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614 General Principles Of Anesthesia > Week 2- OR Safety & Opioids > Flashcards

Week 2- OR Safety & Opioids Flashcards

1
Q

The synthesis of heroin in 1874 was based on the empirical finding that boiling _________ caused the replacement of the two groups: __________ by __________

A

Morphine; -OH by -OCOH3

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2
Q

7 uses of opioids

A
  • preoperative meds
  • anesthesia
  • Induction
  • intraop pain control
  • post op pain control
  • spinal/epidural anesthesia
  • OB
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3
Q

Normal fentanyl dose

A

50-100 mcg

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4
Q

Common opioid added to epidurals and spinal

A

Duramorph

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5
Q

Name the piperidines

A

-fentanyl
-sufentanil
-alfentanil
- remifentanil

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6
Q

Piperidine opioids are

A

Synthetic

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7
Q

Synthetic opioid commonly used for eye blocks due to its fast on/off onset/DOA

A

Alfentanil

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8
Q

What side effect may be seen after intraoperative morphine use in the postoperative area

A

Itching

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9
Q

Dilaudid:

Acts on _________ and is an __________
Comes in a ____________ vial
Typically it is ____________
Common name for Dilaudid is _________

A

Mu, agonist
10 mg/cc
Diluted
Hydromorphone hydrochloride

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10
Q

What type of agonist/antagonist is Ketamine and on what receptor does it act

A

NMDA receptor antagonist, also works on opioid receptors

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11
Q

Clinical effects of acting on mu-1

A
  • supraspinal analgesia
  • bradycardia
  • Sedation
  • pruritis
  • N/V
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12
Q

Examples of mu-1 agonists

A

Morphine and meperidine

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13
Q

Clincal effects of acting on mu-2

A
  • respiratory depression
  • euphoria
  • physical dependence
  • pruritis
  • constipation
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14
Q

Clincial effects of acting on the K (kappa) receptor

A
  • Spinal analgesia
  • respiratory depression
  • sedation
  • miosis
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15
Q

Clinical effects of acting on the delta receptor

A
  • spinal analgesia
  • respiratory depression
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16
Q

Example agonists of the mu-2 receptors

A

Morphine and meperidine

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17
Q

Example agonists of the kappa receptors

A

Fentanyl, morphine, and nalbuphine

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18
Q

Example agonists of delta receptors

A

Oxycodone, B-endorphine, Leu-enkaphalin

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19
Q

Are piperidines lipophilic or lipophobic

A

Lipophilic

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20
Q

Where are fentanyl, alfentanil, and sufentanil metabolized and what enzyme catalyzes these breakdowns

A

Liver; cytochrome P450 enzyme system

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21
Q

How much more potent is fentanyl than morphine

A

~ 100 x more potent

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22
Q

Why is fentanyl typically used in anesthesia

A

To decrease CV response to noxious stimuli from laryngoscopy, intubation, skin incisions, and surgical stress

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23
Q

Administering fentanyl can decrease inhalational anesthetic requirements by 50% by administered _________________ IV fentanyl

A

1.5-3 mcg/kg

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24
Q

The two most pain provoking things that occur in surgery

A

Intubation and skin incision

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25
Q

T or F: Fentanyl is considered an “additive drug”

A

T

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26
Q

Sufentanil is a ___________derivative of fentanyl and is _________ more potent than fentanyl

A

Thienyl; 10 X

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27
Q

What meds lipophilicity is 2x greater than fentanyl’s

A

Sufentanil

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28
Q

Is sufentanil metabolized to inactive or active compounds

A

Both

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29
Q

Where is sufentanil metabolized

A

Liver

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30
Q

Metabolizes remifentanil

A

Blood and tissue nonspecific esterases

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31
Q

What type of chemical side chain on remifentanil affects its metabolization

A

Methyl ester

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32
Q

CSHL of remifentanil

A

2 minutes

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33
Q

Most rapidly acting opioid available

A

Remifentanil

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34
Q

Clearance of remifentanil

A

3-5 L/min

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35
Q

Is remifentanil metabolized in liver? Why or why not

A

No. It’s clearance exceeds liver blood flow affirming its extrahepatic clearance

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36
Q

Why is remifentanil usually a continuous infusion

A

It’s plasma level decreases by 50% in ~ 40 seconds

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37
Q

Active metabolite of ________ can cause seizures

A

Meperidine

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38
Q

Does morphine cross BBB quickly or slowly? Why?

