screen display audio developer notes section 1 ... · february 6, 2007 script draft 2 surgical...

Client Logo

Production Company 1 Client February 6, 2007 Script Draft 2 Surgical Procedures – Carotid Endarterectomy

Screen Display Audio Developer Notes

SECTION 1: INTRODUCTION

1.1 SCREEN TITLE: SURGICAL PROCEDURES TRAINING Shot of the opening screen centered in content area. Surgical Procedures Training:

Carotid Endarterectomy This course is for Sales Training Only, Do Not Distribute, Disseminate, or Duplicate.

NARRATOR: The Product Surgical Procedures Training program contains six modules. Each module presents a surgical procedure in which Product can play an important role in hemostasis. This course is for Sales Training Only, Do Not Distribute, Disseminate, or Duplicate.

Fade up title center screen: Flash NEXT button

Client Logo



1.2

SCREEN TITLE: SURGICAL SPECIALTIES • Orthopedic Surgery

• Vascular/Thoracic Surgery

• Neurosurgery

NARRATOR: The specialties include Orthopedic Surgery, Vascular/Thoracic Surgery and Neurosurgery. The procedures are performed by recognized leaders in the specialties. They include commentary by the surgeon and additional information to help you present pertinent information about The Product to medical professionals who use hemostatic agents in their daily practice.

Fade title under and build bulleted list as called Flash NEXT Button

Client Logo


SECTION 1: INTRODUCTION

1.3

SCREEN TITLE: COURSE STRUCTURE • Introduction

• Program features • Surgical Team

• Pre-Operative

• Meet the patient • Procedure Overview

• Operating Room

• Narrated surgical video • Product applications

NARRATOR: In addition to this Introduction, each module has three content areas, accessible by clicking on the section tabs at the top of the screen. They include:

• Pre-Operative, where you meet the patient and access a high level overview of the procedure;

• Operating Room, where you can

access a narrated video of the procedure with Product applications; and,

Fade under specialties, fade up section definitions as called and highlight interface. Highlight Pre-Operative Tab Highlight Operating Room Tab Flash NEXT button

Client Logo



1.4

SCREEN TITLE: ASSESSMENT Shot of Knowledge Check opening screen

NARRATOR: You can access the sections in any order. Each section has a series of self assessment questions at the end so you can check your knowledge of that section. While no exam is required in this program, you will have to pass an exam covering the content of this program in the Client LMS System. If you are unfamiliar with the procedure in this module, It is recommended that you follow the program in order from Pre-Operative, through the Operating Room, to Post-Operative, taking the self assessment quizzes in each section. This will prepare you for the Client LMS exam.

Fade under section definitions Fade up Knowledge Check title screen Flash NEXT button

Client Logo



1.5

SCREEN TITLE: ADDITIONAL FEATURES Glossary Definitions Appendix Additional Information Help Assistance with program features Course Return to course

NARRATOR: The four icons at the top right of the screen provide access to additional features of the program including a Glossary with definitions of relevant terms, an Appendix containing further information about selected topics, and a Help section which has information on how to use the features of the program. The “Course” tab returns you to the course from the Glossary, Appendix or Help sections.

Fade under Knowledge Check screen, build list of feature sections as called Flash NEXT button

Client Logo



1.6

SCREEN TITLE: CONTROLS Highlight control panel Highlight Play, Stop and Progress Meter Highlight Volume slider Highlight Page Counter Highlight BACK and NEXT buttons

NARRATOR: The control panel is on the bottom of the screen. It contains several features that let you control the presentation. The Play Controls have a Start and Stop button and a progress meter that gives you a visual indicator of your progress through the Section. The Volume slider controls the audio level. The Page Counter lists your current page and the total number of pages in the section. The BACK and NEXT buttons allow you to move forward or back one page at a time.

Fade out definitions. Highlight control panel and individual controls as called. Flash NEXT button

Client Logo



1.7

SCREEN TITLE: SURGICAL TEAM Drawing of Surgical Team in OR (similar to example). Team highlights as called. Supered Titles:

• Surgical Team • Chief Surgeon • OR Nurse (scrub

nurse) • Anesthesiologist • Circulating Nurse

NARRATOR: The core surgical team for the procedures consists of the Chief Surgeon who directs the surgery, an Anesthesiologist who controls administration of the anesthetic, an Operating Room or OR nurse, also referred to as a scrub nurse, who passes instruments to the Surgeon as needed, and a circulating nurse who manages nursing care in the OR and provides additional equipment to the surgical team.

