Behind The Red Line

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***Previously Recorded***

Tammy is here to give you a look into the OR, how to stay calm during a crisis in the OR and also what surgery looks like from start to finish as support to the surgeons! You won’t want to miss it.

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Video Transcript

Yup. It’s here. Yeah. What’s up? Welcome. Who’s here from the last session who just attended the last session with sandy and back again for more who can’t get enough, Steve? Of course, Steve just had to make sure you were in here, man.
[inaudible] cool. Today we’re going to have Tanny who maybe some of you guys have seen on social media, especially like in a Facebook group, uh, or possibly on Instagram Messenger. Um, can’t get rid of me. Um, so maybe some of you guys have seen Tammy before. Maybe you’ve talked to her before, but Tammy, before starting with interest in g, she was actually a surgical tech at one of the largest and best orthopedic surgery hospitals in the country. So I know there’s a lot of, m is back. So I know there’s a lot of you or me specifically as I was going through nursing school, I had a lot of interest in, Oh, our nursing. What does it mean to work in the or what would it look like? What would it feel like? So that’s the whole term red line. You guys know as you walk through the hospital, there’s that big red line that that’s where, um, you gotta be clean. That’s where you gotta be sterile. That’s where you do the surgeries. So have you guys ever considered, or have you ever had a chance to be in the LRU if you had a chance to look around in the war yet?
Cvs. Cool. One of my first experiences was actually the, or with a podiatrist. And I never have felt queasy or anything. That was never something that I kind of had felt. But when he started like drilling through an ankle, for some reason, that to me kind of set me off. But, cool. So today we have Tammy, uh, with [inaudible] and g, her career. She’ll tell you a little about what she’s done in her career, but she’s got a lot of experience in or so she’s had a chance to work with a lot of nurses in the or and see kind of what makes a nurse successful. No. So if you have any interest in it, if you’re considering going over, if you just want to know more what it’s like Tan, he’s going to help you guys with that. So be sure to ask her all your questions. Be sure to get everything answered you guys have today about war nursing. All right,
so
you may be wondering, what can a surgical technologist teach me about how to be a successful or nurse? Um, I was doing the math as I was preparing for this session and I calculated with probably scrubbed about 8,000 cases from a tonsillectomy, aesthetics from a tonsillectomy to a heart transplant. Um, I’ve been called in at like 2:00 AM in the morning for a nine hour bilateral femur fracture. I’ve seen what makes a successful nurse. And today I’m going to show you guys that, um, can you guys see my slides here? So that’s kind of what it looks like in the surgery room. Um, as John stated, I landed my first job out of a surgical tech school, um, at Dallas Children’s hospital. Um, so it was pretty cool. Loved it. Um, so today I’m going to teach you, I want you to understand the different stages of surgery. Uh, I’m going to tell you what makes a good operating room nurse. And I want to teach you guys how to stay calm in stressful situations. So let’s go ahead and dive in first to the different stages of surgery. So there’s three different stages of surgeries. You’re going to have a pre-op, you’re going to have inch rock, and you’re going to have post op. All three of those make up what we call the Inter operative or perioperative services.
All right. Um, so let’s go ahead. Sorry, they’re messing around with all this stuff. Okay. So let’s go ahead and dive into the first part, which is the preop. So before you go and get your patient, you want to make sure your room is all set up. You want to make sure that your, um, gather all the supplies that you’ll need for surgery. So each surgery is going to be different. So for a tonsillectomy, you, there’s like hurting pride around her head. For a tonsillectomy. Um, you’re going to have different instruments than you would for say a fever fracture. So you want to make sure that all of that you have all of those different supplies that you’ll need. You want to make sure that your scrub tech and your anesthesia provider has what they need. So for instance, you want to make sure that you have the right medications that your anesthesia provider will need for that specific case.
If your scrub tech is ready, then you can go ahead and initiate the first count and also provide a medication to the surgical field that will be needed for that procedure. So once you’ve done all of that, then you will go over to the preop area and you’ll pick up your patient from that time. All of your attention needs to be on that patient. Um, you’re going to take them back to the Orr and go over to the bed and help with the intubation process. Now guys, imagine this. Um, this really happened to me. So, uh, my nurse and my anesthesia provider, they come back with a, our little tiny seven pound baby from the NICU. The anesthesia prior carries them over to the or bed and begins to mask the baby down. So the, it seemed to be going well. So this, the nurse went over to the other room to pick up a blanket for the patient because the patient was really cold.
