surgeons, using the latest in cutting edge surgical technology to save lives? You've

外科醫生，使用最新的尖端外科技術來拯救生命？你已經

seen it on TV shows, but perhaps never stepped in the OR yourself. It seems mysterious, intense,

在電視節目中見過它，但也許自己從未踏入過手術室。它似乎很神祕，很緊張。

even a little intimidating. Here's what to expect when you first enter the operating

甚至有點嚇人。以下是你第一次進入操作時的情況

room. Dr. Jubbal, MedSchoolInsiders.com.

房間。Jubbal醫生，MedSchoolInsiders.com。

For many medical students and aspiring surgeons, the first time you enter the operating room

對於許多醫學生和有抱負的外科醫生來說，第一次進入手術室時

will be in your third year, during your clerkship rotations. The common theme of your third

這將是你第三年，在你的實習輪換期間。你們第三年的共同主題是

year of medical school is that you want to learn, be helpful, and not get in the way.

醫學院的一年是，你想學習，有幫助，而不是礙手礙腳。

This is most apparent in the operating room, where it's difficult to help and easy to get

這一點在手術室裡最為明顯，在那裡很難提供幫助，也很容易得到

in the way. When you enter the operating room, always

礙。當你進入手術室時，一定要

introduce yourself, and usually it's best practice to write your name on the whiteboard.

介紹自己，通常最好的做法是在白板上寫上你的名字。

This is because the circulating nurse needs to chart in the computer who all was in the

這是因為循環護士需要在電腦中記錄誰在那裡。

room. Do your best to not get in the way. Your first

房間。盡力不要妨礙到別人。你的第一個

few times in the OR, you may be confused by all the moving pieces. That's fine, as long

在手術室的幾次手術中，你可能會對所有移動的部件感到困惑。這很好，只要

as you don't slow other people down in doing their job.

因為你不會拖累其他人做他們的工作。

Avoid being on your phone. Even if you're trying to be useful or studious, it looks

避免玩手機。即使你想成為一個有用的人或學習的人，但它看起來

like you're texting and not paying attention. Surgery is often high stress, and there will

就像你在發短信，沒有注意到。手術往往是高壓力的，而且會有

be moments of high tension where you may be yelled at or not like how someone talks to

在高度緊張的時刻，你可能會被罵，或者不喜歡別人的談話方式。

you. Don't beat yourself up, and don't take it personally. It's more often a reflection

你。不要自責，也不要把它當做個人問題。它更多地是一種反映

of the situation or the character of the individual, and surgery tends to have a higher proportion

狀況或個人性格，而手術往往有更高的比例。

of more abrasive personality types. Your aim as a medical trainee is to learn,

更加磨人的性格類型。作為一名醫學實習生，你的目的是學習。

and you should be asking questions, but timing is critical. You don't want to be the annoying

而且你應該提出問題，但時機是關鍵。你不希望成為一個令人討厭的

student that asks too many questions, and you also don't want to be the student who

你也不希望成為那個問太多問題的學生。

asks questions at inappropriate moments. During times of high stress and tension, refrain

在不適當的時候問問題。在高度緊張和壓力的時候，要避免

from asking questions and allow the various members of the surgical team to resolve the

不問問題，讓手術小組的各個成員解決這個問題。

situation. The more you work with a particular surgeon and other members of the surgical

情況。你與某位外科醫生和其他外科成員的合作越多

team, the more you'll get a feeling for what is and is not appropriate. Timing is important,

你就會越發感覺到什麼是合適的，什麼是不合適的。時機很重要。

as you don't want to interrupt their focus during moments of higher acuity.

因為你不想在高度敏銳的時刻打斷他們的注意力。

It's also viewed favorably by all members of the surgical team when you firmly, but

當你堅定不移地去做時，也會被外科團隊的所有成員所看好，但

with surgical precision, press on both the like and subscribe buttons of this video.