Provide opt out for Surgical Team Fade up drawing of surgical team in OR Highlight team members as called Super titles Flash NEXT button

Client Logo



1.8

SCREEN TITLE: ASSESSMENT Drawing fades under Titles appear as called:

• Assistant Surgeon(s)

• Certified Nurse Anesthetist

• Specialist(s)

• Technologist(s)

NARRATOR: In some environments the surgical team may also include one or more assistant surgeons who help the Chief Surgeon with the procedure. In some procedures, a Certified Registered Nurse Anesthetist, or CRNA, may administer the anesthetic rather than an Anesthesiologist. In specialized procedures, such as cardiac bypass, the surgical team will include specialists, such as a perfusionist who operates the heart-lung machine. In some cases, unlicensed assistive personnel, such as surgical technologists, may also assist the surgical team.

Fade under drawing Super titles as called Flash NEXT Button

Client Logo



1.9

SCREEN TITLE: HELP Help tab highlight

NARRATOR: If you have questions about the navigation options or features of the program, click on the Help tab at the top of the screen. If you are ready to begin learning about this surgical procedure, click a section tab above.

Highlight Help tab Drop highlight Flash NEXT button.

Client Logo



SECTION 2: PRE-OPERATIVE

2.1

SCREEN TITLE: Carotid Endarterectomy General shot of operating room during carotid endarterectomy procedure

NARRATOR: Carotid endarterectomy is the most commonly performed non cardiac vascular procedure with over 130,000 performed in the U.S. each year. 1 The procedure was developed in the mid 1950’s and has been refined over time. 2 It is a very safe procedure and almost all patients experience excellent results. 3

FADE UP to OR photo Flash NEXT button

Client Logo



2.2

SCREEN TITLE: CEREBROVASCULAR DISEASE

Drawing of head and neck with carotid arteries visible Dissolve to cross section of carotid artery at bifurcation with plaque around lining Animate plaque increasing and artery narrowing slowly to total occlusion Small bit of plaque breaks away from main mass

NARRATOR: Carotid endarterectomy is a surgical treatment for carotid arteries that are partially blocked by atherosclerotic plaque and the goal of the procedure is to prevent stroke. Cerebrovascular disease may result secondary to atherosclerosis in which there is a buildup of plaque in the arteries that supply blood to the brain. The plaque is composed of cholesterol, fat and other substances. It collects in the arteries and forms stenoses, or narrowings of the vessels. If the plaque ulcerates, a thrombus, or blood clot, can form on the plaque and cause an occlusion preventing blood flow to the brain. More commonly, bits of plaque break off and travel to the brain causing an embolism in the brain. Either occurrence can cause ischemic stroke resulting in severe disability or death. 4

FADE UP to drawing of head and neck with carotid arteries visible Dissolve to cross section of carotid artery at bifurcation with plaque formation Animate artery closing Small bit of plaque breaks away from main mass Flash NEXT button

Client Logo



2.3

SCREEN TITLE: BENEFITS OF CAROTID ENDARTERECTOMY

Shot of OR with surgery in progress Photo of older man walking briskly, smiling

NARRATOR: In carotid endarterectomy, surgeons open the diseased artery and remove the plaque to restore normal blood flow. For most patients the long term results of the procedure are excellent and there is a success rate of 98 to 99%. Studies indicate that once blockages exceed 60%, over the next five years, twenty percent of people will have a neurological event and the tighter the blockage, the higher the risk. The studies suggest that the risk of carotid endarterectomy for this population is less than the risk of having a stroke if the procedure is not performed.5 It has been shown to be three times as effective as medical therapy alone in reducing stroke in patients with symptomatic stenosis of 70 to 99%. 6

FADE UP to shot of OR

DISSOLVE to Photo of older man walking briskly, smiling

Flash NEXT button

Client Logo



2.4

SCREEN TITLE: ARTERIES OF THE NECK Drawing of the head and neck with carotid arteries visible Highlight carotid arteries Fade up labels for carotid arteries as called

NARRATOR: The carotid arteries are the major arteries of the neck. The right and left carotid arteries are located on either side of the neck and carry blood from the aorta to both sides of the neck, the head and the brain. The common carotid artery bifurcates midway along the neck into the exterior carotid artery and the internal carotid artery. The external carotid artery supplies blood to the face and neck and the internal artery supplies blood to the brain. Two vertebral arteries pass through openings on either side of the spinal column to provide blood to the lower parts of the brain. 7

