AORNPreparingfortheCNORExam

Trauma

LAPAROTOMYSCENARIO
RNCirculator
A. Pullappropriatetraumacart.
B. Startopeningsupplies
C. Callforextrahelpifneeded.
D. Callforbloodrecoverystaff.
E. Havescrubpersonstartscrubbingifenoughhelpavailable.
F. Checkroomforsuction.
G. Setupbloodrecoverymachineryifnecessary.
H. PatientmaycomeovertotheORwithemergencyreleasebloodhangingorthe
massivetransfusionprocedurehasbeeninitiated.Plantosendatypeandcrosspatient
ifithasntbeendone.OnceTandCiscompleted,callbloodbankforavailableunits,
checkwithanesthesiaonhowmuchtobringover.
I. Personalprotectiveequipment,makesureeveryoneinroomhaseye
protection/reinforcedgowns/traumaboots.
J. Stayfocused.
K. IDthepatient,PatientsName,MedicalRecord#,andbloodID#
L. Keepinmindthatthepatientmaynothaveachart.Youneedtoprintoutneeded
information.Printandapplypatientlabels,assembleanticipatedpaperwork.
M. Placebladdercatheterifnecessary.
N. Circulatethecase.
O. Skinpreps:Ifthereisanobjectprotrudingfromthepatientsuchasaknifeorother
weapon,itisnotremovedbeforethesurgery.Theskinandforeignobjectareprepped.
Thisobjectmaybetheplugkeepingthepatientfrombleedingtodeath.
P. Note:thepatientmaybekeptawakeuntilthesteriledrapesareinplaceandthe
surgeonisready.
Q. Beavailabletothesterilefieldforsupplies,requests.
R. Callreporttoappropriatenursingunit.
S. AnesthesiologistandanesthesiatechwillaccompanythepatientfromORtothe
appropriatenursingunit.

Scrub
A. TaketraumacarttoORSuite.
B. Helpopensupplies,ifenoughhelp,scrubpersoncanstartscrubbing.
C. Opentraumapack.
D. Openmajorlaptray.
E. Openlaparotomyretractorset.
F. Open2018"silkties.
G. Open3018"silkties.
H. Open20T5silkpopoffsuture.
I. Openglovesforattendingphysician.
J. Openscrubgownandglove.
K. HaveBookwalter,Balfour,andVascularTrayavailable
L. Setupbacktablequicklyandneatlysotherewillbetimetocount.Speedandaccuracy
arevital.
M. Alwayssetupthebacktablethesamewaysotherewillbenoconfusionwhenyouare
inatrauma.
N. Loadtwo#3knifehandleswith#10bladesandone#7knifehandlewitha#15blade.
AORNPreparingfortheCNORExam
Trauma

O. DrapeandsetuptheMayotrayafterthecount:
1. Scissors,straightandcurvedMayo,7"metzenbaum
2. 8"DeBakeyforceps
3. Criles x4
4. Tonsils x6Loadoneeachsizeofsilktie.
5. Rightangles x2
6. Babcocks x2
7. Largeabdominalretractor
8. Suctions x2Oneabdominaltipandonetonsiltip
P. Leavelargebasinempty,ifthereisseriousbleeding,itcanbeplacedbetweenthe
patient'slegsandusedtocatchlargeclotsandbloodysponges.
Q. Draping:mostsurgeonsprefertodrapenipplestomidthighwith68clothtowels,
grointowel,mayusetheskinstapler,splitsheet,topsheet.(Mayuse2splitsheets).
Note:thepatientmaybekeptawakeuntilthesteriledrapesareinplaceandthesurgeonis
ready.
R. Ifmajorbleedingissuspected,openthevascularclampsonthetraumacart.Ifthe
patientislarge,openalongESUtip.
S. BringMayostanduptothefieldandpassofftheESUcableandthesuction.Have5lap
spongesimmediatelyavailable.Stayaheadofthesurgeon.Donotletthemrunoutof
sponges.
T. Stayfocused.
U. Packing:Useradiopaquespongesforpackingand/oruseradiopaquetowels.
V. Wringoutspongesintothelargebasinifbloodrecoveryisbeingused.Bloodrecovery
willnotbeusedforabowelinjury.

PossibleInjuries:
1. BowelInjury:Surgeonwillprobablyplacebabcocksonholesinbowelandgoon
tolookformoreseriousinjuryandbleeding.Mayusesuture,staplers,or
resectionwithostomy.
2. Spleen:Mayberepairedsometimeswithtopicalhemostaticagents.May
removethespleenandsurgeonwillaskforlargepeansandOsilkties.
3. Liver:CanberepairedwithOchromicwithNE9needle,keptontraumacart
andmainsuturecart.Willprobablyaskfortopicalhemostaticagents.
4. Kidney11001200mlofbloodflowsthroughthekidneyeveryminutesothere
canbeagreatdealofbloodloss.Ifthekidneyisdamagedbeyondrepair,itmay
needtoberemoved.Mayneedvascularclamps,umbilicaltapes,andkeepers.
5. Bementallypreparedtoopenthechest.Ifthishappens,openthetrauma
supplementtray,whichcontainsalebskeknife,ribspreader,lung,andvascular
clamp.Askforasternalsaw,andchesttrays.
6. Ifpossible,keeptheRNcirculatorinformedwithwhatishappeningatthefield
(forexample,theaortaisclamped,thereisatearintheliver.)

CRASHOVERLAPAROTOMY(PatientunstableandmaygettotheORsuiteassoonasyoudo)
Everythingaboveand..
RNCirculator
1. Foryoursafetyandthesafetyofotherstaffmembers,countthesharpsifyoucan
2. Followthehealthcareorganizationspolicyandprocedureifthereisnotimetocount
3. Completereport
AORNPreparingfortheCNORExam
Trauma

Scrub
Workoutoftheinstrumenttray.ItisnotnecessarytosetupaMayostand.
SetuptheMayostandwhentimepermits.
Getanotherscrubifneeded.

CRASHOVER(OPEN)CHEST
CirculatorandScrub

I. Patientwillprobablyarrivewithribspreaderinplaceandanynumberofclampsinthechest.
II. Makesurethecodecartisintheroom.
III. Opentheinternalpaddles.
IV. Openthebasichearttray,sternalsaw,openthebladeandloadtheblade.
V. Havewarmsalineavailabletohelpresuscitatetheheart.
VI. Ifthereisaholeintheaortaorheart,itispossibletouseabladdercatheterandinflatethe
balloontostopthebleeding.Thiscathetermayalsobeusedtoaddfluidtotheheart.
VII. AnIVmaybestartedinthegroin.
VIII. Heartsurgeonsmaybecalledin.
Whenthechestisalreadyopen,thereisprobablynotimetoprep.Theonlydrapemaybeasplitsheet
youplaceonthepatient.

BasicHeartTray,SternalSaw,ChestTubes,ChestDrainageSystem,BloodRecovery

NEURO
UsetraumaNeurocart.

Openforabasiccraniotomy.MostofNeurotraumadealswithintracranialbleeding.Therewillbetime
tosupplementwithotherinstrumentation(microinstruments,specificplates).
PowerEquipment,Headlight,Bipolar,Suctionsx3,MayfieldHeadrestandpins