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Biochemistry/Physics Exam 3 > Fire Safety > Flashcards

Fire Safety Flashcards

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1
Q

There are an estimated 200-650 surgical fires annually. What percentage occur in the airway? What areas on the patient have the greatest percentage at 44%?

A
  • 21% occur IN the airway

- 44% occur ON the head, neck or upper chest

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2
Q

Where can surgical fires occur?

A

ANYWHERE!

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3
Q

How many fatalities occur annual as a result of an OR fire? How many are serious and result in disfiguring/disabling injuries?

A

1-2 fatal

20-30 serious and result in disfiguring/disabling injuries.

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4
Q

Describe the surgical procedures that pose the greatest risk for OR fires to occur?

A

Surgical procedures performed above the xiphoid process and in the orohpharnyx.

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5
Q

Name 3 surgical procedures that are high risk for surgical fires.

A
  • Lesion removal on head, neck, or face
  • Tonsillectomy
  • Tracheostomy
  • Burr hole surgery
  • Removal of laryngeal papillomas
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6
Q

What are the sides of the Surgical Fire Triad?

A
  • Oxidizer
  • Ignition Source
  • Fuel
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7
Q

Name oxidizers that can contribute to surgical fires.

A
  • Oxygen
  • Nitrous Oxide
  • Room Air
  • Oxygen-enriched environment
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8
Q

Name ignition sources of surgical fires.

A
  • ESUs (Electrosurgical Unit)
  • Lasers
  • Fiberoptic Light Sources
  • Argon beam coagulator
  • Power tools
  • Defibrillator
  • Electrical equipment
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9
Q

Name fuel sources of surgical fire.

A
  • Alcohol-based skin preps
  • Surgical drapes
  • Patient
  • Personnel
  • Gowns
  • Towels
  • Sponges
  • Dressings
  • Tapes
  • Linens
  • Head coverings
  • Shoe covers
  • Alcohol-based skin preparations
  • Human hair
  • Endotracheal tubes
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10
Q

What is the recommended concentration of oxygen to minimize the oxidizing affect of a surgical fire?

A

< 30%

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11
Q

Name 5 interventions to control ignition sources.

A
  • Place patient return electrode on a large muscle mass close to surgical site
  • Keep active electrode cords from coiling
  • Store the ESU pencil in a safety holster when not in use
  • Keep surgical drapes or linens away from activated ESU
  • Moisten drapes or place absorbent towels and sponges in close proximity to the ESU active electrode
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12
Q

True/False: You should not use an ignition source to enter the bowel when it is distended with gas.

A

True

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13
Q

True/False: The ESU active electrode should remain near the oxygen or nitrous oxide source.

A

False; keep the ESU active electrode away from oxidizing sources

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14
Q

In regard to controlling ignition sources, what preventative steps can be taken when using ESUs?

A
  • Inspect minimally invasive electrosurgical electrodes for impaired insulation; remove electrode from service if not intact
  • Use “cut” or “blend” settings instead of coagulation
  • Use the lowest power setting for the ESU
  • Only the person controlling the active electrode activates the ESU
  • Remove the active electrode from electrosurgical or electrocautery unit before discarding
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15
Q

In regard to controlling ignition sources, what preventative steps can be taken during oropharynx procedures?

A
  • Use a laser-resistant endotracheal tube when using a laser during upper airway procedures
  • Place wet sponges around the endotracheal tube cuff if the surgeon is operating in close proximity to the endotracheal tube
  • Use wet sponges or towels around the surgical site/ place wet sponges in back of patient’s throat
  • Only the person controlling the laser beam activates the laser
  • Have water or saline and the appropriate type of fire extinguisher available
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16
Q

In regards to controlling ignition sources, what steps can be taken to reduce fire risk while using fiberoptic light sources?

A
  • Place the light source in standby mode or turn it off when not in use
  • Inspect light cables before use and remove them from service if broken light bundles are visible
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17
Q

What steps can be taken to prevent defibrillators from becoming potential ignition sources?

A
  • Select defibrillator paddles that are the correct size for the patient
  • Use only manufacturer-recommended defibrillator paddle lubricant
  • Place defibrillator paddles appropriately
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18
Q

What is a common characteristic of using supplemental oxygen via an open delivery system?

A

-Creates an oxidizer-enriched atmosphere in proximity to an ignition source

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19
Q

Who has direct control over the delivered concentration of oxygen and method of administration?

A

Anesthesia providers

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20
Q

What can you do to the endotracheal tube to provide a quick indicator of an intra-airway fire?

A

Inflate the endotracheal tube cuff with tinted saline

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21
Q

What preventative steps can be taken to prevent the oxidizer contribution to a fire?

A
  • Tent drapes to allow for free air flow
  • Keep the oxygen percentage as low as possible
  • Use an adhesive incise drape (ioban) when appropriate
22
Q

What is an important thing to do if you place wet sponges in the patient’s throat?

A

Document throat pack was placed and removed.

23
Q

What important steps should be taken by the Anesthesia Provider during the peri-operative period to reduce oxidizer risk?

A
  • Inform the surgeon that an open O2 source is being used
  • Stop supplemental O2 or nitrous before and during the use of an ignition source
  • If O2 is being used, suction the patient’s oropharynx deeply before using the ignition source
  • Check the anesthesia circuits for possible leaks
  • Turn off the O2 at end of each procedure
24
Q

During head, face, neck, and upper chest surgery; what considerations should be taken when supplemental oxygen is required?