以外科手術般的精確度，按住這個視頻的喜歡和訂閱按鈕。

Not too hard as to cause unnecessary tissue damage, and not too gently, otherwise it's

不要太用力，以免造成不必要的組織損傷，也不要太輕柔，否則就會

as if no intervention ever occurred. The single most important thing is that you

彷彿從未發生過任何干預。最重要的一件事是，你

don't contaminate the sterile field. Doing so won't make you any friends.

不要汙染無菌區。這樣做不會讓你成為任何朋友。

The purpose of creating a sterile field around the surgical site is to reduce the number

在手術部位周圍建立一個無菌區的目的是為了減少

of microbes and therefore the risk of infection and complications.

的微生物，是以有感染和併發症的風險。

How do they decide where to draw the line on sterility? Well, making the whole operating

他們是如何決定在哪裡劃定無菌線的？嗯，讓整個操作

room sterile isn't practical, nor does it confer improved infection risk. On the other

房間無菌並不實用，也不會帶來更好的感染風險。另一方面

hand, sterilizing only the immediate area of the incision would still introduce microbes

滅菌，只對切口附近的區域進行滅菌，仍然會引入微生物。

from movement and touching surrounding unsterilized structures.

從移動和接觸周圍未消毒的結構。

For this reason, the sterile field generally includes the drapes over the patient, down

由於這個原因，無菌區一般包括病人身上的窗簾，下邊的

to about your waist height. If you're scrubbed in, meaning you are wearing a surgical gown

到大約你的腰部高度。如果你穿的是手術服，也就是說你穿的是外科手術袍

and gloves, then your hands and arms, and anterior torso from your chest down to your

衣服和手套，然後是你的手和胳膊，以及從你的胸部向下到你的前軀體。

waist are in the sterile field too. If a sterile object makes contact with a non-sterile

腰部也在無菌區。如果無菌物體接觸到非無菌的

object, we call that contaminating the sterile field. If your nose is itchy and you're scrubbed

物，我們稱之為汙染無菌區。如果你的鼻子很癢，你被擦洗過

in, too bad, as touching it will contaminate the sterile field. You'll have to wait for

在，太糟糕了，因為觸摸它將汙染無菌區。你將不得不等待

it to pass, as touching your face, glasses, mask, or anything that isn't sterile is a

觸摸你的臉、眼鏡、口罩或任何沒有經過消毒的東西，都會被認為是通過。

big no-no. If your mask is fogging up or you're having issues seeing, then ask one of the

大錯特錯。如果你的面罩起霧了，或者你的視力有問題，那麼請問其中一個

nurses who isn't scrubbed in to help make adjustments.

沒有被刷入的護士，幫助進行調整。

Standing by the operating table, your hands should either be resting on the drapes on

站在手術檯邊，你的手應該放在手術檯的窗簾上。

top of the patient, or you should hold your hands in front of you. Do not drop your hands

在病人的上方，或者你應該將你的手握在你的面前。不要放下你的手

below your waist or to your sides, as doing so would contaminate them.

腰部以下或兩側，因為這樣做會汙染它們。

If you're going to sneeze and you're standing at the sterile field, then take a step or

如果你要打噴嚏，而你又站在無菌區，那麼請走一步或

two back and sneeze directly into your mask, facing toward the sterile field. Do not raise

向後退兩步，直接對著面罩打噴嚏，面朝無菌區。不要抬頭

your arm to cover your mouth, as that would contaminate your sterile sleeves, and do not

用你的手臂捂住你的嘴，因為那會汙染你的無菌袖子，而且不要

turn to the sides, as doing so will allow microbes to escape from the sides of your

轉向兩側，因為這樣做會使微生物從你的側面逃逸。

mask and toward the surgical field. The first time you're in the operating room,

面罩，走向手術室。第一次進入手術室。

you likely won't be scrubbed in, meaning you'll just be wearing regular scrubs and no part

你很可能不會被擦洗，這意味著你只是穿著普通的擦洗服，沒有任何部位。

of you will be considered sterile. In this case, you always want to maintain a safe distance

的人將被視為不育。在這種情況下，你總是要保持一個安全距離

from the sterile field as to not contaminate it.

