 All right, what's up you guys? So I've been talking to you guys about my switch and me being an OB and I've been getting a lot of questions about what like my life in OB entails. And I did a video last week on kind of like my first week on the job, but I wanted to specifically talk about what I do during the C-section, okay? And so I had that question asked and it's basically, you know, I'm answering what does it mean to be a first assist in the OR. So if you are interested in any OR work or becoming a PA or a first assist, like a certified registered nurse first assist, you should watch this video. Let's get into the video right now. What's up you guys? It's Edana, welcome back to my channel. You see my new title right here on the screen. I am officially an OB-GYN PA before I was in trauma. And in trauma, we also went to the OR and we first assisted. But in OB, it's a little bit more structured because we have scheduled C-sections. So it's structured on that end, but not on the end where somebody may come in as a trauma and need OB care or come in with like abnormal uterine bleeding or ectopic pregnancies that will require like GYN services in the OR. So that is where myself and my attending comes in because we are the ones that are in the OR, like doing the OR cases. So as an OB-GYN PA, I am first and foremost like in the OR and then dealing with like post-op patients and postpartum patients throughout the day afterwards. So when I'm in the OR, I am the first assist and what does that mean? You know, I think you guys have heard like me kind of throw that word around before or you may have heard other people throw it around before and if you're a pre-PA or a PA student, you definitely will need to know what a first assist is because that's what you're gonna likely be doing on your rotation. Sometimes you second assist, but for the most part they will allow you to like be in that position literally right across from the surgeon, right across from your attending and you guys are kind of working in tandem, working in collaboration, working as a team to get the surgery done. So what does it mean for me as an OB-GYN PA? When I first assist, so I like to be very helpful, okay? And I think it's important to be helpful to your scrub techs and your OR staff. You know, when patients are coming down, you wanna help like prep the patient if you can. So like I put in a ton of folies in the ED, like when I was working in the trauma base. So I will put in a foley. I know how to put in folies. So I will definitely put in a foley for the OR patient if they don't already have one. So we will move the patient from like their bed, from their hospital bed to the operating table. And I'll help move, I'll put in a foley. I don't prep in like, you know, prepping with like the chloroprep, which is the solution that keeps like the area that you're about to work on sterile. But like when it comes to OB and prepping like the abdomen slash like suprapubic area, I am not doing that. That is really for the nurse to handle because there's like, you know, a way that they have to do it, there's a certain number of times they have to go back and forth and then go up the abdomen like this way and then come back down into like the crotch last. And I don't wanna mess up the order or anything like that. So I leave that for the OR nurse to do, but I definitely will put the foley in. If they don't already have my gloves in my gown, which typically they do, I'll go get my gloves in my gown and I'll put it on the table for them. Never touch the sterile table, you guys. You open it sterilely and I'll probably show you guys a video of all like the various different sterile things that I have because I had some from like, way back when I was in PA school because I had thoughts of doing videos like that for you guys, but I just never got around to it. So I will definitely like maybe make some shorts for you guys on that so you can see that. But open it up sterilely to drop it on to the sterile table. If you are a student, so like if you're preparing for your general surgery or your OBGYN rotation, definitely know how to like sterile open, sterile prep and know like OR etiquette, okay? So never touch anything blue if you're not sterile and definitely don't touch the sterile table. But I'll open that up and then from that point on, it's like getting the grounding. So there's like a grounding kind of pad that you put on the patient so that the Bovee tip can work and the Bovee tip is the little machine that kind of cauterizes and cuts tissue. So you can use it to either like cut through like the fat in the subcut area or cauterize like a little bleeder because you don't want those bleeders in your field cause it's gonna make your feel all like ugly and bloody and you can't see anything. And if you can't see what you're cutting into that you're just setting yourself up for problems, okay? So put the grounding pad on, get all of that together, put the SEDs on because they're gonna be immobile for a little while. So you wanna make sure that they're still like, you know, getting like movement in their legs and then I help and like I hug, you know? So we hug them and have them like crouch over, bend their back, shoulders down, bend your back, push your back out so that the anesthesiologist or the CRNA can do the tap for where their epidural is gonna go. And so that is, that's like the initial part. And then after that, like I go and I get sterile and I wash, you