CSFA cheat sheet

ASA fasting intervals for elective surgery: clear liquids 2 hours, breast milk 4 hours, nonhuman milk and light meal 6 hours, fatty or fried meal 8 hours.

The time-out occurs in the operating room immediately before incision and confirms patient identity, procedure, site and side, consent, allergies, positioning, implants, antibiotics, and imaging availability.

Chlorhexidine gluconate in alcohol must be allowed to dry completely before draping; pooled solution in skin folds or under drapes causes chemical burns and is a fire hazard.

Skin prep direction: start at the planned incision and move outward in concentric circles; when a stoma or draining wound is present, prep the contaminated area last.

Surgical hand antisepsis: scrub hands and forearms to 2 inches above the elbows, keep hands higher than the elbows throughout, and dry with a sterile towel before gowning.

ASA Physical Status: I healthy; II mild systemic disease; III severe systemic disease; IV constant threat to life; V moribund; VI brain-dead organ donor; suffix E denotes emergency.

Malignant hyperthermia is inherited in an autosomal dominant pattern and is triggered by volatile anesthetics and succinylcholine; the earliest sign is an unexplained rise in end-tidal CO2 with masseter rigidity.

The WHO Surgical Safety Checklist has three phases: Sign In before induction, Time Out before incision, and Sign Out before the patient leaves the operating room.

Hair removal, when required, is done by clipping immediately before surgery; razor shaving creates microabrasions and increases surgical site infection risk.

Suture size convention: as the number before the zero increases, diameter decreases, so 2-0 is thicker than 4-0, and 4-0 is thicker than 6-0.

Needle selection rule: taper-point for soft tissue, bowel, and vessels; conventional cutting for skin; reverse cutting for tough tissue under tension; blunt for friable organs such as liver.

Monopolar cautery passes current through the patient to a return electrode pad; bipolar cautery confines current between its two tips and is preferred near pacemakers, nerves, and in neurosurgery.

Upper extremity tourniquet inflation is generally limited to about 2 hours; inflation time is announced and documented, and deflation follows surgeon order.

Sponge, sharp, and instrument counts are performed at baseline before incision, before closure of any body cavity, and at skin closure, with scrub person and circulating nurse counting together.

Abdominal wall layers superficial to deep: skin, subcutaneous fat, anterior rectus sheath, rectus muscle, posterior rectus sheath, transversalis fascia, peritoneum.

Lidocaine maximum dose is 4.5 mg/kg without epinephrine and 7 mg/kg with epinephrine; the dose is calculated before infiltration.

Wound classification: I clean; II clean-contaminated (controlled entry into GI, respiratory, or GU tract); III contaminated (gross spillage or acute nonpurulent inflammation); IV dirty or infected.

Laparoscopic pneumoperitoneum is typically maintained at 12-15 mmHg; higher intra-abdominal pressure reduces venous return and can impair ventilation.

Wound healing phases: hemostasis (minutes to hours), inflammation (days 1-5), proliferation and granulation (days 3-21), maturation and remodeling (3 weeks up to 1-2 years).

Healing intention: primary (edges approximated), secondary (left open to granulate), tertiary or delayed primary (closed after a delay in a contaminated wound).

Surgical site infection categories: superficial incisional (skin and subcutaneous), deep incisional (fascia and muscle), organ/space.

Evisceration is a surgical emergency: cover extruded viscera with sterile saline-soaked gauze, place the patient supine with knees flexed, keep the patient NPO, and notify the surgeon immediately.

Postoperative fever timing: atelectasis within 48 hours, pneumonia or urinary tract infection days 3-5, surgical site infection days 5-7, deep vein thrombosis days 7-10.

Suture removal times: face 4-5 days, scalp and trunk 7-10 days, arms and legs 10-14 days, over joints 14 days; staples typically 7-14 days.

Negative pressure wound therapy usually applies -125 mmHg continuous or intermittent; it is contraindicated over exposed vessels, nerves, anastomoses, or malignancy.

Drain management: a drain is typically removed when output falls below 20-30 mL per day or per surgeon order; a chest tube is never clamped without a specific order.

Wet-to-dry dressings provide non-selective mechanical debridement and are removed while still damp; they are not appropriate for clean, granulating wounds.

Standard precautions apply to every patient regardless of diagnosis; hand hygiene is the single most effective measure for preventing healthcare-associated infection.

Needlestick exposure: wash with soap and water without squeezing or scrubbing, report immediately, document the event, and arrange source testing and post-exposure prophylaxis evaluation.

Operating room fire requires three elements: oxidizer (oxygen or nitrous oxide), ignition (electrocautery or laser), and fuel (drapes, hair, alcohol-based prep). Stop the oxygen flow first.

Specimen labeling requires two patient identifiers, anatomic source, orientation when relevant, and collection time; most tissue goes in 10% formalin, while fresh, frozen, or special media follow the order.

Certification is maintained through continuing education and recertification, but the legal scope of practice is set by state law, facility policy, and privileging rather than by the credential alone.

Ethical principles: autonomy (patient's right to decide), beneficence (act for the patient's good), nonmaleficence (do no harm), justice (fair allocation of care).

Electrosurgical return electrode placement: clean, dry skin over a large muscle mass, as close to the surgical site as possible, avoiding bony prominences, scars, and metal implants.

Sharps safety: pass instruments through a neutral zone or hands-free, double-glove, never recap a needle by hand, and replace sharps containers when about three-quarters full.

Radiation safety follows ALARA: minimize time, maximize distance, use shielding, and wear a lead apron with a dosimetry badge.