Environmental Hazards

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Environmental Hazards
2014-01-21 15:58:38

Principles Exam 1
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  1. Types of physical hazards in OR
    • waste anesthetic gases
    • electrical/fire
    • laser
    • radiation
    • chemicals
    • sharps
    • latex
  2. What have several studies linked exposure to anesthetic waste gases to
  3. people that are exposed to waste anesthetic gases usually complain of
    dizziness, nausea, fatigue
  4. How much halogen is safe to be exposed to
    2 parts/million
  5. how much halogen when combined with nitrous is safe to be exposed to
    0.5 parts/million
  6. how much nitrous only is safe to be exposed to
    25 parts/million
  7. What were initial solutions to reduce release of WAG
    • collection device (mask)
    • negative pressure suction
    • soda lime CO2 absorbent
    • gas-tight circuits, tubing, breathing bags etc.
  8. Nitrous oxide is unique because it inactivates
    • methionine synthase (an amino acid that is vital for production of DNA)
    • - because of this prolonged exposure to nitrous oxide can lead to bone marrow suppression, megoblastic anemia, neuropathies, and other deficits.
  9. health concerns with nitrous oxide
    • chronic exposure lead to cumulative effects
    • -neurological/behavioral deficits
    • -liver and kidney toxicity
    • -spontaneous abortion in females
    • -teratogenic in animal models
  10. 100 % isoflurane = _____ ppm
    1% isoflurane =_____ppm
    .0002% isoflurane =______ppm
    • 1 million
    • 10,000
    • 2
  11. Limit exposure of nitrous oxide by
    • avoid insufflation of gases with children
    • turn off gas prior to induction
    • tight mask seals with induction
    • don't ever clear circuit to environment
    • use low flows
    • scavenging system
  12. active scavenging
    utilizes vacuum system
  13. passive scavenging
    is direct line to atmosphere
  14. What 3 things are in fire triangle
    • fuel
    • oxygen
    • energy source
    • *if you remove one you will not have fire
  15. How much oxygen in room air
    • RA=21%
    • 1L=24%
    • 2L=27%
    • 3L=30%
    • 4L=33%

    O2 is heavier than air, it can fall under drapes so be careful
  16. What are procedures that have increased risk of fire because of oxygen enriched atmosphere
    • 1.tracheostomy-use of ESU, and pulmonary condition so require O2
    • 2.facial procedure under MAC-nasal cannula above or below drapes, ESU, cautery
    • * consider RA, if supplemental O2 needed use cuffed ETT, consider coating facial hair with water soluble jelly (non flammable)
    • 3.uncuffed endotracheal tube- peds, newborns, airway under drapes be careful because O2 can become trapped.
    • *heat=lasers ESU
    • *oxidizer=O2 and nitrous
    • *fuel= sponges, pledgets, and strings should be moist.
  17. Examples of fuels
    • surgical drapes
    • gowns
    • gauze
    • pledgets
    • flammable anesthetics
    • bowel gas (methane)
    • body hair
    • surgical preps and degreasers *make sure dry before starting procedure
    • ETT
    • LMA
    • Masks
    • gloves
    • mattress, egg crate, blankets
  18. guidelines for using surgical prep
    • keep away from fire or flame
    • -to reduce risk of fire
    • do not use 26 ml applicator for head or neck surgery, do not use this size on area smaller than 8x10 inches
    • use small applicator instead
    • -solution gives off flammable vapors
    • -do not drape or use ignition source until solution is completely dry (minimum of 3 minutes on hairless skin)
    • -avoid getting solution on hairy area
    • -do not allow solution to pool
  19. petroleum jelly is
  20. When using ESU make sure contact plate
    has good contact with skin, do not fire this unless there is contact with tissues
  21. How to reduce risk of fire when using Lasers
    • proper ETT for head and neck cases
    • wrap face in saline gauze, keep wet
    • water based lube for facial hair
  22. Ignition sources
    • ESU
    • Lasers
    • hot wire cautery
    • defibrillators
    • surgical drills, saws, and burrs
    • fiberoptic light sources
    • static electricity
  23. CRNA duties with fire
    • maintain pt breathing with ambu bag
    • turn off medical gas supply
    • disconnect all electrically powered equipment on machine
    • disconnect leads, lines, and other equipment
    • d/c o2 and nitrous
    • maintain anesthesia depth
    • gather meds for transport
    • place additional IV for transport
  24. Fire extinguisher
    • A-wood
    • B-liquid
    • C-electrical equipment

