Your FREE CSFA Flashcards 2026 – 100+ Cards

A qualified surgical professional who, under the surgeon's direction, provides exposure, hemostasis, tissue handling, and wound closure — without making independent surgical decisions.

Certified Surgical First Assistant — the NBSTSA's advanced first-assistant credential, distinct from the CST scrub-role credential.

The set of practices that keep the surgical field free of pathogenic microorganisms; the governing rule is that sterile touches only sterile.

Scrub from the fingertips toward the elbow so the hands stay the cleanest area; afterward hold hands and forearms above the waist and in sight.

Self-gloving in which the hands stay inside the gown cuffs until the gloves are pulled over them, keeping the sterile gown sterile.

A scrubbed person is sterile only from the chest down to the level of the sterile field (table top); the axillae and gown back are not sterile.

Contamination that occurs when moisture wicks through a sterile drape or gown, breaching the sterile barrier.

The honesty and discipline to recognize and correct any break in sterile technique — even when unobserved — because patient safety depends on it.

The outer ~1 inch (about 2.5 cm) of a sterile drape or wrapper is considered nonsterile, a boundary that must not be crossed.

Holding tissue or organs out of the operative field to give the surgeon clear exposure — the first assistant's defining duty.

Opposing forces applied to tissue to create even tension, opening the anatomic plane so the surgeon can dissect sharply along the correct plane.

Gentle tissue handling, strict asepsis, sharp dissection, careful hemostasis, preserved blood supply, no dead space, and no tension.

Cutting tissue with a scalpel or scissors along an anatomic plane, as opposed to blunt dissection, which separates tissue by tearing or spreading.

A fine, atraumatic retractor chosen for small, delicate structures that would be injured by a larger instrument.

Control of bleeding by mechanical, thermal, or chemical means — the first assistant's central role in keeping a dry, visible field.

Physically occluding a vessel: direct pressure, hemostatic clamps, ligatures, vessel loops, surgical clips, bone wax, and the pneumatic tourniquet.

Agents that promote clotting: gelatin (Gelfoam), oxidized cellulose (Surgicel), microfibrillar collagen (Avitene), thrombin, and fibrin sealant.

A single strand of suture looped and tied around a clamped vessel to occlude it; can slip off a large, pulsating vessel.

Suture on a needle passed through a large vessel's wall and tied, anchoring the ligature so it cannot slip off.

A thin silicone band passed around a vessel; doubled and snugged it can temporarily occlude blood flow or simply isolate the vessel.

A topical hemostatic agent that works by providing a surface that triggers platelet aggregation.

A mechanical hemostatic agent smeared onto cut bone surfaces to physically occlude bleeding from the bone.

An inflatable cuff that occludes arterial flow to a limb for a bloodless field; the limb is usually exsanguinated first, and prep must not pool beneath it.

Suture broken down by the body over time (gut, polyglactin/Vicryl, poliglecaprone/Monocryl, PDS); for deep layers and ligation needing only temporary support.

Suture that retains strength long-term (silk, nylon, polypropylene/Prolene, steel); for skin, tendon, anastomoses, and permanent implants.

A single-strand suture with low tissue drag that resists harboring bacteria but handles stiffer (nylon, polypropylene, PDS).

Many strands braided together; handles and ties easily with good knot security, but interstices can wick fluid and harbor bacteria (silk, braided polyester, Vicryl).

Individually placed and knotted stitches; if one fails, the rest of the closure holds — more secure than a continuous suture.

A single strand sewn down the wound; fast and tension-distributing, but a single break can loosen the whole line.

Placing each bite at equal depth on both sides of a wound so the edges approximate evenly.

Excessive tension is avoided because it compromises blood supply to the wound edges and impairs healing.

Skin staples are removed postoperatively with a dedicated staple extractor (remover), not a clamp.

A device that evacuates fluid or air from a wound; where it exits the skin the first assistant typically secures it with a suture.

Vacuum-assisted closure using foam under suction to promote healing; the foam dressing is changed on a scheduled interval (commonly every 2–3 days).

Surgical sponges used in a body cavity contain a radiopaque marker so a retained sponge can be found on X-ray.

Marking the surgical site and confirming it during the Time Out helps prevent wrong-site surgery.

Injecting a local anesthetic into the wound margins, often before closure, to provide postoperative pain control at the incision.

