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Coexisting diseases > Safety Issues in the OR > Flashcards

Safety Issues in the OR Flashcards

1
Q 
–Studies inconclusive????
–Reproductive – fertility and pregnancy
•Infertility
•Spontaneous abortion higher incidence
•Congenital anomalies higher incidence
–Bone marrow depression
–Numbness, tingling, and muscle weakness
–Liver disease
A

Halogenated Agents

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2
Q

•Standards - NIOSH, OSHA
-Nitrous oxide less than ___
-Halogenated agents less than ___ OR ___ when combined with ___
•Management - equipment, practice
-? (top things we use to make sure taking away excess gas, prevent exposure)
-routine machine maint., a/w management, adeq. air exchange in OR
-Another big time we get exposure?

A
  • 25 ppm
  • 2 ppm or 0.5 ppm nitrous
  • scavenge
  • vaporizer (filling)
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3
Q

Infections - HIV:

  • Greatest risk is ___, deep cutaneous injury with a large hollow needle
  • Can also occur with a small break in skin or splatter in mouth
  • 0.3%-0.4% seroconversion rate after single exposure needlestick
  • occurs within ___
  • retested ___ and at ___ after exposure
  • postexposure antiretroviral prophylaxis regimens
  • started ___ after exposure
A
  • needle-stick injuries
  • 6-12 weeks
  • 6-12 weeks and at 6 months
  • less than 24 hours
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4
Q

Infections:

  • ___ is the most serious occupational health danger facing anesthesia providers
  • 20-49% providers have markers of previous exposure to ___
  • Risk of infection after ___-contaminated percutaneous exposure is 37-62%
  • Vaccination
  • Virus remains active ___ in dried blood
A
  • Hepatitis B
  • Hep B
  • HBV
  • 1 week
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5
Q

Infections:

Predominantly from transfusions?

A

Hepatitis C

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6
Q

Infections:
•Herpes •Rhinovirus
•____-Spread-airborne droplets, 10% chance of developing after exposure, ___ has the highest incidence
-Isolation, filters, protective equipment, fit-tested NIOSH-approved N95 or higher level respirator, annual skin tests
-Treatment: Isoniazide, rifampicin

A
  • Tuberculosis

- DC

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7
Q

Infections: Policies/regulations
-CDC - ___ = gloves, eyewear, gowns, masks, handwashing, needles, isolation
-___ – Guidelines to minimize occupational exposure to blood-borne pathogens (employer’s responsibilities)
-2002 Needlestick Safety and Prevention Act
•DO NOT ___ •___ systems
•Other exposure control plans (ie. puncture resistant containers)

A
  • Universal Precautions
  • OSHA
  • recap
  • Needleless
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8
Q

Chemical Exposure: ___!
-People at risk: Patients with frequent exposure (spina bifida, urologic patients), Health care workers with frequent exposure
•Symptoms- dermatitis, urticaria, rhinitis, conjunctivitis, asthma, laryngeal edema, anaphylactic shock
•Associated with allergy to avocado, potato, banana, tomato, chestnuts, kiwi, papaya
•Management- reduce undue exposure, hand washing after exposure, consider pretreatment - AANA Latex Protocol
•Latex free equipment

A

Latex

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9
Q

Chemical Exposure - ___: Acrylic cement used for prostheses
–Supplied as liquid and powder components that are mixed, Potential __
*Risks:
–Patient = ___ (can go all the way to bradycardia, cardiac arrest)
–Health care providers- dyspnea, wheezing, coughing, rhinorrea, hypertension, erythema, headache
–Caution with ___

A

Methylmethacrylate

  • toxic vapors
  • hypotension
  • pregnancy
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10
Q 
Chemical Exposure: Methylmethacrylate
~Recommendations (NIOSH)
-Maximum \_\_\_ exposure to \_\_\_
~Management
-Patient – \_\_\_, \_\_\_ support 
-Health care providers- adequate \_\_\_, scavenge
A
  • 8 hour exposure to 100 ppm
  • hydration
  • vasoactive support
  • ventilation
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11
Q

Chemical and Biological Weapons:
*___ = Irreversible inhibition of acetyl & butyryl-cholinesterase
–Hypersecretions, bradycardia, AV block, bronchospasm, seizures, resp. depression, paralysis
–Treatment: Atropine and OXIMES

A

*Nerve Agents (Sarin gas)

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12
Q

Chemical and Biological Weapons:
*___ = “blistering agents”
–Treatment: respiratory support, fluid therapy

