Safety Issues in the OR Flashcards
–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
Halogenated Agents
•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?
- 25 ppm
- 2 ppm or 0.5 ppm nitrous
- scavenge
- vaporizer (filling)
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
- needle-stick injuries
- 6-12 weeks
- 6-12 weeks and at 6 months
- less than 24 hours
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
- Hepatitis B
- Hep B
- HBV
- 1 week
Infections:
Predominantly from transfusions?
Hepatitis C
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
- Tuberculosis
- DC
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)
- Universal Precautions
- OSHA
- recap
- Needleless
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
Latex
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 ___
Methylmethacrylate
- toxic vapors
- hypotension
- pregnancy
Chemical Exposure: Methylmethacrylate ~Recommendations (NIOSH) -Maximum \_\_\_ exposure to \_\_\_ ~Management -Patient – \_\_\_, \_\_\_ support -Health care providers- adequate \_\_\_, scavenge
- 8 hour exposure to 100 ppm
- hydration
- vasoactive support
- ventilation
Chemical and Biological Weapons:
*___ = Irreversible inhibition of acetyl & butyryl-cholinesterase
–Hypersecretions, bradycardia, AV block, bronchospasm, seizures, resp. depression, paralysis
–Treatment: Atropine and OXIMES
*Nerve Agents (Sarin gas)
Chemical and Biological Weapons:
*___ = “blistering agents”
–Treatment: respiratory support, fluid therapy
*___ = Inhaled, injected, or ingested
–Respiratory distress, chest tightness, pulm edema
- Vesicant agents (“mustard gas”)
* Ricin
Chemical and Biological Weapons:
*___
–Laryngospasm, pulmonary edema
–Treatment: respiratory support, limit inflammation
•Choking agents (chlorine/ phosgene)
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
- Blood agents (cyanide)
- Toxins (botulinum toxin)
- Biologicals (anthrax)
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
- fluoroscopy
- less than 5 rem
- less than 500 mrem
- 3 feet
*___ 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!!!!!
- MR Imaging
- electric
- METAL
*___ = 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
- Lasers
- eye injury
*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
Oxygen/nitrous, fuel, ignition source
- think…FINO I blow up this place ;-)
- oxygen
- nitrous oxide
- paper drapes
- oil based
- alcohol
- Tenting, sedation
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
normal saline
*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)
- defib
- electroconvulsive therapy
- Shock
•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
- 1 mA
- 5 mA
- 10-20 mA
- 50-100 mA
- 100-300 mA
- > 6000 mA
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!!
- 10 mA
- 100 microamperes
- intact equipment ground wire
•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
- ungrounded
- ground potential
- isolation transformer
- Power
•Grounding of electrical equipment
–electrical equipment should always be ___
•provides ___ pathway for currents to ground
•dissipates leakage current
•provides information to LIM
- grounded
- low resistance