Um, as she left the room, this anesthesiologist begins to lose the airway on this patient. Um, he needed to reach behind him inside of the anesthesia cart to grab, uh, oral area, which is what you’ll see here. So he tries to turn around to grab the oral and behind him and every time he moves the mask, the patient begins to turn blue because the airway, he can’t get a good seal on the airway. So what do you do in that situation? The nurses in the other room, uh, grabbing a baby blanket for that patient, uh, is keeping the baby warm, important? Absolutely. The guys, what are the abcs? Can anybody jump on here and say that? Um, give it a second.
So Airway, breathing, and circulation. So C does not stand for cold. There you go. So, uh, c does not stand for cold is, um, so stay with your patient guys. Once the patient is intubated in the two secured, then go into the other room and get the, uh, patient up Lincoln. So let’s go ahead and jump into the interoperative. So once the two secured, uh, the surgeon will come in, he’ll position the baby or a patient however he wants, um, for that particular procedure. He’ll go out, he’ll scrub his hands, come back in, and then the surgical tech will go ahead and gown and drape or gown him and glove him and then drape out the patient. Then the surgery weekends. So during the whole surgical procedure, uh, your job as the nurse will be to chart, um, open supplies that might not have been open before the, um, case began.
And as well as you always want to make sure that you stay aware of what is going on during the surgery. So pay attention to that surgical field. So, for instance, um, I was doing a dialysis catheter removal on um, like a two year old patient and the catheter was being real, real stubborn. So the surgeon was trying to get that out and he tucked as soon as he did that little tug. I look up and right here, this is usually how the patients are draped out so that the, the anesthesia provider can take, keep an eye on the airway. I look up and I see my CRN a pull the drape down and say, what the Hell did you just do? So apparently the surgeon pulls a little too hard on that catheter and the baby was bleeding internally or something had gone down, gone on to make the steps, begins to drop because the cra was paying attention to the surgical field and what was happening, I was able to apply dressings to the womb.
I was able to secure my back table and then we were being, uh, then we were able to begin the CPR on that patient. So make sure you’re always paying attention to what is going on and you’re not on your computer looking around at your next vacation or whatever. Um, so after the surgery and when the surgeon begins to close, you want to make sure that you, uh, count with your surgical tech. So counting can be real monotonous cause you’re going to be doing it quite a bit, um, during the procedure. And as you begin to close, you’re going to do initial count as he starts to close real deep. So I’m going to tell one more story for you guys. Um, I was doing, I can’t remember what the case was, but it was a lobectomy or something on our patient. And I did my first count with my nurse and we were off, our count was off.
That’s kind of common sometimes during these long procedures, account can be wrong cause a sponge can be hiding underneath the drape or in the trash actually got thrown away. So I let the surgeon know, I was like, Hey, uh, we’re missing a sponge. Um, and he’d be, he’s like, okay. And he continues to close the patient. The nurse went and looked inside the trash and I was looking under the drapes, trying to find that other sponge and we count again and that account was still off. We notified the surgeon again, we’re like, Hey, our count is still off. And he says to us, there was no way that sponge is in this wound. So he proceeds to apply the dressing to the wound. He breaks scrub and he leaves the Omar. The anesthesia provider goes ahead and reverses, uh, the anesthetic and begins to work with wake the patient patients up.
But at our hospital, our protocol is if, um, we’re missing a sponge or the count is off, you have to do an x ray. So we call the X-ray tech down and she comes and takes a picture of the surgical site. And sure enough, the sponges left right under the left lung. Yikes. So if we had listened to that surgeon and we were like, okay, the surgeon knows best, he has eyes on the field, he knows what was inside that patient, what came out. That patient would have gone upstairs and he would have been the only kid in kindergarten at recess with a sponge inside of him. I’m only kidding, I’m making light of this, but I just want you guys to understand how important it is to count. Um, so make sure you do that and you trust the trust the policies and make sure you follow those policies.
