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Basic Principles > 4 - Safety > Flashcards

4 - Safety Flashcards

1
Q

What is a conductor?

A

Any substance that permits the flow of electrons

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2
Q

What is the difference between AC and DC?

A

DC = direct current. Electrons flow in one direction.

AC = alternating current. Electron flow reverses direction at a regular interval.

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3
Q

What is impedance?

A

the sum of forces that oppose electron movement in an AC circuit

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4
Q

What is resistance?

A

Resistance to flow via Ohm’s Formula

Used in DC circuits

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5
Q

What is an insulator?

A

Substance that opposes the flow of electrons

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6
Q

What is a capacitor?

A

two parallel conductors separated by an insulator

HAS THE ABILITY TO STORE A CHARGE

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7
Q

Which requires more charge to cause damage: AC or DC?

A

it takes approximately three times as much DC as AC to cause ventricular fibrillation

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8
Q

What is a short circuit?

A

Zero impedance load and high frequency flow

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9
Q

How does electricity cause damage in the body?

A
  1. Causes electrical interferance (electrical conductivity of the heart, muscle contraction etc)
  2. Any resistance to the electricity creates heat, and burns form
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10
Q

What kind of electrocution usually results in burns?

A

Usually NOT household currents

Generally high voltages like power transmission lines

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11
Q

What is macroshock?

Microshock?

A

Lare amounts of current flowing through a person

small amounts

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12
Q

Microshocks only apply to what kinds of patients?

A

Patients with conduits in direct contact with heart (pacemakers)

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13
Q

Electrical power is usually ______ in the home but ______ in the OR

A

grounded

ungrounded

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14
Q

Electrical equipment in the home is ________

but OR equipment should always be _______

A

may or may not be grounded

grounded

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15
Q

What happens if a faulty piece of equipment is plugged into an isolated OR circuit?

A

The piece of equipment will continue to function normally, but will convert the OR from an isolated circuit to a normal grounded circuit

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16
Q

What is the purpose of the Line Isolation Monitor?

A

To alarm if the system loses isolation

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17
Q

What does the reading on the LIM mean?

A

It’s the amount of current that would flow with a fault

NOT the amount of current flowing at that moment

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18
Q

The LIM will only detect faults if:

A

pieces are connected to the LIM

AND

have a grounding wire

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19
Q

What should you do if the LIM alarms?

A

Check the gauge

See if too many things are plugged in

Start unplugging things one by one to determine which piece of equipment is faulty

If the faulty device is life saving, it can continue to be safely removed until the end of the case, but nothing else should be plugged in and everyone should know the OR is no longer isolated

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20
Q

What is a GFCI/GFI?

A

Ground Fault Circuit Interrupter

The red test button thing on hairdryers etc

Should be present in any electrical environment that may come into contact with water (that’s why newer bathroom outlets always have the test button)

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21
Q

What does the GFCI do?

A

Prevents a life threatening shock in the even of an electrical fault

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22
Q

When it is acceptable for a piece of equipment to have two prongs instead of 3?

A

When it’s double insulated

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23
Q

How has healthcare developed ways of protecting electrically susceptible patients from microshock?

A

Pretty much all patient equipment has extremely high impedance, allowing tiny amounts to pass toward the patient

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24
Q

What’s the difference between electrosurgery and electrocautery?

A

Electrocautery is a little hand held device with a heated wire to cauterize

The ESU generates extremely high frequency currents that pass through the tissues

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25
Q

Why is it that cautery machines don’t cause cardiac arrhythmias?

A

the extremely high frequency doesn’t penetrate deep into tissues, and slides right over the surface of the pericardium

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26
Q

Does the bovie pad ground the patient?

A

No

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27
Q

Why do burns occur when the bovie pad is not placed?

A

The return plate provides a large surface area to absorb the electricity leaving the pen. If it’s not there, the energy will return via other sources like the ECG pads, which have a very small surface area and therefore more resistance and therefore causes a burn

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28
Q

Where should the ESU dispersive plate be placed?

A

As close to the surgical site as possible

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29
Q

When using an ESU in a patient with a demand pacemaker, why should you put a magnet over it?

