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SRNAProfessionalGuide II > Environmental Hazards > Flashcards

Environmental Hazards Flashcards

1
Q

3 types of Hazards

A

Physical
Infectious
Psychological

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2
Q

Types of Hazards

A 
Waste Anesthetic Gases (WAG)
Electrical/Fire 
Laser  Radiation
Chemicals Sharps
Latex
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3
Q

Waste Gases: Vapors are

A

always present in the O.R.

No current evidence exists that proves Waste Anesthetic Gases are a health hazard.

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4
Q

Role of scavenging systems

A

Proper scavenging DECREASES Waste Anesthetic Gases

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5
Q

Is there evidence that gases wasted are health hazard?

A

No current evidence exists that proves Waste Anesthetic Gases are a health hazard.

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6
Q

1977 NIOSH recommendation:

A

No worker shall experience to halogenated agents at concentrations
>2ppm alone
>0.5 ppm when combined with nitrous oxide over a 1 hour sampling period.

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7
Q

Nitrous Oxide exposure shall not exceed time weighted average concentration of ____ppm during anesthetic administration when used alone.
Results of air sampling methods, locations, dates and concentration measured and results of leak tests shall be maintained for at least _______

A

25ppm

20 years.

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8
Q

Scavenger systems were equipped on anesthesia machines year ____

A

1980s:

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9
Q

Nitrous oxide is unique in its ability to inactivate __________an amino acid essential to production of _______This effect of prolonged exposure can result in bone marrow depression__________ Neuropathies, and other deficits.

A

methionine synthase; DNA; (MEGALOBLASTIC ANEMIA),

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10
Q

Because of the possibility of TERATOGENIC effect______ is often avoided in the anesthetic of pregnant women undergoing surgery.

A

N2O

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11
Q

Health Concerns with Chronic exposure

A

Neurological/Behavioral deficits
Liver and Kidney Toxicity
Spontaneous Abortion in Females in Infertility
Teratogenic in Animal Models

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12
Q

N2O < ______ppm

Halogenated Agents

A

25 ppm
2 ppm
0.5 ppm

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13
Q

100% Halothane =
1% Halothane =
.0002% Halothane = 2 ppm

A

1 million ppm
10,000 ppm
2 ppm

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14
Q

Things to do to limit exposure

A
  • Avoid insufflation of gases with children
  • Turn off your gases prior to intubation, but don’t forget to turn them back on!
  • Tight mask seals with induction
  • Don’t EVER “clear” your circuit to the environment
  • Scavenging system
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15
Q

What are the elements of a Fire triange

A

Fuel
Oxygen
Energy source

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16
Q

OEA

A

Oxygen Enriched Atmosphere

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17
Q

OEA fires can include

A
  • Tracheostomy
  • Facial procedures under MAC
  • Uncuffed endotracheal tubes
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18
Q

Tracheostomy involves risk of fire vs

A

Risk of fire vs. risk of hypoxemia

  • Pulmonary condition
  • Use of electrosurgical unit
  • Difficulty of airway
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19
Q

Nasal Cannula OEA

A

Fire in airway due to OEA

Fire under drapes

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20
Q

ET tube fire on ____

A

Fire on entrance to trachea

Possibly catastrophic

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21
Q

Facial Procedures Under MAC

A

Consider room air
Consider level of sedation
If supplemental O2 needed consider cuffed ET tube

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22
Q

Fuels are (SUPPLIES)

A 
Surgical drapes
Gowns
Gauze
Pledgets
Flammable anesthetics
Bowel gas (methane)
Body hair
Petroleum Jelly
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23
Q

Fuels EQUIPMENT

A 
Endotracheal tubes
LMAs
Masks, nasal cannulas, breathing circuits
Endoscopes
Gloves
Smoke evacuator hoses
Mattresses, egg-crates, blankets
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24
Q

Ignition Sources

A 
ESU (BOVIE) 
Lasers
Hot wire cautery
Defibrillators
Surgical drills, saws and burrs
Fiberoptic light sources
Static electricity
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25
Q

