This free CSFA study guide teaches the advanced first-assistant knowledge and skills the Certified Surgical First Assistant exam tests, organized to the current CSFA Examination Content Outline.[1] It covers all three scored domains: Perioperative Care, Ancillary Duties, and Advanced Science.
It’s interactive, not a wall of text: every module has built-in checkpoint quizzes, flashcards, and practice questions, so you learn first-assisting by doing — not just reading.
A note on scope: the CSFA is the advanced first-assistant credential. If you are studying the scrub role — sterile setup, instruments, counts, and specimens — see our companion CST study guide instead. This guide focuses on what the first assistant does at the field: exposure, hemostasis, tissue handling, and wound closure.
What a Surgical First Assistant Does
The is the surgeon’s second pair of hands. Under the surgeon’s direction, the assistant provides exposure of the operative site, controls bleeding, handles tissue, and helps close the wound.[3] The single most useful thing to know before you study: most exam items ask what a competent first assistant would do at a given point in the case — and the answer almost always follows a predictable order.
- 1
Provide exposure
Retract and apply traction/counter-traction so the surgeon can see and reach the operative site — the assistant's defining duty. Hold tissue at the right tension and protect it from injury.
- 2
Maintain a dry field
Achieve hemostasis: sponge and suction blood, apply pressure, and assist with clamping, ligating, electrosurgery, or topical hemostatic agents so structures stay visible.
- 3
Handle tissue
Follow Halsted's principles — gentle handling, strict asepsis, sharp dissection along anatomic planes, careful hemostasis, no dead space, no tension — to protect tissue and speed healing.
- 4
Assist the technical steps
Cut suture, tie and pass ligatures, place vessel loops, manage drains and staplers, and anticipate the surgeon's next move — under the surgeon's direction, never as an independent operator.
- 5
Close the wound
Approximate tissue layer by layer with the chosen suture technique, eliminate dead space, avoid tension, and place the dressing — restoring the protective barrier.
Keep one boundary straight throughout: the first assistant assists — they do not make independent surgical decisions or perform the surgeon’s role. When an answer choice has the assistant acting outside scope or against the surgeon’s direction, it is almost always wrong.[3]
CSFA Exam Snapshot
| Detail | CSFA exam |
|---|---|
| Credential | Certified Surgical First Assistant (CSFA), awarded by the NBSTSA |
| Items | 175 multiple-choice (150 scored + 25 unscored pretest) |
| Time limit | About 4 hours |
| Delivery | Computer-based at a PSI testing center |
| Passing standard | Criterion-referenced pass/fail — minimum number of the 150 scored items correct (verify the current number at nbstsa.org) |
| Eligibility | Graduate of a CAAHEP-accredited surgical first assistant program (or another NBSTSA-recognized pathway) — confirm with the NBSTSA |
| Exam fee | ~290 nonmember (dated anchor — verify current fee) |
| Recertification | Continuing-education credits per NBSTSA cycle, or re-examination — verify the current requirement |
The CSFA scores three content domains.[1] Study by weight—Perioperative Care is more than half the exam, and within it Intraoperative Procedures alone is 67 of the 150 scored items:
Within Perioperative Care the official subsections are Preoperative Preparation (8 items), Intraoperative Procedures (67 items), and Postoperative Procedures (8 items). Advanced Science groups Advanced Anatomy & Physiology (36), Microbiology (5), and Surgical Pharmacology & Anesthesia (5); Ancillary Duties groups Administrative & Personnel (6) and Equipment Sterilization & Maintenance (15).[1]
Module 1 · Perioperative Care
One scored domain — 83 of 150 items (about 55% of the exam), the single largest. This is the heart of first-assistant practice: keeping the field sterile, exposing the operative site, controlling bleeding, handling tissue gently, and closing the wound.[1]
1.1 Aseptic Technique & the Sterile First Assistant
is the foundation under everything else. The governing rule is simple: sterile touches only sterile— any contact with an unsterile item is contamination.
