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Spring '20/ L. BASICS- Immune, OR Hazards, OP > OR Hazards > Flashcards

OR Hazards Flashcards

1
Q

Electrical shock occurs when a

A

person becomes part of/or completes an electrical circuit.

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2
Q

BOVIE

A
  • 1926 by Professor Bovie
  • Hastened end of explosive anesthetic agents
  • interferes with EKG monitoring
  • potentially interferes w/Pulse ox and pace makers
  • may cause vfib (w/a stray when activated @50-60hz)
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3
Q

3 components of a fire:

A
  1. ) ignition source (surgeon/bovie)
  2. ) Fuel (nurse/ prep)
  3. ) Oxygen (anesthesia/oxidizer)
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4
Q

Products of combustion are called:

A

Toxicants

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5
Q

examples of Toxicants

A 
Co2
Ammonia
Hydrogen Chloride
Cyanide
*byproducts of burning materials like plastics
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6
Q

Common injuries from Toxicants

A

Airway and lung tissues, asphyxia

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7
Q

OR Fire Priority

A

Evacuation!

*a lot of smoke and heat must be produced before sprinklers detect fire

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8
Q

Two Types of OR Fires:

A

Type 1 - IN or ON the patient

Type 2 - Remote from patient (equipment)

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9
Q

Most common type of OR Fire?

A

Type 1

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10
Q

Common Type 1 Fires:

A
  • ET Fires
  • oropharynx during T&A
  • in breathing circuit
  • during laparoscopy
  • in high risk procedures in which an ignition source is used in O2 rich environment.
  • b/c of O2 spread faster and burn vigorously
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11
Q

Fires on patients involve:

A
  • head and neck
  • can happen under regional/MAC where pt receiving high O2 deliveries
  • surgical towels
  • drapes
  • body hair
  • body reservoirs where prep may pool (belly button, sternal notch)
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12
Q

Solutions to reduce Type 1 Fires:

A

Wet Laps in O2 rich environments

-if surgeon needs lung inflated –> do it with CPAP with AIR instead of O2

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13
Q

ET Fire Need to knows

A
  • DEVASTATING!
  • disasterous
  • O2 & N2O produce a blowtorch type flame
  • severe injury to trachea, lungs, and surrounding tissues
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14
Q

Produces a blowtorch type flame

A

O2 & N2O when ignited

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15
Q

Situation:
Uncuffed ETT in Ped T&A; use of laser to CAUTERIZE tonsil bed.
-What could happen?
-What can you do to prevent/decrease Risk?

A
  • Spark!
  • no cuff = O2 free flowing around airway

Prevent - cut O2 with air or decrease

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16
Q

Majority of OR Fires occur with?

A

MAC during Head and neck surgery

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17
Q

75% of surgical fires are:

A

O2 enriched

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18
Q

What % of O2 is safest ideally to prevent MAC fires?

If not, do what?

A

<30% O2 if possible

if not - add room air to reduce concentration
or consider LMA/ETT

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19
Q

How do PREPS contribute to OR fires?

  • Interventions to reduce?
A
  • Iodaphor has 74% Isopropyl Alcohol = very Flammable
  • be aware of prep pooling
  • allow prep to DRY COMPLETELY 4-5 mins
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20
Q

Can undergo EXOTHERMIC Chemical Reaction with desiccated CO2 Absorber (warm!)

A

SEVO

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21
Q

Sevoflurane is

A

Volatile (at room temp liquid volatizes into vapor)

but considered “nonflammable”

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22
Q

Sevo is nonflammable in….. (but….)

A

AIR

but can serve as fuel at concentrations as low as 11% O2 and 10% N2O

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23
Q

Manufacturers of SEvo suggest:

A
  • avoid desiccated co2 absorbents
  • monitor temp of absorbers and insp Sevo concentration.
  • sudden/unexpected influx of sevo inhalation –> Remove circuit and assess for thermal/chemical injuries
  • Use absorbents w/o strong alkali
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24
Q

example of absorbent w/o strong alkali?

A

AMSORB

contains Calcium Hydroxide and Calcium Chloride

  • no strong alkali
  • unreactive with volatiles
  • doesn’t produce CO or Compound A
  • no interaction w/Sevo or cause exothermic reaction
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25
Q

What do you do in ETT Fire? (steps/order)

A

INTERRUPT THE FIRE TRIAD

  1. ) O2 OFF - flowmeters off, d/c circuit from ETT and machine,
  2. ) Remove ETT - examine for missing pieces
  3. ) Flood/Flush - saline or sterile H20; extinguish any embers
    - Resume ventilation w/AIR preferably (avoid O2 & N2O)
  4. ) Re-establish Airway - will swell.
    - consider bronchoscopy (assess damage)
    - tx for smoke inhalation and possible tx to burn center
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26
Q

You remove an ETT after airway fire, what do you do with ETT?

