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SURG > Chapter 6 > Flashcards

Chapter 6 Flashcards

1
Q

What are some components of Electronic Medical Records (EMR’s)?

A

-Centers for Medicaid/Medicare (CMS) mandated
-Facilitate the sharing of pt data (lab, pathology, billing, sharing between hospitals)
-Surgical records are immediately added to the pt’s chart
-Must follow HIPPA regulations and guidelines.

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2
Q

What are some ways computers have become helpful in the OR?

A

-scheduling patients (pt info is sent in, easily saved and updated, and dispersed to surgical personnel)
-doctors and review and submit surgical dictation from the hospital
-DPC’s can be easily updated and copied and transferred between hospitals
-list/count sheets easily updated and sterilization records saved
-facilitates annual staff competency training

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3
Q

Who developed the first ESU?

A

Physicist W.T Bovie and neurosurgeon Harvey Cushing (modern ESU is completely different but called Bovie bc they made the precursor)

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4
Q

What is the principle that governs the behavior of electrons?

A

Electron Theory

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5
Q

What creates electricity?

A

The movement of free electrons (electrons in outer orbits that are less attracted to the nucleus and when heated/lighted they speed up and leave the atom)

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6
Q

What is the law of electric charges?

A

Like repels and opposite attracts
- + don’t like +
- - don’t like -
- + likes -

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7
Q

What is a conductor?

A

Material that allows the free flow of electrons (copper, silver, aluminum, zinc, brass, iron, saltwater, carbon, acids, water, and us)

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8
Q

Why must humidity be maintained in the OR?

A

High humidity often results in static charge leakage and low humidity results in the formation of sparks; Humidity should be maintained between 20-60%

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9
Q

What is an insulator?

A

Materials the inhibit the flow of electrons (rubber, plastic)
-wrapped around insulator to prevent the leakage of electrons

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10
Q

What is an electrical current?

A

The movement of electrical charge
Ex: Traditional lightbulb where electrons move through tungsten (swirly thing) and heat up and brighten.

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11
Q

What are some sources of electricity?

A

Heat, solar, gas, hydroelectricity, magnetic fields

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12
Q

What is a magnetic field?

A

Electric charges line up in the same direction and their fields combine and strengthen. Attract /repel each other and other metallic objects

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13
Q

What are the applications of magnetism in the OR?

A

Magnetism can create a electric current and electricity is used to generate magnetism

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14
Q

What is an electromagnet?

A

metals that become magnetic when a conductor, such as copper wire, is wrapped around them.
-Current flowing through the wire creates magnetic field
-The interaction between the wires and magnets is what produces power
-Can turn a normal magnet into a super magnet (MRI Machine)

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15
Q

what is a generator?

A

device that turns mechanical energy into electric

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16
Q

What is an electrical circuit?

A

The path that electricity travels from the energy source to a device and then back to the energy

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17
Q

What is a simple electrical circuit composed of?

A

power, conductor, load, and switch.
example: ESU generator-bipolar cord-one prong of bipolar forceps-tissue-other prong of forceps-bipolar cord-ESU generator

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18
Q

What is voltage (volts)?

A

electric potential between two points (pressure/force)
ex: 12v cord can potentially move 12v from the wall outlet to the equipment

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19
Q

What is current (amps)?

A

flow of electric charge or the rate of flow of electrons

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20
Q

What are ohms?

A

Resistance

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21
Q

What is power (watts)?

A

Work per time. Rate at which work is done.
-can be converted to kilowatts; 1000 W=1kW

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22
Q

What is load?

A

devices that can recieve or modify the amount of power from a source. (surgical lamps, ESU, drills, robots, monitors)

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23
Q

What are resistive energy loads?

A

The conductor material, such as the filament in a light bulb, has a high resistance to the flow of electricity. Resistance refers to restricting the flow of current. The electricity has to force its way through the resistance and the energy causes the conductor to glow or heat up. When the load increases or decreases, the power source delivers more or less power.

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24
Q

What is a switch?

A

A device used to open and close the circuit (open-no flow; closed-flow)

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25
Q

What are some components of wall outlets in the OR?