After a surgical hand scrub the assistant progresses from fingertips toward the elbow (keeping the hands the cleanest area) and holds the hands and forearms above the waist and in sight. The assistant gowns and gloves using , keeping the hands inside the gown cuffs until the gloves are pulled over them.[3]
Know the sterile boundaries cold: a scrubbed assistant is sterile only from the level of the chest down to the level of the sterile field (table top); the axillary regions and the back of the gown are never considered sterile because they cannot be observed. —moisture wicking through a drape or gown—breaches the barrier. Above all, the assistant practices a : the honesty to recognize and correct any break in technique, even when no one is watching.
1.2 Exposure: Retraction & Tissue Handling
Providing is the first assistant’s defining duty—the surgeon cannot operate on what cannot be seen. The assistant retracts tissue and organs out of the field and applies : opposing forces that put tissue under even tension, opening the anatomic plane so the surgeon can perform accurately along the correct plane. As the surgeon develops a flap, the assistant continuously adjusts the tension to keep the working plane taut.[3]
Tissue handling follows : gentle handling, strict asepsis, sharp dissection, careful hemostasis, preserved blood supply, no dead space, and no tension. A fine retractor such as a vein retractor or nerve hook is chosen for small, delicate structures that need an atraumatic tip. Effective, well-judged exposure protects tissue, reduces bleeding, and speeds the case.
1.3 Hemostasis
Achieving and maintaining —a dry, visible field—is the first assistant’s second core contribution. The methods fall into three categories you must keep straight: mechanical, thermal, and chemical.[3]
Mechanical
Direct pressure, hemostatic clamps, ligatures (free tie & suture ligature/stick tie), vessel loops, surgical clips, bone wax, pneumatic tourniquet
Physically occludes a bleeding vessel. A stick tie anchors the ligature through the vessel so it cannot slip off a large pumping artery.
Thermal
Monopolar & bipolar electrosurgery, advanced bipolar vessel sealing, ultrasonic (harmonic) devices, argon beam, laser
Uses heat to coagulate tissue and seal vessels. Electrosurgery passes current through tissue; electrocautery heats a wire that does not pass current to the patient.
Chemical / pharmacologic
Absorbable gelatin (Gelfoam), oxidized cellulose (Surgicel), microfibrillar collagen (Avitene), thrombin, fibrin sealant, epinephrine
Promotes the body's own clotting. Collagen and cellulose give a scaffold for platelet aggregation; thrombin acts directly in the clotting cascade.
Among mechanical methods, know the cold. A free tie is looped around a clamped vessel; a is suture on a needle passed through the vessel wall and tied, anchoring it so it cannot slip off a large, pulsating artery.
A doubled snugged around a vessel can temporarily occlude blood flow. Chemical agents such as microfibrillar collagen and oxidized cellulose provide a surface that triggers platelet aggregation, while thrombin acts directly in the clotting cascade.
1.4 Suturing & Wound Closure
Closing the wound is where the first assistant’s technique shows. Suture choice comes down to two questions: how long the tissue will need support, and how the suture should behave in the tissue.
- Absorbable. Broken down by the body (hydrolysis or enzymes); for deep layers that need only temporary support — fascia, subcutaneous, ligating vessels. Examples: plain/chromic gut, polyglactin (Vicryl), poliglecaprone (Monocryl), PDS.
- Non-absorbable. Retains strength long-term and is removed or stays permanently; for skin, tendon, vessel anastomosis, and permanent implants. Examples: silk, nylon, polypropylene (Prolene), stainless steel.
- Monofilament. A single smooth strand; passes through tissue with little drag and resists harboring bacteria, but handles stiffer and needs more knots. Examples: nylon, polypropylene, PDS.