*___ = Inhaled, injected, or ingested
–Respiratory distress, chest tightness, pulm edema

A
  • Vesicant agents (“mustard gas”)

* Ricin

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13
Q

Chemical and Biological Weapons:
*___
–Laryngospasm, pulmonary edema
–Treatment: respiratory support, limit inflammation

A

•Choking agents (chlorine/ phosgene)

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14
Q

Chemical and Biological Weapons:
*___ = Inhibits cytochrome oxidase enzymes, causes cellular Hypoxia
–Treatment: Sodium thiosulfate
*___ = Inhibits release of acetylcholine
–Treatment: antiserums
*___ = Pulmonary edema, widened mediastinum
–Antibiotics, vaccine

A
  • Blood agents (cyanide)
  • Toxins (botulinum toxin)
  • Biologicals (anthrax)
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15
Q

Ionizing Radiation = Risks - rapidly replication cells
-Greatest risk for us from ___
•Policies/regulations = Max. yearly exposure ___ (during pregancy ___)
•Management:
-Distance- minimum of ___ (6 ft air = 9 inches concrete = 2.5 mm lead)
-Protection (aprons, lead shields, walls)
-Exposure: eyes, reproductive organs, thyroid

A
  • fluoroscopy
  • less than 5 rem
  • less than 500 mrem
  • 3 feet
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16
Q

*___ does not require ionizing radiation, but high radiofrequency power
•Risk- magnetic fields may be changed to ___ fields (by connection of two circuit elements by a wire or resistor)
•Dangerous with pacemakers or implanted stimulators, vascular clips, or any other ferromagnetic metal
•Noise •Small space •Unknown effects on pregnancy
•NO ___ ALLOWED!!!!!

A
  • MR Imaging
  • electric
  • METAL
17
Q

*___ = Light Amplification by Stimulated Emission of Radiation
-CO2, Nd: YAG, argon
•___ – cornea, retinal burns, destruction of macula, caracts
–protective eye wear, biggest risk for HC providers!!
•Vapors and debris – infections (HVP- human papilloma virus, HIV)
–plume evacuator system, high filtration masks

A
  • Lasers

- eye injury

18
Q

*Fires - Fire triad = ???
•Use lowest concentration of __ possible, avoid __, avoid __, beware of __ lubricants and ___ based preps, use special ETT and fluid in cuff
•Beware of ___, too much ___ (will require more oxygen!)
•Know location of nearest fire extinguisher, oxygen shut-off valves!!
•Fire drills: ERASE: extinguish, rescue, activate, shut (doors), evaluate

A

Oxygen/nitrous, fuel, ignition source

  • think…FINO I blow up this place ;-)
  • oxygen
  • nitrous oxide
  • paper drapes
  • oil based
  • alcohol
  • Tenting, sedation
19
Q 
If fire:
–remove drapes and burning material
–douse flames with \_\_\_
–assess for smoke inhalation
•If airway fire:
–remove ETT
–turn off all gases
–extinguish fire/ pour saline into airway
–remove burning materials
–mask ventilate, assess injury, replace ETT, bronchoscopy
A

normal saline

20
Q

*Electricity = Risks- shock, burns, explosions, arrhythmias, pacemaker disruption, FIRE!
From: equipment (surgical, anesthesia), monitoring equipment
-___, ___

*___ - even small amounts of electrical current can disrupt muscle and nerve function (macroshock, microshock)

A
  • defib
  • electroconvulsive therapy
  • Shock
21
Q

•MACROSHOCK - Large voltage of electricity flowing through a person
•Response depends on amplitude and frequency of current.
–___ = perception threshold –___ = maximal harmless current intensity
–___ = “let-go” threshold, then muscle contraction
–___ = pain
–___ = ventricular fibrillation, respiratory paralysis/apneic
–___ = sustained myocardial ctx, temp respiratory paralysis, burns

A
  • 1 mA
  • 5 mA
  • 10-20 mA
  • 50-100 mA
  • 100-300 mA
  • > 6000 mA
22
Q

MICROSHOCK - Direct application of very small amounts of electric current in an electrically susceptible patient who has an external conduit that is in direct contact with HEART
–cardiac pacing wires
–invasive monitoring catheters
•Maximum leakage allowed is ___
•A current as low as ___ can be fatal (ventricular fibrillation)
•An ___ is the most important factor in preventing microshock!!