A

Slowly due to low lipophilicity

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39
Q

Goal for patient in preoperative timeframe

A

To RELAX then not to sedate them…. Yet

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40
Q

How long to the onset of action for dilaudid

A

10- 15 mins

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41
Q

Who tends to have higher effects from narcotics?

A

Neonates, elderly, patient with OSA

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42
Q

What causes an increase in biliary pressure

A

Contraction of the sphincter of Oddi as a result of opioid use

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43
Q

Can you reverse the contraction of of the sphincter of Oddi?

A

Yes with naloxone or glucagon

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44
Q

How do opioids cause N/V

A
  • Stimulates the chemoreceptor trigger zone in the postrema of the brain stem.
  • direct effects on the GI tract,
  • increased sensitivity of the vestibular system
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45
Q

What can be given to descrease incidence of coughing during an EGD and why

A

Fentanyl … acts on medullary cough centers

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46
Q

What is wooden chest syndrome

A

After giving narcotics, you can’t ventilate

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47
Q

Risk factors for wooden (rigid) chest syndrome

A
  • high cumulative doses
  • extremes of age
  • concamitant use of meds that modify dopamine levels
  • rapid IV admin
  • critical illness
  • lipophilic opioids
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48
Q

The duration of effect of narcan is

A

15-45 minutes

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49
Q

Administration of narcan

A

40 mcg every 1-2 minutes until good RR/ventilation

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50
Q

How to dilute narcan

A

4 mg per vial, 1 vial diluted in 9 cc NS = 40 mcg/cc

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51
Q

Adverse effects of reversing the effects of narcotics with naloxone

A
  • sudden pain
  • pulm edema
  • cardiac arrhthymias
  • HTN
  • Seizures
  • cardiac arrest
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52
Q

What type of receptor family are opioids acting on

A

G-protein coupled receptor family

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53
Q

When opioid receptors are signaled, what happens to the channels

A

K+ and Ca2+ activation

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54
Q

In reference to the function of an opioid receptor, what is the cascade of the signaling pathway

A
  1. Inhibit adenyl cyclase & decrease cyclic AMP
  2. Activation of Ca2+ and K+ channels
  3. Activation of mitogen activated protein kinase/extra cellular signal/regulates kinase, protein kinase C, and P13 KK/Akt
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55
Q

What two things can antagonism of NMDA receptors lead to

A

-reduce opioid tolerance
- reduce opioid induced hyperalgesia and hypersensitivity (in chronic disease states)

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56
Q

What does NMDA stand for

A

N-methyl-D-Aspartate

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57
Q

Explain the receptors ketamine works on

A

NMDA antagonist causing anesthetic properties and analgesic effects due to MOR activation

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58
Q

What is nociception

A

Neural process of encoding and processing of noxious stimuli that can cause tissue damage

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59
Q

3 examples of analgesia driven by endogenous opioid system

A
  1. Stress induced
  2. Placebo induced
  3. Condition pain modulation (CPM)
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60
Q

What is conditioned pain modulation (CPM)

A

Pain from noxious stimuli applied to one part of body is decreased by application of second remote noxious stimuli

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61
Q

What causes CPM

A

Activation of descending inhibitory pathways by higher brain centers

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62
Q

Opioids are involved in peripheral analgesia in what ways

A

Act directly on sensory neurons (A and C fibers) to inhibit pain transmission

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63
Q

opioid receptors found in (name 2)

A

Neurons & immune cells (leukocytes)