FADE UP to drawing of head and neck with carotid arteries visible Label common carotid artery below bifurcation and internal and external carotids above bifurcation as called FADE IN vertebral arteries Flash NEXT button

Client Logo



2.5

SCREEN TITLE: VEINS AND MUSCLES OF THE NECK Drawing of head and neck with carotid arteries visible Jugular veins appear as called Carotid sheath appears Sternocleidomastoid and infrahyoid muscles appear Platysma appears

NARRATOR: The major veins of the neck are the internal and external jugular veins, the anterior jugular vein and the posterior external jugular vein. The internal jugular vein drains blood from the brain. The carotid artery and the internal jugular vein are enclosed in a layer of connective tissue called the carotid sheath. 8

The carotid sheath lies above the sternocleidomastoid muscle and the infrahyoid muscles lie above the carotid sheath. The infrahyoid muscles are thin, strap-like muscles that move the larynx. They are covered by a wide, thin muscle called the platysma, that attaches to the skin and produces facial expressions.9

FADE UP to drawing of head and neck with carotid arteries visible FADE IN jugular veins as called FADE IN carotid sheath FADE IN sternocleidomastoid and infrahyoid muscles as called FADE IN platysma Flash NEXT button

Client Logo



2.6

SCREEN TITLE: INTERACTIVE NECK Drawing of head and neck with arteries, veins and muscles visible Names as labels in random order including: Carotid artery Vertebral artery Internal jugular vein Carotid sheath Sternocleidomastoid muscle Infrahyoid muscle Platysma

NARRATOR: Using your cursor, accurately label the parts of the neck and major vessels Correct Feedback: Good, that’s correct. Negative Feedback: Sorry, try again

Label neck and vessel procedure - Drag name tags parts to label heart and vessels - When assembled, click on commit - If correct, get correct feedback - If wrong, name tags fly apart and negative feedback presented - Get second try - If correct, get correct feedback - If wrong, tags correctly attach themselves

Client Logo



2.7

SCREEN TITLE: ATHEROSCLEROTIC PLAQUE

Carotid artery Highlight bifurcation CU plaque

NARRATOR: Most atherosclerotic plaques in the carotid arteries occur at the bifurcation and usually involve the common carotid artery and the origin of the internal carotid artery.10 They have features common to other complex atherosclerotic lesions. They have a soft central core and a fibrous cap of varying thickness that can rupture and release debris from the core. 11

FADE UP to drawing of carotid artery Highlight bifurcation Dissolve to CU plaque Flash NEXT button

Client Logo



2.8

SCREEN TITLE: PRE-OPERATIVE TESTS General shots of blood testing

NARRATOR: Several screening tests may be performed before surgery to determine if the patient has a bleeding disorder. The CBC or complete blood count is the most common test performed. It determines the number of red and white blood cells and can also include a platelet count. The number of platelets is an important indicator of the blood’s ability to stop bleeding by clotting and a physician may order a separate Platelet Count Test. Two tests are commonly performed to test the overall function of proteins required for normal blood clotting: the prothrombin time test, or PT, and the Activated Partial Thromboplastin Time, or aPTT test. 12

Fade up shot of blood testing SUPER: CBC: Complete Blood Count SUPER: Platelet Count SUPER: PT: Prothrombin Time aPTT: Activated Partial Thromboplastin Time Flash NEXT button.

Client Logo



2.9

SCREEN TITLE: PRE-OPERATIVE TESTS

General shots of blood testing Super as called:

● BUN ● Serum Chloride ● CO2 ● Creatinine ● Glucose ● Serum Potassium ● Serum Sodium

Ultrasound display

NARRATOR: Some surgeons also order a Chem 7 test which is a series of seven chemical tests on the serum. They include: blood urea nitrogen, serum chloride, carbon dioxide, creatinine, glucose, serum potassium and serum sodium. 13

Several diagnostic tests may be performed to determine the location and severity of the stenosis. Doppler ultrasound imaging is a common test for carotid atheroma, and some physicians may also order an arteriogram or Magnetic Resonance Angiography or MRA.14

SUPER titles as called:

