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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)

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.

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.

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

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.

33
Q

What is electrosurgery?

A

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

34
Q

What are some components of an ESU (Bovie)?

A

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

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.

36
Q

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

A

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

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.

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

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

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)

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)

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)

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

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

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

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

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, and time. Fluence is a measurement of joules divided by square centimeters

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

color and consistency of the tissue, laser wavelength, and 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 are the parts of a laser unit?

A

console, cooling system, and vacuum pump.

63
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.

64
Q

What are some benefits of minimally invasive surgery?

A

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

65
Q

What does NOTES stand for?

A

Natural orifice transluminal
endoscopic surgery

Uses medium, specialized sheath, and instrumentation

66
Q

What are some natural orifices?

A

mouth, nares, vagina, urethra, anus

67
Q

What is a method of access?

A

Route of entry into the body

68
Q
A

SURG (4 decks)

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