A

usually 110 volts (V), excluding the outlet for the mobile X-ray unit and some laser units, which require 220 V.

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26
Q

What are some components of the three plug prong?

A

First prong-positive (hot)
Second prong- negative (neutral)
Third Prong- ground pin (where electric short redirects to)

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27
Q

What is direct current?

A

electrical current that flows in one direction from the negative pole to the positive pole

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28
Q

What are the four components of a direct current?

A

Source of electricity (e.g., battery)

Conductor (e.g., wire from source to load)

Control device (e.g., switch)

Load (e.g., bulb, heater, or other load)

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29
Q

What is alternating current?

A

flow of current that reverses direction periodically. A complete AC cycle occurs when current moves in one direction and then reverses its course. (measured in hertz- 1 AC cycle is 1hz)

Frequency (f) is number of cycles per second

AC can be delivered at a high voltage and then “stepped down” (by a transformer) to a lower voltage at the point of use.

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30
Q

What is an advantage of alternating current?

A

its voltage can be modified relatively easily using a transformer, which allows power to be transmitted at very high voltages before being taken down to safer voltages for commercial and residential use.

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31
Q

What is radio frequency?

A

Electromagnetic waves that travel from a transmitter to an antennae (radio and television)

Travels via cable of atmosphere/space

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32
Q

What are isolated power systems (IPS) in the OR?

A

System that monitors potential fires and power overloads.

-if alarm goes off unplug the last piece of equipment plugged in.

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33
Q

What is electrosurgery?

A

application of alternating electrical current through tissue to coagulate or cut tissue. (original developed in 1921)

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34
Q

What are some components of an ESU (Bovie)?

A

generator, optional foot pedal, cords, an active electrode, and a patient return electrode.

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35
Q

What are the two modes of delivery (ESU Circuit)?

A

Monopolar: Used most frequently for both cutting and coagulation. For large surgical areas

Bipolar: Used for delicate procedures or when there is moisture, nerves, or a pacemaker that can’t be turned off. Can only coagulate.

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36
Q

What are the components of a monopolar Bovie (ESU)?

A

generator, active electrode (pencil), and patient return electrode (grounding pad)

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37
Q

What is the pathway of a monopolar Bovie (ESU)?

A

Current travels from the generator to the active electrode (ESU pencil or laparoscopic instrument with ESU cord attached).

The active electrode is activated by the surgeon to deliver the cutting or coagulating current to the tissue or vessel.

The electrical current then passes through the patient’s body to the grounding pad.

The current exits the patient’s body via the grounding pad and returns to the generator.

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38
Q

What are some components of the generator for the ESU?

A

-an active electrode that is activated by the surgeon w hand or foot pedal
-a three pronged plug should be used (no extension cord)
-when in use it emits a sound (volume should never be turned down or off)
-front: on/off switch, plug-ins for the active electrode and grounding pad, power level adjustment controls, and blend (cutting/coagulating) adjustment controls. Some generators are equipped to handle two active electrodes at the same time.
-self check before entering the “ready” mode

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39
Q

What are some components of the active electrode/Bovie pencil?

A

-packaged and sterilized by the manufacturer
-comes with removable metal tip and holster
-cord and holster is attached to the drapes and cord is passed to circulator to plug into generator
-when not in use, should be in the holster to prevent injury

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40
Q

what are the different types of tips a bovie/active electrode could have?

A

blade shaped (spatula), ball tipped, loop, needle tip, long extended tip, teflon coated (allows charred tissue to be wiped clean)

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41
Q

What are some precautions to take when it comes to the Bovie?

A

-keep free of char
-current should be allowed to flow freely
-use scratch pads
-considered a sharp (dispose in sharps container)

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42
Q

What is argon gas/what are some components of it?

A

-inert and incapable of combustion
-enhances the effectiveness of the Bovie (ionized by the current and becomes for conductive than air)
-provided via portable tank
-used with special pencil
-appears as a bright light beam
-heavier than air (less plume/tissue damage)

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43
Q

What are some components of the bovie grounding pad?

A

-flexible, disposable, size dependent
-a conductive cord (plugged into generator)
-uses a conductive gel
-used when in monopolar mode

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44
Q

Where should the grounding pad be placed?