● BUN ● Serum Chloride ● CO2 ● Creatinine ● Glucose ● Serum Potassium ● Serum Sodium

Dissolve to ultrasound display Flash NEXT button

Client Logo



2.10

SCREEN TITLE: SURGICAL PROCEDURE

MS general OR shot with surgery in progress Drawing of patient on operating table with head turned to side

NARRATOR: The following narration is a description of carotid endarterectomy that was synthesized from several sources.15 The techniques and outcomes of the procedure may vary somewhat by the performing surgeon. The procedure can be performed under local or general anesthesia. Since there is a slight chance of ischemia or stroke during the procedure, the patient is often monitored with electroencephalography if general anesthesia is used. If a regional block is used, the anesthesiologist will assess the patient neurologically during the procedure.

FADE UP to OR shot DISSOLVE to drawing of patient on operating table with head turned to side Flash NEXT button

Client Logo



2.11

SCREEN TITLE: SURGICAL PROCEDURE MCU side view of neck and head Incision appears Retractors appear and wound is opened CU incision showing common, internal and external carotid arteries

NARRATOR: The surgeon makes an oblique incision about ten centimeters long above the carotid bifurcation to open the skin. Then the platysma muscle is incised and retractors are used to open the incision. The infrahyoid muscle is incised and retracted and the carotid sheath is opened. Depending on the patient’s anatomy and the location of the stenosis, one or more veins may be resected to provide a clear approach. Once the carotid sheath is opened, the jugular vein is retracted posteriorly from the carotid artery and the common carotid, internal carotid and external carotid are dissected in sequence with minimal manipulation of the diseased area to prevent emboli.

FADE UP to MCU side view of neck and head DISSOLVE in line to indicate incision DISSOLVE IN retractors and open wound DISSOLVE to CU incision showing common, internal and external carotid arteries Flash NEXT button

Client Logo



2.12


CU of carotid artery at bifurcation Shunt appears inserted into common and internal carotid arteries Dissolve to drawing of clamp on internal carotid artery then on common carotid artery

NARRATOR: The surgeon may or may not use a shunt to provide blood flow through the artery during the procedure. If a shunt is required it is inserted first into the internal carotid artery, allowed to back bleed, and then inserted into the common carotid artery. If no shunt is required the internal artery is clamped first, followed by the common and external carotid arteries in sequence. The order is used to minimize the fracture of plaque and prevent emboli from reaching the brain if it is disturbed during the procedure. Before applying clamps or a shunt, the patient is heparinized to further reduce the potential for clotting.

FADE UP to CU of carotid artery at bifurcation DISSOLVE IN shunt inserted into common and internal carotid arteries DISSOLVE to drawing of clamp on internal carotid artery then on common carotid artery Flash NEXT button

Client Logo



2.13


CU carotid artery at bifurcation Dissolve to opened artery with plaque visible Plaque dissolves away Dissolve to artery closed with stitches

NARRATOR: The surgeon begins the arteriotomy by incising the common carotid artery below the plaque with a scalpel and then uses angled scissors to incise the artery through the plaque to the undiseased interior carotid artery. The plaque is carefully dissected from the arterial wall and removed. The surgeon takes great care to make sure that all debris is removed from the vessel and it is meticulously cleaned. Then the arteriotomy is closed with a primary closure or with a vein or a prosthetic patch. Just before completing the closure, the shunt is removed and all vessels are allowed to flush to remove air and debris. Many surgeons will insonate the carotid bifurcation with a continuous wave Doppler probe to confirm unimpeded diastolic flow in the interior carotid artery.

FADE UP to CU carotid artery at bifurcation DISSOLVE to opened artery with plaque visible DISSOLVE away plaque DISSOLVE artery closed with stitches

Flash NEXT button

Client Logo



2.14


Drawing of open wound with artery closed Animate wound closing Dissolve to general OR shot

NARRATOR: The vessels are repositioned and the carotid sheath is closed. Then the infrahyoid and platysma muscles are closed in sequence and the skin incision is closed. The procedure takes from one to two hours to perform. The patient is monitored for several hours in a recovery room and is often released the day following the procedure. Discomfort is usually minimal and patients can usually resume a normal activity level in several days.