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64
Q

OIH activation mechanisms (name 3)

A
  1. Central glutaminergic systems
  2. Central nitric oxide production
  3. Facilitation of descending pronociceptive systems
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65
Q

Postoperative patients who received _________ during surgery may have higher incidence of OIH. How can you prevent it

A

Remifentanil
- administer morphine (0.1-0.25 mg/kg) 45-60 minutes before surgery ends OR can add low dose ketamine (10-30 mg/hr)

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66
Q

Semisynthetic exogenous opioids

A

Dilaudid
Buprenorphine
Oxycodone
Codeine

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67
Q

Full opioid agonist of the MOR

A

Morphine, piperidines, and methadone

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68
Q

Opioids that are partial agonist

A

Buprenorphine

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69
Q

Opioid antagonists

A

Naloxone and naltrexone

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70
Q

Explain opioid metabolism that may occur in GI, brain, kidney

A

Extraction of parent drug/metabolites via kidney and/or biliary tract into the gut where some opioids reuptake the compound in the blood stream. Examples are morphine and buprenorphine

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71
Q

Enzyme metabolizing morphine in phase II reaction

A

UGT2B7

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72
Q

Active metabolite of morphine? What percentage is converted to active form? What should you be cautious of?

A

M6G
5-10%
Patient with decreased renal function

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73
Q

Transport protein that moves M3G and M6G to bloodstream? To bile ducts?

A

MRP3 bloodstream

MRP2 bile duct

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74
Q

Opioids that readily cross BBB

A

Pipieridines

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75
Q

The most important metabolic pathway of naloxone is via ________ and the metabolite is ________

A

Glucuronidation
Inactive naloxone-3-glucuronide

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76
Q

The opioid affect sites for analgesia, sedation, constipation, and respiratory depression

A

CNS- analgesia, sedation, respiratory depression
GI- constipation

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77
Q

Explain how opioids affect respiratory rate

A

Reduced TV due to decreases input to brain stem
If given slowly, respiratory neuron depression coincides with increased arterial CO2 accumulation which stiulates peripheral ad central chemoreceptors which offsets decrease in tidal volume and reduced RR
Opioids can increase collapsibility of upper airways d/t suppression of neurons in brain stem or from loss of muscle tone related to sedation

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78
Q

Naloxone onset

A

6.5 minutes

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79
Q

Special considerations when administering naloxone to reverse buprenorphine

A

Consider naloxone infusion d/t long actin buprenorphine and short acting naloxone

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80
Q

What area is triggered that could cause PONV following opioids

A

Chemoreceptor trigger zone (CTZ) which is near vagal nerve, and vestibular organs

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81
Q

Treatment for PONV from opioids

A

Dopamine antagonist (droperidol)
5HT-antagonist (Zofran)
Corticosteroids

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82
Q

What do opioids do to GI tract

A
  • Inhibit intestinal and pancreatic secretion,
  • increase bowel tone,
  • decrease intestinal propulsive activity
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83
Q

How to treat opioid induced bladder dysfunction

A

Opioid antagonist

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84
Q

Remifentanil PCA for labor pain

A
  • used when epidural contrainidcated
  • bolus dose 30 mcg with a 3 minute lockout
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85
Q

WHO surgical checklist only applies to what people in the OR

A

it applies to the WHOLE OR

86
Q

when are surgical checklists performed

A
  • prior to induction of ANE
  • pre-op
  • prior to skin incision
  • before pt leaves OR
87
Q

rate of anesthetic drug errors

A

1 in 133

88
Q

3 most common meds involved in medication errors

A

-opiates
- muscle relaxants
- antibiotics

89
Q

from who’s study did the WHO surgical checklist originate and when

A

2009- Dr. Gawande and his group from Harvard

90
Q

in summary: why are we learning the entirety of the ANE machine

A

the study where they created 5 leaks in the machine
- ave number faults found= 2.2
- 7.3% found no faults
- only 3.4% found all five

greater emphasis on fundamentals of ANE machine

91
Q

Causes of failure to deliver O2 to the alveoli- Upstream from workstation (6)