A

-warn pt that it is cold
-avoid wrinkling, tunneling
-on large, fleshy area (not over bony prominences)
-not over metal prothesis and have pt take off jewelry
-as close to operative site as possible
-use brand new pad if readjustment is needed
-do not let prep pool
-pacemaker/internal defibrillator may malfunction
-avoid flammable anesthesia

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45
Q

What are some components of a bipolar ESU (bovie)?

A

-Used only for coagulation
-bipolar forceps so no grounding pad needed
-the generator is activated by a foot pedal
-reusable forceps and cord

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46
Q

What is the pathway for a bipolar ESU (bovie)?

A

Generator to active electrode (one prong of forceps)
* Across patient tissue between forceps tips
* return electrode (other prong of forceps) to the generator

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47
Q

What are some other bipolar ESU’s?

A

Enseal® G2 Super Jaw—bipolar vessel sealing and cutting device designed to accommodate vessels up to 7 mm in diameter for use in multiple specialties.

Ligasure™—bipolar vessel sealing and cutting devices available for open and laparoscopic procedures with minimal thermal spread.

Coblator®II Surgery System—bipolar device used in ENT procedures.

Thunderbeat™—combination bipolar and ultrasonic scalpel vessel sealing and cutting device designed to accommodate vessels up to 7 mm in diameter used in multiple specialties.

Spetzler™ Malis® irrigating bipolar—nonstick, dual irrigation channel, disposable forceps for neurosurgical and spinal procedures.

48
Q

What are the advantages of electrosurgery?

A

-reduces blood loss (bleeding is quickly controlled)
-saves time (faster than suturing and blend setting will cut and coag at the same time)
-Seals small spaces in tissue and lymph vessels that ooze fluid
-Reduces resorption of toxic fluid, edema and postoperative pain

49
Q

What are the risks of electrosurgery?

A

Electrical Burn from:
-instrument insulation failure
-RF coupling
-dielectric breakdown
-vaporized tissue plume

50
Q

What is radio frequency (RF) coupling?

A

when an alternating current travels from the active electrode, through intact insulation, and into the skin

example: When a surgeon is holding a vessel in a clamp, the assistant bovies the clamp and
the current runs down the clamp to the tissue and down the clamp through the glove
to the surgeons hand

causes:
-thin gloves
-size of active electrode
-strength of current
-duration

to prevent:
-double glove
-place tip of bovie blow surgeon’s hand on clamp

51
Q

What is dielectric breakdown?

A

when high voltage breaks down an insulating material, such as sterile gloves.

causes:
-thin gloves
-strength of current
-duration of activation

reduce risk by double gloving

52
Q

What is plume?

A

smoke and vaporized tissue.

has:
-carcinogens, bloodborne pathogens, mutagens

to prevent:
-use smoke evacuator system
-keep suction 1cm

53
Q

What is the harmonic scalpel (ultrasonic energy)

A

uses ultrasonic energy rather than electricity to cut and coagulate tissue at the point of impact; utilizes mechanical vibrations at the rate of 55,500 times per second, which separates tissues and coagulates bleeding vessels by denaturing the cellular proteins and creating a sticky coagulum that “welds” severed ends shut

54
Q

What are some of the benefits of the harmonic scalpel?

A

Precise and at a lower temperature (below boiling point)
* Less thermal damage
* Less plume (consists of water and not vaporized tissue)
* Grounding pad is not necessary (no electricity)

55
Q

What is the cavitron ultrasonic surgical aspirator (CUSA)?

A

Removes tumors in the brain or liver
* Used high-frequency sound waves that create imploding bubbles to
fragment and emulsify tumor tissue but leave vascular structures
intact.

56
Q

What is plasma vaporization?

A

Utilizes bipolar current and plasma technology to
create a thin layer of highly ionized particles that
vaporize tissue without having to make direct
contact.
* Minimal thermal damage
* Used for BPH (benign prostatic hypertrophy)
-alternative to ablation techniques

57
Q

What are lasers and what are some characteristics?

A

stands for light amplified by the stimulation of emitted radiation
-monochromatic; wavelength color determines tissue reaction. (red absorbs red well)
-collimated; waves are parallel and do not diverge
-coherent; light waves travel in the same direction and in phase with each other. (increases strength)

58
Q

What is fluence?

