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Orthopaedic Technologist Exam
solution - Surgery
What to report to surgeon regarding fx - answer --Location
- Open/closed
- Type of fx
- Anatomical alignment
- Angulation- degree
- Neurovascular status of limb Surgical hand washing procedure - answer --Examine skin for damage
- Nail pick to clean under nails
- Sterile scrub brush
- One arm at a time, 30 passes in each area
- Each side of each finger
- Extend to 2 inches above elbow
- Excess water allowed to drip into sink Protective attire - answer - Protects from radiation, lasers, and microbes. Scrub suit, mask, hair cover, shoe cover, non sterile gloves, protective eyewear, and radiation protection. Attire worn in the OR - answer - Limits microbial spread. Scrub suit, hair cover. Mask and shoe covers. A cap or hood is worn to cover hair.
Sterile scrub attire - answer - Worn by surgical team. Put on after surgical scrub. Sterile gown, sterile gloves. Required for entry into sterile field. Made of lint-free fabric. The cuffs of the gown are not considered sterile and must be covered by the glove. Double-gloving is recommended. Double-gloving - answer - Provides extra protection from injury and disease. As a sharp object passes through the glove material, bioburden is removed. Additionally, the ability of latex to act as a barrier decreases over time. A glove of a larger size is worn next to the skin, and a glove of normal size is worn on top. Supine position - answer - Patient flat on back. Arms secured at the sides of the body, palms facing inward. Legs are straight out. A safety belt is positioned across the thighs approximately 2 inches above the knees. If arm boards are used, the arms are no more than 90 degree angle. Pillows are placed where necessary, and a foot board is used to prevent prolonged plantar flexion. Fowler's position - answer - Modified supine position. Decreases blood circulation to the upper body, and encourages venous drainage. An air embolism is a potential hazard of the position. Allows easy access to the head, neck, shoulder and breast. Arms are secured across the stomach. The upper section of the table is raised to a 45 degree angle. The whole table is tilted downward Prone position - answer - The patient is anesthetized before being placed on the operating table in this position. The safety strap is applied on the thighs above the knees.
made through the drape. Aperture drapes have fenestrations surrounded by adhesive backing. Fabric drapes - answer - Nonwoven textile fabrics are disposable, light, and strong. Synthetic. Reinforced layers of material surround the fenestration. Woven textile fabrics are reusable. The material swells when wet and becomes impermeable. Treated with a fluorochemical to increase fluid repellent nature. Must be washed, sterilized, inspected for damage, and repaired. Fenestrated drapes - answer - Openings to expose surgical site. Fenestration of a particular shape depending on the intended use. Nonfenestrated drapes - answer - Used to cover sections not covered by fenestrated drapes. Custom made for surgeries on specific body parts. Sterile packs - answer - Designed for medical specialties and for specific procedures. Contain the required supplies for the particular surgery. Basic packs contain: Mayo stand cover, 2 surgical gowns, a suture bag, 4 sticky paper drapes, and 2 paper towels. Stockinette drapes - answer - Cover the arms and legs. The closed end covers the distal part of the extremity. May be covered with plastic to make it impermeable to fluids. Used during coronary bypass surgeries or hip replacement surgeries. General anesthesia - answer - Used for extensive procedures. Administered by injection, instillation, or inhalation.
