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Gen Exam 1 > OR > Flashcards

OR Flashcards

1
Q

Leading cause of medical errors/patient harm

A

ineffective communication

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2
Q

Ineffective communication causes about ___ % of sentinel events.

A

70

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3
Q

Most common med errors

A

opioids
muscle relaxants
antibiotics

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4
Q

1 in ___ anesthetics are assoc. w/ an error

A

133

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5
Q

OR temp
when is it higher?

A

68-73 F
burns, peds, greater body exposure, trauma

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6
Q

Hypothermia risk factors

A

wound infxn
higher blood loss
impaired coagulation

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7
Q

OR humidity

A

30-60%

too low = greater airborne motility (infxn risk)

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8
Q

OR air exchange frequency

A

25x/hr

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9
Q

How loud can it get in the OR?

A

70-80 decibels

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10
Q

Fire Triad

A

Ignition source
Oxidizer
Fuel

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11
Q

Fire risk factors

A
  • Increased risk w O2 concentration of 30% or greater
  • Surgery above the xiphoid
  • Laser surgery and surgery in the airway
  • Alcohol-based skin preps that don’t dry
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12
Q

Fire prevention

A

*COMMUNICATION
*O2 <30%
*let alcohol dry
* Wet gauze around the area to prevent
* Turn O2 down for 2-3 min before surgeon needs cautery

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13
Q

Airway Fire

A
  1. Turn off gas source
  2. Stop vent
  3. Pull breathing tube
  4. Pour saline in the airway
  5. Reintubate
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14
Q

CO2 extinguisher
when to use
pros

A

Safe during external and internal exposure for fires in the OR

Nontoxic
readily dissipates
less likely to cause thermal injury
not liquid

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15
Q

Electric shock is produced by ___.

A

current

NOT VOLTAGE

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16
Q

What do line isolation monitors do?

A
  • Continuously monitors the integrity of an isolated power system
  • Does not provide complete protection from electrocution

alarms @ 2-5 mA
alarm = leak

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17
Q

Which is more common?
microshock
macroshock

A

macroshock

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18
Q

OR power is ____. Machines in the OR are ___.
(grounded/ungrounded)

A

OR = ungrounded
machines = grounded

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19
Q

Maximum harmless current

A

5 mA (miliamps)

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20
Q

Most common cause for macroshock?

A

damaged/faulty equipment wiring

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21
Q

Isolation transformer

A

isolates the operating room power supply from ground

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22
Q

T/F
You can use the outlets in the back of the anesthesia machine for equipment.

A

False
don’t plug stuff into the back of the machine

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23
Q

If the line isolation monitor starts alarming, what does this mean? Are we all gonna die?

A

alarms at 2-5 miliamps

reading is not the actual current flowing
it is how much current WOULD flow in the event of a second fault (a second fault could/would be bad)

does not indicate a hazardous situation

it indicates that OR is no longer isolated from the ground

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24
Q

If the line isolation alarms, do we unplug life support machines?

A

No
unplug all other nonvital equipment, as this may be reason for alarm

vital equipment can be safely used but do not plug in more equipment, as it can introduce a second fault

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25
Q

Electrosurgical Units (cautery)

A
  • Doesn’t usually produce shock effects
  • Remember placement of the return plate on the patient
  • Bipolar cautery is usually used for much smaller/finer areas to have more control
26
Q

When and how to disable cardiac implants

A

when cautery is used

placing a magnet over the AICD device during electroconvulsive therapy

27
Q

Electrosurgical units can interfere with what other equipment?

A

ECG
CO
pulse ox

28
Q

ALARP

A

as low as reasonably possible

(exposure to ionizing radiation)

29
Q

Factors to protect from radiation

A

time
distance
sheilding

30
Q

Can gas sampling lines be reused?

A

No

31
Q

Whats the number 1 occupational hazard in anesthesia?

A

substance abuse

32
Q

Macroshock starts at….

A

1+ mA

33
Q

How much amperage is needed to cause vfib?

A

100 mA

34
Q

Touching a faulty piece of equipment in the OR causes…

A

IPS (Instant Power Supply) to be converted into grounded system

35
Q

What is needed to increase risk to macroshock?

A

a second piece of faulty equipment

36
Q

T/F
The Line Isolation monitor prevents shock

A

False
only able to alert increased risk of shock

37
Q

ground-fault circuit interrupter (GFCI)

A

monitors hot and neutral wires
ensures equal current flow
interrupts power if difference is detected

38
Q

In the case of faulty equipment, current may flow thru the person touching it and trip the ____.