So let’s go ahead now and dive into postop. So once the surgeon has broke scrub, he’s, um, he’s dre or he’s applied dressings and everything. He’s going to leave and now you’re going to go back up to that patient in the anesthesia provider and help with excavation. During this time, you’re also going to call, um, pack you ICU backs the floor, wherever the anesthesia provider and the surgeon, uh, feel is best for your patient to go and recover. So you’re gonna call, you’re going to get report to that nurse who’s going to be taking over for you. Um, then once the anesthesia provider is ready, you guys are going to go and take that patient to the designated area. So it just depends on where it is. Like I said, and then you’re going to get reports. That nurse, again, once you get there, make sure you tell them the procedure, any complications, the medications, make sure you give a real detailed report on, um, what was done in that case.
So now I’m like, those are the different stages of surgery. So pre-op, Inter op, a post op and they all make up the perioperative services. I really went fast, um, in that. So if y’all have questions you can feel free to ask me after. So now I want to jump in and talk about what makes a successful or nurse. So there’s lots of different things that will make you successful as an er nurse. But I pulled out the top three that I felt was really important and what helped me be able to, um, work well with my nurses. So their teamwork, willingness to listen and patient centered care. So I want to jump into each one of these first ones. Step one, teamwork. So you are a team from the anesthesia provider to the a surgeon, the scrub tech, the extra tech, which is right here with me.
In this picture, you guys are all there for one common goal and that is your patient. So think about it. If anybody was missing from that team, that case would not be as successful. So keep that in mind as you, as you’re a working in the or and the next step is, uh, be willing to listen and take, uh, to all your team members. So what I mean by that is each one of your, uh, people willing to listen to what other people have to say in the room, they might actually have a better way of doing things. Uh, for example, I worked with a nurse and he had the attitude that he knew everything and it was real hard to work with him. If you asked him why he was doing something, he would just say it’s just the way that it is and would not take your suggestions. So be willing to listen because somebody might have a better way of doing things even if you have been doing it this way for the past 20 years. So that is step two. Step three is you are there for the patient. So as soon as you get your, uh, patient from pre-op and take them back to the, or remember this guys, be the voice when they do not have one,
your patient is literally taking their lives in your hand, right? So be their voice. All right. Now I want to talk about, um, the last thing and that is how to stay calm in stressful situations. So if you guys learn one thing from today, um, I want it to be this and it doesn’t just apply to working in the, or you guys can use this anywhere. You decided to work as a nurse. And that is when things get tough or when you feel start to feel doubt, remember to stay calm in those stressful situations. So can I share one more story with you guys today?
Awesome. So as I arrived to work on a Monday morning, um, I got a call over her head. I was in the locker room changing and, uh, the charge nurse says to me, hey, hey Tammy, um, hurry and change and then come meet me up here at the front desk. So I was like, okay. You know, that’s never real good on a Monday morning anytime, really. So I changed real quick. I head up, I head down to the front desk and my charge nurse says, Tammy, you’re the extra person today and there is a emergent case up on the 11th floor in the NICU. I was like, okay, uh, what is this case? And she said, it’s a general case with Doctor So-and-so. So as John told you, um, I was an orthopedic tech and this is a general case and not only that, it is an emergent general case.
So I was really, really scared guys. I was shaking and I was like, okay, cause like gather all my supplies. So basically you’re taking this or room, you guys can’t really see this, but you’re taking an or room right here, all of these instruments as a sterile supplies and everything like that. And you’re taking it up here and you’re transforming a little NICU room into an operating room. So I gather all the supplies, I make my way up to the 11th floor and the elevator doors open. I don’t know if you guys have ever been involved in a code or you’ve seen a code, but you know where they’re happening because there is a shit ton of people. So I walk off the elevator, I make my way down to the uh, NICU room where this code was happening. And I see the family over here with the chaplain and the, and the, uh, the social services, they’re crying because they’re, they’re little tiny two week old baby who was healthy couple days ago is now coding up here in the NICU.
Okay.
