How to Help in the OR

2 minute read

Introduction

The OR is a foreign place for many medical students on their surgery clerkship. Coupling this with the whirlwind nature of the OR and the student’s desire to help the team, it can lead to a lot of stress. The following is a list of things that students can help with before the patient arrives, the time the patient arrives to the start of the case, during the case, and after the case is over.

Before the case

  • Ideally the student would arrive 5-15 minutes before the patient arrives.
  • Introduce yourself to the circulating nurse and/or scrub tech.
  • Open your gown and gloves. The circulating RN may offer to open these for you.
  • Pull up imaging if needed for the case. Pulling up imaging is never a bad thing, even if it turns out to not be needed.

Time from patient arrival to start of the case

This is a fast-moving time where a lot of people are working and a lot of things are going on. This is an ideal place for a student to help, but it’s hard to learn the work flow and not feel like you are in the way. The following is a rough order of operations of the tasks that are completed during this time. No one person completes all of these tasks, but if you can do a couple of them it goes a long way towards helping the team.

  • Patient arrives
  • RN will ask the patient questions so usually nothing is done at this time.
  • Offer the patient a warm blanket
  • Anesthesia monitoring equipment is attached
  • SCD compression stockings are applied.
  • Arm boards attached to the bed
  • Anesthesia does pre-induction timeout so nothing is done at this time
  • Someone needs to stand on the patients right side during this time in case anesthesia needs assistance. Often this is RN but if comfortable you can take this spot unless otherwise told.
  • anesthesia will pre-oxygenate the patient. They may request you hold the mask.
  • Anesthesia attending will push sleep medicine and muscle relaxants
  • ET tube is placed on the patient’s chest.
  • Anesthesia looks for coords
  • hold the ET tube by the patient’s head so anesthesia can grab it without taking their eyes away
  • Shaving
  • Procedure specific positioning (watch if unsure, then help the next time)
  • The nurse will prep the patient. Make sure to treat the prepped area like a sterile field even though it has no blue drapes on it.
  • You should likely be already scrubbing at this time so you can try to be the first to gown and glove as to not slow down the resident and attending.

During the case

  • Do not act as a middle-man between the tech and the resident/attending when instruments are being passed unless asked directly. This can be dangerous, especially with sharp instruments.
  • Adjust lights as needed
  • Suction fluid or smoke
  • Hold retractors
  • Try to pay attention
  • Procedure specific items
  • Hopefully suture at the end!
  • Help apply bandages and dressings at the end of the case

After the case

  • Stand near anesthesia in case they need help with extubation
  • Ask anesthesia about removing monitoring equipment
  • Help transfer patient to cart
  • Give pt a warm blanket
  • Go with patient to PACU unless told otherwise
  • Rarely, a surgery resident may ask you to pass off to the PACU RN. Pay attention to this handoff so you can repeat similar information if you have to pass off

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