A

precision of the laser beam and consists of three properties: spot size, watts, joules (laser pulse energy per second), and time. Fluence is a measurement of joules divided by square centimeters
-concept of fluence emphasizes highest safest wattage for as little time as possible to keep damage to a minimum

59
Q

What are the four interactions of tissues and lasers?

A

absorption, transmission, reflection, or scattering

60
Q

What determines the penetration depth of a laser beam?

A

-power of the laser beam.
-color and consistency of the tissue
-laser wavelength,
-duration of beam exposure.

to prevent damage to surrounding tissues use backstop (wet sponges, titanium, quartz rods)

61
Q

What are the parts of a laser system?

A

energy pump or excitation source, laser head, ancillary (auxiliary) components, control panel, and delivery system. These are the parts that should undergo annual maintenance.

62
Q

What is the CO2 laser?

A

-one of the most frequently used in surgery.
-beam is invisible so helium-neon laser beam (red) is combined with it however it has no effect on the tissue.
-absorbs into the fluid of the cell so not dependent on the pigment of the tissue. water absorbs so cannot be used through clear fluids or gas
-beam does not scatter
-backstop may be needed
-hand piece is attached at the end of the arm. Has articulated joint with mirrors at the bend point. Be careful moving laser as to not disrupt the alignment of the mirrors. Displacement of the mirrors will misalign the helium-neon beam from the CO2 beam
-Produces laser plume
-can be pulsed and continuous
-use with ebonized instruments for safety

63
Q

What are some benefits of minimally invasive surgery?

A

reduced pain and scarring, faster procedure/recovery, and reduced risk of infection

64
Q

What does NOTES stand for?

A

Natural orifice transluminal
endoscopic surgery

Uses medium, specialized sheath, and instrumentation

65
Q

What are some natural orifices?

A

mouth, nares, vagina, urethra, anus

66
Q

What is a method of access?

A

Route of entry into the body

67
Q

What is a transcutaneous access?

A

Small incision or puncture sites that are used to gain access to internal tissues.

-uses long modified instruments
-a medium (gas or fluid) may be used for distension

68
Q

What are insufflation (Veress) needles?

A

Small cannulated needle that may be used to separate intraabdominal structures.

-come in 120 and 150mm
-some are ball float. incision is made and needle is put in. saline is injected into chamber. if floats, the needle is in a solid structure and insufflation is not initiated. if ball falls, it is in a hollow space.
-some are spring loaded. will hear a pop which indicates its in a hollow space.
-Syringe plunger may be pulled out and if there is blood a perforation has occurred and process has to be restarted.

69
Q

What is a trocar?

A

Metal rod that has a three-sided sharp point that is used to penetrate the skin and the wall of a cavity or a joint, and when removed allows instruments or catheters to be inserted

70
Q

What are the different types of trocars?

A

-sharp (bladed), -blunt (aka Hasson; may be used to establish pneumoperitoneum) -dilating (used with Veress needles and expandable plastic sheaths to establish entrance to the abdominal cavity without creating fascial incisions that must be sutured_, -single-site multiport; straight
-pistol-shaped;

71
Q

What is the typical trocar design?

A

outer sheath or cannula (hollow tube), an inner obturator that either cuts through tissue layers or is blunt or dilating and provides atraumatic passage through deep tissue layers, a valve mechanism that allows insertion of operating instruments without loss of insufflation, and a stopcock valve for attachment of tubing or closure if no tubing is attached.

72
Q

What is pneumoperitoneum?

A

Collection of air or gas within the peritoneal cavity of the abdomen; it can be abnormal such as the release of gas due to the rupture of a gas-containing organ or induced by the introduction of air or gas for diagnostic purposes

73
Q

What are some components of peritoneal gas insufflation?

A

-Uses CO2
-rate of flow is controlled (6-10L a min)
-intraabdominal pressure is monitored (12-18 for adults; less for elderly or children, more for obese)
-gas is warmed (prevents hypothermia of fogging of camera)
-contaminants are filtered out of gas (filter side gets handed off to circulator)

74
Q

What are some adverse effects of peritoneal gas insufflation?