    *only use as last resort
  25. ABC multipurpose dry chemical fire extinguisher
    good for commercial and industrial use, poor for OR
  26. BC dry chemical sodium bicarbonate fire extinguisher
    • destroys sensitive electrical equipment
    • not good for patients
    • poor for OR
  27. Pressurized water fire extinguisher
    • type A
    • good for trash, wood, paper
    • not good for class C electrical fire
    • poor for OR
  28. CO2 extinguisher
    • BC (liquid, and electrical)
    • -good for sensitive equipment
    • -does not leave reside that will harm the patient, staff or OR equipment
    • **best choice for putting out fires in OR,
  29. Ohms law
    E=I X R

    • E= electromotive force (volts)
    • I= current (amperes)
    • R= resistance (ohms)
  30. W (watts) =
    E X I

    electromotive force x current
  31. Don't forget triangle to solve math problems
    • E
    •   I   R

    • E= I x R
    • I= E/R
    • R= E/I
  32. impedance (z)
    sum of force that oppose electron movement in ac circuits

    impedance + capacitance
  33. conductor
    substance with low impedance (speeds up)

    E= I x Z (impedance)
  34. insulator
    • substance with high impedance
    • (going to slow it down)

    E= I x Z (impedance)
  35. capacitance
    • any two parallel conductors that are separated by an insulator.
    • Has the ability to store a charge
  36. inductance
    production of a magnetic field around a wire when current flows
  37. What happens if there is disturbance of electrical function of cells (by electrical shock)
    • contraction of muscle
    • alteration of brain function
    • paralysis of respiration
    • vfib
  38. macroshock
    gross amount of shock that will cause harm or death
  39. what is microshock
    • amount of shock that will harm or kill a patient with a conduit to the heart
    • -can be as low as one milliamp
    • -worry about this the most because it messes with conduction
  40. frequency is an important factor in electrical safety.
    higher frequency current ex: 1,000,000 Hz current is generally regarded as safe up to 3 amp. very high frequency do not excite contractile tissue
  41. circuit breakers
    protect from overload of electrical wires, does not protect from shock.