A

examine it for missing pieces

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27
Q

Is it important what order your Flush an airway or Pull an ETT after airway fire?

A

M/M says no as long as done immediately if not at teh same time

-Hammon: remove tube — then flood/flush airway with saline or sterile water

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28
Q

Cotton Huck Towels

O2% and ignition speed

A

TYPE 2 Fire - remote of pt

  • 21% O2 ignition 12 seconds
  • 95% O2 ignition 0.1 seconds
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29
Q

Two major ignition sources for OR fires are?

barash p. 376

A 
the ESU (electrosurgical unit) &amp; Laser
-the ends of some fiberoptic light cords can also become hot enough they can start a fire if placed on paper drapes.
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30
Q 
Preventing ESU (electrosurgical unit) burns is the responsibility of: 
barash p. 361
A

All OR staff

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31
Q

Most important factor for preventing ESU fires?

barash p. 362

A

proper application of the return plate

  • Place the return plate as close as possible to the site of the operation.
  • ECG pads as far from site as feasible.
  • essential that the return plate has appropriate amt of gel and an intact return wire.
  • reusable plates must be cleaned after each use.
  • disposable plates checked to ensure the electrolyte gel has not dried out.
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32
Q

Hospital Grade plugs are marked by a

A

Green Dot

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33
Q

Hospitals must test their emergency power supply systems (generators) how frequently?

A

Once a month for at least 30 mins

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34
Q

The best way to prevent any fire?

A

keep the three legs of the fire triad from coming together.

  • ignition
  • oxidizer
  • fuel
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35
Q

Laser light can be…

A

reflected off any metal surface

-all or personnel should wear protective goggles

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36
Q

flammable gases that are frequently present in bowel gas?

A

Methane (~56%)

Hydrogen (~69%)

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37
Q

ERASE:

A 
Extinguish -the fire 
Rescue- pt and all other persons/evacuate 
activate- fire alarm 
shut - OR Doors and medical gas shut off
evaluate - for injury
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38
Q

In the OR, electrical equipment should always be:

A

Grounded

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39
Q

Supplying ungrounded power to the OR requires the use of an

A

Isolation transformer

40
Q

What continuously monitors the isolated power to ensure that it is indeed isolated from ground, and the device has a meter that displays a continuous indication of the integrity of the system?

A

the LIM (Line Isolation monitor)

41
Q

The LIM (line isolation monitor) is a device that

A

continuously monitors the integrity of an IPS (isolated power system)

42
Q

There is one instance in which it is acceptable for a piece of equipment to have only a two-prong and not a three prong plug. This is permitted when the instrument has what is termed _______ ________.

A

Double insulation

43
Q

Tell me what a macroshock is

A

involves relatively large amounts of current applied to the surface of the body.

(the current is conducted through all the tissues in proportion to their conductivity and area in a place perpendicular to the current.

44
Q

Shock from very small currents

A

microshock

45
Q

What kind of patients are at greater risk for microshock?

A

one who has a direct, external connection to the heart, such as through a CVP catheter or TVP wires.

46
Q

even very small amounts of current applied directly to the myocardium will cause

A

v.fib.

47
Q

all materials burn in the presence of an

A

oxygen-enriched environment

48
Q

at 21% O2, how fast can a cotton huck towel ignite?

A

12 seconds

49
Q

at 95% O2, how fast can a cotton huck towel ignite?

A

0.1 seconds

50
Q

Laser is the acronym for

A

Light Amplification by Stimulated Emission of Radiation

51
Q

PASS acronym

A 
to effectively use a fire extinguisher:
Pull the pin
Aim at the base of the fire
Squeeze the trigger
Sweep the extinguisher back and forth across the base of the fire.
52
Q

RACE Acronym

A 
when responding to a Fire:
Rescue
Alarm
Confine
Extinguish
53
Q

The reading on the LIM Meter does not mean ….

A

that current is actually flowing

54
Q

Is the reading on the LIM telling us the current?

A

no

it indicates how much current WOULD flow in the event of a first fault.

55
Q

How much current would flow in the event of a first fault is read by what device?

A

LIM (Line isolation monitor)

56
Q

The LIM is actually measuring the impedance to the ground of each side of what?

A

the IPS

57
Q

A basic principle of electricity is known as

A

Ohm’s Law (Voltage = current x resistance)

58
Q

Voltage = current x resistance is

A

Ohm’s Law

59
Q

To have a completed circuit necessary for current flow what must exist?

A

A closed loop must exist and a voltage source must drive the current through the impedance.

60
Q

To receive a shock, one must do what? What else must happen?