- Multifilament (braided). Many strands braided together; handles and ties easily with great knot security, but the interstices can wick fluid and harbor bacteria. Examples: silk, braided polyester, Vicryl.
is broken down by the body and suits deep layers and ligation that need only temporary support; holds long-term for skin, tendon, anastomoses, and implants. A strand passes through tissue with little drag and resists harboring bacteria, while a braided (multifilament) suture handles and ties more easily.
are individually knotted, so if one stitch fails the rest of the closure holds—an advantage in security over a continuous suture; each bite is placed at equal depth on both sides so the edges approximate evenly. Closure under excessive tension is avoided because it compromises blood supply to the wound edges and impairs healing, pushing a clean wound away from .[5]
Good closure technique is also infection control. Strict asepsis, gentle tissue handling, careful hemostasis, eliminating dead space, and avoiding tension all reduce the risk of a .[4]
Checkpoint · Perioperative Care
Question 1 of 8
During a traditional surgical hand scrub, which direction should the scrub progress to keep the cleanest area at the conclusion of the process?
Module 2 · Ancillary Duties
One scored domain — 21 of 150 items (about 14% of the exam). This domain covers the responsibilities around the case: the energy devices used for hemostasis and cutting, the safety hazards they create, and the professional, legal, and ethical duties the first assistant carries.[1]
2.1 Electrosurgery & Energy Devices
The most-tested distinction here is vs electrosurgery. In monopolar, current flows from the active electrode through the patient’s body to a dispersive return (grounding) pad and back to the generator—so a return electrode is required, and it is placed over well-perfused muscle, not a bony prominence. In bipolar, current flows only between the two tips of the instrument, so no patient return pad is needed and the current path is far smaller and safer near delicate structures.[8]
Keep and distinct: electrosurgery passes current throughthe patient’s tissue (the tissue completes the circuit), while electrocautery heats a wire element directly with current that does not pass through the patient. Advanced bipolar vessel-sealing devices and ultrasonic (harmonic) instruments seal vessels up to a rated diameter using impedance feedback and are chosen when a durable seal without a metal clip is wanted.
| Feature | Monopolar | Bipolar |
|---|---|---|
| Current path | Active electrode → patient → return pad → generator | Only between the two instrument tips |
| Return (grounding) pad | Required — placed over muscle, not bone | Not required |
| Field of effect | Larger; current travels through the body | Small and localized |
| Best use | General cutting and coagulation | Delicate work near vital structures |
2.2 Surgical Smoke & OR Safety
is produced when electrosurgery or laser thermally destroys tissue, releasing a vaporized mixture of fine particulates, chemicals, and potentially viable cells or viral DNA—a respiratory and biological hazard to the whole team. It is controlled with a smoke evacuator held close to the source (within about two centimeters) plus in-line filtration.[4] Laser plume can carry a laser-specific hazard beyond the chemical and biological risk.
OR fire is the other safety staple. A fire needs the three sides of the fire triangle—an ignition source (electrosurgery, laser), fuel (drapes, prep, gauze), and an oxidizer. The oxidizer-enriched atmosphere that makes OR fires especially dangerous comes from supplemental oxygen and nitrous oxide accumulating beneath the drapes.
To use a portable extinguisher correctly, follow PASS: Pull the pin, Aim at the base, Squeeze the handle, and Sweep side to side. Letting alcohol-based prep dry fully before draping or activating energy prevents many fires.
2.3 Professional, Legal & Ethical Duties
The first assistant carries real legal and ethical responsibility. is an unintentional tort: harm resulting from failing to act as a reasonably prudent CSFA would. To establish it, a plaintiff must prove four elements—duty, breach, causation, and damages—and missing any one defeats the claim.[3]
Duty
The first assistant owed the patient a recognized standard of care — to act as a reasonably prudent CSFA would in the same situation.
Breach
That duty was breached — the assistant did something a reasonable CSFA would not do, or failed to do something one would.
Causation
The breach actually and proximately caused the harm — the injury would not have occurred but for the breach.
Damages
The patient suffered actual, compensable harm (physical, financial, or emotional) as a result.
Under , an employer can be held responsible for an employee’s negligent acts within the scope of employment—but the assistant remains personally accountable for their own conduct. Two duties recur on the exam: lists the correct patient, procedure, and site and is properly signed before the case; and maintaining patient confidentiality, a legal and ethical duty whose breach exposes the assistant to liability. Practicing within scope and to the standard of care is the best protection against liability.