A
  • liquid O2 reservoir empty or filled with hypoxic gas (nitrogen)
  • crossed hospital pipelines
  • crossed hoses or adapters in OR
  • closed pipeline valves
  • disconnected O2 hose
  • failure to back up hospital O2 reserve
92
Q

Causes of failure to deliver O2 to the alveoli- within the machine or circuit (12)

A
  • cylinder filled with hypoxic gas
  • empty O2 cylinder
  • incorrect cylinder on O2 yoke
  • crossed pipes with machine
  • closed O2 cylinder valve
  • O2 flowmeter off
  • failure of the proportioning system
  • O2 leak within the machine or flowmeter
  • incompetent or absent circuit unidirectional valves
  • breathing circuit leak
  • closed system ANE w/ inadequate fresh O2 supply
  • inadequate ventilation
93
Q

3 complications of failure to deliver O2 to alveoli

A
  • hypoxia
  • hypocarbia
  • hypercarbia
94
Q

what would cause you to suspect the substance being delivered isn’t actually O2 and what should you do

A

the oxygen analyzer alarm
disconnect pipeline and open O2 tank on back of machine for O2 delivery

95
Q

normal OR temperature

A

68-73 degrees

96
Q

in what situations should the OR be kept warmer

A
  • burns
  • large surface area exposed
  • pediatric patients
  • trauma
97
Q

usual humidity level of OR
&
ideal humidity level of OR

A

30-60%

50-55%

98
Q

what happens if the OR humidity is too high

A

damp or moist supplies increase the incidence of contamination

99
Q

what happens if the OR humidity is too low

A
  • facilitate airborne motility of particulate matter, vector for infection
  • increase incidence of static changes
100
Q

what does WHO stand for

A

World Health Organization

101
Q

what does NIOSH stand for

A

National Institute for Occupational Safety and Health

102
Q

what does NIOSH do

A

ensure employees work in safe and healthy environment

103
Q

what are NIOSH recommended exposure limits (REM) for halogenated agents

A

2 ppm for halogenated agents

104
Q

what are NIOSH recommended exposure limits (REM) for halogenated agents when used in combination with N2O

A

0.5 ppm for halogentaed and 25 ppm for N2O when used in combination

105
Q

what are NIOSH recommended exposure limits (REM) for nitrous oxide alone

A

25 ppm for N2O alone

106
Q

potential leak sources of anesthesia machine

A
  • tank valves
  • high/low pressure machine connections
  • connection in breathing circuit
  • defects in rubber and plastic tubing, hoses, reservoir bags, vet bellows, and y-connector
107
Q

potential OR contamination sources

A
  • spills while filling vaporizers, flushing circuits
  • loose fitting masks
  • uncuffed ETT
  • malfunction/leak in the scavenging system
  • cryosurgery, CV bypass units, PACU
108
Q

what can decrease contamination of the surgical site and how is it done

A

high rate of OR airflow

blend 80% recirculated air with fresh air

109
Q

T or F: ventilation systems in OR are not suitable for WAGD

A

True

110
Q

is OR pressure + or - and why

A

slightly +

** drive away gases that escape scavenging
** Fresh Air flow moves/enters from the ceiling to the floor

111
Q

what does NFPA stand for

A

National Fire Protection Agency

112
Q

NFPA recommendation for air exchange and why

A

25 air volume exchanges/ hour from OUTSIDE.. not from hospital air

decrease the risk of stagnation and bacterial growth

113
Q

why halogenated lights in OR

A

less fatiguing on the eyes
- light is given off as brightness rather than heat to protects delicate tissues

114
Q

normal OR noise levels

A

70-80 decibels (dB) with frequent sound peaks

114
Q

why is anesthesia compared to flying a plane

A

pre-flight planning= pre-anesthetic assessment and plan
take-off= induction
autopilot= maintenance
landing= extubation
taxi to terminal= PACU