為了不汙染無菌區，要從無菌區移開。

Surgery is still very much an old boys' club, and even as a student there will be several

外科手術在很大程度上仍然是一個老男孩的俱樂部，即使作為一個學生，也會有幾個

unspoken expectations of you, and you should always come prepared.

對你的期望不言而喻，你應該總是有備而來。

If it's your first time and you're not scrubbing in, still make sure you wear a mask and eye

如果這是你的第一次，而且你沒有在裡面擦洗，仍然要確保你戴上口罩和眼睛。

protection. Everyone inside the operating room must wear a mask to reduce airborne microbes,

保護。手術室內的每個人都必須戴上口罩以減少空氣中的微生物。

and once you see fluids squirt around, you'll understand why eye protection is paramount.

一旦你看到液體四處噴灑，你就會明白為什麼保護眼睛是最重要的。

If you are scrubbing in, make sure you know proper scrub technique and follow it closely.

如果你要擦洗，確保你知道正確的擦洗技術並嚴格遵守。

To reduce interruptions, use the bathroom prior to entering the surgical suite. It's

為了減少干擾，在進入手術室之前先使用衛生間。它是

generally frowned upon to excuse yourself to use the bathroom, particularly if you're

一般來說，藉口上廁所是不受歡迎的，特別是如果你是

scrubbed in, and even more so if it's a shorter case. It shows you simply weren't prepared.

擦洗過的，如果是較短的案件，就更要注意了。這表明你根本沒有準備好。

You should also avoid chugging a gallon of water right before surgery for obvious reasons.

出於顯而易見的原因，你也應該避免在手術前就灌下一加侖的水。

In line with reducing interruptions, put your phone on silent or vibrate, as you don't want

在減少干擾的同時，將手機調至靜音或振動狀態，因為你不希望

to distract the surgeon while your Drake ringtone blasts at max volume.

在你的德雷克鈴聲以最大音量響起時，分散外科醫生的注意力。

Complications and unexpected delays in the operating room are common, and you should

手術室裡的併發症和意外延誤是常見的，你應該

be prepared to stick around longer than expected. No food is allowed in the operating room,

準備好比預期更長的時間。手術室裡不允許有食物。

so be sure to fuel yourself ahead of time. If you're a medical student rotating on the

所以一定要提前給自己加油。如果你是一名輪換的醫學生，在

surgical service, be ready to be pimped, meaning quizzed by your residents or attending. You

手術服務，要準備好被拉皮條，也就是被你的住院醫生或主治醫生問話。你

should absolutely know the patient, why the surgery is indicated, the nature of the surgery,

應該絕對了解病人，瞭解為什麼要做手術，瞭解手術的性質。

the anatomy you'll be seeing intraoperatively, and other relevant details. Expectations will

你將在術中看到的解剖結構，以及其他相關細節。期待將

vary depending on your stage in training and whether or not you're pursuing a surgical

根據你所處的訓練階段以及你是否在追求外科手術而有所不同。

specialty for residency. A third year medical student on their first day in the OR will

駐院實習的專業。一個三年級的醫學生在手術室工作的第一天將

have different expectations than a fourth year who is doing a plastic surgery sub-internship

與正在進行整形外科實習的四年級學生相比，他們有不同的期望。

and hoping to match into the field. After a few cases in the OR, you should start

並希望能匹配到實地。在手術室做了幾個病例後，你應該開始

to form an understanding of how things work. The room is prepared, the patient is rolled

以形成對事情如何運作的理解。房間準備好了，病人被捲起來了。

in, anesthesia begun, time out is performed, and the first incision is made. After the

麻醉開始後，進行計時，並進行第一次切口。在

incision is closed, the site is properly bandaged or dressed, the patient is woken up and extubated,

縫合切口，適當包紮或包紮部位，喚醒病人並拔管。

transferred to a hospital bed, and wheeled out to post-op.

