Hazards Flashcards
What does LASER stand for
Light amplification stimulated emission of radiation
Laser hazards?
Patient:
- Airway fires
- Theatre fires/igniton
- Damage/burns/ large blood vessels unable to be coagulated
Personnel:
- Eye damage
- Fires
- laser plume inhalation
Mitigating laser hazards
Patient:
- Gauze soaked in water in oropharynx
- Laser tube, double cuff filled with saline
- Eye protection
- Low conc. O2/low flows
- Avoid N2O
Theatre:
- Matt black non reflective surfaces
- Eye goggles specific wavelength
- Warning signs/blinds/
- Laser safety officer
Different types of lasers, wavelengths and uses
- CO2, wavelength 10600nm: coag cutting in superficial surgery - airway, neuro, ent
- Nd-YAG - wavelength 500nm - photocoagulation and tumour debulking, endoscopic
- Argon - wavelength 1060nm - photocoagulation (ophth, dermatology)
Steps to take airway fire
STOP
EXTINGUISH
REMOVE ETT - inspect for damage. patency, and removal of debris.
VENTILATE - 21% o2 until fire extinguished, then 100%
REINTUBATE and saline lavage
other:
- Steroids
- ICU involvement
- CXR
ENT opinion, early tracheostomy
Repeat bronchoscopy
Describe type of light with lasers
Coherent, monochromatic collimated (parallel and shape maintained through distance), all have different wavelengths based on the medium used.
3 most common nerve injuries
Ulnar nerve
Brachial plexus
Lumbar plexus and common peroneal nerve
Risk factors for peripheral nerve injury
Surgical factors
- use of tourinquets, retractors
- cutting, burning, incising peripheral nerves
- surgery specific positioning - trendelenburg, lithotomy, lateral, prone, arms out
Patient factors
- obese or underweight
- t2dm, peripheral neuropathy, PVD
Anaesthetic factors
- Poor positioning
- Peripheral nerve block
- BP cuff
- Invasive monitoring
- Hypothermia, hypotension
- Inadequate padding of extremities
Risks with lithotomy position (3)
- Common peroneal nerve compression (poles)
Flattening of lumbar lordosis -> - Sciatic nerve
- Lumbar plexus