115
Q

7 principles of crew resource management

A
  1. Communication
  2. Assertiveness
  3. Situational awareness
  4. Analysis
  5. leadership
  6. adaptability/flexibility
  7. decision making

Acronym: Crew Resource Management wants a C.A. SALAD

116
Q

patient safety concerns of anesthesia practitioners

A
  1. distractions
  2. production pressures
  3. communication (handoffs)
  4. med safety
  5. postop respiratory and NMB monitoring
117
Q

the triad necessary for OR fire and examples of each

A

O- oxidizer (oxygen, nitrous oxide)
F- fuel (ETT, drapes, surgical supplies)
I- ignition source (cautery, laser)

118
Q

O2 content < than _______% decreases fire risk

A

30

119
Q

T or F: a major cause of fire in the OR is failing to allow the alcohol-based skin prep to dry for 90 seconds

A

F- 3 minutes!

120
Q

steps to perform if you have an airway fire

A
  1. pull tube
  2. turn off all gas
  3. pour fluid down airway
121
Q

steps to avoid airway/OR fire

A
  • prevent triad
  • O2 < 30%
  • wet gauze around area
  • decrease O2 during cauterization
  • turning down the O2 2-3 minutes before the surgeon need cautery
  • let alcohol-based solutions dry
  • communicate
122
Q

estimated # of surgical fires per year in US

A

600

123
Q

T or F: all surgeries have a risk of fire

A

T

124
Q

surgeries to what body area account for 65% of surgical fires

A

head, face, neck, and upper chest

125
Q

examples (3) of cases where you may need to use O2 with an awake patient

A
  • cartoid artery surgery
  • neurosurgery
  • some pacemaker implantations
126
Q

what does APSF stand for

A

anesthesia patient safety foundation

127
Q

what is Ohm’s law

A

E (electromotive forces)= I (Current) X R (Resistance)

128
Q

what are the units for E= I X R

A

E= volts
I= amperes
R= ohms

129
Q

in Ohms law E= I X R, what is the current representing

A

flow of electrons

130
Q

what is Ohms law related to in the body

A

BP!
BP = CO X SVR
BP ~ voltage, CO = current and SVR = resistence

131
Q

two types of defibrillators

A

DC - direct current (Monophasic)
AC- alternating current (Biphasic)

132
Q

any substance that permits flow of electrons

A

conductor

133
Q

opposes flow of electrons

A

insulator

134
Q

electron flow is always in the same direction

A

direct current

135
Q

electron flow that reverses directions at regular interncval

A

alternating current

136
Q

sum of forces that opposes electron movement in an AC current

A

impedene

137
Q

is Ohms law usually applied to AC or DC currents?

A

DC

138
Q

3 ways electricity can cause morbidity/mortality

A
  1. electrocution
  2. burns
  3. ignition of flammable material, causing a fire or explosion
139
Q

electrocution effects depend on what 4 factors

A
  1. the amount/current of electricity
  2. where the current flows and its density
  3. type of current
  4. current durations
140
Q

what voltage and Hz do utility companies supply to house

A

120 V

Frequency of 60 Hz

141
Q

typical power cords has two conductors

A
  • one hot that carries current to the impedance
  • one neutral and returns current to the source
142
Q

is a house a grounded or ungrounded system

A

Grounded to EaRtH

143
Q

when does electric shock occur

A

when a person becomes part of/completes the circuit

144
Q

how does electrical injury occur (name 2)

A
  1. release of thermal energy= burns
  2. disruption of nervous, muscular, and cardiac function (Vfib)
145
Q

the extent of injury following electrical shock is a function of the __________ and _________

A

current (amperes) and duration of current flow

146
Q

maximum harmless current intensity
(Macroshock)

A

5 mA

147
Q

“Let-go” current above which sustained muscle contraction occurs
(Macroshock)