FADE UP to drawing open wound with artery closed Animate wound closing DISSOLVE to general OR shot Flash NEXT button

Client Logo



2.15

SCREEN TITLE: SURGICAL TEAM Stock photo representing patient

NARRATOR: In the procedure we will observe, the surgeon performs a carotid endarterectomy involving bilateral stenosis. The procedure is performed on the patient’s left carotid artery. The patient is an eighty-three year old female who presented with transient ischemic attack on the right side. A carotid ultrasound showed that the patient was severely calcified. CT angiography showed critical bilateral stenosis. The patient had an endarterectomy on the right side three weeks prior to the current procedure.

FADE IN patient photo Flash NEXT button

Client Logo



2.15

SCREEN TITLE: SURGICAL TEAM Stock photo of surgical team members highlighted as called

NARRATOR: The patient was taking aspirin and Plavix prior to surgery. Plavix was stopped one week before the procedure. The surgeon ordered several blood tests prior to surgery including a CBC, platelet count, PT, aPTT, hematocrit and hemoglobin, type and cross, creatinine and BUN. In this procedure the lead surgeon will direct the surgery and perform the primary steps in the procedure. He will be assisted by an assistant surgeon and a scrub nurse who will hand him the instruments he needs in sequence as required in the procedure. An anesthesiologist will administer the anesthesia and monitor the patient neurologically. A circulating nurse will supervise the overall nursing care during the operation.

DISSOLVE to photo of surgical team highlight members as called Flash NEXT button

Client Logo



2.16

SCREEN TITLE: ASSESSMENT 1. What is the most common

condition resulting from rupture of an atherosclerotic plaque in the carotid artery?

a. Thrombus forms on the

plaque b. Aneurysm in the brain c. Total arterial occlusion d. Embolism in the brain 2. Compared to medical

therapy in patients with symptomatic stenosis of 70 to 99 %, carotid endarterectomy is:

a. Twice as effective b. Not as effective c. Three times as effective d. About the same

effectiveness

NARRATOR:

Correct answer: d Correct answer: c

Client Logo



2.16

SCREEN TITLE: ASSESSMENT 3. Which vessels are in the carotid sheath? a. Carotid artery and internal jugular vein b. Interior carotid artery and anterior jugular vein c. External carotid artery and external jugular vein d. Common carotid artery and anterior jugular vein 4, If general anesthesia is used, the patient is often monitored by: a. electrocardiography b. electroencephalography c. electrocochleography d. electromyography

NARRATOR:

Correct answer: a Correct answer: b

Client Logo



2.16

SCREEN TITLE: ASSESSMENT 5. If a shunt is used, in which sequence is it inserted: a. Internal carotid artery then external carotid artery b. Internal carotid artery

then common carotid artery

c. External carotid artery then common carotid artery

d. Common carotid artery then aorta

NARRATOR:

Correct answer: b

Client Logo



3.1

SCREEN TITLE: MEET THE SURGEON The following video of a carotid endarterectomy is real-life and represents the technique of the specified vascular surgeon. The audio portion of this program has been edited for content. Changes do not affect the outcome or conclusions of this program. Photo of Dr. Vascular Surgeon

NARRATOR: The following video of a carotid endarterectomy is real-life and represents the technique of the specified vascular surgeon. The audio portion of this program has been edited for content. Changes do not affect the outcome or conclusions of this program. We will observe a carotid endarterectomy performed by Dr. Vascular Surgeon. Dr Surgeon is a Fellow of the American College or Surgeons. He is a vascular surgeon practicing at TheHospital in Anytown, USA. He is also a Clinical Associate Professor of Surgery at the Medical College of The University.

Video controls will allow users to rewind, but not to fast forward. FADE UP to disclaimer text DISSOLVE to photo of Dr. Vascular Surgeon Flash NEXT button

Client Logo



3.2

SCREEN TITLE: PREPARATION FOR SURGERY

NARRATOR: The procedure will be performed under local anesthesia. When the video opens, the patient has received a cervical block anesthetic. She has been positioned on her right side to provide an approach to the left carotid artery and draped. We join the procedure as Dr. Surgeon is drawing the incision guide.

Client Logo



3.3

SCREEN TITLE: PROCEDURE VIDEO

NARRATOR: This video shows a carotid endarterectomy. This is being performed under cervical block anesthesia with the patient awake. He is able to respond to simple commands. The incision is made on the anterior portion of the neck just in front of the sternocleidomastoid muscle. It’s deep and down through the skin and soft tissue. It will go through the platysma muscle and then in through the carotid sheath.