    • 15 amp circuit breaker for lights
    • 15 amps x 120 volts = 1800 watss
  42. to get shocked there must be contact with loop in how many places?
    • 2
    • one is ground so only one additional contact point is needed to complete circuit
  43. isolated ungrounded system
    • used in ORs
    • no direct connection to ground but acts like it is grounded because of isolation transformer in the middle.
    • -current is isolated from ground potential
    • 120 volt potential between wire and ground
    • -connection from line 1 must be to line 2 to be completed. connection from line 1 to ground will not complete circuit
    • -thus touching one side of circuit will not result in macro shock
  44. Line isolation monitor
    • for ungrounded electrical systems
    • -measures total leakage in system to ground
    • -does not measure actual current flow, but how much would flow in the event of fault
    • -if either side of the isolated power system has < 60, 000 ohms impedance to ground LIM will alarm
    • -LIM will not detect a faulty equipment ground wire
    • ***these will not alert to micro shock, only macro shock
    • **alerts to let you know system has changed to grounded or partial grounded
  45. If LIM monitor alerts what do you need to do
    • correct problem
    • -unplug and get new equiptment
  46. Ground faulted interrupter
    • for grounded electrical systems
    • -measures both sides of grounded systems to see that flow is equal, if not breaker will trip
  47. Microshock in OR
    • catheters or wires near the heart provide pathway for a small amount of electricity to have a large current density in the heart
    • -currents that are not perceptible may cause Vfib in sensitive patients
    • -equipment ground wire important in taking stray capacitance to ground s o that no current can flow to patient,
    • -to provide additional safety from microshock direct patient inputs are isolated
  48. patients are protected from microshock by
    • ground wire
    • -if ground wire broken patient will get microshocked
  49. Electrosurgery
    • bovi directs current through tissue
    • current returned through large surface area dispersive plate (grounding pad)
    • if return plate not properly applied current finds alternative pathway and a burn will result on patient.
    • -return plate must have gel placed on it
  50. Bipolar ESU
    • dosnt have grounding pad
    • -electrical energy in both prongs
    • -if possible use this with pacemaker patients
  51. monopolar ESU
    • needs grouding pad
    • -be careful when flammable solutions are used.
  52. blood and electrolyte solutions do or do not conduct energy
  53. Carbon dioxide (gas) laser
    • used for gyn procedures
    • -widely used, long wavelength
    • -poor penetration in tissue
    • -effects are localized due to its increased water absorbency and wave length
  54. Nd: YAG laser (solid)
    • medium wave length
    • -neodymium yttrium aluminum garnet
  55. Dye laser (liquid)
    less common
  56. lasers are named how
    according to the medium within its optical cavity (gas, solid, or liquid)
  57. Argon laser (gas)
    • used in ophthalmology
    • -treatment of macular degeneration and open-angled glaucoma
  58. hazards of lasers
    • atmospheric contamination  (suction this out)
    • -perforation of a structure
    • -gas embolism
    • -inappropriate energy transfer (pressing button at wrong time) - eye injury, ett fires, drape fires
  59. Laser plume
    • tissue vaporization produces fine particles
    • -size range (0.1-0.8 micrometers)
    • -alveolar deposition possible (<5 micrometers can enter alveoli)
    • vector for viruses
    • bacterial spores
    • cellular tissue
  60. Safety precautions with lasers
    • smoke evacuators during all laser procedures that generate visible smoke
    • -wear protective masks
    • high efficiency laser mask <0.1 micometer
  61. eye protection with lasers
    -reflected light has caused retinal burns, and corneal injury

    • O.R personnel
    • -wrap around goggles specific for laser wavelength

    • Patients
    • if awake- appropriate goggles
    • if asleep- tape eyes, saline gauze pads.
  62. Laser precautions with anesthesia
    • -use a laser tube
    • silicone with imbedded aluminum powder
    • aluminum spiral tubes
    • saline-inflatable cuffs
    • -inspired FIO2 <30%
    • -replace N20 with air
    • -fill cuff with saine
  63. Radiation scatter
    • backward and forward scatter up to three feet.
    • -protect yourself
    • lead apron
    • thyroid shield
    • -lead shield
    • -keep your distance
    • **remember law of inverse squares
  64. law of inverse squares
    • states the amount of radiation changes inversely with the square of the distance
    • Example at 4 meters the radiation with be 1/16 of what it is at 1 meter
  65. Methylmethacrylate glue
    • bone cement implantation syndrome
    • -results form absorption of glue
    • -hypoxia, hypotension, and dysrrythmias
    • noxious smell, irritates eyes and nose
    • vapors can penetrate contacts
    • -pts having second hip done can have anaphylactic reaction to this
  66. Hep B
    most common blood born occupational hazard
  67. TB
    • airborne droplets
    • -transmission more likely during coughing procedures such as bronch, laryngoscopy, suctioning
    • - we are prime target- regular o2 mask will not work to protect against tb
    • -need high efficiency mask (1-4 micrometers)
    • -need disposable circuit, absorber and filer on maching
    • -Need HEPA filter