The Surgical Team | Surgeon, Anesthesiologist, First Assist, Scrub Nurse, & More

Thanks for watching! Which surgical team member do you want to be in the future? Let us know with a comment below!

thank you for the informational video!!!!!!

and last but NOT least: the clean-up crew, who have to get a room ready and clean after a procedure...😊

Circulating nurse here, from Brazil. Great to see how it's like on other parts of the world 🌎
Amazing, keep on the professionalism!

👌

Just commenting for the algorithm 💜

What about the CRNA? The anesthesiologist typically only there at the beginning & only sometimes at the end.

Came across this channel as I started rewatching Scrubs...I'm glad some people recognize its brilliance in the medical-themed shows.

kevin: Anesthesiologists are second in command"
Me, An anesthesiologist: "And I took that personally...😑






Anyways, great video😄

So interestingly enough, when you're comparing the Ologist to the Surgeon, let me ask you this question: When stuff really hits the fan, where does the entire OR look to? That's right! The Anesthesiologist. You got it backwards in your video. Surgeon is in charge when everything is going just fine and nothing is going wrong (probably because of a baller anesthetic tbh). Anesthesia is really captain of the ship.

Lmao the intro

Surgeon is in charge of the surgical procedure. Anesthesiologist is in charge of the patient.

Training trainees do explain to a patient who will do the surgery if you have a senior surgeon teaching a fellow trainee or assistant surgeon ?

I work in outpatient surgery, and I can't remember the last time I saw a surgeon wait until extubation to leave - if there is a PA closing, the surgeon is usually out of there before the patient is even sutured up.

It will vary from facility to facility, but where I work the anesthesia provider is usually a CRNA and only occasionally an MD. The scrub person is rarely an RN and usually a surgical technologist. Occasionally we have circulating nurses who are also trained to scrub, but I've never met an RN who only scrubs and doesn't circulate.

Regarding the work of the circulating nurse, you missed a lot of the tasks that circulators do - the real work starts long before the patient enters the room. Getting the room ready, equipment set up, helping scrub tech open pans and supplies, looking over the patient's chart, doing baseline counts with scrub tech, making sure anesthesia has seen the patient, and pulling medications and supplies and dispensing them to the sterile field. Then you go meet the patient in pre-op, verify the consent, laterality where applicable, surgical site marking, allergies, NPO status, belongings, etc., before transporting the patient back to the OR. Circulating nurse is also primarily responsible for patient positioning, although it is usually a team effort especially for cases requiring more complicated positioning like prone or lateral, or if it is a high BMI patient. Sometimes an anesthesia tech or a second anesthesia provider will be in the room assisting with induction, but if not, it is the circulating nurse's job to assist for general or regional anesthesia cases. Once the case starts, in addition to documentation and running for supplies, we also receive specimens from the field, label and document them, and send them off to pathology. At the end of the case, we transport the patient to PACU with anesthesia and give handoff report to the PACU nurse. It can be exhausting and at times stressful, but when you have a good team, barring major complications, everything runs like clockwork and there is lots of fun to be had.

A lot of surgeons, first assists, and scrub techs incorrectly believe that the circulator's primary role is assisting the surgical team, but actually our primary role is ensuring patient safety. Assisting the surgical team is merely a means to that end.

Sooo you forgot to add the xray tech who does the imaging in the OR. But it's cool.

Things in France do not care about patient ‘ s informe about who does what and why in the or and questions are not clearly answered.

Thanks for remembering the rad techs. =P

Thanks for this video! However, the "Scrub Nurse" in an incorrect, antiquated, and out dated term. The appropriate term is the "Surgical Technologist". Scrub Nurse refers back to around WWI when nurses began scrubbing into surgeries to assist surgeons due to the influx of surviving patients thanks to antibiotics. However, in the last 40-50 years, the Certified Surgical Technologist is the title of the individual who is the second assistant (and everything that is stated under "scrub nurse" in this video), who has a degree in surgical technology ( a more comprehensive expertise in surgery) and is nationally certified. Traditionally, "scrub nurses" were (and still are if a RN is taught to scrub) taught on the job. Nurses have a different degree and also an equally important, but different expertise and skill set in surgery. The term "scrub nurse" has actually negatively contributed to the assumption that Surgical Technologists are just "nurses who scrub" and detracts from national efforts in the federal government for comparable wages for "techs" and nurses (because everyone assumes Surg Techs are nurses and therefore receiving a nurses wage due to this outdated term) and licensing.

