Intraoperative Surgical Procedures Flashcards

The surgical first assistant notices a sponge count discrepancy at wound closure. The most appropriate action is to:

Answer: Inform the surgeon immediately, halt closure, and search the wound and field before closing

A retained surgical item is a sentinel event; closure must be halted and a thorough search conducted before the wound is closed.

During a spinal fusion procedure, the surgical first assistant is asked to apply bone wax. Its primary purpose is:

Answer: Mechanical hemostasis of bleeding cancellous bone surfaces

Bone wax physically occludes the haversian canals of cancellous bone to mechanically control bleeding from cut bony surfaces.

During a cesarean section, the surgical first assistant assists with uterine closure. Which suture configuration is most commonly used for the uterine incision?

Answer: Two-layer closure with running absorbable suture

A two-layer running absorbable closure of the uterine incision provides secure hemostasis and reduces the risk of uterine rupture in future pregnancies.

When a laparoscopic trocar is inadvertently placed into a major abdominal vessel, the surgical first assistant's first priority is:

Answer: Leave the trocar in place to tamponade the vessel and call for immediate open conversion assistance

Removing a trocar from a vessel removes the tamponade effect and causes uncontrolled hemorrhage; leaving it in buys time for emergency conversion.

During orthopedic surgery, pulsatile lavage irrigation is used primarily to:

Answer: Mechanically debride and reduce bacterial counts in the surgical site

Pulsatile lavage uses pressurized fluid to mechanically dislodge debris, necrotic tissue, and bacteria from the wound.

The surgical first assistant is managing a Bookwalter retractor system. To prevent neuropraxia, which precaution is essential?

Answer: Ensure blades are not pressing on peripheral nerves, especially the femoral nerve in pelvic cases

Rigid retractor blades can compress the femoral nerve at the psoas margin in pelvic surgery, causing postoperative neuropraxia if not carefully positioned.

When assisting with a skin graft harvest using a dermatome, the surgical first assistant should apply counter-traction by:

Answer: Stretching the skin taut ahead of the advancing dermatome blade with a tongue depressor or gloved hand

Adequate counter-traction ahead of the dermatome blade keeps the skin taut, ensuring a uniform, consistent split-thickness graft.