A

R shoulder pain from phrenic nerve disruption

-PE
-hypercapnia
-pulmonary decompression
-cardiac compression -

75
Q

What are some methods of distention? (besides peritoneal gas insufflation)

A

Mechanical Distention- pinching and lifting skin with towel clips; expandable balloon trocars (used commonly for great saphenous vein harvesting and lap hernia repairs)

Fluid Distention- Hollow organs (knee, uterus, bladder) are filled with fluid to distend.

76
Q

What are some components of endoscopes?

A

any instrument with the capability to look within the body
-named according to anatomical location and size
-available in flexible (usually for diagnostic) and rigid/semi-rigid (used for foreign body removal or viewing)
-attached to a camera and light cord
-produces images on a video monitor
-can be used in conjunction with ESU for cut/coag
-they come in variety of angles (0, 25, 30, 45, 70)

77
Q

What are some components of fiberoptic light cords?

A

-bundles of very thin, coated glass fibers surrounded by plastic to deliver very bright light to the field
-referred to cold light as there is no heat produced at the end of the endoscope
-can be a fire hazard
-should be coiled loosely and handled with care

78
Q

What is a robot?

A

A sophisticated machine used to perform a specific task. Has to have some degree of mobility, perform automatically, and do a variety of tasks

79
Q

How are robots classified?

A

Generation 1- No AI is required; performs a repetitive motion and is the only gen where constant oversight is not required

Generation 2- Some AI, tactile and pressure sensors, some vision & hearing, occasional monitoring (O.R.)

Generation 3- Work independent, no overseeing human or
computer (autonomous: satellite). Controlled by a larger central AI computer (insect robots)

Generation 4- Movie kind, out think humans, terminators, learn,
reproduce, evolve

80
Q

What are some advantages of surgical robots?

A

-Overcomes limitations in human precision and reliability (mitigates surgeon tremors from fatigue)
-Require surgeon control and input by remote control and voice activation
-Control costs (replace expensive personnel, enable surgeon to perform from a distance, shorter recovery time)

81
Q

What does articulated mean?

A

Separated into sections by joints. Many robot arms have articulated geometry and the versatility. Ability to extend and reach via joints

82
Q

What is binaural hearing?

A

Ability to determine the direction from which sound is coming.

83
Q

What is cartesian coordinate geometry?

A

Also called rectangular coordinate geometry. Refers to the Cartesian system used for graphing mathematical functions in which the axes are always perpendicular to each other.

84
Q

What is cylindrical coordinate geometry?

A

Refers to a plane coordinate system and elevation in conjunction with a robotic arm.

85
Q

What are the degrees of freedom?

A

Number of ways that a robot manipulator can move in three dimensions. Seven degrees of freedom for the human wrist and robotic manipulators include:

Clockwise—Rotation around an axis from left to right, as in the hands of a clock

Counter-clockwise—Rotation from right to left, opposite of hands of a clock

Grip—Opening and closing an instrument

Insertion—Back-and-forth motions

Pitch—Up-and-down movements

Roll—Rotation and circumduction

Yaw—Side-to-side movement

86
Q

What are expert systems?

A

Method of reasoning in AI used to control smart robots. The expert system consists of facts or data supplied to the robot about the robot’s environment; also called rule-based system.

87
Q

What is resolution?

A

Extent to which a machine, microscope, human, or robot can differentiate between two objects.

88
Q

What is sensitivity?

A

Ability of a machine or robot to see in dim light or detect weak impulses at invisible wavelengths

89
Q

What is telechir?**

A

Name given to remotely controlled robots.

90
Q

What is telepresence?

A

Refers to the operation of a robot from a distance, meaning the operator is situated in one location, usually miles apart, and the robot is on-site with the patient.

91
Q

Who creates the davinci surgical robot?

A

Intuitive Surgical

92
Q

What are some components of the davinci surgical robot?

A

Console where surgeon sits and
engages the hand manipulators.
* Patient side cart
* Manipulators (4)
* HD 3D vision system
* Minimally invasive (1-2mm
incisions)
* Endowrist instruments
* Full range of motion
(human wrist joint)
* 7 DoF (degrees of freedom)
* 90 DoR (degrees of rotation)

93
Q

What are some components of the davinci robot console?