Also, there is a critical role of the CRNA (Certified Registered Nurse Anesthetist) missing. They, like the anesthesiologist administer anesthesia, and monitor the patient thorough out surgery. These are registered nurses, who have at least 1 year experience in an ICU, who then go back for an additional degree in anesthesia. They are equipped to care for the patient in the same ways as an anesthesiologist, while also providing one on one care while an anesthesiologist can rotate and round on several patients at a time, providing support to the CRNA's as needed. As a Certified Surgical Technologist for 15 years, I appreciate your effort to educate (because this is how the culture changes, as well as positive exposure) but I felt compelled to advocate for these life changing, crucial roles.

Pls make a video on anaesthesia technician

I watched this to prepare for my upcoming lung surgery. It’s good to know who will be in the room and what their roles are. Thanks for the info!

They “reverse the analgesics” at the end of the case? Yeah, so they administer naloxone and somehow reverse the acetaminophen and ketorolac?

With all due respect, I didn’t see or hear other Allied Health Professionals who also contributes to patient care within the surgical and anesthesia team such as:

1. Certified Anesthesiologist Assistant (CAA) also referred to as anesthetist in the same manner as a CRNA within the anesthesia care team model (ACT) surgical service.

2. Certified Surgical Technologist (CST), who mostly are the unsung hero’s who usually are the ones who scrubs (95% of the time) vs a scrub nurse. No disrespect to any scrub nurses, just pointing out facts!

3. Certified Anesthesia Technologist (Cer.A.T.T.) / Certified Anesthesia Technician (Cer.A.T.) and Anesthesia Technician (AT).

4. Certified Clinical Perfusionist (CCP).

Every other medical, allied health and nursing professions were mentioned with the exception of the other four valuable and important allied health professional providers of the surgical and anesthesia team! as mentioned above. Most people in general would be offended.

That’s why research and doing your home work is very important, so you don’t offend other people or their profession.

My Own Opinion!

The Surgical Team Consist of as followed below:

PHYSICIAN - Doctor of Medicine:
Surgeon, MD / Surgeon, DO

SURGICAL FELLOW:
Physician, MD / Physician, DO

SURGICAL RESIDENT:
Physician, MD / Physician, DO

PRACTITIONER APP:
Certified Physician Assistant, PA-C

PRACTITIONER APP:
Advanced Practice Registered Nurse, APRN

Certified Surgical Technologist, CST

Scrub Registered Nurse, SRN

Certified Nurse Operating Room, CNOR

Certified Clinical Perfusionist, CCP

First Surgical Assist, FSA

Registered Nurse First Assist, RNFA

Certified Surgical Assist, CSA

Medical Device Representative, MDR

Ancillary Staff OR Attendant/Nurse Tech/CNA/HCT/PCT/PCA etc.

ANESTHESIA
The Anesthesia Care Team Model consist of as followed below (PeriOperative):

PHYSICIAN - Doctor of Medicine:
Anesthesiologist, MD / Anesthesiologist, DO

FELLOW:
Anesthesiology, MD / Anesthesiology, DO

RESIDENT:
Anesthesiology, MD / Anesthesiology, DO

CLINICAL ANESTHETIST APRN
Certified Registered Nurse Anesthetist, CRNA

CLINICAL ANESTHETIST APAP:
Certified Anesthesiologist Assistant, CAA

CLINICAL ALLIED HEALTH
Certified Anesthesia Technologist, Cer.A.T.T.

Certified Anesthesia Technician, Cer.A.T.

Anesthesia Technician, AT

Anesthesia Technical Assistant, ATA

Gha, I love that you try to be as encompassing as possible and also cover people OUTSIDE the operating room, and surgical techs but what about the imaging department?! You just completely skipped over radiographers/x-ray techs! I guess they're not the first thing that comes to mind when someone thinks about an operating room, especially since most people immediately think of more invasive surgeries where the person's cut open and you can see what's going on, but a lot of procedures are less invasive and require some kind of imaging to see what you're doing inside the patient (fracture reductions, screwing bones together, pace maker installation, you might also need them for intubation to make sure you didn't put a tube in too far and go right into a lung and cause an atelectasis. . . . . ) Fluoroscopy (what the x-ray techs/radiographers will be using in these scenarios) is super important in the OR!!!