Client Logo



3.3

SCREEN TITLE:

SURGEON: Visualized right now is the internal jugular vein. The vein crossing interiorly is called the transverse facial vein. This vein will be divided and the common carotid artery can then be exposed. At the base of the incision there’s the pulsatile common carotid artery. Soft tissue is removed with electrocautery. The common carotid artery is gently mobilized to come out into the field. If the patient suffers any discomfort the field is infiltrated with Xylocaine.

Client Logo



3.3

SCREEN TITLE: Pop Up The hypoglossal nerve is a cranial nerve. It is a motor nerve that supplies the tongue and hyoid assembly. The vagus nerve is also a cranial nerve that supplies primarily the viscera with autonomic sensory and motor fibers. The laryngeal nerve is a branch of the vagus nerve that supplies the larynx.16

SURGEON: The video now reveals the common carotid artery in the upper portion. The internal and external carotid arteries are now being dissected free from the surrounding tissue. Care is taken to avoid injury to nerves, especially the hypoglossal nerve, the vagus nerve, and the superior branch of the external laryngeal nerve. That is the hypoglossal nerve which is being shown on the video at this time. The looping vessel loops around the common carotid artery. The carotid bifurcation is visualized with the internal carotid artery in the upper portion. The external carotid artery is inferior.

Pause video if necessary and pop up text: The hypoglossal nerve is a cranial nerve It is a motor nerve that supplies the tongue and hyoid assembly. The vagus nerve is also a cranial nerve that supplies primarily the viscera with autonomic sensory and motor fibers. The laryngeal nerve is a branch of the vagus nerve that supplies the larynx16

Restart video if necessary

Client Logo



3.3

SCREEN TITLE: Pop Up: Vessel loops are silicon bands used to mobilize vessels without damaging them. They are used to provide access to the arteries for the surgeon and to move other vessels in the area out of the surgical field during the procedure.

SURGEON: Dissect out as much common carotid artery as possible. Superior thyroid artery is also looped and preserved. We are now dissecting out the internal carotid artery. The loop is placed around the internal carotid artery distal to any palpable plaque. The patient is now heparinized prior to clamping of the carotid vessels. Clamps are then carefully placed on the carotid vessels beginning with the internal carotid artery, followed by the common carotid artery, and last, the external carotid artery.

Pause video if necessary. Pop up text: Vessel loops are silicon bands used to mobilize vessels without damaging them. They are used to provide access to the arteries for the surgeon and to move other vessels in the area out of the surgical field during the procedure.

Client Logo



3.3

SCREEN TITLE: Pop Up: If general anesthesia is used, patients are often monitored by continuous EEG17

SURGEON: As the patient is awake, the patient is asked to squeeze a ball which is in the opposite hand and also wiggle the toes and occasionally to say his name or phone number or other simple maneuvers. Stay sutures are placed at the level of the arteriotomy. The internal carotid artery is opened in a transverse fashion and then this arteriotomy is extended into the internal carotid artery.

Pause video if necessary and pop up text: If general anesthesia is used, patients are often monitored by continuous EEG Re-start video if necessary

Client Logo



3.3

SCREEN TITLE:

NARRATOR: Some surgeons prefer a technique called eversion carotid endarterectomy in which the internal carotid artery is transected at the level of bifurcation and reimplanted into the common carotid artery. They feel that this technique provides a simpler technique, faster operating times and other advantages. Randomized studies have determined no differences in rates of death or recurrent stenosis.18

Pause Video if necessary for Narrator

Client Logo



3.3

SCREEN TITLE: Pop Up: Some surgeons use a shunt to provide blood flow during the procedure, especially if general anesthesia is used, because there is no way to monitor how much blood is getting to the brain.19

SURGEON: The plaque is now being exposed. It is dissected free from the normal artery and to a point where it feathers without any residual plaque distally. The internal carotid artery is carefully examined so that there is no flap or remaining plaque. The endarterectomy is then performed on the common carotid artery and on the external carotid artery.

Pause video if necessary and pop up text: Some surgeons use a shunt to provide blood flow during the procedure, especially if general anesthesia is used, because there is no way to monitor how much blood is getting to the brain.