A

-surgeon sits at the console and is not on the field
-surgeon has a view of the site
-finger movements translate to robot manipulators

94
Q

What is the surgical technologist’s role when it comes to davinci robots?

A

Positioning the system
* Connecting electrical cords and systems
* Testing the system
* Loading and switching out surgical instruments on manipulators
* Troubleshooting the robotic system and instrumentation
* Proper draping and sterilization of instrumentation
* Watch the surgical progression on the slave monitor

95
Q

What are some advantages of remote robotic manipulation?

A

-Eliminate hand tremors for more precise surgical technique and fewer errors.
-Allow the surgeon to effectively perform complex interventions within a confined space via small access portals
-Enhance visualization of the operative site through three-dimensional imaging.
-Foster increased utilization of telesurgery, which is a benefit to isolated or small rural hospitals (obstacle is delay between surgeon and manipulator movements)

96
Q

What are some components of manipulators?

A

-categorized by their geometrical design
-joints are referred to as shoulders, elbow, and wrist
-Moves along x (up/down), y
(right/left), and z (front/back)

97
Q

How does the voice controlled system work in surgical robots?

A

Master control unit is activated by the surgeon’s hand and/or voice via
headset and microphone

Can manipulate: Shaver and fluid pumps in arthroscopic surgery
* Light controls, printer, photographic equipment

-programmed to ignore casual conversation
-binaural hearing

98
Q

What are some components of vison in surgical robots?

A

Analogous to binocular human vision
(stereo vision)
* Permits depth perception

-As resolution increases, sensitivity decreases and vice versa

99
Q

What are some other surgical robots?

A

MAKOplasty® for total knee arthroplasty.

Rio® Robotic System by Mako for total hip arthroplasty.

OrthoPilot® for total joint arthroplasty procedures.

NeuroMate® frameless stereotactic system for cranial neurosurgical procedures.

NeuroArm (Canada) MRI-compatible, image-guided, computer-assist device for neurosurgical procedures.

StealthStation® S7® Surgical Navigation System for neurosurgical procedures.

Fusion™ ENT Navigation System, electromagnetic (EM) image-guided system for sinus and anterior skull-base procedures.

100
Q

What is a hybrid suite?

A

Operating room combined with newest technology; radiology, flouroscopy, CT, MRI, cath lab, lazer, angiography, etc.

101
Q

What are some procedures that are performed in a hybrid suite?

A

Endovascular abdominal aortic aneurysm (AAA) repair
* Endovascular thoracic aortic aneurysm repair
* Trans-catheter aortic valve replacement
* Minimally invasive valve repair or replacement
* Coronary artery revascularization
* Atrial fibrillation ablation
* Pacemaker and implantable cardioverter defibrillator (ICD)
implantation
* Diagnostic and intraoperative cranial and spinal
angiography
* Peripheral vascular and embolization procedures

102
Q

What are some advantages of the hybrid suite?

A

The real-time imaging: superior accuracy and the least possible amount of radiation exposure.
* Prevention of lost time/transfer to another room if conversion from MIS to open surgery is required.
* Reduction in potential for infection with higher-level engineering controls of a surgical environment
rather than a diagnostic radiology suite.
* Safety/comfort via close anesthesia monitoring of patients receiving moderate sedation or general
anesthesia.
* Reduction of overall cost reduction of MIS compared to open procedures.
* Shorter hospitalization and recuperation for patients following hybrid MIS

103
Q

How does absorption work with lasers?

A

Thermal damage due to absorption depends on fluence, wavelength, color/consistency of tissue, and cellular water content. As water is absorbed by tissue, heat is produced and damage to tissue can occur.

104
Q

What happens when cellular water content is heated?

A

Once it goes beyond boiling point, water becomes steam causing the pressure inside the cell to increase and the cell to eventually burst (releases debris and smoke aka laser plume)

105
Q

What does the absorption of lasers depend on?

A

Chromophores, hemoglobin, and melanin. Wavelength is absorbed by chromophores and causes heating of surrounding tissue.