I’m a certified surgical technologist (CST). 🙋🏽‍♀️

Question: should I had done a surgical tech program ? I declined a good offer to one and now I kinda regret it like would it have been helpful to my career goal of becoming a surgeon?

I work in an OR but as the person who sets up the room and cleans it once a case is over but I’m a pre Med student I will become a surgeon 👩🏽‍⚕️ and the personalities in surgery can get to you for sure because people will try to look down on you because of your role but they always need help

Don't forget about the surgical vendors/reps!

I want to become a surgeon I definitely crack neet UG to get gov seat this year I am going to give exam

Enjoyed the video, but can you change the scrub nurse to Certified Surgical Technologist? A surgical technologist is trained and specializes in the OR environment and in surgical procedures and all that relates to the OR. A nurse does not have the same training. Also a video covering the specialty and role of a Certified Surgical Technologist would be appreciated as well.

Oh dear: if 'Med school insiders' don't know what analgesics are that's very serious. Analgesia is pain relief (are pain killers), so no: at 4.46 when we're told (as a 'fact') '‘after the surgery they’ll reverse the analgesics " - this is nonsense: they stop the anaesthetic (gas or liquid) going into us (breathed/ventilated in or put in IV) & if paralyzing drugs (neuromuscular blocking drugs = NMBs, too often wrongly called 'muscle relaxants' which they aren't, those are a very different class of drugs which do as their name says = relax & don't paralyze) have been used they must (unless they have already totally worn off) reverse these using another drug that counteracts the effect/s - hopefully/usually. They must never stop ventilating us until they are sure we can breathe for ourselves: when we have enough muscle function & control to be able/safe to do so & our airway is clear of blood (can easily be damaged, caused by clumsy & incompetent use of laryngoscope blades & more) and secretions - must be carefully suctioned because whilst anesthetized/paralyzed and with a tube down our throats we can't do this for ourselves. 

"Errors & complications" - wilful breaches of laws/rules/regulations etc are not errors - I am a survivor of a catalogue of these by several medics who all knew that what they were doing was very wrong and that it might harm me; haste & not bothering to be careful and fatigue can and does cause lots errors and harms including from using the wrong drug/wrong route/wrong amount - which can kill patients. I hate how medics use the word 'complications' as a way of trying to pretend they didn't cause them and our resulting (sometimes very serious) injuries. You never hear of a vehicle mechanic using this word nor a plumber - only in medicine; this word denied and belittles the devastating harms and deaths errors and 'slips & lapses' can and do cause; BAM that day (for surgery they knew I didn't need & had twice refused consent for - which they ignored) they gouged-out my throat & broke a bone/cartilage in front of my throat which is still unstable 16 years later and these make my swallowing difficult and unsafe; they damaged my brain and neck and vision and digestion - and more; then they all covered-up (this had already started before I woke in Recovery Room (PACU); they had caused me to suffer the torture of awake paralysis & suffocation - for so long that I died and went outside my body 'looking' down. They refused to answer my questions and lied and pretended nothing had gone wrong when those there knew very well that it had; they prevented me from getting my info and from being able to access remedial care - my throat became (ubsurprisingly) very infected & ulcerated and medics knew I could die from this and the resulting difficulty breathing, but they didn't care: they only cared about themselves and their jobs, pay-packets, careers and reputations - criminal neglect of a patient they knew was in desperate need of care - Consultant Surgeon next day refused to answer my question and did not ask me even one question before immediately & inappropriately discharged me after he had heard Dr/surgeon lie to me and they all knew that I knew things had gone very wrong and I was badly injured. Did they hope I'd die = problem out of the way?

I don't know why they give trainee medics In US & here in the UK) fancy names, why not just call them Apprentices - that is what they are.

This film says how it all should happen but in the real world (especially here in the UK with NHS?) it too often doesn't: they ignore refusals of consent & prefer to treat us as though we are kids and refuse to answer our questions (which are difficult to ask: how can we ask about things we don't know?) at all often, let alone fully and honestly. They never tell us we'll have a tube put down our throats nor the injuries this can cause, nor anything about the cocktail of restricted & very dangerous (can de deadly) drugs they plan to use on us; they don't ask us if we consent to trainees using our throats/bodies to learn & experiment on - they must because no: the extra risks (when they aren't ready to do this & nobody is overseeing them at all or properly), are too great and give us no benefit at all and can/do maim and kill patients.

