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

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Presentation on theme: "Frozen, Gross Room, and Sign Out TIPS Aleksandra Paliga July 8 th 2013."— Presentation transcript:

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

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20 When in doubt = Ask +/- Photograph

21 Signing Out

22  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)

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