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| The Surgical Technologist | SEPTEMBER 2017 402 After the surgeon has achieved hemostasis, any muscles will be closed with a 0 polyglactin 910 suture and the dermis will be closed with 2-0 polyglactin 910 sutures. A final count of softs and instruments will need to be completed when clo- sure begins, with an additional soft count performed before the final skin closure. The skin will be closed with a skin sta- pler, and sterile dressings will be placed over the incision sites. An X-ray of the surgical area will be taken before the patient is extubated to ensure reduction of their fractures. The surgical technologist will need to maintain sterility of their Mayo stand and backtable until the patient is safely out of the OR suite. Another consideration the OR team will need to be aware of is if the patient needs to undergo a bilateral fixation. In this case, the patient may need to be repositioned for a sec- ond and separate surgery if their fractures need repair on the opposite sides of the ribs. If this is the case, the surgical tech- nologist will need to anticipate additional draping supplies, gloves and gowns, and soft goods such as laps and sutures. The circulating nurse and surgical technologist will need to complete all counts on the initial side, and maintain sterility of the Mayo stand and backtable while the patient is reposi- tioned and prepped for the second repair. During the closure and counting, and repositioning of the patient, it is advised that the surgical technologist and circulating nurse not be relieved and remain in the OR suite to ensure that no inad- vertent contamination of the area occur and all supplies have been accounted for from the initial surgery. Unless other injuries to the patient require additional stay and attention, the patient can be transferred to the medical intensive care unit for observation and pain control. A U T H O R B I O Julie Beard, CST, has worked as a surgi- cal technologist for 12 years, all at Denver Health Hospital in Denver, Colorado, with eight of those years as the chief surgical tech for general surgery. R E S O U R C E S 1. Anatomy – Imaging of the diaphragm. Interventional Radiology Site. 2017. Accessed August 8, 2017. http://www.openradiology.org/presentations/ imagingdiaphragm/anatomy 2. Gray’s Anatomy. Henry Gray, FRS. Fifteenth Edition. 3. Professional Guide to Diseases.Amended Reprint. 1984 4. Surgical Report Integrating Surgical Rib Fixation Into Clinical Practice. Sep- tember 2013.A Report From the Rib Fracture Consensus Meeting. 5. Thoracic diaphragm. Wikipedia. 2017. Accessed August 8, 2017. https:// en.wikipedia.org/wiki/Thoracic_diaphragm C E E X A M Earn CE Credits at Home You wi l l be awarded cont inuing educa- tion (CE) credits toward your recertifica- t ion af ter reading the des ignated ar t i- cle and completing the test with a score of 70% or better. If you do not pass the test, it will be returned along with your payment. Send the original answer sheet from the journal and make a copy for your records. If possible use a credit card (debit or credit) for payment. It is a faster option for processing of credits and offers more flexibility for correct payment. When submitting multiple tests, you do not need to submit a separate check for each journal test. You may submit multiple journal tests with one check or money order. Members this test is also available online at www.ast.org. No stamps or checks and it posts to your record automatically! Members: $6 per credit (per credit not per test) Nonmembers: $10 per credit (per credit not per test plus the $400 nonmember fee per submission) After your credits are processed, AST will send you a letter acknowledging the number of credits that were accepted. Members can also check your CE credit status online with your login information at www.ast.org. 3 WAYS TO SUBMIT YOUR CE CREDITS Mail to: AST, Member Services, 6 West Dry Creek Circle Ste 200, Littleton, CO 80120-8031 Fax CE credits to: 303-694-9169 E-mail scanned CE credits in PDF format to: [email protected] For questions please contact Member Services - [email protected] or 800-637-7433, option 3. Business hours: Mon-Fri, 8:00a.m. - 4:30 p.m., MT