Interesting to hear the US job titles for medics as compared to those in the UK. Here we are anesthetized in a little anesthetic room & then wheeled (unconscious, with all drips/tubes & machines attached to us) into the operating theatre - this must cause lots of extra risks & harms, I don't know why they do it like this when, I think, most other countries don't.

At the end we are told: "At the end of the day it’s all about the patient” - but throughout we (people) are referred to as 'a case' - so very dehumanizing and this ;latter reflects how we are too often treated/mistreated. Words matter because they shape thoughts/beliefs/actions.

Please fix the glaring error.

Thank you.

Amazin . I show this video to all my new nursing students. It really highlights the importance of every member on the team!

Scares the living daylight out of me

Wow, didn’t know surgery is much like dota, different people assigned for each role, each different in importance but are all essential for the same goal

Most operating rooms have CRNA’s in the anesthesia role and most have surgical technologists in the role of a scrub nurse. The only RN in the room is the circulating RN.

Great video.

Anesthesiologist is captain of their own ship anesthesiology and surgeon is captain of their ship surgery..

Please make a video highlighting the role of CRNA and surgical nurse practitioners! Currently in nursing school and extremely interested in being involved with the surgical team 😷💉🩸

As a scrub, I kind of think the description of what we do was a bit off. Yes, I’ll pass instruments and set up the case, but often, I’m also assisting, retracting, and a host of other things.

In my role as a rep, I spend most of my time with the scrub helping set up and in the basement doing paperwork. Luckily, the surgeon I work with in that capacity has way more knowledge about the product than I do!

Every role is important and fills a niche that others are unable to fill.

I love the OR. The days are long and can be crazy, but it really is my happy place.

That's not true, an anesthesiologist is the one who makes the most important decisions in the operation room -> they have all the responsibility for the patient

You forgot about Anesthesia Technologiest “first assistants to the Anesthesiologist” , it’s essential to have him/her in the room for an efficient anesthesia, the physician can’t to it alone ,

thank you for this video it was amazing, all love from Saudia Arabia.💚

Don't you miss the OR? I do sometimes, but being a surgeon has never been my goal.

I would like to see something more about Medcial Tech or Biomedical engineering? Are they also in operating room at some casses? Like implanting mechanical hearth? Thanks a lot!

I want to be a scrub nurse

Hopefully I get matched to that unit!! 🙏🏾🙏🏾

I trained as a First Assistant years ago however left medicine to become self employed in a completely different field.

What? I've never seen a surgeon hang around until the patient is extubated...they usually run out of the room before that, leaving someone junior to do the closing and all the rest. Hanging around would imply that they don't trust the anesthesiologist--a good way to piss off the gas-passer.

Where I am, what you call a "scrub nurse" frequently isn't a nurse at all--that's often a surgical tech who passes instruments and suture to the surgeon, holds retractors, etc. They are graduates of surgical tech programs with at least one year of training and OR internship before taking a certification exam.

Another part of the team is the sterile processing department, where instruments are maintained, cleaned, sterilized, and packaged into sets.

Med students be standing in the back like: “don’t sneeze, don’t sneeze, don’t sneeze….”

You should do a video like this but for the emergency room, great video btw

I could not stop lauguing and scoffing and rolling my eyes during this video. I am an anesthesiologist. Out of the different roles played in the OR, we get the LEAST respect, as physicians and as people and being a woman can make everything worse trying to relate to the circulating nurse (among a whole lot of other things). Know why the surgeon is considered the team leader? Because s/he brings money-- oops, I mean the patient-- to the hospital. No one EVER considers that it is the anesthesiologist that ensures that the patient can LEAVE the hospital. Surgeons are excellent bus drivers too -- when anything, ANYTHING goes wrong, they crush that anesthesiologist carotid artery quite skillfully with the driver's side front tire of said bus. Not every interaction is negative; but these days...
Uhhmmm, BTW, the anesthesiologist does not reverse the analgesia at the end of the case, unless there is reason to believe the patient has received excessive doses of opioid. We guide the patient back to consciousness, from wherever the patient went during general anesthesia. I'm gonna leave you with this fact: GENERAL ANESTHESIA IS NOT NATURAL SLEEP. I have been practicing over 20 years, and I STILL have to broach this topic with patients, families, nurses and SURGEONS. (Epilogue: damn you, Michael Jackson and your stupid live-in cardiologist. Although it's necessary less often these days, I still have to have the "I'm trained to administer propofol. You're not gonna die today, at least not from propofol!" 🙄)