Module 11 Flashcards
What agency publishes standards for fire prevention, detection, and suppression?
National Fire Protection Agency
Which code of the NFPA is specific to health care systems?
NFPA 99
Name the 3 limbs of the fire triad
- ignition source (heat)
- oxidizer
- fuel
A chemical reaction of a fuel rapidly combining with an oxidizer to release energy in the form of heat and light
Fire
Name 3 examples of ignition sources in the OR
- fiberoptic cables
- ESUs (bovies)
- lasers
Name 3 of the main oxidizers in the OR
- air
- O2
- N2O
(T/F) Basically almost everything is a fuel source in the OR
True
Name the 3 major dangers from an OR fire
- burns
- toxicants released
- smoke
Name 3 of the common toxicants from an OR fire that can damage to airways and cause lung parenchyma
- carbon monoxide
- hydrogen chloride
- ammonia
- cyanide
What are the four types of burn injuries?
- thermal/heat
- electrical
- chemical
- inhalation
What is the most common type of thermal/heat burn injury recorded?
Flame injury (43% of injuries reported)
What type of burn injury is most common to children up to age 4?
Scald injury
Which type of burn injury can be the most damaging?
Electrical
The extent of an electrical burn depends on the amount of ______ _______ conducted through the skin, which is based on the _______ and _______ of contact with the electrical source
thermal energy
voltage
duration
10 - 46% of those who have experienced an electrical injury experience some form of cardiac ________ and damage to the _________ can occur.
arrhythmias
myocardium
If the amount of muscle damaged from the conducted electric current is significant, _______ can be released into the circulation affecting nephron and renal tubular function, increasing risk of developing _____ _______.
myoglobin
renal failure
What is the initial treatment for chemical burns?
copious amounts of water or normal saline irrigation
This type of burn injury can often accompany a thermal burn and airway damage can vary
Inhalation injury
Inhalation burn injuries are classified based on _______ location
anatomical
What are the 3 types/classifications of inhalation burn injuries
- upper airway
- lower airway
- metabolic asphyxiation
This classification of inhalation injury is caused primarily by thermal injury to the mouth, oropharynx, and larynx
upper-airway
This classification of inhalation injury includes injuries to the trachea, bronchioles, and alveoli caused by chemical and particulate constituents of smoke
lower-airway
This classification of inhalation injury in which certain smoke constituents such as carbon monoxide or hydrogen cyanide impair oxygen delivery or use by the tissues
metabolic asphyxiation
Most common classification of inhalation injury
Lower-airway
What are the 3 phases of burn treatment
- resuscitation phase
- burn management phase (skin grafting and debridement)
- reconstruction phase
(T/F) The most common type of fire in the OR occurs on/in the patient
True
What surgery areas on the patient increase the risk for fire dramatically, especially when the patient is receiving a high amount of supplemental O2?
Head
Neck
ENT
Upper Chest
What factor dramatically increases risk of fire, and dangerously reduces ignition times?
An oxygen-enriched environment
All materials burn in an ______-_______ environment
oxygen-enriched
What are the 2 major ignition sources in the OR?
- ESUs
- Lasers
(T/F) You should not conduct open oxygen delivery in MAC cases involving the head and neck or upper body
True
(T/F) A CO2 absorber fire is considered a type of remote fire
True
This piece of equipment works via Light Amplification by Stimulated Emission of Radiation
Laser
What is the laser acronym?
Light Amplification by Stimulated Emission of Radiation
A laser consists of an energy source and material that the energy _____ to emit light
excites
In a laser, the material that the energy excites is called the_____ ______ and provides the name of the particular type of laser
lasing medium
Name and describe the 3 properties of lasers
- coherent radiation (meaning all the waves have the same frequency and phase)
- monochromatic (of a single color or wavelength)
- collimated (the beam does not disperse as the distance from the source increases)
(T/F) There are several types of lasers used for different procedures and areas of the body
True
Filling the ETT cuff with ______ can help with early detection of rupture and help alleviate the addition of O2 to an airway fire during high risk procedures
Saline
(T/F) The ETT is basically a blow torch when it catches fire
True
The ____ was found to be the ignition source of 90% of airway fires.
ESU
Which type of ESU is safer?
Bipolar
What are 3 ways to prevent airway fire in high risk procedures?
- dont use free flow of O2 unless truly required
- use minimum O2 needs (<30%)
- ensure no leaks in ETT/LMA
- dont cover face unless truly required
- make sure drapes are secure at surgical site
- use moist gauze/sponges near ignition sources
- allow alcohol prep to dry completely
What “nonflammable” halogenated inhalation agent specifically has been linked to airway fires under certain conditions?
Sevoflurane
Sevoflurane is nonflammable in air, but serves as a fuel in combinations of ___ and ____
O2 & N2O
Sevoflurane in _________ CO2 absorbent can undergo exothermic chemical reactions implicated in OR fires
desiccated
What CO2 absorber is the safest to use with sevoflurane regarding risks of airway fires?
Amsorb
What are the 10 detailed steps to take during an airway fire?
- Extinguish ASAP, Call for Help, and Interrupt the Fire Triad!!!
- Stop ignition source: laser, ESU
- Stop oxidizer (O2 flow)
- Stop ventilation to limit lung exposure to flame & heat
- Remove burning ETT: place in water bucket or away from flammable material
- Extinguish fire with NS, remove drapes
- Mask ventilate with air until fire extinguished, then FiO2 1.0 (100%)
- If stable, assess airway for damage with bronchoscopy
- Reintubate if needed or significant damage noted
- Arrange for ICU and supportive therapy
What are the 5 simplified steps to take during an airway fire? (BE ABLE TO ANSWER IN <10 SECONDS)
- Disconnect ETT circuit
- removed ETT
- exstinguish fire with NS
- re-intubate or mask ventilate
- assess damage and consult appropriate resources
(T/F) N2O is flammable and acts as oxidizer fuel.
True
______ _______ are impervious to water; thus, throwing water or saline on them will do little to extinguish the fire.
Paper drapes
Most effective way to extinguish fire on patient (unless the paper drape is on fire)
Saline
If paper drape is on fire what do you do first to extinguish?
Remove it!
If you are working a procedure with a high risk of fire, you better have a bottle of what on your cart, readily available?
NS
If a fire is on the patient and you dont have saline, do not fan it, _______ it.
Smother
Name the 4 risk factors associated with high fire risk procedures
- open O2 delivery or O2-rich environment
- Ignition source use (ESU/laser)
- surgical location head/neck/ENT/upper chest
- alcohol based prep solutions
If > or = ____ fire risk factors exist, then the procedure is at high risks for fires, requiring preventative steps.
> or = 3
What can class A fire extinguishers be used on?
Paper, cloth, plastics
What can class B fire extinguishers be used on?
Flammable liquids or grease
What can class C fire extinguishers be used on?
Electrical
What type of fire extinguisher is best for the OR?
CO2
What 2 classes can CO2 extinguishers be mainly used on?
B & C (some A)
This type of fire extinguisher removes oxygen & heat with cold discharge
CO2