A
  • 10 mA
  • 100 microamperes
  • intact equipment ground wire
23
Q

•Grounding of electrical power
–electrical power usually ___ in hospital
–the current is isolated from ___
–requires the use of ___, which converts the grounded power (from utility) to an ungrounded system
•___ is isolated from ground

A
  • ungrounded
  • ground potential
  • isolation transformer
  • Power
24
Q

•Grounding of electrical equipment
–electrical equipment should always be ___
•provides ___ pathway for currents to ground
•dissipates leakage current
•provides information to LIM

A
  • grounded

- low resistance

25
Q

*___ = Device that continuously monitors the integrity of an isolated power system
•LIM alarms at ___ or an impedance of ___
•Device will change system to a ___ if a faulty piece of equipment is connected to the isolated power system
•If alarms, check gauge:
–If between ___ – too many pieces of electrical equipment plugged in
–If ___ – faulty piece of equipment, unplug

A
  • Line Isolation Monitor
  • 2-5 mA
  • less than 60,000 ohms
  • conventional grounded system
  • 2-5
  • greater than 5
26
Q

-Only anesthetic gas consistently teratogenic????
–Inactivates vitamin B12 dependent enzyme methionine synthetase involved in DNA production, myelin sheath assembly, and methyl substitution in neurotransmitters
•Leads to ___, polyneuropathy
•Increase ___
•Increase rate of ___

A

Nitrous oxide

  • anemia
  • infertility
  • spontaneous abortions
27
Q

Electrocautery = ___ = most common
•Current applied via cutting/coagulation electrode (generates heat in a very small area)
•___ = ground pad outside surgical field.
•Proper application of ___ very important
–Appropriate amount of gel –Intact return wire
–Place close to operative site –Caution with flammable preps
–If pacemaker, place below ___ and prepare for treating ___, including magnet, defib, external PM »Can have reprogramming and microshock

A

Unipolar

  • Second electrode
  • return plate
  • thorax
  • dysrhythmias
27
Q

Cutting or coagulation combining high resistance with high current

A

Electrocautery

28
Q

Electrocautery = ___
•Two pencil-point electrodes applied to site and current flows btw them
•Generates ___ than unipolar
•Recommended for patients with ___
–But, pacemaker still at risk of program disruption

A

Bipolar

  • less power
  • pacemakers
29
Q

***___ =
•MRI, ESWL, drills, monitors, surgical equipment, alarms, music
•Hazardous noise when ___ for ___ hours/day
•Interferes with work performance, vigilance, fatigue, irritability, hormonal stress response

A

***Noise
greater than 90 decibels (db)
8

30
Q

***___ =
•Surgical lights
•Laparoscopic equipment
•Dark

A

***Lighting

31
Q

Personal hazards
•___ - injury, temperature, sleep deprivation/fatigue, illness, aging

  • ___- substance abuse, stress, interpersonal, economic, distractions
  • Policies/regulations- AANA, COA, departmental
A
  • Physical

- Psychological

32
Q

Review slides

A

5, 6, 37-39, 42, 43 didn’t make cards for these slides, info not really important in my opinion but review if you want.

33
Q

Med Errors: (Other = more complex event not fitting categories below)

  • ___ = drug not given
  • ___ = extra dose of an intended drug
  • ___ = incorrect drug instead of the desired drug
  • ___ = a drug that was not intended to be given at a particular time or at any time
  • ___ = wrong dose of an intended drug
  • ___ = wrong route of an intended drug
A
  • Omission
  • Repetition
  • Substitution
  • Insertion
  • Incorrect dose
  • Incorrect route
34
Q

Impaired Provider:

  • ___ = use of a psychoactive substance in a manner detrimental to the individual or society
  • ___ = a primary, chronic DISEASE
  • Characterized by impaired control over drug use
  • Compulsion or craving
  • Continued use in spite of adverse consequences
A
  • Abuse

* Addiction

35
Q

Abuse/Addiction Scope of Problem:

  • Incidence
  • Drug of choice ?
  • Fentanyl, alcohol, cocaine, propofol
  • Inhalational agents, especially ?
A
  • Opioids

- Sevoflurane

36
Q

Needle Safety:
*****DON’T ____! (she wrote it like 800 times on the slide)
*One needle, one syringe, only one time = One and only campaign
^^^Don’t you feel like this is a line someone would say to you when they want you to try drugs for the first time?

A

RECAP

Coexisting diseases (8 decks)

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