Checkpoint · Ancillary Duties
Question 1 of 8
A first assistant must explain why bipolar electrosurgery does not require a patient return electrode (dispersive pad). The correct reason is that:
Module 3 · Advanced Science
One scored domain — 46 of 150 items (about 31% of the exam), the second largest. This domain is the science behind the procedures: surgical pharmacology and anesthesia, the surgical emergencies the team must recognize, and the pathology, microbiology, and wound-healing principles that shape every case.[1]
3.1 Pharmacology & Anesthesia
The highest-stakes anesthesia topic is : a rare, inherited hypermetabolic crisis triggered by volatile inhalational anesthetics or the depolarizing relaxant succinylcholine. The earliest and most sensitive sign is a rapidly rising end-tidal CO₂, often with muscle rigidity; a temperature rise is a late sign.[6]
- 1
Recognize the earliest sign
An unexplained, rapidly rising end-tidal CO₂ (ETCO₂) is the earliest and most sensitive sign, often with masseter/generalized muscle rigidity, tachycardia, and — late — a rising temperature.
- 2
Know the triggers
Volatile inhalational anesthetics (e.g., sevoflurane, isoflurane) and the depolarizing relaxant succinylcholine trigger MH in genetically susceptible patients.
- 3
Stop triggers, get help
Discontinue the triggering agents, call for help and the MH cart, hyperventilate with 100% oxygen, and convert to non-triggering anesthesia.
- 4
Give dantrolene
Dantrolene is the specific antidote; many vials must be reconstituted quickly, so several people mix it at once while cooling measures and supportive care continue.
- 5
Monitor afterward
After treatment the patient is monitored in an ICU because MH can recur, and the family is counseled about the inherited (genetic) susceptibility.
On the pharmacology side, know the recurring concepts: is when two drugs together produce an effect greater than the sum of each (a risk with combined CNS depressants); atropine, an anticholinergic, produces a dry mouth and dilated pupils; and monitored anesthesia care (MAC) is sedation in which the patient breathes on their own while an anesthesia provider monitors and titrates. must be reconstituted quickly during an MH crisis, so several people mix many vials at once.
3.2 Shock & Surgical Emergencies
is inadequate tissue perfusion, and the exam expects you to classify it into four types and link each to its underlying cause.
Hypovolemic
Loss of intravascular volume
Hemorrhage or fluid loss (burns, dehydration) drops circulating volume and preload. In surgery the most common cause is blood loss — replace volume and control the bleeding.
Cardiogenic
Pump failure
The heart cannot pump effectively (MI, arrhythmia, failure), so cardiac output falls despite adequate volume.
Distributive
Massive vasodilation
Widespread vasodilation drops systemic vascular resistance — anaphylactic (e.g., latex), septic, and neurogenic shock. Anaphylaxis adds hives, bronchospasm, and hypotension.
Obstructive
Blocked circulation
A mechanical block to blood flow — tension pneumothorax, cardiac tamponade, or massive pulmonary embolism — obstructs filling or output.
In surgery the most common cause is hypovolemia from blood loss—another reason hemostasis matters so much. is a sub-type of distributive shock: a severe, rapid allergic reaction—commonly to latex or a prophylactic antibiotic—causing hypotension with hives and bronchospasm, treated emergently with epinephrine. Obstructive shock comes from a mechanical block to flow, such as a tension pneumothorax, cardiac tamponade, or massive pulmonary embolism.[5]
3.3 Pathology, Microbiology & Wound Healing
A handful of pathology and microbiology distinctions recur. A benign tumor stays localized and does not invade or metastasize, unlike a malignant one.
Among malignancies, a arises from epithelial tissue, while a arises from connective or mesenchymal tissue (bone, cartilage, fat, muscle). A fistula is an abnormal connection between two structures; peritonitis is inflammation of the peritoneum lining the abdominal cavity; and a deep incisional surgical site infection involves the fascia and muscle, unlike a superficial one.