ESU (BOVIE)

A

Good contact with return plate
Clean contact frequently
Do not fire unless in contact with tissues
Communication

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26
Q

Fire Extinguishers: ABC Multi-Purpose Dry Chemical

A

Good for commercial and industrial uses

Poor for operating room

27
Q

BC Dry ChemicalSodium Bicarbonate

A

Destroys sensitive electrical equipment
Not good for patients
Poor for OR

28
Q

Pressurized Water

A

Type A
Good for trash, wood, paper
Not good for class C (electrical) fire
Poor for OR

29
Q

CO2

A

BC
Good for sensitive equipment
Not good for patients, OR

30
Q

Halon

A

ABC
Good choice
Being phased out because of ozone depletion

31
Q

Water mist

A 
Class A fires
Good in class C (electrical) hazards
Mist droplets do not conduct electricity
Cools and soaks
Non-toxic
Non-ozone depleting
32
Q 
Electrical mishaps (3) 
Leads to (3)
A

Inadequate grounding devices
Faulty equipment
Overloaded circuits

Leads to:
Burns
Fire
Electrocution

33
Q

OHMS LAW
E = ________
I = ____________
R = ___________

A

OHMS LAW E = I * R
E = electromotive force (volts)
I = current (amperes)
R = resistance (ohms)

34
Q

I =

A

W/E

35
Q

R=

A

E/I

36
Q

IMPEDANCE (Z)

A

sum of forces that oppose electron movement in AC circuits

37
Q

Conductor -

A

substance with low impedance

38
Q

Insulator

A

Substance with High impedance

39
Q

Capacitance

A

any two parallel conductors that are separated by an insulator.

40
Q

INDUCTANCE

A

production of a magnetic field around a wire when current flows.

41
Q

Disruption of electrical function of cells

A

a. contraction of muscles
b. alteration of brain function
c. paralysis of respiration
d. ventricular fibrillation

42
Q

Macroshock -

A

Gross amounts of shock that will cause harm or death

43
Q

Microshock

A

Amount of shock that will harm or kill a patient with a conduit to the heart

44
Q

Frequency (cycles per second or Hz) is

A

an important factor in electrical safety -

45
Q

Higher frequency current__________, current is generally regarded as safe up to. Very high-frequency currents do not excite contractile tissue.

A

e.g., 1,000,000 Hz ; 3 amp; excite contractile tissue.

46
Q

Grounding

A

a. Hot and neutral wires from FPL.
b. Neutral wire is connected to neutral bus bar which returns to electrical company ground and is also connected to a grounding pipe.
c. Grounding wire is connected to neutral bus bar and ground.
d. Circuit breakers - protect from overload of electrical wires - does not protect from shock.
e. Hot wire distributed through building to electrical devices.
f. 120 volt potential difference between hot and any object referenced to ground, neutral, ground or any grounded object.
g. For current to flow, there must be a closed loop to ground.
h. Circuit can be completed from hot wire to neutral or ground.
i. To get a shock, there must be contact with the loop in two places–one is ground so only one additional contact point is needed to complete the circuit.

47
Q

Safety Outlets : 3 prong plug

A

Three prong plug provides a low resistance path to carry a short circuit to ground. It will prevent a large current flow from improperly energized equipment through person.

48
Q

Line Isolation Monitor -

A

for ungrounded electrical systems

49
Q

LM functions

A

(1) Measures the total leakage in the system to ground
(2) Does not measure actual current flow but how much would flow in the event of a fault
(3) If either side of the isolated power system has < 60,000 ohms impedance to ground LIM will alarm
(4) LIM will not detect a faulty equipment ground wire

50
Q

Ground Fault Interrupter - For grounded electrical systems

A

(1) Measures both sides of grounded system to see that flow is equal. If it is not a breaker will trip
(2) Disadvantage is that faulty equipment is not usable unlike in LIM where alarm sounds but power does not shut off.

