Introduction to the Operating Room 1st Edition

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 From Amalia:
To my Mom for teaching me how to be a teacher and for fostering my
curiosity.
To Danny Custer for showing me how to be a kind, successful, and happy
surgeon.
To my learners for inspiring me every time you have a “Gee Whiz”
moment.

From Ruth:
To my husband Michael, who encouraged me to go to nursing school
(despite my fear of blood) and supported me through everything that
followed it.
For Brandon, Mindy, and Nick for reminding me that life is precious.
To everyone who continues to take a chance on me—thank you.
Contents

Our OR Team
Preface

SECTION 1: Pre-Op (Before the OR)

A. Know Before You Go
1. The Operating Room as a Study in Cultural Anthropology
Amalia Cochran, MD, FACS, FCCM

2. From Start to Finish: Understanding How We Get Here

Ruth Braga, MSN, RN

3. The Myth of the Kind Surgeon

Thomas K. Varghese Jr., MD, MS, FACS

4. Who Are These People?

4A. The Anesthesiologist
Christopher J. Behrens, MD
4B. The Nurse Anesthetist
Clive Thirkill, MSN, CRNA
4C. From Medical Student to Surgeon
Brian J. Gavitt, MD, MPH
4D. The Role of the Resident in the Operating Room
 Lara Senekjian, MD, MAT
4E. How to Be a Superstar Medical Student in the Operating
Room
Madeline B. Torres, MD
4F. The Operating Room: View from a Physician Assistant
Crystal D. Webb, PA-C37
4G. The OR Staff
Karen Porter, BSN, RN
4H. The Perfusionist
Jennie O’Shea, BS, CCP
5. Teamwork and Communication in the Operating Room
Louise Hull, PhD and Nick Sevdalis, PhD

B. And Now For Something Completely Different

6. The OR and Humor
Ruth Braga, MSN, RN

7. Personalities in the Operating Room

Ross M. Blagg, MD

8. 2015 Grammy Awards Category: Music in the Operating Room

Winner: Marie Crandall, MD, MPH, FACS

SECTION 2: Intraop (In the OR)

9. Welcome to the Jungle: The Five Senses of the Operating Room
Elizabeth Hanes, BSN, RN

10. Robots and Ring Stands

10A. Operating Room Equipment From A To Z
Diane Tyler, MSN, RN and Ruth Braga, MSN, RN
10B. Robot Basics: The Nurse’s Perspective
 Sebrena Banecker, RN, BSN, CNOR
10C. My Robot Experience, or How Surgeons Learn New
Techniques
Walter Medlin, MD, FACS
11. Dancing Around the Room
Ruth Braga, MSN, RN
12. The OR and The Surgical Field
Karen Porter, BSN, RN
13. Lines and Tubes: What Are All of Those Things Sticking Out of
the Patient’s Body?
Halle Kogan BSN, RN, CCRN and Thaona D. Garber, RN
14. Positioning the Patient
Karen Porter, BSN, RN
15. Patient Safety in the OR
Jon Worthen, MSN, RN, CNOR
16. Distractions and Interruptions in the Operating Room
Nick Sevdalis, PhD and Louise Hull, PhD
17. A View into the Operating Room
Ruth Braga, MSN, RN
And Now For More Entertainment…
18. Notes from Your Attending
Lawrence A. Shirley, MD and Christian Jones, MD, FACS
19. Tomfoolery, Shenanigans, and Hazing in Surgery
Luke V. Selby, MD

SECTION 3: Post-Op (After the OR)

20. Privacy—Keep It To Yourself
 Ruth Braga, MSN, RN
21. Keep Calm and Trust the Count
Cynthia Howard, RN, CNC, PhD
22. A Brief Post-Op Note
Amalia Cochran, MD, FACS, FCCM

APPENDIX
Quick Guide—Answers to the “What Ifs of the OR”…. in 100
Words or Less
Amalia Cochran, MD, FACS, FCCM; Ruth Braga, MSN, RN;
Karen Porter, BSN, RN; and Jon Worthen, MSN, RN, CNOR

Index
Our OR Team

Editors
Ruth Braga, MSN, RN
Department of Surgery
University of Utah
Salt Lake City, Utah
@RuthBragaMSN