In microbiology, require oxygen to grow while anaerobes grow without it and favor deep, poorly oxygenated tissue; fungi such as Candida are eukaryotic, unlike bacteria. occurs when clean edges are approximated and held together; adequate tissue oxygenation is one of the most important local factors, which is why smoking—through nicotine’s vasoconstriction and reduced oxygen delivery—impairs healing.[5]
Checkpoint · Advanced Science
Question 1 of 8
Malignant hyperthermia is a hypermetabolic crisis triggered in susceptible patients by certain anesthetic agents. Which sign is often the earliest and most sensitive indicator the team detects?
How to Use This CSFA Study Guide
This guide is built to be worked, not just read. Because the CSFA exam tests applied first-assistant judgment, the most efficient path to a pass is to learn the material and the order in which a competent assistant acts:
- Study by weight. Perioperative Care (83 items) is more than half the exam — and Intraoperative Procedures alone is 67 items. Start there, then Advanced Science (46) and Ancillary Duties (21).
- Master the high-yield staples. Sterile boundaries, retraction and counter-traction, the methods of hemostasis, stick ties, suture selection, monopolar vs bipolar, malignant hyperthermia, and the four types of shock recur constantly.
- Practice the role. Expose, keep the field dry, handle tissue gently, assist the technical steps, close — the right answer usually fits that flow, always under the surgeon’s direction.
- Check off as you go. Use the Study Guide Contents to mark each section done — it raises your exam-readiness score.
- Take every checkpoint. The end-of-module quizzes show exactly which domains need another pass.
- Then prove it. Send your weak area into the flashcards and a practice test, and read every rationale — that is how the knowledge sticks. Scrub-role candidate? Use the CST study guide.
CSFA Concept Questions
Common first-assistant concepts candidates search while studying for the CSFA (NBSTSA) exam — each answered briefly and backed by an official source. Test yourself, then drill them as flashcards.
CSFA Glossary
The high-yield CSFA terms in one place — hover any dotted term in the guide, or flip the whole deck here as a self-grading flashcard set.
- Absorbable suture
- Suture broken down by the body over time (e.g., gut, polyglactin, poliglecaprone); used for deep layers and ligation that need only temporary support.
- Aerobic bacteria
- Bacteria that require oxygen to grow; contrasted with anaerobic bacteria, which grow without oxygen and favor deep, poorly oxygenated tissue.
- Anaphylaxis
- A severe, rapid allergic reaction causing distributive shock — hypotension with hives, swelling, and bronchospasm; common surgical triggers include latex and antibiotics, treated with epinephrine.
- Asepsis
- The absence of pathogenic microorganisms; aseptic (sterile) technique is the set of practices that keep the surgical field free of contamination.
- Bipolar electrosurgery
- Current flows only between the two tips of the instrument, so no patient return pad is needed and the current path is small.
- Carcinoma
- A malignant tumor arising from epithelial tissue — the linings and coverings such as skin and organ linings.
- Closed gloving
- A self-gloving technique in which the hands stay inside the gown cuffs until the gloves are pulled over them, keeping the sterile gown sterile.
- CSFA
- Certified Surgical First Assistant — the advanced first-assistant credential awarded by the NBSTSA, distinct from the CST scrub-role credential.
- Dantrolene
- The specific antidote for malignant hyperthermia; many vials must be reconstituted quickly, so several people mix it at once during a crisis.
- Electrocautery
- Heating a wire element directly with current that does not pass through the patient; the hot wire transfers heat to coagulate tissue.
- Electrosurgery
- The use of high-frequency electrical current passed through the patient's tissue to cut or coagulate; the tissue completes the circuit.
- Halsted's principles
- The classic principles of good surgical technique: gentle tissue handling, strict asepsis, sharp dissection, careful hemostasis, preserved blood supply, no dead space, and no tension.
- Hemostasis
- The control of bleeding by mechanical, thermal, or chemical means — the first assistant's central role in keeping a dry, visible field.
