mini study guide (LASER to hypothermia)

Question 1

Laser is an acronym for?

Answer 1

light amplification by stimulated emission of radiation

Question 2

there are two types of lasers what are they?

Answer 2

long wavelength lasers

short wavelength lasers

Question 3

long wavelength lasers do what?

Answer 3

absorb more water and do not penetrate deep into tissue

Question 4

short wavelength lasers do what?

Answer 4

absorb less water and penetrate deeper into tissue

Question 5

when using lasers you should use how much FIO2?

Answer 5

less than 30%

Question 6

should you use nitrous oxide with lasers? why?

Answer 6

no

because it supports combusion

Question 7

what must be immediately avaiable when using a laser?why?

Answer 7

water or saline

most ETT are flammable

Question 8

what ETT are flammable?

Answer 8

made from polyvinyl chloride (PVC) red rubber, and silicone

Question 9

how should you protect the eyes during a laser case?

Answer 9

tape eyelids closed
avoid petroleum based lubricants
cover eyelids with saline soaked gauze
use protective glasses specific to the laser being used.

Question 10

what is the most vulnerable component of the ETT?

Answer 10

the cuff

Question 11

laser resistent ETT do not have laser resistant?

Answer 11

cuffs

Question 12

name the three components fo the fire triad?

Answer 12

ignition source
oxidizer
fuel

Question 13

name examples of the ignition source?

Answer 13

electrosurgeical cautery

laser

Question 14

name examples of the oxidizers?

Answer 14

oxygen

nitrous oxide

Question 15

name examples of the fuel

Answer 15

ETT
drapes
surgical supplies

Question 16

according to the ASA operating room fire guidelines, what should you do in order, when a fire is present?

Answer 16

1. stop ventilation and remove the ETT
2. stop the flow of all airway gases
3. remove other flammable material from the airway
4. pour water or saline into the airway
5. if fire isn’t extinguished on the first attempt, then use a CO2 fire extinguisher

Question 17

according to the ASA operating room fire guidelines, what should you do in order, after the fire is controlled?

Answer 17

1. re-establish ventilation by mask, avoid supplemental O2 or nitrous oxide
2. check the ETT for damage, fragments may remain in the patient’s airway
3. perform bronchoscopy to inspect for airway injury or retained fragments

Question 18

why do you not squeeze the reservoir bag as you extubate the patient when an airway fire has been present?

Answer 18

this can create a blow torch effect at the distal end of the ETT and/or push debris into the lower airway

Question 19

the body regulates core temperature between ___ and ___ degrees celsius.

Answer 19

36.7 - 37.1 celsius

Question 20

hypothermia is defined as core body temperature less than _____ celsius

Answer 20

36 degrees

Question 21

who is at the greatest risk of developing perioperative hypothermia?

Answer 21

patients at extremes of age are at the greatest risk of developing perioperative hypothermia

Question 22

the maintenance of body temperature involves three components which are:

Answer 22

afferent limb
control center
efferent response

Question 23

what components make up the afferent limb of thermoregulation?

Answer 23

thermoreceptors:
skin
deep tissue
spinal cord

Question 24

what components make up the control center of thermoregulation?

Answer 24

hypothalamus: preoptic region

brainstem

Question 25

efferent response to cold produces what?

Answer 25

vasoconstriction piloerection shivering non-shivering themogensis

Question 26

shivering increases oxygen consumption by up to what percent

Answer 26

400-500%

Question 27

what are you at increased risk for when you are shivering d/t increased oxygen consumption?

Answer 27

myocardial ischemia and infarction

Question 28

non-shivering thermogenesis occurs in what population?

Answer 28

babies

Question 29

what is the efferent response to being hot?

Answer 29

vasodilation and diaphoresis

Question 30

list the 4 ways to transfer heat in order from greatest to least?

Answer 30

radiation convection conduction evaporation

Question 31

describe radiation?

Answer 31

heat follows a temperature gradient. if the patient is warmer than the environment, then heat is lost to the environment in the form of infrared radiation

Question 32

most heat is lost how with radiation?

Answer 32

skin

Question 33

how can you reduce radiation heat loss?

Answer 33

covering the patient

Question 34

describe convection?

Answer 34

the transfer of heat by the movement of matter (air)

Question 35

wind chill is an example of what type of heat loss?

Answer 35

convection

Question 36

what type of flow increases the amount of heat lost to convection?

Answer 36

laminar flow

Question 37

the rate of evaporation is based on?

Answer 37

function of the exposed surface area and the relative humidity of the environment

Question 38

describe how evaporation can happen during surgery?

Answer 38

from respiration, wounds, and exposure of internal organs during surgery

Question 39

describe conduction?

Answer 39

heat lost when the patient comes into direct contact with a cooler object

Question 40

what determines the amount of conductive heat loss?

Answer 40

the temperature gradient and the thermal conductivity of the object

Question 41

give examples of how you can loss heat due to conduction?

Answer 41

cold OR table, IV fluids, and irrigation fluids

Question 42

how many stages are there in intraoperative heat transfer?

Answer 42

three

Question 43

what happens in phase 1 of intraoperative heat transfer?

Answer 43

heat distribution from core to periphery

Question 44

what happens in phase 2 of intraoperative heat transfer?

Answer 44

heat transfer is greater than heat production

Question 45

what happens in phase 3 of intraoperative heat transfer?

Answer 45

heat transfer is equal to heat production

Question 46

during what types of procedures does the distribution of heat from core to periphery occur with?

Answer 46

general spinal epidural anesthesia

Question 47

anesthetic agents impair the thermoregulation in three ways which are?

Answer 47

altering hypothalamus response prevent shivering cause vasodilation

Question 48

A _____ amount of heat is lost during phase 1

Answer 48

nominal, heat redistribution is way more important during this phase

Question 49

how can the anesthesia provider improve the redistribution of heat from the core to periphery in phase 1?

Answer 49

place a warm blanket on the patient before entering the OR, minimizes the central to peripheral temperature gradient.

Question 50

perioperative hypothermia increases the risk of ?

Answer 50

morbidity and mortality

Question 51

what 3 medication are used to treat postoperative shivering includes?

Answer 51

meperidine clonidine dexmedetomidine

Question 52

oxygen consumption is reduced by ____ percent for every 1 degree C reduction in body temperature

Answer 52

5-7%

Question 53

name 7 incidences where induced hypothermia is useful during?

Answer 53

``` cerebral ischemia (stroke) cerebral aneurysm clipping TBI cardiopulmonary bypass cardiac arrest aortic cross clamping carotid endarterectomy ```

Question 54

name three ways to minimize intraoperative heat loss?

Answer 54

HME warming blanket Fluid warmers

Question 55

perioperative hypothermia affects the patient pharmacologically how?

Answer 55

slowed drug metabolism = prolonged effects of anesthetic agents increased solubility of volatile agents = prolonged emergence

Question 56

perioperative hypothermia affects the patient cardiovascular status how?

Answer 56

SNS stimulation - myocardial ischemia and dysrhythmias shifts the oxyhemoglobin curve to the left- decreased o2 available to the tissues vasoconstriction meaning decreased tissue PO2 = surgical site infection coagulopathy and plt dysfunction - increased blood loss sickling of hemoglobin 5- risk of sickle cell crisis