Added for vasoconstriction, which prolongs the anesthetic effect and reduces bleeding; avoided in digits, nose, ears, and other end-arterial structures.

Wearing two pairs of gloves, commonly practiced by the first assistant to reduce the risk of exposure if the outer glove is punctured.

A clean wound whose edges are approximated and held together, healing quickly with minimal scarring.

When moving a patient to lithotomy, both legs are raised and lowered together to protect the hips and prevent injury.

The grounding pad is applied over well-perfused muscle rather than a bony prominence to prevent return-electrode burns.

A drape found to have a hole or tear after application is contaminated and must be covered or re-draped, not used as is.

Confirming the signed consent lists the correct patient, procedure, and site before the procedure begins.

Draining blood from a limb (often with an Esmarch bandage) before inflating a pneumatic tourniquet to create a bloodless field.

Gentle, atraumatic handling that minimizes tissue injury, preserves blood supply, and promotes faster, complication-free healing.

Small metal or polymer clips applied to occlude a vessel quickly when a tie would be slower or harder to place.

An unattended, uncovered, or out-of-sight sterile field is considered contaminated.

Antiseptic prep is applied starting at the incision and moving outward in expanding circles, clean to dirty, without returning a used sponge to the center.

The CSFA assists under the surgeon's direction and does not make independent surgical decisions or perform the surgeon's role.

Passing high-frequency current through the patient's tissue to cut or coagulate; the tissue completes the circuit.

Heating a wire element directly with current that does NOT pass through the patient; the hot wire transfers heat to tissue.

Current flows from the active electrode through the patient to a dispersive return pad and back to the generator; a return electrode is required.

Current flows only between the two tips of the instrument, so no patient return pad is needed and the path is small and localized.

A monopolar coagulation technique that sparks the electrode across a gap to char and coagulate a broad tissue surface.

The cut mode uses a continuous low-voltage waveform for cleaner cutting; coagulation uses an interrupted higher-voltage waveform; blend combines cutting with hemostasis.

A device that uses pressure and bipolar energy with impedance feedback to fuse vessel walls into a permanent seal, often up to a rated diameter.

An energy device that uses high-frequency mechanical vibration to cut and coagulate tissue with little lateral thermal spread.

A generator that references current to itself rather than ground, largely replacing older ground-referenced units to reduce alternate-site burns.

Vaporized mixture of fine particulates, chemicals, and possibly viable cells released when energy thermally destroys tissue — a respiratory and biological hazard.

Hold the evacuator wand close to the source (within about 2 cm) to capture plume effectively, with in-line filtration.

Surgical plume from some lesions can carry viable viral particles (e.g., HPV DNA), adding a biological risk beyond the chemical one.

An unintentional tort — harm resulting from failing to act as a reasonably prudent professional would.

Duty, breach of that duty, causation, and damages — all four must be proven, or the claim fails.

A doctrine holding an employer liable for an employee's negligent acts within the scope of employment; the individual remains personally accountable.

A legal and ethical duty of the first assistant; breaching it violates patient privacy obligations and exposes the assistant to liability.

From a legal standpoint, the assistant verifies the consent form lists the correct patient, procedure, and site and is properly signed.

An OR fire needs an ignition source (electrosurgery, laser), fuel (drapes, prep, gauze), and an oxidizer (oxygen, nitrous oxide).

Supplemental oxygen and nitrous oxide accumulating beneath the drapes create the oxidizer-enriched atmosphere that makes OR fires especially dangerous.

Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep side to side.

Let alcohol-based prep dry completely before draping or activating energy, because pooled prep is a fire and burn hazard.

The structured command framework a facility activates during an external disaster or mass-casualty event to coordinate the response.

During an intraoperative power failure, the team relies on backup power and stabilizes the patient while maintaining the sterile field and safety.

Smoke from a laser case carries a laser-specific hazard in addition to the chemical and biological risks of surgical plume.

Accurate charting distinguishes electrosurgery (current through tissue) from electrocautery (heated wire) — they are not interchangeable terms.

Treating all blood and body fluids as potentially infectious and using appropriate barriers and practices with every patient.

Within Ancillary Duties the CSFA may serve as a technical resource to the surgical team on equipment and assisting technique.

An advanced bipolar vessel sealer is chosen over a metal clip when a durable seal is wanted without leaving a foreign body or interfering with later imaging.

