CST cheat sheet

Universal Protocol: verify patient identity, procedure, and site; mark the site; perform a time-out immediately before incision.

ASA fasting guidance for elective procedures: clear liquids 2 hours; breast milk 4 hours; infant formula, nonhuman milk, and light meal 6 hours.

Valid surgical consent requires capacity, voluntary choice, disclosure of risks/benefits/alternatives, and the surgeon's signature; a witness documents signature, not consent.

Prophylactic antibiotics are given within 60 minutes before incision; vancomycin and fluoroquinolones may be started within 120 minutes.

Chlorhexidine-alcohol skin prep: apply from the incision site outward, allow complete drying, and avoid pooling under the patient.

Surgical scrub: use antiseptic and friction on hands and forearms; keep hands above elbows; dry before gowning.

Sterile gown boundaries: front chest to waist and sleeves are sterile; neckline, back, cuffs, and areas below waist are nonsterile.

Latex allergy: document the allergy and use latex-free gloves, tubing, tourniquets, and supplies; schedule as first case when feasible.

Initial counts of sponges, sharps, and instruments are completed and documented before incision.

Time-out confirms patient, procedure, site, consent, allergies, positioning, antibiotics, imaging, and equipment before incision.

Counts occur before incision, at cavity closure, at skin closure, and at procedure end; any discrepancy stops closure until resolved.

Electrosurgical dispersive pad: place on clean, dry, well-perfused muscle near the site; avoid bony prominences, scars, implanted devices, and metal contact.

Tourniquet: record inflation time; common limits are 60 minutes for upper limb and 90 minutes for lower limb, with release before exceeding limits.

Local anesthetic maximums: lidocaine plain about 4.5 mg/kg; lidocaine with epinephrine about 7 mg/kg; bupivacaine about 2.5-3 mg/kg; calculate by weight.

Malignant hyperthermia: hypercarbia, tachycardia, rigidity, hyperthermia, and acidosis; give dantrolene, 100% oxygen, cooling, and treat acidosis.

Positioning: abduct arms less than 90 degrees, pad pressure points, avoid ulnar nerve compression, and protect eyes and dependent areas.

Specimens: label with patient identifiers, source, date/time, and test; use formalin only when indicated and send fresh or culture specimens appropriately.

Suture sizing: more zeros means smaller diameter; 2-0 is larger than 3-0; metric size expresses diameter in tenths of a millimeter.

Aldrete score assesses activity, breathing, circulation, consciousness, and oxygenation; a score of 9 or more commonly meets PACU discharge criteria.

Postop fever: first 48 hours suggests atelectasis or malignant hyperthermia; days 3-5 pneumonia; days 5-7 urinary tract infection; later wound infection or abscess.

Wound healing phases: hemostasis immediate; inflammation about 1-5 days; proliferation about 5-21 days; remodeling 21 days to 1 year.

Hemorrhage signs: tachycardia, hypotension, decreasing hematocrit, oliguria, restlessness, and wound drainage; report and prepare volume replacement.

Adult urine output minimum is generally 0.5 mL/kg/hour; lower output may indicate hypovolemia, obstruction, or renal hypoperfusion.

Surgical site infection signs: increasing pain, redness, warmth, swelling, purulent drainage, fever, and leukocytosis; evaluate and culture.

DVT prevention: early ambulation, sequential compression devices, compression stockings, and prescribed anticoagulants.

PACU monitoring includes respiratory rate, oxygen saturation, breath sounds, sedation, pain, temperature, urine output, and surgical site.

Discharge teaching covers wound care, fever threshold, pain control, activity limits, follow-up, and when to call the surgeon.

Spaulding classification: critical items enter sterile tissue and require sterilization; semicritical items contact mucosa and require high-level disinfection; noncritical items contact intact skin and require low-level disinfection.

Gravity displacement steam sterilization commonly uses 121 C for 15 minutes or 132 C for 4 minutes; monitor temperature, pressure, exposure time, and biological indicators.

OSHA exposure response: wash a needlestick site with soap and water, report immediately, document, and follow occupational health testing and prophylaxis recommendations.

Fire triangle: fuel, oxidizer, and ignition; OR risks include alcohol prep, oxygen-enriched drapes, and electrosurgery; stop oxygen flow and remove burning material.

Incident reports document unexpected events for risk management and quality improvement; they are not part of the medical record and do not assign blame.

Consent witness role: verify voluntary signature and form completeness; the witness does not obtain consent or explain surgical risks.

Standard precautions: treat all blood and body fluids as potentially infectious; use PPE based on anticipated exposure and perform hand hygiene before and after contact.

Scope of practice: follow state law, facility policy, and professional standards; do not perform tasks outside training or authorization.

Quality improvement uses data, root-cause analysis, and sentinel event review to reduce recurrence; nonpunitive reporting supports safety.