A

ground-fault circuit interrupter (GFCI)

GFCI trip: disconnects the current flowing through an unintended ground path (even if the current is too small to trip a typical circuit breaker)

39
Q

Risks for hypothermia

A

Wound infection
increased intraoperative blood loss
impaired coagulation

40
Q

What does a leak check of the machine’s low-pressure system evaluate? Why is this so important?

A

The integrity of the anesthesia machine from the flowmeters to the common gas outlet.

Important: Leaks in this circuit can lead to hypoxia and/or patient awareness

41
Q

Does a manual positive-pressure leak test check the integrity of the unidirectional valves?

A

No
This test does not check the integrity of the unidirectional valves

42
Q

What are the risk of hypothermia in the patient?

A

Wound infection
increased intraoperative blood loss
impaired coagulation

43
Q

What if the humidity in the OR is too low or high?

A

Humidity too high: damp or moist supplies (contamination)

Humidity too low: increases incidence of static changes & airborne motility of particular matter (vector for infection)

*Maintained between 30-60% humidity

44
Q

What should you do if there is fire on the patient?

A

Turn off gases
Remove drapes & burning materials
Extinguish flames with water, saline, or fire extinguisher
Assess pt’s status, devise care plan, assess for smoke inhalation

45
Q

What should you do if the line isolation monitor’s alarm is activated?

A

Check gauge to determine if true or false alarm
Gauge reads > 5 mA = likely a faulty piece of equipment plugged into IPS
Identify fault equipment by unplugging each piece of equipment
Remove unneeded equipment from room
*If faulty piece is needed for life support then it can be safely used

46
Q

What is a line isolation monitor (LIM)?

A

Continuously monitors the integrity of an isolated power system
Primary purpose: alarm if power system is no longer “ungrounded” due to faulty equipment.

If a faulty piece of equipment is connected to the IPS, this will change the system back to a conventional grounded system; the faulty piece of equipment will continue to function normally

Reading LIM indicates how much current would flow in the event of a first fault - it would require a second fault to create a dangerous situation

47
Q

What is an isolation transformer?

A

Supplies underground power to OR

Uses electromagnetic induction to induce a current in the ungrounded or secondary winding of the transformer from energy supplied to the primary winding

Prevents shock from occurring in the OR by isolating the electrical power system and keeping it ungrounded

48
Q

What are the OSHA occupational limits on radiation exposure?

A

OSHA dose limit for whole body radiation is 1.25 rem per calendar quarter

*not to exceed a 5-rem annual whole body-dose of ionizing radiation

49
Q

How are various anesthesia equipment kept clean? (Airway equipment, anesthesia machine, face masks)

A

Wiped down in the morning and in between each case by cleaning staff.
Circuits/masks are replaced for every single pt

50
Q

What are the CVC insertion, a-line insertion, and regional anesthesia precautions?

A

Sterile technique is maintained

51
Q

Describe the fire triad?

A

Ignition: electrosurgical cautery, laser
Oxidizer: oxygen, nitrous oxide (Anesthesia)
Fuel: endotracheal tube, drapes, surgical supplies, surgical prep (alcohol, chlorhexidine)

52
Q

What are the CDC Tier I and II precautions?

A

Tier 1: standard precautions - Used for all patients

Tier 2: transmission-based precautions for pts with known/suspected infections

Contact: gown + gloves
Droplet: mask for workers + mask on patient
Airborne: N95 masks for workers + mask on patient

53
Q

How can you prevent an OR fire?

A

Keep inspired O2 low (< 30%)
Wet gauze around the area
Turn down O2 for 2-3 min before surgeon needs cautery
Communicate/Timeouts

54
Q

When should you wash your hands in the operating room?

A

after induction
before and after entering OR
follow universal precaution

55
Q

Discuss the one needle, one syringe, and one time campaign.

A

The CDC’s and SIPC’s campaign to provide guidance on safe infection and medication vial management to eliminate unsafe medical injections

56
Q

What is the AANA’s position statement on infection control during an anesthetic?

A

Per AANA they “support patient safety through the use of evidence-based infection prevention and control practices”

57
Q

What should you do if there is fire on the patient?

A

Turn off gases
Remove drapes & burning materials
Extinguish flames with water, saline, or fire extinguisher
Assess pt’s status, devise care plan, assess for smoke inhalation

58
Q

What effects do the anesthetic gases have on the health care worker?

A

Studies have not shown any evidence
conflicting evidence
headaches, possible DNA damage due to exposure to high levels, cancer, miscarriage per Barash

59
Q

How many air exchanges occur per hour in the operating room?

A

CDC: minimum of 15 total air change per hour
National Fire Protection Agency (NFPA): 25

60
Q

At what temperature is the operating room usually maintained?

A

between 68-73°F
Kept warmer for: burns, large surface area exposed (i.e., plastic surgery), pediatric patients, trauma

Gen Exam 1 (4 decks)

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