A

This converts the pacemaker to a fixed rate, so that it’s not administering a set shock regardless of whether or not it can sense intrinisic electrical activity

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30
Q

Do you need a bovie pad with a bipolar machine?

A

No

The electricity in a bipolar bovie passess only between the two prongs of the forceps

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31
Q

If a patient with an AICD comes in for non-cardiac surgery, what should be done prior to surgery?

A

Tachytherapies should be turned off, either with a magnet or by programming

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32
Q

What is conductive flooring?

A

flooring that’s able to conduct electricity off its surface, preventing the buildup of static electricity

mandatory when flammable anesthetic gases are used

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33
Q

In the event of power loss, if you can’t find a flashlight what else can you use?

A

the laryngoscope handle!

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34
Q

How long does the battery last on most anesthesia machines?

A

30-60 minutes

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35
Q

According to the FDA, cellphones should be kept how far from pacemakers?

A

6 inches

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36
Q

What should be done to prevent fire in the OR?

A
  1. Use minimal O2 required and configure drapes so that oxidizer doesn’t build up underneath them
  2. Avoid N2O
  3. Allow prep to dry completely
  4. Keep oxidizers away from cautery, and help surgeon maintain awareness
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37
Q

What should you do in the even of an airway fire?

A

Stop gases and remove ETT simultaneously

Pour saline in the airway

Remove burning materials

Assess patient and reintubate

38
Q

What is the fire triad?

A

Ignition

Fuel

Oxidizer

39
Q

What are the three oxidizers in the OR?

A

Air

O2

N2O

40
Q

Which ETT type is laser proof?

A

Mallinckrodt LaserFlex

41
Q

What is used to inflate the cuff of the Malinckrodt tube?

A

Methylene blue dyed saline

allows surgeons to see immediately if they have perforated the cuff

42
Q

Methylene Blue is used as a treatment for:

A

Hypotensive Shock

Vasoplegic Syndrome

Acquired Methemoglobinemia

43
Q

What are some contraindications for methylene blue?

A

Pregnancy (Known teratogen)

SSRI use (serotonin syndrome)

G6PD deficiency (can cause hemolytic crisis)

44
Q

What safety precaution should be in place when lasers are in use?

A
  1. All staff must wear protective goggles
  2. Patient’s eyes should be covered with wet gauze
  3. Staff should wear high filtration masks d/t laser fumes
  4. Signs must be posted on the OR doors
45
Q

Does CO2 promote combustion?

A

No

46
Q

In laparoscopic surgery, why should N2O not be used as an inhalation anesthetic?

A

It diffuses into the tissues and N2O gas can actually form in the abdomen, causing a fire hazard

47
Q

Bowel fires are greatest risk in which surgeries?

A

Emergent colon surgeries

Unprepped or ruptured bowel may leak methane or hydrogen

48
Q

The majority of OR fires occur:

A

With MAC during head and neck surgeries (76%)

49
Q

If paper drapes are on fire, what should you do?

A

Throw them on the floor.

DUMPING SALINE ON THEM WON’T WORK BECAUSE THEY’RE WATER RESISTANT

50
Q

ERASE stands for:

A

Extinguish

Rescue

Activate

Shut

Evaluate

51
Q

When is an OR considered a high fire risk?

A

When three of the following are present:

Open delivery of O2

Ignition/Heat Source

Surgery in the head, neck, or upper chest

Alocohol Prep Solution

52
Q

Class A Fire Extinguishers work on:

A

Paper

Cloth

Plastic

53
Q

Class B Fire Extinguishers Work on:

A

Liquid or grease

54
Q

Class C Fire Extinguishers are used for:

A

Electrical Fires

55
Q

What is the best extinguisher for the OR?

A

CO2

56
Q

What are the two most common lasers?

What is gaining popularity?

A

CO2 & Nd:YAG

Argon

57
Q

What is the difference between laser light and regular light?

A

lasers have only one wavelngth (this makes them monochromatic)

Laser light is coherent (oscillates in the same phase) and collimated (parallel beam)

58
Q

Which has more tissue penetration: CO2 or Nd-YAG?

A

CO2

Nd:YAG has shorter wavelength, which means less tissue penetration.

An Nd-YAG laser can pass through the cornea, whereas a CO2 laser would burn the cornea

59
Q

What is use to aim or direct CO2 laser beams?