A
  • Do not use open delivery of 100% oxygen
  • Intubate or use a laryngeal mask airway if supplemental oxygen needed
  • If O2 is greater than 30% via open delivery, use 5-10 L of air/minute under the drapes
25
Q

What are the indications when open delivery of supplemental oxygen is required for head, face, neck, and upper chest surgery?

A
  • Patient verbal response required during surgery (eg, carotid artery surgery, neurosurgery, pacemaker insertion)
  • Open oxygen delivery required to keep the patient safe
26
Q

What tool can you use to determine whether to intubate versus an open oxygen delivery system?

A

Fire Prevention Algorithm

27
Q

What type of ointment is recommended for facial hair and other hair near surgical sites?

A

Water-based ointments

28
Q

What preventative steps can be taken to control the risk of fuel sources?

A
  • Remove prep-soaked linen and disposable prepping drapes
  • Allow skin-prep agents to dry and fumes to dissipate before draping
  • Allow chemicals (eg, alcohol, collodion, tinctures) to dry
  • Conduct a skin prep “time out”
29
Q

Describe the CMS regulations regarding use of Alcohol-Based Skin Preps.

A
  • Policies and procedures must be in place to reduce risk of fire
  • Personnel must be aware of these policies
  • Products are packaged for controlled delivery with clear directions that must be followed
  • Documentation of implementation of fire prevention practices must be present in the patient’s medical record
  • Personnel must demonstrate practice of the policies and procedures
30
Q

The CMS inspector approaches you and asks, What is your facility doing to reduce the risk of fires related to alcohol-based skin preps?…How do you respond?

A

We take it seriously and have a Fire Risk Assessment completed before start of procedure, all members of the team participate, We communicate this assessment during ‘time out’, and we always document the assessment in the record.

31
Q

The Fire Triangle is incomplete. What is the Risk Assessment level, and what action should be taken?

A

This is LOW RISK, and NO further action or assessment is required.

32
Q

The Fire Triangle is complete and the procedure is above the diaphragm with presence of unconfined or poorly confined oxidants. What is the Risk Assessment level, and what action should be taken?

A

This is HIGH RISK; Should trigger a discussion among the team on ways to manage, minimize, or eliminate the risk of fire

33
Q

The Fire Triangle is complete, but the case is below the diaphragm. What is the Risk Assessment level, and what action should be taken?

A

This is MODERATE RISK; The team acknowledges risk of fire, location of fire suppression tools known

34
Q

What questions are included on the Fire Risk Assessment tool?

A
  • Is an alcohol-based prep agent or other volatile chemical being used preoperatively? Y or N
  • Is the surgical procedure being performed above the xiphoid process? Y or N
  • Is open oxygen or nitrous oxide being administered? Y or N
  • Is an ESU, laser, or fiber-optic light cord being used? Y or N
  • Are there other possible contributors? Y or N
35
Q

What are the 3 types of surgical fires?

A
  • On the patient
  • In the patient (airway fire)
  • On or In a piece of equipment
36
Q

What is the first thing YOU (the anesthesia provider) do if a surgical fire occurs?

A
  • Stop the flow of oxidizers (oxygen source)
  • Disconnect the breathing circuit
  • Turn off oxygen gas tanks
37
Q

How long do you have to recognize and remove an ETT in the presence of an airway fire?

A

6 Seconds

38
Q

What are the signs of an Airway Fire?

A
  • Darkening of the ET tube or breathing circuit with soot
  • An orange or red glow to the ET tube
  • Presence of flames in or around ETT
39
Q

What does the ETT act like with high concentrations of O2 adding to the intensity of the fire?

A

A blowtorch

40
Q

Name the steps to take in Rapid Succession if an airway fire occurs.

A
  • Disconnect breathing circuit
  • Remove endotracheal tube and have another member extinguish fire
  • Remove any smoldering segments from airway
  • Pour saline or water in patients airway to extinguish any residual smoldering material and cool the tissues
  • Reestablish ventilation and avoid nitrous oxide and oxygen until all risk of re-ignition is eliminated
  • Inspect the ET tube for intactness
  • Consider bronchoscopy to assess for thermal injury to the lungs and airway and removal of foreign material
  • Save involved materials and devices for later investigation
41
Q

What size tube should be utilized if re-intubation is required after an airway fire?

A

A smaller one.

42
Q

After an airway fire, what tests should be completed?

A
  • Obtain a CXR and ABG to guide postoperative management

- Carboxyhemoglobin (CoHbg) levels are needed for assessment of smoke inhalation

43
Q

What post fire monitoring should be completed for MINOR burns?

A

24 hour observation; monitor for development of laryngeal tracheal edema

44
Q

What post fire monitoring should be completed for SEVERE burns?

A

24 hour observation; Pt should remain intubated and receive 30-60% humidified oxygen; consider tracheostomy and mechanical ventilation with PEEP

45
Q

What type of medication have been recommended for treatment of smoke inhalation and bronchospasm?

A

Corticosteroids

46
Q

How long could complications, such as tracheal stenosis, be delayed?

A

Months

47
Q

True/False: Fire blankets should NEVER be used in the OR.

A

True

48
Q

What is the primary recommended method to extinguish a fire on/in the patient?

A

Aqueous solutions;

  • Bottled water or saline for NON-ELECTIRC fires
  • Aim at the base of the fire
  • Remember: Fluid resistant drapes may be resistant to water
49
Q

Fire extinguishers are not recommended as first choice, but what type of extinguisher is best if used?

A

CO2 extinguisher

50
Q

When do you evacuate the OR?

A

If smoke or fire cannot be controlled.

51
Q

What does the R.A.C.E. acronym stand for?

A

Rescue
Alarm
Confine
Evacuate

Biochemistry/Physics Exam 3 (2 decks)

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