106
Q

What is transmission?

A

When the laser travels through various media with equal effect. For example, ND: YAG can transfer through glycine and argon can transfer through aqueous humor.

107
Q

What is specular reflection?

A

when the angle of the reflection is equal to the angle of the oncoming light, thereby maintaining the beam. used when the beam is reflected off a laser mirror to direct it toward hard-to-reach tissues or areas. can be a hazard if the laser beam reflects off a surgical instrument, causing it to scatter unpredictably. surg tech must ensure there are non-reflective instruments are avaliable.

108
Q

how does a laser work?

A

The laser chamber or tube contains the active medium, which is the substance that is energized (excited) by exposure to electrical or chemical energy or flash lamps. Excited electrons in the mirrored chamber collide and create photons, the fundamental particles of light, which can combine to become waves and produce the actual laser beam. Mirrors are positioned at both ends of the laser chamber to increase the excitation and rate of electron collisions. The mirror at one end of the laser head is completely reflective and the mirror at the other end is partially reflective, which allows the laser light to exit as a narrow beam that is focused by a lens or passes into the delivery fiber or tube.

109
Q

What are the different types of active mediums?

A

Gas: energized by electricity (argon, CO2, helium neon, krypton)

Solid: energized by flash lamps (ruby and Nd: YAG)

Liquid: Energized organic dye by laser beam to produce laser light in various
wavelengths.

Semiconductor Crystal: Laser energy is delivered directly to tissue through a filter or slit-lamp
microscope.

110
Q

What are the laser unit components?

A

console: Houses and protect inner components of laser system. May be locked to prevent unauthorized access to the system

cooling system: Air/water system to prevent laser head from overheating

vacuum pump: (CO2 system only) draws CO2 from tank to be delivered to the laser head.

111
Q

Neodymium: Yttrium Aluminum Garnet (Nd: YAG) Laser

A

Semiconductor crystals (laced with neodymium) exposed to flashlamps
2. Invisible beam so He-Ne Laser aiming beam is transmitted with it
3. Absorbed by darker pigmented tissue
a. Can be transmitted through clear fluids (glycine for bladder tumors)
4. Powerful and precise
5. Minimal vaporization
6. Contact fiber system: Held directly against tissue.
a. Interchangeable nondisposable cut, vaporize or coagulation tips.
b. Cooled by fluid or air flowing through fiber and exit at tip.
c. No pressure on tip, the laser is doing the cutting not the movement
7. Non contact quartz fiber delivery system: Laser spreads out as distance from target increases
a. Must be calibrated before each use.
*GYN or prostate

112
Q

Ho: YAG Laser

A

Discharges a pulsed beam
a. Can have a scattered beam
2. Flexible fiber held less than 5mm from tissue
3. Transmits through clear liquids
*arthroscopy

113
Q

Krypton Laser

A
  1. __Gas______ laser via electricity
  2. Green, yellow and red (most used) laser beams depending on wavelength
  3. Chromophore absorption
    a. Less absorption than argon
    *opthamology
114
Q

Argon Laser

A
  1. Blue or Green visible light within a ___plasma____tube.
  2. Absorbed by dark or red tissues
    a. Travels through clear fluids
    b. Can travel through light colored tissue without harming it.
  3. *Retinopathy (Retinal bleeding)
    *Colon polyps
    *Cystoscopy
115
Q

Potassium Titanyl Phosphate (KTP) Laser

A
  1. Produces green light
  2. Red or darker tissues
    a. Travel through clear fluids
  3. Smaller beamed fiber for more precise coagulation that CO2 or ND:Yag
    *Lap chole
    *Laparoscopy
116
Q

Eximer Laser

A
  1. Gases and halogens
    a. Argon fluoride, xenon fluoride, krypton fluoride and xenon chloride.
    b. Gases are _____very toxic and fatal_____.
  2. Pinpoint ultraviolet laser beam
    a. UV rays may have mutagenic/carcinogenic effects on cells.
  3. Absorbed by protein with no noticable thermal spread
    *Reshape cornea for radial keratoplasty
    *Destroy plaque within a stenotic artery for angioplasty

SURG (7 decks)

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