A

low enegery helium neon lasers!

60
Q

What color glasses are required if an Nd:YAG laser is in use?

A

Green

61
Q

Protective eyewear for CO2 lasers can be:

A

clear glass or plastic that surrounds the face

62
Q

What protective eyewear is required for KTP lasers?

Argon lasers?

A

Orange-Red

Orange

63
Q

What are laser plumes?

A

the smoke and vapors formed from laser cutting

potentially toxic and infectious

64
Q

Is N2O flammable?

A

NO but it does support combustion and can propagate the flame

65
Q

Why is an inflated cuff problematic in laser surgery?

What should be used instead?

A

Provides a generous resevoir of combustible gas

Methylene Blue

66
Q

Where there is electrical current, there is also ______

A

magnetic waves

Also, where there are magnetic waves, there are always electrical currents

67
Q

What is electromagnetic radiation?

A

electric and magnetic waves oscillating in unison but perpendicular to each other

68
Q

EMR is the only wave that can:

A

propagate independently of matter

69
Q

How is energy measured?

A

e, represents one electron’s energy

but because e is so small, we use coulombs

1 coulomb = 1.619 e

70
Q

Coulomb’s Law

A

like charges repel each other

opposite charges attract each other

71
Q

what is a volt?

A

electrical potential energy

represents the electrical pressure or the gradient of the charge that could potentially flow

72
Q

what is current?

how is it measured?

A

rate of flow through a conductor

amperes

73
Q

Ohm’s Law

A

the potential flow of electric charge is proportional to actual current after accounting for resistance

74
Q

What is used to isolate electrical supply systems from one another?

A

A transformer

75
Q

Explain first and second faults

A

The first fault is when a grounded piece of equipment becomes ungrounded. This occurs when there’s contact between the live wire and the ground, like if the live wire is touching the metal casing.

a second fault would be the OR no longer being isolated and developing a grounding mechanism. Then a shock can occur

76
Q

What is the purpose of the Line Isolation Monitor?

A

placed between the live wires and the ground to measure their impedance to flow

77
Q

What does Planck’s Constant express?

A

the quantized (particle) nature of EMR

defined by energy, time, and frequency

78
Q

How is EMR thought to travel?

A

both as photons and waves, depending on how it is observed

79
Q

What is the mass of a photon?

A

It has no mass. It’s pure energy.

80
Q

The energy of EMR is directly related to _________

A

its current

81
Q

What happens to the velocity of EMR in a vacuum?

A

It remains constant, regardless of frequency

82
Q

How does infrared absorption analysis work?

A

A sample or mixture of gas is sunjected to a known range of infrared frequencies. The frequenes that are lost due to absorption are measured, and the gases can be identified by which they absorb.

83
Q

How does Raman scattering anaylsis work?

A

The gas mixture is hit with a laser.

The frequency changed caused by the gas scattering the laser beam is predictable and identifies which gas is being lasered

84
Q

Which gas cannot be identified by Raman scattering?

A

Helium

85
Q

How does mass spectrometry work?

A

Ionizes gas molecules and passes them through a magnetic field. The amount the magnetic deflect the molecules determines which gas is present

86
Q

What is a photoacoustic gas analyzer?

A

subjects a gas sample to a filtered, pulsating infrared beam; induces an increase then a decrease in temperature, and listens to the pressure waves hitting the walls of the container

87
Q

Which oxygen sensors have a lifespan limited by the amount of oxygen they come in contact with?

A

Electrogalvanic

88
Q

How do paramagnetic oxygen sensors work?

A

oxygen is uniquely attracted into magnetic fields

89
Q

What is fluroescence quenching?

A

Oxygen is able to suppress or quench certain molecules from fluorescing. Depending on how much fluorescence is released, you can tell how much oxygen there is

Can also be used to detect CO2 because it increases pH which liberates H ions that react with a quenching agent in the sensor

90
Q

How does a Severinhaus PCO2 electrode work?

A

Converts CO2 into hydrogen ions and measures the electric charge of the current generated

91
Q

What does LASER stand for?

A

Light

Amplification by

Stimulated

Emission of

Radiation

92
Q
A

Basic Principles (15 decks)

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