1 / 26

Frozen, Gross Room, and Sign Out TIPS

Frozen, Gross Room, and Sign Out TIPS. Aleksandra Paliga July 8 th 2013. Frozens. AKA Intraoperative Consultations Key responsibility; MUST carry pager from 8-4:30 p.m. Should (must) review operation list beforehand and determine whether or not slides need to be pulled/what to expect

abrial
Download Presentation

Frozen, Gross Room, and Sign Out TIPS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Frozen, Gross Room, and Sign Out TIPS Aleksandra Paliga July 8th 2013

  2. Frozens • AKA Intraoperative Consultations • Key responsibility; MUST carry pager from 8-4:30 p.m. • Should (must) review operation list beforehand and determine whether or not slides need to be pulled/what to expect • Review with staff in morning • Eventually you go down alone and only call staff at the end to confirm your diagnosis • Key time where you potentially can cause harm

  3. Frozen Section • Measure and describe • ORIENT • +/- Palpate • +/- Ink • Take representative section(s) • Document! (be brief) • Time!

  4. Potential Pitfals • Not knowing orientation of margins • Ureters, skin margins • Taking margin before staple line • Bronchial/wedge • Not inking, mauling specimen • Sloughing off lining by over palpating ovary • Sampling the wrong thing • Ovary/sarcomas/complex specimens • Dropping small specimens on floor/losing them • Submitting too much (or too big piece)/ not enough • Bad placement on chuck

  5. Wedge for Frozen Section • DO NOT try to take the margin BEFORE the Staple Line

  6. Then take the whole bronchial ring

  7. Don’t over palpate ovarian lining

  8. Understand proximal/distal ureter orientation and skin orientation

  9. Never Forget! • Microscopy is not the most difficult part of frozen section. • The appropriate macroscopical judgement is more important. • You will only see lesions in your microscope if they are on the slide.

  10. Grossing

  11. Grossing • AKA Macroscopic Examination • Flexible, generally 8-5 p.m. • Should (must) go to gross room evening before and select specimens for next day • Must keep your own record of grossed specimens • May have to supervise and teach med students on elective • Key time where you potentially can cause harm • Review clinical history on Oasis • Use Lesters and Surgpath manual on W Drive • Call staff or supervising senior resident (ask PA as last reort)

  12. Grossing • Measure and describe • ORIENT: Know your margins! • +/- Palpate • +/- Ink • Take representative section(s) • Document • Understand what is important for staging and diagnosis • Understand “normal”

  13. Make sure you understand the margins • i.e. Mesenteric vs. Radial margins in colon

  14. When in doubt = Ask +/- Photograph

  15. Signing Out

  16. Signing Out • AKA Shadowing the staff • 8-5 p.m. • Should discuss with staff afternoon before about meeting time • COMMUNICATION IS KEY • Can check evening before to see if any cases out (head start) • Try to read around cases; for yourself and the patient! • Check patient histories when appropriate • You are very supervised and safe in signout • … except maybe during inter-staff consultations: make sure you understand the question and answer (write it down)

More Related