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Flashcards in Laser ppt Deck (55)
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1
Q
What does LASER stand for
A
Light
Amplification
by
Stimulated
Emission
of
Radiation
2
Q
what is a device that controls the way energized atoms release photons
A
Laser
3
Q
what are the 3 main properties of a laser that make if very different from other lights
A
monochromatic
coherent
directional
4
Q
what property of a laser is that it contains one specific wavelength of light (one specific color).
A
monochromatic
5
Q
the wavelength of light is determined by what?
A
the amount of energy released when the electron drops to a lower orbit
6
Q
what property of a laser describes how it is organized- thus each photon moves in step with the others, this means that all the photons have wave fronts that launch in univision
A
coherent
7
Q
which laser property is that a laser light has a very tight beam and is very strong and concentrated
A
directional
(a flashlight in contrast releases light in many directions, the light is very weak and diffuse)
8
Q
Carbon dioxide laser properties (2)
A
invisible
marked with a helium-neon aiming beam
9
Q
what is the Carbon dioxide laser used for
A
upper airway sx
10
Q
is carbon dioxide laser common
A
yes,
very common
11
Q
Nd-YAG laser stand for what?
A
neodymium-yttrium aluminum-garnet laser
12
Q
Nd-YAG laser properties (1)
A
short wave length allows transmission by fiberoptics
13
Q
Nd-YAG laser is used for what sx's
A
distal tracheobronchial tree and retina sx
14
Q
KTP laser stand for what?
A
Potassium-titanylphosphate laser
15
Q
KTP laser can be transmited by what?
A
fiberoptics
16
Q
KTP laser is used in what sx's
A
neurosurgical and
otolarygeal
17
Q
Argon Laser can be transmitted by what
A
fiberoptics
18
Q
Argon laser is used in what sx's
A
neurological, retinal, and otolaryngological
19
Q
7 wavelengths in order of power (weakest to most powerful
A
radio
microwave
infrared
visible
ultraviolet
x-ray
gamma ray
20
Q
with laser wavelengths longer wavelengths= what?
A
lower freq and lower energy
(all start with L)
21
Q
with laser wavelengths shorter wavelengths= what?
A
higher freq and higher energy
(for jake sHorter= Higher and Higher) : )
22
Q
frequancy is inversly proprtional to what??
A
wavelength
the higher the frequency the smaller the wavelength
23
Q
what has a higher freguency?
KTP Wave length is 532
or
Nd:YAG wave length 1064
A
KTP
remember
freq is inversly proportional to wave length
the longer the wavelength the lower freq
24
Q
which laser is for deep tissue? and why?
A
Nd-YAG
b/c of near infrared I guess????
25
Q
what is the only laser that wet tissue can protect pt (like a wet towel)
A
CO2 laser
26
Q
what 2 lasers are absorbed by Hgb and melanin or other similar pigments? transmitted through clear substances.
tissue penetration 0.5-2 mm
A
Argon
KTP
27
Q
which laser is more readily absorbed by dark tissue?
transmitted through clear fluids
tissue penetration 2-6 mm
A
Nd-YAG
28
Q
which laser is strongly absorbed by water, and thus by all tissue, pigmented or not. tissue penetration <0.5mm
A
CO2
29
Q
the greater the wavelength = the _______ absorption by water
A
greater
CO2 greatest WL 10,600
30
Q
CO2 laser properties?
WL 10,600
A
Longer WL= Low freq= Low energy
31
Q
Nd-YAG laser properties
WL 2064
A
sHorter WL= Higher freq= Higher energy
32
Q
Lasers are freq used in airways for what sx's
A
laryngel papillomas
tracheal scaring
vascular malformations
neoplasms
idiopathic subglottic stnosis
33
Q
Risk of lasers in sx
A
loss of AIRWAY
FIRE
burns
eye damage
34
Q
Preoperative preperation for laser sx
A
antisialagogue
Eye protection for personnel and pt
Laser tube or ETT wrapped with laser tape
35
Q
Airway concerns with laser
A
shared airway
airway obstruction (foreign body, edema, obstructive mass/lesion)
36
Q
Induction concerns?
A
airway patency
RSI vs smooth IV or mask
OSA
(must preoxygenate (may need oral airway))
(sevo least irritating to airway)
37
Q
OSA is who princilple
A
burnelli's (spelling???)
thats why we give CPAP they lost pressure
38
Q
Causes of OSA
A
floppy upper airway
redundent fat deposits (in lateral pharyngeal walls)
sleep and anesthesia- increased pharyngeal musculature relaxation and posterior tongue displacement
airway narrowing (bernoulli effect)
39
Q
Maintenance for laser airway sx
A
PREVENT LOSS OF AIRWAY
with shared airway
-communicate with surgeon
-closely monitor breath sounds and EtCO2
PREVENT BURN INJURY
don't look into laser
confirm standby mode
-know aiming beam vs power beam
don't allow laser on drapes
PREVENT EYE INJURY
PREVENT INHALATION INJURY
40
Q
what do you want to do to protect the pt's eyes from laser
A
lub eyes
tape shut
saline soaked pads (CO2 only)
Laser goggles (not glasses)
41
Q
how do you prevent inhalation injury? (to yourself and pt)
A
continually assess integrity of cuff
don't breath laser olume
42
Q
when doing airway sx with a laser what do you want to do with FiO2?
A
40% or less (preferable 21%)
43
Q
When doing airway sx with a laser what VAA do you want to avoid? and why?
A
N2O
supports combustion
44
Q
when doing airway sx with a laser what must you always have immediately available?
A
bottle of saline or water
45
Q
when doing airway sx with a laser what 2 things are important about the OETT tube
A
use a laser or protected ETT
fill endotracheal cuff with saline or dye
use smallest allowable tube for surgical exposure and ventialation
usually 5.5-6.5
46
Q
can you wrap a ETT in laser foil to protect from laser
A
yep
47
Q
what 2 things do you want to be prepared for duing airway laser sx (in case of fire)
A
be prepared to extinguish and treat
be prepared to emergently extubate
48
Q
what do you do for an airway fire?
A
-stop ALL gas flows
-cut pilot tube
-extubate pt
__________________
-extinguish with water or saline
_____________________
-reintubate pt
-ventilate with air only until remaining no remaining fire is confirmed
_______________________
- ventilate with 100% O2
______________________
-assess (DL and FOB) larynx, trachea, bronchiole tree for damage
49
Q
what 3 things are needed for a fire
A
oxidizer (N2O or O2)
fuel (drapes or ETT)
Ignition source (laser or Bovie)
50
Q
what meds do you want to give post airway fire?
A
corticosteroids
Antibiotics
51
Q
No fires back to regular sx with laser
what are poss complications/ concerns of extubation
A
-possible deep extubation
- airway blood may remain despite sxn
-laryngospasm
-be sure any saline pledgets and throat packs have been removed by surgeon
52
Q
Postop risk of laser sx in airway
A
laryngospasms (due to irritation and remaining blood)
-stridor, coughing, bronchospasm
53
Q
A laryngospasm is caused by what?
A
vocal cord irritation
54
Q
what is the primary muscle responsible to laryngospasms
A
cricothyroid
55
Q
Treatment of laryngospasms
A
-CPAP by mask (attempt positive pressure ventilation <20cm H2O
-jaw thrust (at angle of Ramus-accupressure point)
-Succinylcholine if needed