Fire Safety and Lasers in OR

Question 1

The causes of OR fires are primarily from?

Answer 1

Electrocautery - 90%
Lasers - 10%

Question 2

What percent of OR fires occur during high risk cases involving the head, neck, and upper chest?

Answer 2

85%

Question 3

What percent of OR fires involve the airway? Head and Neck?

Answer 3

34% airway
28% head and neck

Question 4

If you know or suspect patient inhalation injury from toxic fumes: ex - CO, HCL, Cyanide - the patient is at risk for? What should your actions be?

Answer 4

At risk for airway edema. Look quickly, if any indication, including airway/voice hoarseness, intubate immediately.
You can always extubate later the same day.

Question 5

What are the three components of the fire triangle?

Answer 5

Fuel Source
Ignition Source
Oxidizer

Question 6

What are some Fuel Sources in the OR

Answer 6

surgical prep and alcohol [Allow to dry!]
petroleum ointments, facial hair, drapes, gloves, breathing circuits, dressings, ETT

Question 7

What are some Ignition Sources in the OR

Answer 7

ESUs, fiberoptics, high-speed drills, laser, monitors, defibs, desiccated soda lime

Question 8

What are some Oxiders in the OR

Answer 8

Air, O2, N2O
in 95% of cases it is O2 because it is heavier than air, and it accumulates around and under drapes

Question 9

What are some surgical fire prevention strategies

Answer 9

-Avoid open air O2 delivery. ETT (closed) or LMA (less closed but more than open)
-Communicate fire sources and if O2 requirements are raising in ESU cases
-Coat facial hair with water-soluble lubricant
-Laser resistant ETTs
-Moistened sponges
-Flame retardant drapes

Question 10

When using O2 in an ESU procedure. The supplemental O2 should be less than what % and off fore how many minutes before ESU use?

Answer 10

Less than 30% and off for 1min prior

Question 11

Anesthesia providers are responsible for what portion of the fire triangle

Answer 11

Oxider

Question 12

What steps should be taken if an airway fire occurs?

Answer 12

1. Stop ventilation and remove ETT
2. Stop flow of all gases
3. Remove all other flammable material away from airway
4. Pour water or saline into airway
5. Fire extinguisher if water did not clear fire (BC extinguisher)
6. Assess for airway edema / trauma
7. Consider steroid admin
8. Monitor in ICU for 24 hours
9. Report to joint commission and FDA

Question 13

To avoid a blow torch effect, what should you NOT do when extubating the patient because of an airway fire?

Answer 13

do not squeeze the reservoir bag

Question 14

Why do O2 devices ignite easily?

Answer 14

They contain polyvinyl chloride (PVC)

Question 15

What does RACE stand for

Answer 15

Rescue
Alarm
Contain
Extinguish

Question 16

What does P.A.S.S. stand for

Answer 16

Pull pin
Aim at base of fire
Squeeze
Sweep side to side

Question 17

Laser light differs from ordinary light because of what three things:

Answer 17

1. Monochromatic - single wavelength
2. Coherent - light oscillates in the same phase
3. Collimated - exists as a narrow parallel beam

Question 18

Long wavelength lasers absorb _____ ____ and (do or do not) penetrate deep into tissue

Answer 18

Absorb more water and do NOT penetrate deep into tissue

Question 19

Short wavelength lasers absorb _____ ____ and (do or do not) penetrate deep into tissue

Answer 19

less water and DO penetrate deeper into tissue

Question 20

CO2 lasers require what color eye protection to protect which eye structure

Answer 20

Clear lenses - cornea

Question 21

Nd:YAG lasers require what color eye protection to protect which eye structure

Answer 21

Green goggles - Retina

Question 22

Ruby lasers require what color eye protection to protect which eye structure

Answer 22

Red goggles - Retina

Question 23

Argon lasers require what color eye protection to protect which eye structure

Answer 23

Amber goggles - Retina