Suppresses coughing, gagging, breathing, and other protective reflexes. Requires the use of a breathing tube. Local anesthesia - answer - Injection of an agent that blocks nerve conduction into the tissues around a peripheral nerve. Does not affect alertness. Produces anesthesia within 5- 15 minutes. Effectiveness may be prolonged with epinephrine or hyaluronidase. Used for procedures such as skin biopsies or stitches. Frequently used injectables include procaine, lidocaine, and tetracaine. Topical anesthesia - answer - Blocks nerve conduction after being placed directly on a tissue layer. Rapid onset. Cryoanesthesia- localized cooling. Absorbed through skin and come in contact with peripheral nerve endings. Conscious sedation - answer - Intravenous sedation. Induces relaxation and sleepiness. Pain medication and mild sedative. Causes temporary forgetfulness. Protective reflexes are not affected. Patient is awake. Used for procedures such as colonoscopies. Regional anesthesia - answer - Administration of an anesthetic along a major nerve tract. Blocks nerve conduction from all tissues distal to the site of injection. Does not cause loss of consciousness or alertness. Slow onset. Includes a spinal block and epidural block. Nerve plexus block - answer - Injection of an agent into the site of a major plexus- e.g. brachial plexus. Affects all tissue innervated by the plexus.
Transthecal block used to anesthetize the digits- injected into the flexor sheath. Monitored anesthesia care - answer - MAC. Use of local or topical nerve blocks combined with analgesics, sedatives, or amnesiacs. Low enough that patient ventilation is not required. Patient is able to respond. Surgical sponges - answer - Laparotomy sponge, Raytech sponge, neurosurgical sponge, tonsil sponge, Kitner dissecting sponge, and peanut sponge. Used to absorb bodily fluid. Also used as barriers to prevent structures from being damaged during surgery. Have radiopaque strip so that they can be located by radiograph. Always counted. Ex fix vs ORIF - answer - Ex fix: frame outside body. Attached to bone by pins via small incisions. Pins proximal and distal to fracture site. Used in fx healing with extensive soft tissue damage, or to stabilize fx to allow time to make a surgical plan. High risk of infection. Radiography - answer - Most commonly used are x-ray and fluoroscopy (C-arm). Used to determine if hardware has been placed correctly. Tourniquets - answer - Sterile or non sterile. Used with a layer of cast padding between skin and tourniquet. Pneumatic tourniquet: blood drained by ace bandage and then tourniquet inflated. Methyl methacrylate - answer - Bone cement. Customarily used during total joint replacement. Fumes are toxic.
Orthopedic implants - answer - Screws, plates, wires, pins, nails, rods, and joint components. Most common alloys for implants are titanium, stainless steel, and cobalt-chromium. All implants in a surgery must be made of the same material. The FDA requires implants to be documented and traceable. Sutures - answer - Hypoallergenic. Absorbable (used internally) and non absorbable (used for tendons, ligaments, bone). Made of steel, polyester (Ethibond), polypropylene (Prolene), Nylon, chromic, and polyglactin (Vicryl). Cutting internal sutures - answer - First assistant cuts sutures after tying. Several millimeters above knot. Equipment for arthroscopic surgery - answer - Video monitor, light source, arthroscopy pump and tubing, shaving system, camera, video recorder. Used for diagnostics and to repair tissue within a joint. Saws, drills, and reamers - answer - Powered by air, nitrogen, and electricity. Power saws either oscillate or reciprocate. The kind of saw used is dictated by the surgical requirements. Lasers - answer - Carbon dioxide laser and Nd:YAG laser sometimes used during arthroscopies of the knee. Used to remove bone cement during revisions. Hemostatic agents - answer - Used to stop bleeding. Include Gelfoam, Avitene, thrombin, and bone wax (sterile beeswax). Repairing a syndesmostic rupture surgically - answer - Tear of the interosseous membrane between tibia and fibula. Bones moved back in place and held with a bone clamp. Syndesmotic
Bone stimulation - answer - Used to treat nonunion or delayed union. Requires patient to be immobilized. Passes low level electrical current through the skin. Abduction slings/splints - answer - Used postoperatively to rotator cuff repairs. Humerus positioned away from the body to take tension off of tendon. Uses a pillow against body. Precautions for hip replacements - answer - [Replaces acetabulum with artificial cup.] Can result in instability- precautions needed to prevent dislocation.
- Hip flexion limited to 90 degrees or less
- Avoid sitting in low seats
- Patient should not cross legs
- Do not sleep on side of replacement
- Abduction pillow used while sleeping