I was so scared y’all. I make my way in. I look and I see about 20 people in there taking turns doing compressions on the PA a baby and people writing things down. I see the surgeon coming up to us and she says, we’ve just pulled out all of the lines on this baby and we have no way to access. You guys need to open up stat for a central line. Now it was so, I can’t stress it enough guys. I was shaking, but I was like, okay, I open up a gown, the surgeon like Glover and we go and we, we, uh, drape out the patient during the entire time. They’re still doing compressions on this patient. I hand her the knife. She makes a little tiny incision in the neck, uh, for the Central Line Catheter to go in and she has her life back. And I brace myself because I don’t know if you’ve worked with doctors and surgeons, but in stressful situations they tend to be a little bit more hyper as well. Um, I braced myself for the right, but to my surprise, she turns, she looks at me calmly and she says,
[inaudible] he misstep please. Chaos turned to calmness
and I was able to think more clearly. I was all like my shaking. Everything went away because of the way that she acted. From that day on. I told myself, I want to be like this in every case because the way you’re able to think, the way you’re able to concentrate is so much better when you’re able to think clearly when you’re not stressed about what is going on. Now you can’t always choose your surgeons or your doctors. So I came up with four tools that have helped me, um, to be able to get to this point. Now I’ll be honest, it is, it is hard to do it but it really does help. So I’m going to share those with you guys right now. So the first one is, is positive self talk. So for example, if I had a case that I didn’t know what it was or I was scared, I would always be like, I would stop, I would stop completely what I was doing and I would say, you can do this Tammy. I mean it helped guys. It really did. Um, so this may be real contradictory. The second step, it may be contradictory because you’re always taught to anticipate the surgeon’s needs to be one step ahead. However, I found that, um,
I would anticipate the needs, but I would take the case minute by minute. By doing this I was able to alleviate those fears and be able to stay calm in those situations. The third thing is, is I would ask if I didn’t know what the case was or I was unaware of how the surgeon operates or I didn’t know what this instrument was, I would go and I would find a friend or the charge nurse or anybody and I’d be like, hey guys, can you help me out here? And they were always help out. You know, you always find at least one or two people that are very helpful. Now, the fourth thing is, and it kind of goes along with asking is I would prepare the night before. So, uh, the day before I would look at the, uh, the schedule and see where I was at. If I didn’t know some of the cases, then I would go home.
I would read textbooks or I would, again, I would ask a friend, um, how this, how this case went or, or what instruments I would need for that case. So those are the four steps that I used, um, to be able to stay calm and, uh, stay aware of all everything that was going on. So whether you decide to, uh, work in the operating room or someone else, um, as a nurse, I want you guys to remember that you can do this. You guys hear this all the time, um, from all of us that interest in g, but you can do this
now. [inaudible] as you’re preparing for your quizzes, your exams or studying for the boards, just tell yourself when you start to get stressed, say I can do this,
um,
from all of us. I, like John said, I’m your community manager here, interests in g. So I am on the Facebook group or you guys can always email me directly. But I love hearing your successes. I love answering all your questions. So if you ever feel like you need to reach out, please do so. Um, all of our support ladies here, they’re awesome and they will also help you out. So anybody have any questions? Thank you so much for listening today. If you don’t have any questions, I actually have some surgical supplies that I can show you since we have about five more minutes. Um, so I was talking about a central line and this is kind of what a central line looks like right here.
[inaudible] on a little tiny baby. So I’ll kind of show you guys how this works. Pretty cool.
Um,
so there’s different kinds of different catheters that you put in. So this right here is the actual official line. So this part they’ll kind of, we’ll make them, they’ll put the 18 gauge needle, or this one’s a little smaller, but they’ll put it in a to kind of find the vessel or whatever. And then they’ll put this, uh, she’d been there and then they’ll feed this down, try to get the, trying to get it in the right area that they want, and then they’ll cut the bull, cut it. So we’ll kind of measure out, cut it, and then this will kind of hang out and this is where the medication will go. So that is a central line. You have the wire that feeds down into the,
how common are nurse assists for search texts? I’m honestly, like in the hospitals that I’ve worked at, uh, you really just had like the surgical technologists and then the, um, the nurses would, uh, just be the circulators, but um, they really like it when the nurses know how to scrub. And um, same here, same here. Um, I’m sorry, I’m new to this system. Um, so they really like it when the nurses know how to scrub because a lot of times, um, you’ll have to go and then scrub a case, but usually they’ll put them with like simpler cases. So you, unless you feel comfortable doing it. Um, but as far as like narcissists, we really didn’t have just one nurse that was just to scrub cases, so, so yeah. So that’s a central line. They’ll use this catheter to kind of pull to make sure they have the syringe or the needle, the right area to get some blood back. So that’s a central line. Does anybody know what this is?