know, you do your three minute wash, you come in. This is like, you know, the sexy medicine, like you come in and you're like dripping wet or, you know, you're not trying to be as wet, wet, wet cause you don't want people like sliding on your water when they're coming in. So you're like coming in, but they come in and their hands are up in the air and you back up into the OR and, you know, you wait for hair scrub tech to give you the towel. So I don't like to be wet. So I, what I typically do is I wash, like I do my wash, I'm wet. I dry with a paper towel. And that's, I do that when I first get in into the hospital because I know that at some point in the day I'm gonna be in the OR. And then every time after that, I just use the Avagard and I, you know, I'm more dry. So it's like a solution, like a very, very thick, very, very thick hand sanitizer. I guess is the only way I can explain it. But I use that and I still do like my wash. So I'm still sterile and clean, but I'm not wet cause I hate being wet. And then I walk in and I gown up. So when I'm gowned up, that's when I will then put the sterile covers on the lights, position the light in the way that it should be for the surgery. And during this whole time I attending is still like doing other things, right? Maybe like delivering a baby vaginally or something like that while we're prepping in the OR. Then as long as like the time has passed for the abdomen that my, the nurse has already like gone through and done the prep, as long as that time has passed cause there has to be a certain length of time for it to dry and set. Then we get the drape and I drape it onto her abdomen and in the area that we're gonna be cutting like the suprapubic area. We drape that so you have that area and then you kind of tape it down and then you have your nice, beautiful, like sterile set up C-section ready to go. So once that is said and done, typically like my attending walks in and then she gets gowned or he gets gowned and it's time to rock and roll. And so she'll be like, all right, time out. And so the time out happens where they go through the name of the patient, like there are date of birth and stuff, what procedure they're here for and kind of like who's in the surgery with them. And after time out starts, then and it's finished. Like then we say, all right, incision and that's when the surgery begins. So my attending makes the first incision. I'm on, depending on if they're left handed or right handed, I'm on the opposite side. So if they're right handed, depending on the OR as well, they're on that side of the table and I'm over here. Okay, so it's like I'm looking at you and you are my attending, okay? If you're watching this video. And so they'll make the cut. I'll have like the suction in one hand and I'll have a towel, like a lap or a retractor in another hand because my job is to make their job a little bit easier. And so I'll be suctioning to get any blood out of the field and retracting back so that we can get a good view of the area that we're trying to get into. Once we make that first cut and we get through like a sub queue area, then they kind of like do some blunt dissections here and there. We'll like dissect through like the muscle layer and the fascia layer obviously of just like the abdominal wall. And usually like I said, we work in tandem. So like when we're doing like retractions, like getting to the uterus, like they'll do one side, I'll do the opposite side. Cause it's just, you know, it's just like a little bit easier. Like if you're coming this way and then I'm facing that way, it's just easier for me to go that way and cut that area, right? And obviously like I'm new. So there are some people that are like, you know, like, okay, you do it and then there are others like, all right, I'm like, I'll do this. Let me like see how you work first type of thing, which I am fine with because I am new. So please go ahead and coddle me all you want. I like, I'm okay with that. But with that being said, once we get to the uterus, my attending will make the incision for the uterine incision. And then that's when like you're prepared with like fluid, with a suction for the fluid that's gonna come out. Cause there's usually like a gush. This is like when there's like the gush, when people think like they're water races, we're like breaking the water. So you cut into the uterus, there's a bunch of fluid just splashing. And then you like suction that all up. And then you like note the consistency and like if it's clear or not of the fluid and then it's time for baby. And so after we make that incision, I am like pushing on the top of the fundus of the uterus to get baby out. So I'm like pushing from here and my attending is like pulling from our incision, the head. So it's like very much like a dance, right? So I push, they pull, I push and it's just consistent, constant pressure. And they pull and they pull and then baby comes and baby's there and sometimes baby's like crying and sometimes baby needs a little bit of help. And so like baby's there on the table and I'm suctioning and I'm patting baby and I'm cleaning baby up and I'm suctioning like fluid and blood and stuff cause all of that's coming out. And then I'm suctioning in the nose and I see their little baby face and they look so cute. And what we do this thing called delayed cord clamping. So we delay clamping the cord for one minute because studies have shown that that delay in cord clamping