A

10-20 mA

148
Q

current at which vfib will start but respiratory center remains intact

A

100-300 mA

149
Q

current at which there is sustained myocardial contraction, followed by normal heart rhythm; temporary respiratory paralysis, burns if current density is high

A

6000 mA or 6 A

150
Q

define macroshock

A

a large amount of current applied to the external surface of the body which can cause harm or death

151
Q

define microshock

A

relatively small current applied directly to the myocardium in susceptible patients

152
Q

recommended maximum leakage current vs VFIB current for microshock in pacemakers

A

10 uA (0.01 mA) vs 100 uA (0.1mA)

153
Q

most common cause of macroshock

A

faulty or damaged wires in electrical equipment

154
Q

which is more common… microshock or macroshock

A

macroshock

155
Q

describe the grounding of equipment in the OR

A

electrical power is ungrounded BUT the equipment is grounded

156
Q

Electricity entering the OR is NOT grounded, it is electrically ____________

A

isolated

157
Q

what is an isolation transformer

A

isolates the OR power supply from ground

158
Q

where does the line isolation monitor (LIM) take effect

A

with the first fault, sets off the LIM and OR becomes grounded. after the second fault, the circuit is complete and electrical shock occurs

159
Q

features of the isolated power system

A
  • provide protection from macroshock
  • faulty equipment will not usually trip circuit breakers (life support systems)
160
Q

will an individual contacting one side of the isolated power system and standing on the ground be shocked

A

no

161
Q

what does a line isolation monitor do

A

continuously monitors the integrity of an isolated power system

162
Q

when is a line isolation monitor alarm activated

A

2-5 mA

** Alarm is activated if an unacceptably high current flow to ground becomes possible

163
Q

T or F: line isolation monitor does not provide complete protection from electrocution

A

T

164
Q

what does 2 mA or 3 mA on a LIM tell you

A

indicates how much current WOULD flow in the event of a second fault

** the reading on the LIM meter does not mean that the current is actually flowing; rather indicates how much would flow in the event of a second fault.

165
Q

LIM is triggered…. what are the next steps (5 of them)

A
  1. check the gauge to see if a real alarm
  2. if gauge > 5 mA, there is likely faulty equipment
  3. identify faulty equipment by unplugging each piece of equipment (start with the once connected last).
  4. if the faulty piece is not needed, then remove it
  5. if the faulty piece is needed, can be used, but do NOT plug in new additional equipment
166
Q

what is longest piece of plug and why

A

the ground portion to prevent electrocutionnnnn

  • first to enter the receptacle
167
Q

why would ground fault circuit interrupters be bad in the OR

A

it would interrupt life-saving monitors without warning.

168
Q

what are electrosurgical units (ESU) used for

A

to cut or coagulate tissue using high radiofrequency electrical energy

169
Q

ESU can cause electrical interference with what?

A

your equipment like ECG, CO, Pulse OX

170
Q

what type of ESU system has electricty that travels from the probe thru the patient and then exits vie the return pad to complete the circuit and requires a return pad

A

monopolar ESU

171
Q

what type of ESU system has electricity travel from the active electrode, through the local tissue, and then exits the patient thru the return electrode

A

bipolar ESU

172
Q

when would you typically see bipolar ESU

A

surgery you dont need a lot of energy– eye, neuro

173
Q

the use of what type of ESU may cause electrical interference in an AICD

A

unipolar ESU

**AICD could interpret it as V.Tach and trigger defibrillation.

174
Q

T or F: MAcroshock occurs when a current as small as 1 uA flows through a person

A

F

175
Q

radiation-sensitive organs

A

eyes, thyroid, gonads, blood, bone marrow, and the fetus

176
Q

what radiation level should be monitored

A

Above >40 REM

** will need film badge

177
Q

the basic principle of radiation safety

A

ALARP= As Low As Reasonably Possible

178
Q

T/F: Anesthesia has their own scavenging system and the OR has their own scavenging system.