A

One must contact the electrical circuit at two points, and there must be a voltage source what causes the current to flow through the individual.

61
Q

Grounding is applied in two separate concepts:

A
  1. ) grounding of electrical power

2. ) grounding of electrical equipment

62
Q

To provide an extra measure of safety from gross electrical shock (macroshock), the power supplied to most ORs is grounded or ungrounded?

A

UNgrounded.

63
Q

The line isolation monitor is a device that does what?

A

continuously monitors the integrity of an isolated power system.

64
Q

What is a popular device used to prevent individuals from receiving an electrical shock in a grounded power system?

A

The ground fault circuit interrupter

65
Q

What does the ground fault circuit interrupter do?

A

prevents individuals from receiving an electrical shock in a grounded system.

66
Q

An electrically susceptible patient is:

A

one who has a direct, external connection to the heart

67
Q

Who may be at risk from very small currents (Microshock)?

A

electrically susceptible patients (direct, external connection to the heart)

68
Q

Problems can arise if the electrosurgical return plate is:

A
  • improperly applied to patient

- cord connecting the return plate to ESU is damaged or broken

69
Q

What is just as much of a danger in the OR today as they were 100 years ago when patients were anesthetized with flammable anesthetic agents?

A

OR Fires

70
Q

ESU and the Laser are to major source for:

A

Ignition sources for OR Fires

71
Q

Who should be familiar with the location and operation of fire extinguishers?

A

all OR personnel

72
Q

What can react with sevoflurane to produce a fire?

A

desiccated carbon dioxide absorbent

73
Q

Dessicated carbon dioxide absorbent can produce a fire if a reaction with what agent were to occur?

A

Sevoflurane

74
Q

50-60hz

A

may cause vfib (w/a bovie stray)

75
Q

Oxygen rich atmospheres lower what?

A

the temperature at which fuel will ignite

76
Q

These fires will burn more vigorously and spread faster

A

oxygen rich

77
Q

Cases involving what, can easily result in high concentrations of O2 in the cavity when lung is reinflated due to gas leakage?

A

stripping of the pleura or resection of pulmonary blebs

78
Q

What percentage of surgical fires are O2 enriched?

A

75%

79
Q

Iodaphor is mixed with

A

74% isopropyl alcohol

80
Q

What type of reaction can Sevo undergo with desiccated CO2 absorber? Endothermic or Exothermic?

A

Exothermic

81
Q

What device provides a significant amount of protection from macroshocks?

A

IPS (isolated power system)

82
Q

The LIM is not designed to provide protection from what?

A

microshock

-mA currents involved in microshock are far below the LIM threshold of protection

83
Q

the main oxidizers in the OR are:

A

air, oxygen, and N20

84
Q

what oxidizers function equally well?

A

oxygen and N2O

a combo of 50% O2 and 50% N2O would avidly support combustion, as would 100% O2

85
Q

Fuel sources of PREP agents:

A 
alcohol
degreasers (acetone, ether)
adhesives (benzoin, aeroplast)
CHG (hibitane)
Iodophor (dura prep)
86
Q

Fuel sources of Drapes & Covers agents:

A 
pt drapes
equipment drapes
blankets and sheets
pillows, mattresses, padding
gowns
masks
shoe covers
gloves
clothing
compression stockings
87
Q

Fuel sources of PATIENT agents:

A

hair
alimentary tract gases (methane and hydrogen)
desiccated tissue

88
Q

Fuel sources of DRESSING agents:

A 
gauze and sponges
petrolatum-impregnated dressings
xeroform
adhesive tape
elastic bandages
stockinettes
sutures
steri-strips
Collodion
89
Q

Fuel sources of OINTMENTS agents:

A 
petrolatum
abx (bacitracin, neomycin, plymyxin B)
Nitropaste
EMLA
lip balms
90
Q

Fuel sources of ANESTHESIA EQUIPMENT:

A 
breathing circuit
masks
ETT
oral and nasal airways
laryngeal mask airways
NGT's
suction catheters and tubing
scavenger hoses
volatile anesthesics
CO2 absorbers
IV tubing
monitor tubing and transducers
91
Q

Fuel sources of EQUIPMENT:

A 
charts
cardboard
packing materials
fiberoptic cable covers
wire covers
BP cuffs and tubing
stethoscopes
vascular shunts
dialysis and extracorporeal circulation circuits
mops/brooms
books, instruction manuals, and materials
92
Q

fires in the breathing circuit are what type of fire?

A

type 1

93
Q

fires during laparoscopy are what type of fire?

A

type 1

94
Q

ETT fires are what type of fire?

A

type 1

95
Q

fire of a piece of equipment is a type of fire?

A

type 2

Spring '20/ L. BASICS- Immune, OR Hazards, OP (18 decks)

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