A rare, inherited hypermetabolic crisis triggered in susceptible patients by volatile anesthetics or succinylcholine.

A rapidly rising end-tidal CO₂ (ETCO₂) is the earliest and most sensitive sign; a temperature rise is a late sign.

Volatile inhalational anesthetics (e.g., sevoflurane, isoflurane) and the depolarizing relaxant succinylcholine.

The specific antidote for malignant hyperthermia; many vials must be reconstituted quickly, so several people mix it at once.

Susceptibility is largely inherited, so a family history of anesthesia problems is relevant preoperatively.

Generalized muscle rigidity, especially of the masseter (jaw), in a patient given a triggering agent is an early warning of MH.

Inadequate tissue perfusion; classified as hypovolemic, cardiogenic, distributive, or obstructive.

Loss of intravascular volume — from hemorrhage or fluid loss — dropping circulating volume; the most common surgical cause is blood loss.

Pump failure — the heart cannot pump effectively (MI, arrhythmia, heart failure), so cardiac output falls despite adequate volume.

Massive vasodilation dropping systemic vascular resistance; includes anaphylactic, septic, and neurogenic shock.

A mechanical block to blood flow — tension pneumothorax, cardiac tamponade, or massive pulmonary embolism.

A severe, rapid allergic reaction (distributive shock) with hypotension, hives, and bronchospasm; common triggers are latex and antibiotics; treat with epinephrine.

A form of distributive shock in which infection causes widespread vasodilation and impaired perfusion.

A drug-drug interaction in which two medications together produce an effect greater than the sum of their separate effects.

An anticholinergic; expected effects include a dry mouth and dilated pupils.

Sedation in which the patient breathes spontaneously while an anesthesia provider monitors and titrates the medications.

An antihistamine sometimes given for a mild allergic drug reaction to counter histamine-mediated symptoms.

Topical anesthesia is applied to a surface (skin or mucosa); infiltration anesthesia is injected into the tissue.

A benign tumor remains localized and does not invade or metastasize; a malignant tumor invades and can spread.

A malignant tumor arising from epithelial tissue — the linings and coverings such as skin and organ linings.

A malignant tumor arising from connective or mesenchymal tissue, such as bone, cartilage, fat, muscle, and blood vessels.

An abnormal connection or passage between two structures or organs that are not normally connected.

Inflammation of the peritoneum, the lining of the abdominal cavity — relevant to abdominal surgery.

A fracture through bone already weakened by disease (e.g., tumor, osteoporosis), sometimes from minimal force — unlike a traumatic fracture.

A pathologic loss of bone density that weakens bone and increases fracture risk, raising surgical and positioning concerns.

A deep incisional surgical site infection involves the fascia and muscle layers; a superficial one involves only skin and subcutaneous tissue.

Bacteria that require oxygen to grow; thrive in oxygen-rich environments.

Bacteria that grow without oxygen and may be harmed by it; favor deep, poorly oxygenated tissue and abscesses.

Fungi such as Candida are eukaryotic (have a true nucleus), unlike bacteria, which are prokaryotic.

Adequate tissue oxygenation is one of the most important local factors in wound healing.

Nicotine and carbon monoxide cause vasoconstriction and reduced oxygen delivery, impairing healing of the surgical wound.

A low transverse abdominal incision often chosen over a vertical midline for a stronger, more cosmetic closure with less herniation.

An open procedure may be chosen over laparoscopy for extensive disease, dense adhesions, bleeding, or other complicating conditions.

Prolonged vomiting and gastric suction lose acid and chloride, putting the patient at risk for metabolic alkalosis and fluid/electrolyte imbalance.

The most common surgical cause of shock — another reason meticulous hemostasis and blood-loss monitoring matter.

A buildup of air in the pleural space that mechanically blocks venous return, a cause of obstructive shock.

Fluid in the pericardial sac compressing the heart and limiting filling — a cause of obstructive shock.

A large clot obstructing pulmonary blood flow, which can produce obstructive shock.

Latex is a classic intraoperative trigger of anaphylactic (distributive) shock — recognize hypotension with hives quickly.

The CO₂ measured at the end of exhalation; a rapid, unexplained rise is the earliest sign of malignant hyperthermia.

Connective tissue of mesodermal origin — bone, cartilage, fat, muscle, and blood vessels — the origin of sarcomas.

The linings and coverings of the body (skin, glands, organ linings) — the origin of carcinomas.