from the placenta can boost the baby's blood flow and oxygen intake and overall helps the infant to do better in the long run. Excuse me guys, I'm like a little, little sticky. And so we do delayed cord clamping. So we wait a minute, like the baby's just kind of hanging out there with us. This is when we get to like really see how cute their little faces are. And then we'll clamp the cord with, you know, like the little thing that you see on typically on the umbilical cord, the plastic clamp. So we'll clamp with that and then we'll clamp with like a Kelly and then we'll cut and then we'll go down a little bit further clamp, cut, take that part away. And then I'm holding like the part typically where the placenta is still attached to like a little bit more of the umbilical cord. And I'll open that up for our cord blood so that we can send that for like specimens and get testing. And then once that's done, then we pull the placenta out. And you have to be really like, you know, gentle with a like you massage the uterus to pull the placenta out. So like I massage my attendings pulling. Sometimes I get my ring forceps to like get the little pieces of placenta out because this is where like you'll get more bleeding. If there's like pieces of placenta and stuff still in the uterus, you'll continue. Like your lady will continue to bleed. Your patient will continue to bleed. And you don't want that. So we try to clean that out as best as possible. Sometimes we take a wet lap, a wet like towel and then there's kind of sweep it and clean it out. And I'm doing a bunch of suctioning and this is where we get like how much true blood loss there may have been. And then from that point on, we're trying to close up. And so like, well, you know, I'm clamping different the different corners and edges of the uterus because that's where they will bleed from a lot. If you don't close those edges well. So that's another thing that I'm doing on my side, my attendings doing on their side. And then they are the ones that are closing like the uterus. So they'll close the uterus and then they'll close the fascia and then I close everything after that. So I'll close like sub-Q and then skin. And after they close like the uterus and the fascia usually like they're gone. They say congratulations, oh baby's cute. They'll see the patient post-operatively and they're likely going again to like deliver another baby. You know, post-part, like a like a anti-partum patient that is like vaginally laboring. But I'll close like sub-Q and skin. And then some, you know, some attendings like to close sub-Q and then I'll just close the skin which is fine. And from that, depending on if we felt like there was a lot of bleeding or not, we'll like put a pressure dressing. And so after my attending leaves, like I'm in there by myself with like the scrub tech and the nurse and the anesthesiologist or the CRNA whoever's there with me and we're closing and we're talking and it's like a great time. And this is where I like I say it's like you get to like know these people and it's almost like being a family because you're just like, you're just like talking about random stuff in life. And it's fun and it's exciting and it's cool to just be in the human body and like seeing all the beautiful things that God has created in such like harmony in terms of how it works. So that's typically what I do as a first assist in my C-sections. Obviously I do GYN surgeries as well. So I'm also assisting in those like when it comes to circloges, you know topics and tubal ligations and other things like that. It's the same concept. The more of these surgeries that you see the easier they become. And so because it's very much like a routine, right? Or you hope so. And then from that post-op care. So in the OR like you are the first assistant surgeon on the case and that can be me as the PA or the resident or the certified registered first assist who is usually like an NP, okay? So like those are that's typically my day as a first assist in the OR on OBGYN. I will work on those shorts for you guys so that you guys can see like, you know the sterile opening of things and like place like if you wanna drop it on the table and stuff and we'll go from there and I'll give you some more videos on me and my life as an OBGYN PA cause I'm excited about this you guys. So hopefully you liked this video. Hopefully you learned some stuff. Hopefully you're a little bit more educated on what a first assist does in the OR. And then you know if you're going on your rotation you can expect what you can expect as a first or second assist in the OR. See if it's something that you really like. If you have any questions for me leave them in the comment section below. Don't forget to like this video, subscribe to my channel and follow me on Instagram you guys at AdonanPA and on Instagram at Get That See University where we help you not only get into but through PA school through the use of mock interviews and personal statement reviews and just personal consultations. We're kind of like life coaches for PA school, okay? So if you are interested in that or just in general because we, I have gotten some like personal statement reviews for just like grad school and college in general. So we do that as well and you don't have to be a member to get those services. So just be mindful of that. That's Get That See University dot com. Thank you guys so much for watching. I will talk to you guys next time. Bye.