- Informed consent
- The patient's voluntary agreement to a procedure after being told its nature, risks, benefits, and alternatives; the first assistant helps verify the consent matches the patient, procedure, and site.
- Interrupted suture
- Individually placed and knotted stitches; if one fails, the rest of the closure holds — favored where security matters.
- Ligature
- A strand of suture tied around a blood vessel to occlude it; a free tie is looped around a clamped vessel, while a suture ligature is anchored through the vessel.
- Malignant hyperthermia
- A rare, inherited hypermetabolic crisis triggered by volatile anesthetics or succinylcholine; the earliest sign is a rapidly rising end-tidal CO₂, and dantrolene is the antidote.
- Monofilament
- A single-strand suture that passes through tissue with little drag and resists harboring bacteria, but handles stiffer (e.g., nylon, polypropylene).
- Monopolar electrosurgery
- Current flows from the active electrode through the patient to a dispersive return (grounding) pad and back to the generator; a return electrode is required.
- NBSTSA
- The National Board of Surgical Technology and Surgical Assisting — the body that develops and administers the CST and CSFA certifying examinations.
- Negligence
- An unintentional tort — failing to act as a reasonably prudent professional would; proven by duty, breach, causation, and damages.
- Non-absorbable suture
- Suture that retains strength long-term (e.g., silk, nylon, polypropylene); used for skin, tendon, anastomoses, and permanent implants.
- Primary intention
- Wound healing in which approximated, clean edges are held together (as in a sutured incision), healing quickly with minimal scarring.
- Respondeat superior
- A doctrine holding an employer liable for an employee's negligent acts within the scope of employment; the individual remains personally accountable.
- Retraction
- Holding tissue or organs out of the operative field to give the surgeon clear exposure — a core duty of the first assistant.
- Sarcoma
- A malignant tumor arising from connective or mesenchymal tissue, such as bone, cartilage, fat, muscle, and blood vessels.
- Sharp dissection
- Cutting tissue with a scalpel or scissors along an anatomic plane, as opposed to blunt dissection, which separates tissue by tearing or spreading.
- Shock
- Inadequate tissue perfusion; classified as hypovolemic, cardiogenic, distributive (anaphylactic/septic/neurogenic), or obstructive.
- Strike-through
- Contamination that occurs when moisture wicks through a sterile drape or gown, breaching the sterile barrier.
- Surgical conscience
- The internal honesty and discipline to recognize and correct any break in sterile technique — even when unobserved — because patient safety depends on it.
- Surgical first assistant
- A qualified surgical professional who, under the surgeon's direction, provides exposure, hemostasis, tissue handling, and wound closure during an operation — without making independent surgical decisions.
- Surgical site infection
- An infection of the incision or operative space after surgery; reduced by asepsis, antiseptic prep, prophylactic antibiotics, hemostasis, and gentle tissue handling.
- Surgical smoke
- Plume produced when electrosurgery or laser thermally destroys tissue, releasing fine particulates, chemicals, and potentially viable cells — a respiratory and biological hazard controlled with a smoke evacuator.
- Suture ligature
- A 'stick tie' — suture on a needle passed through a large vessel's wall and tied, anchoring the ligature so it cannot slip off.
- Synergism
- A drug-drug interaction in which two medications together produce an effect greater than the sum of their separate effects.
- Traction and counter-traction
- Opposing forces applied to tissue to create even tension, opening the anatomic plane so the surgeon can dissect sharply and accurately.
- Vessel loop
- A thin silicone band passed around a vessel or structure; doubled and snugged it can temporarily occlude blood flow or simply isolate the vessel.
CSFA Study Guide FAQ
CSFA stands for Certified Surgical First Assistant. It is the advanced first-assistant credential awarded by the National Board of Surgical Technology and Surgical Assisting (NBSTSA) to qualified surgical professionals who provide exposure, hemostasis, tissue handling, and wound closure under the surgeon's direction. The certifying examination tests first-assistant practice across three content domains.