Client Logo



3.3

SCREEN TITLE: Video is paused

SURGEON: After all plaque is removed and visualized that there are no defects, the vessels are flushed with heparinized saline solution. And then an end-to-end anastomosis is constructed between the internal carotid artery and the carotid body with a running 6.0 proline suture. NARRATOR: Some surgeons use a closure technique called vein patch closure in which a portion of the endarterectomy site is reconstructed with endothelial tissue, altering the hemodynamic configuration of the carotid bifurcation. The technique is designed to reduce thrombus accumulation and prevent perioperative stroke and asymptomatic occlusion of the internal carotid artery.20

Pause video for narrator Re-start video

Client Logo



3.3

SCREEN TITLE:

SURGEON: After the anastomosis is constructed, the suture is then tied and the external carotid artery is opened. Then the common carotid artery is opened followed by the internal carotid artery which is opened last. The patient again is checked to see if he has good neurologic function. Flows are routinely checked with a floprobe and occasionally with ultrasound. Floprobe is being attached at this point, and flows are usually greater than 120 cc per minute. The heparin is not reversed. Any oozing from this anastomosis is controlled with The Product soaked into an absorbable gelatin sponge. This absorbable gelatin sponge with The Product can be left in place.

Client Logo



3.3

SCREEN TITLE:

SURGEON: Prior to closing, the area is checked for any bleeding. And if there is no further bleeding, soft tissue is closed with multiple layers of 3.0 Vicryl and the skin is closed with 4.0 Vicryl in a subcuticular fashion and then treated with Dermabond. The patient is taken to post anesthetic care unit for approximately 2-and-a-half hours where his neurologic status is checked approximately every 10 to 15 minutes.

Client Logo



3.3

SCREEN TITLE: Freeze frame from video showing Product soaked gel sponge

NARRATOR: The procedure took approximately two hours to perform from the initial incision to the closing of the wound. Hemostasis of the anastomosis was achieved using a Product soaked, absorbable gel foam which was left in the wound.

DISSOLVE to freeze frame from video showing Product soaked sponge in wound

Client Logo



3.4

SCREEN TITLE: ASSESSMENT 1. To which nerves does the

surgeon take special care to avoid injury?

a. hypoglossal nerve b. Phrenic nerve c. Laryngeal nerve d. Vagus nerve

2. This surgeon used a technique in which the artery was opened with a transverse incision. What is another technique used in this procedure?

a. Carotid angioplasty b. Eversion endarterectomy c. Carotid shunting d. Minimally invasive

endarterectomy

NARRATOR:

Correct answers: a, c, d Correct answer: b

Client Logo



3.4

SCREEN TITLE: ASSESSMENT 3. In which order are arteries

clamped in the procedure? a. Internal carotid, common

carotid, superior thyroid b. Common carotid, external

carotid, internal carotid c. Superior thyroid, internal

carotid, external carotid d. Internal carotid, common

carotid, external carotid 4. This surgeon used an end-

to-end anastomosis to close the arteries. What is another closure technique used in this procedure?

a. Arterial graft closure b. Purse string suture c. Vein patch closure d. Arterial patch closure

NARRATOR:

Correct answer: d Correct answer: c

Client Logo



3.4

SCREEN TITLE: ASSESSMENT 5. Why is a shunt often used if

this the procedure is performed under general anesthesia?

a. Can’t accurately monitor

blood flow to the brain b. Keep blood out of the

surgical field c. Required for effective

anesthesia d. Avoid use of perfusion

machine during the procedure

NARRATOR:

Correct Answer: a

Client Logo


Carotid Endarterectomy - Cited References 1. Carotid Endarterectomy – OSHR, p.2. Sabiston, p.1345. 2. Carotid Endarterectomy – OSHR, p.2. Sabiston, p.1342-1343. 3. The Surgery Book, p.155. MedlinePlus/ORLive video transcript, p.8 4. Current Surgical Diagnosis and Treatment, P. 847. Carotid Endarterectomy – NorthPoint Domain, p.1. 5. Carotid Endarterectomy – MedlinePlus/OR Live video transcript p. 4, p.8. 6. Guidelines for Carotid Endarterectomy, p. 506. 7. Anatomica, p.494-496. Gray’s Anatomy 8. Anatomica, p. 494-496. Gray’s Anatomy 9. Anatomica, p. 494-496. Gray’s Anatomy 10. Carotid Endarterectomy – NorthPoint Domain, p.1. Current Surgical Diagnosis and Treatment, P. 847. Sabiston, p. 1339. 11. Sabiston p. 1340. 12. Merck Manual, p. 980.

