alice" was, and couldn't find them in a book. If I knew they were really a Kocher and Allis, that would have helped
Unless you're doing vascular and they like the metz for ligating those tiny branches. Damn vascular surgeons.
Just get to know the Yankauer intimately....
And if you are on the Ortho Joint service.... Your hands will spend more time with the Hohmann than with your wife/girlfriend.
Don't use the frasier suction with your finger over the hole around arteries or veins; it can damage the "wessel".
I did pick up a book with pictures and short descriptions of the surgical instruments but I am just about to start my surgical rotations so I'm in the same boat as you. I found the book in the Nursing section. The name of it is Surgical Instruments 3rd edition it's spiral bound. The last name of the author is Wells. Hope this helps!
Before a procedure began, my resident asked me if I knew the names of the instruments, and then he walked me through all of it. Was really cool.
IMHO, if you make a post like this, you should offer the ppt.
Recall is good for this.
I can put together a graphic of some kind if you guys can't figure it out though.
I've seen a few books out there. This is a good place, pretty much the basic instruments and you can quiz yourself as well. And better yet, doesn't cost anything...
Well, the upside. I've learned quite a few of the instruments... The downside, wow the scrub nurse gets pissed when you reach onto her mayo stand! Just a little pearl.
"A little pearl?" It's rule #1! If you learn nothing else in surgery, you should learn that.
Rule #1: Never touch the Mayo stand without asking first
Rule #2: If you're sterile, only touch sterile objects
Rule #3: If you're unsterile, only touch unsterile objects
What is the reason behind that, just wondering. Why is it so wrong to grab things from the Mayo stand?
That's the domain of the scrub tech. He/she is constantly trying to make sure you're not contaminating anything, least of all the instruments! So it's just better to ask before you touch it.
As Blade28 pointed out, you may contaminate it. (They're usually more lenient about letting residents and, of course, attendings, touch the Mayo stand without asking.)
I was also told that it makes it hard for the scrub tech to keep track of which instrument is where when multiple people are taking things off the stand.
Yup, that too.
This is especially problematic during big, open abdomen cases when there is the constant fear of leaving something in the abdomen.
One of the scrubs would let me get stuff off the Mayo for myself during laparoscopic cases. The first time he said I could grab something for myself I think I stood there contemplating whether I actually should (with my hand hovering over the Mayo) before I actually grabbed it!!!
Ah, it was like a trick question!
Sort of like when the residents used to tell us (as med students), "There's nothing else going on now, you guys can go home if you want."
And we'd stand there, internally debating - Does this really mean I'm free to go home? Or is it some sort of test, where if I leave they'll give me a bad grade?
I was afraid it was! But he meant it and didn't yell at me!!!
Yes, I know that feeling. I decided that my rule was that if I wanted to go home, I had to be told 2-3 times to go home. I figure if they repeat themselves, they mean it! My other trick is that I ask, "Is there anything I can do?" which gives me a chance to help get them in shape for signout AND calls attention to the fact that a) I'm still there and b) I'm done with my work. Honestly, I don't mind staying and helping with whatever needs to be done, especially if it means I can help get the whole team out on time.
That's prudent thinking!
That's the other game that gets played almost every afternoon:
Student (looking at the clock, noticing it's 5 pm, and realizing that he hasn't studied a single bit that day): "Hey, John, is there anything I can do to help you?"
Resident (also noticing it's 5 pm, but still having a pile of charts to dictate): "Nah, Steve, nothing much going on here, I'm just finishing up paperwork."
Student (seeing an opportunity to leave, starting to become tachycardic, but still worrying about being labelled as "lazy" or "not a team player"): "Oh, are you sure? I'm always happy to help!"
Resident (knowing what the student's thinking, feeling bitter about leaving the hospital late again but knowing that there's not much left for the student to do): "Nah, it's OK. You can stay if you're interested and want to see what I'm doing, but it's probably more educational for you to go home and study."
Student (now freaking out because he's worried that leaving will be portrayed as "not being interested"): "Well, I'm always willing to learn! I can stay, it's OK."
Resident (by now figuring out that the student is only torn between staying or leaving because of grade concerns): "Don't worry, dude. It's OK to go home, you did a good job today."
Student (relieved): "Thanks. See you tomorrow!"
Then one of two options:
Mean resident (watching student leave, thinking to himself): Lazy med student. I'm going to give him a C for the rotation.
Nice resident (watching student leave, thinking to himself): What a good med student! He's a hard worker and a team player.
God I hate mean residents
Don't learn the names! Learning the names of these instruments replaces any and all medical knowledge learned previously!
I kid, I kid..........
well may be true, my glass is getting pretty full, hope everything doesn't just spill onto the floor
Separate names with a comma.