Amalia Cochran, MD, FACS, FCCM

Department of Surgery
University of Utah
Salt Lake City, Utah
@AmaliaCochranMD

Contributors
Sebrena Banecker, RN, BSN, CNOR
Clinical Nurse Coordinator—Operating Room
Huntsman Cancer Institute
Salt Lake City, Utah

Christopher J. Behrens, MD
Department of Anesthesiology
University of Utah
Salt Lake City, Utah

Ross M. Blagg, MD
Division of Plastic Surgery
University of Utah
Salt Lake City, Utah

Marie Crandall, MD, MPH, FACS

Department of Surgery
University of Florida
Jacksonville, Florida
@vegansurgeon

Thaona D. Garber, RN
Burn Trauma Intensive Care Unit
University of Utah
Salt Lake City, Utah

Brian J. Gavitt, MD, MPH

Division of Trauma Surgery
LA County + USC Medical Center
Los Angeles, California

Elizabeth Hanes, BSN, RN

Inkslinger Communications, LLC
Houston, Texas
@EHanesRN

Cynthia Howard, RN, CNC, PhD

Vibrant Radiant Health, LLC
Santa Barbara, California
@masterwellbeing

Louise Hull, PhD

Center for Implementation Science
Kings College
London, UK

Christian Jones, MD, FACS

Division of Acute Care Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland
@jonesssurgery

Halle Kogan, BSN, RN, CCRN

Burn Trauma Intensive Care Unit
University of Utah
Salt Lake City, Utah

Walter Medlin, MD, FACS

Bariatric Medicine Institute
Salt Lake City, Utah
@bonuslife

Jennie O’Shea, BS, CCP

Department of Surgery
University of Utah
Salt Lake City, Utah

Karen Porter, BSN, RN

Department of Clinical Education
University of Utah
Salt Lake City, Utah

Luke V. Selby, MD
Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York
Department of General Surgery
University of Colorado
Denver, Colorado
@lvselbs

Lara Senekjian, MD, MAT

Department of Surgery
University of Utah
Salt Lake City, Utah

Nick Sevdalis, PhD

Center for Implementation Science
Kings College
London, United Kingdom

Lawrence A. Shirley, MD
Division of Surgical Oncology
The Ohio State University College of Medicine
Columbus, Ohio
@drewshirleymd

Clive (CJ) Thirkill, MSN, CRNA

Department of Anesthesiology
University of Utah
Salt Lake City, Utah

Madeline B. Torres, MD
Department of Surgery
Penn State Hershey Medical Center
Hershey, Pennsylvania
@madelinebtorres

Diane Tyler, MSN, RN

Department of Anesthesiology
University of Utah
Salt Lake City, Utah

Thomas K. Varghese Jr., MD, MS, FACS

Department of Surgery
University of Utah
Salt Lake City, Utah
@TomVargheseJr

Crystal D. Webb, PA-C

Department of Surgery
University of Utah
Salt Lake City, Utah

Jon Worthen, MSN, RN, CNOR

Nursing Faculty
Westminster College School of Nursing
Salt Lake City, Utah
Preface

Our interest in writing this book grew out of our common commitment to
the OR being a “civilized” and respectful environment. We want it to be a
place where learners can do so effectively, and where patients receive high
quality care. In order for those things to happen, the OR needs to be a space
of curiosity and questions and growth.
We also recognize that things in the OR typically occur at lightning
speed, which can make it hard to have any concept of what is happening.
And, of course, as a newbie to the OR, sometimes you just don’t want to
ask. Here’s how we see the basic equation driving that behavior:

Completely foreign environment

+ Mystique of “surgical personalities” (they eat their young, right?)
+ Beehive-like activity in the OR

No WAY am I asking a question.

The reality is that no one expects you to show up in the OR on day one
and know it all. And while we do hope that you’ll ask questions to prevent
you from making missteps, this book is also designed to help walk you
through some common issues.
We can’t change the nature of the work in the OR, and we’re trying to
change the culture of surgery for the good. What we can do right now is
help manage the information flow to support you, the OR novice, and help
alleviate your anxiety and normalize your experiences.

Welcome to our OR.