Client Logo


13. Chem7 – MedlinePlus Encyclopedia. 14. Carotid Endarterectomy – OSHR, p.2-3. 15. Carotid Artery Surgery – Surgical Associates of Texas Carotid Artery Surgery – MedlinePlus Medical Encyclopedia Carotid Endarterectomy – MedlinePlus/OR Live video transcript Carotid Endarterectomy – MedlinePlus X-Plain Carotid Endarterectomy – OSHR Carotid Endarterectomy – Pocket Guide to the OR Carotid Endarterectomy – vascularweb.org The Complete Guide to Symptoms, Illness and Surgery Current Surgical Diagnosis and Treatment Sabiston Stroke - Anatomica The Surgery Book 16. Hypoglossal – Vagus – Laryngeal Nerves 17. Carotid Endarterectomy – MedlinePlus/OR Live video transcript, p.19 18. Sabiston, pl 1354 19. Carotid Endarterectomy – MedlinePlus/OR Live video transcript, p.15 20. Sabiston, p. 1352

Client Logo


Carotid Endarterectomy - Bibliography Anatomica Global Book Publishing Pty Ltd Willoughby, NSW Australia Reprinted by Barnes and Noble 2003 Carotid Artery Surgery MedlinePlus Medical Encyclopedia Updated 7/14/2006 J.A. Lee M.D. Division of Surgery UCSF San Francisco, CA Reviewed by VeriMed Healthcare Network Carotid Artery Surgery Surgical Associates of Texas, P.A. Texas Heart Institute Revised April 2005 © 2000 Carotid Endarterectomy MedlinePlus X-Plain The Patient Education Institute, Inc. © 1995-2004 Carotid Endarterectomy Morristown Memorial Hospital MedlinePlus/ORlive Video Transcript January 28, 2005

Client Logo


Carotid Endarterectomy NorthPoint Domain Boston, MA 2005 http://www.northpointdomain.com/ Carotid Endarterectomy Office of Scientific and Health Reports of the National Institute of Neurological Disorders and Stroke, National Institutes of Health in January 1998. Last reviewed: July 1, 2001 Washington University Medical School St. Louis, MO http://www.strokecenter.org/pat/carotid_endarterectomy.htm Carotid Endarterectomy Vascular Web The Society for Vascular Surgery Chicago, IL http://www.vascularweb.org/_CONTRIBUTION_PAGES/Patient_Information/NorthPoint/Carotid_Endarterectomy.html Chem-7 From Medline Plus Medical Encyclopedia Updated 6/13/2005 Updated by: Nader Najafian, M.D., Associate Physician, Renal Division, Brigham & Women's Hospital, Instructor of Medicine, Harvard Medical School, Boston, MA. Review provided by VeriMed Healthcare Network. http://www.nlm.nih.gov/medlineplus/ency/article/003462.htm The Complete Guide to Symptoms, Illness and Surgery 5th Edition Griffith, H. Wynter, M.D. The Berkeley Publishing Group New York 2006

http://www.northpointdomain.com/

Client Logo


Current Surgical Diagnosis & Treatment 11th Edition Way, Lawrence, MD and Doherty, Gerard M, MD, Editors Lange Medical Books/McGraw Hill 2003 Gray’s Anatomy 3. Arteries of the Head and Neck 3b. The Veins of the Head and Neck Gray, Henry 1918 Online at: http://www.bartleby.com/107/143.html http://www.bartleby.com/107/167.html Guidelines for Carotid Endarterectomy Circulation Journal of the American Heart Association Dallas, TX 1998 The Merck Manual of Medical Information Second Home Edition Merck & Co., Inc. 2003 Pocket Guide to the Operating Room 2nd Edition Goldman, Maxine F.A. Davis Company Philadelphia 1988

http://www.bartleby.com/107/143.html

http://www.bartleby.com/107/167.html

Client Logo


Sabiston Textbook of Surgery 16th Edition Courtney M., Jr., M.D. Townsend (Editor); Beauchamp, Daniel R., M.D. (Editor): Evers, B. Mark M.D. (Editor): Mattox, Kenneth L. (Editor); David C. Sabiston (Editor): W.B. Saunders Co. 2001 The Surgery Book Youngson, Robert M., MD; The Diagram Group St. Martin’s Griffin New York 1993

screen display audio developer notes section 1 ... · february 6, 2007 script draft 2 surgical...

Documents