51
Q

MICROSHOCK 1,2

A
  1. Catheters or wires near the heart provide pathway for a small amount of electricity to have a large current density in the heart
  2. Currents that are not perceptible may cause ventricular fibrillation in sensitive part
52
Q

MICROSHOCK 3,4

A
  1. Equipment ground wire important in taking stray capacitance to ground so that no current can flow to patient
  2. To provide additional safety from microshock direct patient inputs are isolated
53
Q

ELECTROSURGERY : BOVIE A-C
ESU generates a current of __________
The tip of the Bovie pencil ___________ it _____
The greater the current density ____________

A

A. ESU generates a current of > 500,000 Hz
B. The tip of the Bovie pencil does not heat up - it directs a current through tissues
C. The greater the current density, the more heat is generated in the tissues

54
Q

ELECTROSURGERY : BOVIE D-F
D______________does not cause ventricular fibrillation or excite contractile cells - see
E. Current returned through ___________dispersive plate - improperly called _________
F. If dispersive plate is not properly applied or if return wire is faulty the current will ________________

A

D. High frequency current does not cause ventricular fibrillation or excite contractile cells - see
E.Current returned through large surface area dispersive plate - improperly called grounding pad
F.If dispersive plate is not properly applied or if return wire is faulty the current will seek an alternate pathway

55
Q

ELECTROPHYSIOLOGY : BOVIE G-I
G. If the surface area of the of the alternate pathway is ________ the current density will be_______________
H. Modern ESUs have __________________
I. Return plates must have ________________

A

G. If the surface area of the of the alternate pathway is small, the current density will be high and a burn will result
H. Modern ESUs have isolated power systems for additional safety but are not foolproof
I. Return plates must have proper gel, be applied properly and have intact return wire

56
Q

ELECTROPHYSIOLOGY : J-M
J. Careful of using ESU when_______Such as _____
K. If surgeon is requesting very high power levels _________Should be inspected
L. If unit is dropped, it should be _____________
M. Bipolar ESU needs______________

A

J. Careful of using ESU when flammable solutions are used, e.g., benzoin, alcohol, collodium, ether, acetone
K. If surgeon is requesting very high power levels return plate should be inspected
L. If unit is dropped, it should be inspected by qualified technician
M. Bipolar ESU needs no return plate

57
Q 
When possible, use \_\_\_\_\_\_\_\_with\_\_\_\_\_\_patients
When in doubt, get a\_\_\_\_\_\_\_\_\_\_
Know type of\_\_\_\_\_\_\_\_\_
Have\_\_\_\_\_\_\_ available if appropriate
Check \_\_\_\_\_\_\_\_\_ before and \_\_\_\_\_surgery
Take the time to \_\_\_\_\_\_\_\_\_\_\_
A 
bipolarpacemaker patients.
cardiac consult
pacemaker
magnet 
pacemaker before and after
Turn in and report faulty equipment
58
Q

REMEMBER that blood and _______do _________

A

electrolyte solutions do conduct electricity

59
Q

Increasing prevalence of

A

laser surgery

60
Q

Unique advantages of Laser Surgery

A

Highly precise microsurgery
Confined and difficult sites
Rapid vaporization of tissue
Dry surgical field with instantaneous sealing of small vessels and lymphatics

61
Q

Types of Lasers

A 
Carbon dioxide (gas)
     Widely used, long wavelength 
      Poor penetration in tissue 
Argon (gas)
Nd:YAG (solid)
      Neodymium yttrium aluminum garnet
Dye (liquid)
      Less common
62
Q

CO2 effects are localized due to its

A

high water absorbency, and wavelength

63
Q

OPHTALMOLOGY

A

Argon beam

Treatment of macular degeneration and open-angled glaucoma

64
Q

Gynecology

A

CO2 laser

Genital tract lesions, laparoscopy

SRNAProfessionalGuide II (13 decks)

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