Okay.
This is a bovie, so this is used to kind of, it uses to cut and calorie. There you go. Katari awesome. And cuts. So yeah, they’ll use this for that. Um, so this right here, this is for tonsillectomy, it’s called the suction Bobi. So it suctions and it cuts at the same time. And the like, the most common place to use it is a, can’t really see it. The most common place to use it is for a tonsillectomy. So this right here is just the plunger cleans out during a tonsillectomy. There’ll be a lot of gross stuff, charred and everything. So they’ll use this to push out all of the stuff to keep it clean. So you can cut off really well. Um, so let’s see here. Uh, let me just have this right here. I can’t really see it, but
okay.
Yeah. Anyways, dermabond, um, in ICU, sometimes we use those on difficult intubation, the suction bovie you do on difficult intubation, I guess that makes sense to guide. Oh yeah, yeah, for sure. Um, so another one, here’s a very common instrument. I talked about this in my case. This right here is a hemostat. So this is, we use these a lot in surgery to dissect. So we’ll just put it on the, and you’ll just dissect down to wherever the surgery is. Um, and then also they’ll use it to kind of hold, uh, vessels or whatever. Um, and then a lot of times actually they’ll use those. They’ll put it on the, on the vessel or artery or whatever, and then they’ll use the bovie to touch the end of it to cauterize it. So it’s kind of cool. Um, anyways, do y’all have any other questions for me?
Um, I have some suture. Here’s a proline, proline sutures a lot of times used to tie off, um, different arteries and stuff. Also, sometimes they use it to uh, close deep. Um, so a taper needle, so there’s different types of needles as well. This taper one, this means that you can use it on like a vessel or something like that. Reverse cutting. You never want to use this, you never want it. You want to make sure you have the right suture, cause you’re going to have a ton of different moniker rules, which is usually used for skin. But if it says cutting on it at all, you not want to give it to the surgeon. If he’s trying to like say for instance, um, suture, uh, of vessel back together or like a attendant or something, you don’t want to give it to them cause it will cut.
But a taper needle is one that you would want to use to give them, um, if they are suturing the vessel. So that’s kind of cool. Um, uh, here’s a pds. PDS is usually used to, to suture deep. So like to close when you do abdominal surgery, they’ll use this for the first layer. And then, yeah, Ethel on reverse cutting. That’s a lot of times on skin. That’s what you’ll see on the outside of people have, um, sutures, individual sutures on the outside. Um, Ooh, here’s something kind of cool. Um, does anybody know what this is? So I don’t have the instrument that goes on it, but this is for a bipolar. Um, so it’s like a forcep that’s smooth on the outside. You have a speech church? Yes, it is USB charter. Uh, so you put this on the outside. It’s like a hemostat or something like that, but it will, they also use this actually for tonsillectomies but that can be used to on a delicate tissues and stuff to cut.
So it’s Kinda like a, uh, bovie and then they hook this up to a machine, um, right here and then this goes off the field and this goes on the field. I think as a nurse, that’s also something like super important to remember is like you have all of these things being thrown off to you at the beginning of the cases. You’ll have like suction Bobi, um, bipolar, like all this stuff. So just remember where it all goes in the machines. But anyways, um, I think our time is up, so I will let you guys go. Thank you so much. I had a chance to assist a position on socially. Yeah, it’s super cool. Right? It’s awesome. So did you like scrub in and everything like that? I guess probably if you were assisting, but anyways, thank you guys so much for joining me. Um, have a great day. You too.
Um,
I’m not sure how to end this, but.

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