Both are NBSTSA credentials, but they are different roles. The Certified Surgical Technologist (CST) works in the scrub role — maintaining the sterile field, passing instruments, handling counts and specimens, and anticipating the surgeon's needs. The Certified Surgical First Assistant (CSFA) is an advanced role that actively assists the surgeon: retracting and providing exposure, controlling bleeding, handling and dissecting tissue, and closing the wound. The CSFA exam goes deeper on hemostasis, suturing, and advanced science. If you're studying the scrub role, see our companion CST study guide.
The 2024 NBSTSA CSFA content outline scores three domains: Perioperative Care (83 of 150 scored items), Advanced Science (46 items), and Ancillary Duties (21 items). Perioperative Care — and especially Intraoperative Procedures within it (67 items) — is more than half the exam, so that is where to spend most of your study time.
The CSFA examination consists of 175 multiple-choice questions, 150 of which are scored. The 25 pretest (unscored) items are distributed randomly throughout for statistical evaluation. The exam is computer-based and runs about 4 hours. Only the 150 scored items count toward your result.
The CSFA is criterion-referenced and reported as pass or fail. The passing score is the minimum number of the 150 scored questions you must answer correctly, set by NBSTSA's standard-setting process. Because the exact passing number can change, NBSTSA directs candidates to nbstsa.org for the current required number. Treat strong, consistent performance across all three domains as the goal.
Eligibility is set by the NBSTSA. The most common pathway is graduating from a CAAHEP-accredited surgical first assistant program; the NBSTSA also recognizes other defined education-and-experience pathways. Always confirm the current eligibility requirements directly with the NBSTSA before applying, as the recognized pathways are updated periodically.
Study by weight and by role. Master Perioperative Care first — sterile technique, retraction and exposure, traction and counter-traction, the methods of hemostasis, suture selection, and wound closure — since it is more than half the exam. Then lock in Advanced Science (anesthesia and malignant hyperthermia, shock, pharmacology, pathology, microbiology, and wound healing) and the Ancillary Duties (electrosurgery, surgical smoke, legal and ethical duties).
Yes — the full guide, the module checkpoints, the glossary, the practice test, and the flashcards are 100% free, with no account required.
References
- 1.National Board of Surgical Technology and Surgical Assisting (NBSTSA). “Surgical First Assistant Certifying Examination Content Outline (2024).” nbstsa.org, 2024. ↑
- 2.National Board of Surgical Technology and Surgical Assisting (NBSTSA). “CSFA Certification & Eligibility.” nbstsa.org. ↑
- 3.Association of Surgical Technologists (AST). “About Surgical Assisting & Standards of Practice.” ast.org. ↑
- 4.U.S. Centers for Disease Control and Prevention (CDC). “Surgical Site Infection Prevention; Control of Surgical Smoke.” cdc.gov. ↑
- 5.American College of Surgeons (ACS). “Wound Healing and Home Skills.” facs.org. ↑
- 6.Malignant Hyperthermia Association of the United States (MHAUS). “Managing an MH Crisis.” mhaus.org. ↑
- 7.U.S. National Library of Medicine (MedlinePlus). “Suture Materials and Wound Closure.” medlineplus.gov. ↑
- 8.U.S. Food and Drug Administration (FDA). “Electrosurgical Devices.” fda.gov. ↑
- 100.National Center for Biotechnology Information (NCBI Bookshelf). “Surgical Technique and Wound Management — Principles of Tissue Handling.” ncbi.nlm.nih.gov, accessed 20 June 2026. ↑
- 101.Association of Surgical Technologists (AST). “Standards of Practice — Intraoperative Assisting and Tissue Handling.” ast.org, accessed 20 June 2026. ↑
- 102.National Center for Biotechnology Information (NCBI Bookshelf). “Local Anesthetics — Pharmacology and Adjuncts.” ncbi.nlm.nih.gov, accessed 20 June 2026. ↑
- 103.National Center for Biotechnology Information (NCBI Bookshelf). “Types of Shock — Pathophysiology and Classification.” ncbi.nlm.nih.gov, accessed 20 June 2026. ↑
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