轉移到病床上，並被推到術後。

Depending on whether or not you're scrubbed in, there will be different tasks you can

根據你是否被刷入，會有不同的任務，你可以

help with. By being attentive and observant, it won't be difficult to figure out where

幫助。通過細心和觀察，不難找出

to be useful. If you're not scrubbed in, you can help the

才能發揮作用。如果你沒有被刷入，你可以幫助

patient get transferred to the operating room table, grab supplies from the back supply

病人被轉移到手術室的桌子上，從後面的供應品中拿起用品。

room, help gown others who are scrubbing in, pull up imaging on the TV screen if the surgeon

如果外科醫生不在的話，他可以在電視屏幕上調出影像，幫助其他正在刷牙的人。

needs to reference something while operating, and anything else you're asked of. After closing,

在操作時需要參考的東西，以及其他任何要求你做的事情。結束後。

you can grab the gurney, which is usually outside the room, transfer the patient, and

你可以抓住通常在房間外面的輪床，轉移病人，然後

so on. If you are scrubbed in, do your best to not

等等。如果你被刷了進去，盡力不要

get in the way, don't contaminate the sterile field, and get great at retracting, since

礙事，不汙染無菌區，並能很好地縮回，因為

you'll be doing a lot of it. Retracting is when you help hold back organs or tissues,

你將會做很多這樣的事情。牽制是指你幫助牽制器官或組織。

usually with one of many tools, allowing the surgeon to more easily view and operate on

通常使用許多工具中的一種，使外科醫生能夠更容易地查看和手術。

the exposed area. You may need to suction, apply pressure, cut sutures, and do other

暴露的區域。你可能需要進行抽吸、加壓、切開縫合，以及做其他工作。

minor tasks too. By first demonstrating proficiency in these basic tasks, you'll then be allowed

小任務也是如此。通過首先證明對這些基本任務的熟練程度，你將被允許

to close, meaning suture the incision, and even do other simple techniques with the scalpel

縫合，即縫合切口，甚至用手術刀做其他簡單的技術。

or bovie. Also understand that each surgeon will have

或bovie。還要了解，每個外科醫生都會有

different preferences. Some will appreciate you helping to drape the patient, while others

不同的偏好。有些人會欣賞你幫助為病人披上衣服，而有些人則是

are more particular and would prefer you stay out of the way. When it comes to cutting suture,

他們比較講究，希望你不要插手。當涉及到切割縫合時。

if you cut the tails too long, then there's excess material in the patient which can lead

如果你把尾巴剪得太長，那麼病人體內就會有多餘的材料，這可能導致

to inflammation and increased risk of infection. If you cut the tails too short, then there's

到發炎和增加感染的風險。如果你把尾巴剪得太短，那麼就會有

a higher risk of the knot failing. The running joke amongst medical students is that you'll

打結失敗的風險更高。在醫科學生中流傳的笑話是，你會

always cut too long or too short, but never just right. That's fine, just do your best

總是剪得太長或太短，但永遠不會恰到好處。這很好，只要盡力而為

to learn the surgeon's preferences and take all feedback in stride.

瞭解外科醫生的喜好，並認真對待所有反饋。

If you found anything in this video helpful, let me know with a thumbs up and if you want

如果你覺得這段視頻有什麼幫助，請用大拇指告訴我，如果你想

to see more like this, tap that subscribe button firmly and with surgical precision.

要想看到更多這樣的內容，請堅定地、精確地點擊訂閱按鈕。

If you enjoyed this, check out my video explaining the various members of the surgical team.

如果你喜歡這個，請看我的視頻，解釋外科團隊的各個成員。

And if you want me to cover something else about surgery or the operating room, let me

如果你想讓我介紹其他有關手術或手術室的內容，請讓我來介紹。

know with a comment down below. Much love, and I'll see you guys there.

請在下面的評論中告訴我。非常感謝，我們會在那裡見到你們。