A

True

179
Q

A _______ rate of the operating room airflow ________ contamination of the surgical site

A

High ; decreases

** OR doesn’t like stagnant air

180
Q

Air return in the OR is handled at or near the ______ level.

A

Floor

181
Q

Human ear drum breaks instantly when exposed to sounds louder than:

A

160 decibel (dB).

182
Q

Cases that involve stripping of the pleural or resection of the pulmonary blobs, or tracheobronchopleural fistula, can easily result in high concentrations of __________ in the thoracic cavity when the lung is reinflated due to gas leakage.

A

Oxygen

**fire hazard

183
Q

If surgeon needs the lung inflated, then applying ________ with air instead of oxygen will greatly reduced the risk of a fire.

A

CPAP

184
Q

Two major ignition sources for OR fires are the:

A

ESU & the laser

185
Q

Instead of an electronic scalpel, a _______ or __________ scalpel should be used to prevent fires.

A

Bipolar/Harmonic

186
Q

Safe during external and internal exposure for fires on the patient in the OR

Readily dissipates, nontoxic, least likely to cause thermal injury

A

CO2 fire-extinguisher

** use it if fire in OR w/ patient

187
Q

This extinguisher contains water but can be a problem around electrical equipment.

A

“ A” rated extinguisher

188
Q

Water mist are good but requires time, enough volume with multiple mist attempts.

A

“AC” rated extinguisher

189
Q

In Ohm’s law. Voltage is:

A

The driving force

190
Q

In Ohms law. Impedance is :

A

Resistance

191
Q

Electrical power (P) is measured in

A

Watts (W)

192
Q

Energy produced by a defibrillator is measured in

A

watt-seconds or joules.

193
Q

An insulator has ________ impedance to electron flow.

A conductor has _______ impedance to electron flow.

A

High

Low

194
Q

T/F it takes as much as 3X DC as to AC to cause V.fib

A

True

195
Q

Refers to LARGE amounts of current flowing through a person, which can cause harm or death

A

Macroshock

196
Q

Refers to very small amounts of current and applies ONLY to the electrically susceptible patient

A

Microshock

(Ex. Individual w/external conduit that is in DIRECT CONTACT w/ the heart - pacing wire, CVC and PA cath).

197
Q

Biggest difference between macroshock and microshock

A

LOCATION.

198
Q

The severity of an electrical shock is determined by the amount of _________and the duration of the flow. NOT ________.

A

Current

**NOT VOLTAGE.

199
Q

Electric shock is produced by _________, not _______.

A

Current ; voltage

200
Q

What color?
Hot wire =
Neutral wire =
Ground wire=

A

Black
White
Green

201
Q

For a shock, contact with the electrical circuit at two points with a _________ source that causes the current to flow through a person

A

VOLTAGE

202
Q

Threshold of perception
(Macroshock)

A

1 mA

203
Q

Pain, possible fainting, mechanical injury;
( heart and respiratory functions continue)

Macroshock

A

50 mA

204
Q

Line isolation system contains:

A
  • a line isolation transformer
  • and line isolation monitor
205
Q

T/F: LIM alarm does not necessarily mean that there is hazardous situation, but rather that the system is no longer totally isolated from ground

A

True

206
Q

Ground fault circuit interrupter:

A

Monitors for equality of current flow
* can detect currents at 5 mA.
*Interrupts current flow before shock occurs

207
Q

When GFCIs are used in an OR, only ______ outlet is protected by each GFCI. The should never be __________, so that one GFCI protects multiple outlets.

A

ONE ; “daisy-chaine”

208
Q

It is essential that the return plate has the appropriate amount of ________ and an intact _______.

A

Conductive gel ; return wire

** pad to no be placed over bony prominences or metal

209
Q

What is Methyl methacrylate

A

Blue cement used in total hips/ total knees
***Causes headaches, N/V, congenital defects.

210
Q

1 occupational hazard in anesthesia

A

Substance Abuse

211
Q

Radiation induces ________

A

Cataracts

614 General Principles Of Anesthesia (14 decks)

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