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Anesthesia Technology > Module 1 Safety in OR > Flashcards

Module 1 Safety in OR Flashcards

1
Q

The Safety of the anesthesia, OR personnel and hospital staff. Regulated by numerous agencies private and federal.

A

Occupational Safety

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2
Q

Increased Safety concerns, avoidance of adverse incidents and events.

A

Patient Safety

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3
Q

ANSI

A

. Replaced by ASTM ( American Society for Testing and Materials).
.Standards reviewed every 8 years
ANSI/ASTM makes sure of standardization of equipments Ex ETT( all ETT fit anesthesia machines and ICU ventilators)
. Cover equipment used from different industries.

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4
Q

NIOSH

A

Department of CDC

Focus on prevention of illness and workplace injury.

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5
Q

OSHA

A 
Department of the DOL
Power of enforcement 
Follows NIOSH guidelines 
Regulates issues of workplace safety
Mandates levels of anesthetic gases, laser protection , UP, etc
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6
Q

Factors affecting occupational Hazard of Anesthesia

A

Physical, Emotional and Environmental Factors.

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7
Q

FDA

A

Responsible for protecting the public health by assuring the safety, efficacy, and security:

humans and veterinary drugs, biological products
medical equipments
food supply,

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8
Q

FDA Chapter 21

A

Part 868 deals with :

anesthesia diagnostic devices and therapeutic devices.

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9
Q

JCAHO

A

Private , Non-profit

Certifying agency for Medicaid

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10
Q

Critical Incident

A

Human error or equipment failure, if not discovered and corrected in time, or lead to an undesirable outcome ranging from extended stay or death. (Cooper, 1978)

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11
Q

Name the two most common sources of Error?

A

Human and Equipment

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12
Q

Name an Occupational Hazard specific to Anesthesia Personnel?

A

Anesthetic Gasses

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13
Q

Name some common anesthesia equipment errors.

A

Breathing circuit disconnections, leaks, defective valves, misconnections, control errors.
Gas supply
Intravenous drug dose errors (including infusion and syringe pumps)
Intravenous drug/fluid delivery system problems
Ventilator missetting or malfunction
Misuse of monitors
Laryngoscope malfunction
Scavenging system problems

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14
Q

Name two sources of error made by Humans?

A

Rule Based Error : occur when rules are deviated from.

Knowledge based error: occur when the event is outside of the experience of the provider.
Provider gets fixated on a wrong diagnostic with a “closed mind”

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15
Q

Two sources of equipment failure?

A

Device failure: Device its not working properly, needs to be replace.
Use error: using a device for other than its intended purpose. Poor or insufficient training in the proper use of the equipment

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16
Q

When does Patient Safety begins?

A

Pre- op Area

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17
Q

Patient Safety in the OR

A

Everyones responsibility
Extends from Pre op, Intra op and PACU
Patients under anesthesia cannot protect themselves
Patient safety its your fully responsibility when under anesthesia .

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18
Q

Major Contributors of Stress for Anesthesia Personnel?

A 
Lack of time to establish rapport with patient 
Quick Turn over 
Long work hours , night calls , fatigue
Alarm Fatigue 
Bad communication between OR team 
Interpersonal conflict 
Sleep Deprivation
Production Pressure
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19
Q

Locations that use remote Anesthesia. More specifically areas in the hospital or health organization not designated to provide anesthesia

A

ER
Psychiatric wards
Hospital Wards

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20
Q

Name locations with fixed equipment installed requiring anesthesia service.

A

MRI
CT scan
IR
Radiation therapy

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21
Q

Designated ORs outside main operating rooms

A

Dental Surgery
Outpatient Surgery
OB units
Burn Units

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22
Q

Specialized Diagnostic suites

A

GI center

Cardiovascular ( Cath lab)

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23
Q

3 main variables to take into consideration when delivering anesthesia in a remote , Outside OR area.

A

Where- Equipment available, obstacles to overcome

What- Procedure specific

Who- Patient condition and pre-existing morbidity

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24
Q

What are the standards to follow when delivering anesthesia outside the main OR in remote areas?

A

Must maintain same standards as in the OR at all times.

Additional Vigilance needed.

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25
Name some of the problems you can encounter and be ready to act upon at remote locations?
Lack of continuous electrical supply Lack of continuous supply of oxygen and nitrous oxide Difficulty with storage of drugs and equipment Lack of maintenance of equipment Lack of skilled assistance
26
Special scenarios requiring delivery of anesthesia outside OR.
Pain management Children, elderly, or disabled patients that will not follow instructions Psychiatric disorders: anxiety and panic disorders, claustrophobia Neurological disorders: movement and seizure disorders, cerebral palsy Trauma: unstable cardiovascular, respiratory, or neurological status Patients with significant co-morbidities that require monitoring Difficult airway
27
Ohm's Law
E= I X R Current in amps = volts/resistance in ohms Current in amps is in mV
28
In Ohm's Law E stands for?
Electromotive force ( unit of measure is Voltage)
29
In Ohm's Law I stands for?
Current (unit of measure is Amps)
30
In Ohm's Law R stands for?
Resistance ( unit of measure is Ohms)
31
How is electrical power measure?
Electrical power is measured in watts. A watt is equal to the product of the voltage and the amperage. W= E x I.
32
A joule ( J )
Unit of electrical or mechanical work defined as the amount of energy spent by 1 watt for 1 second in 1 ohm energy = watts x seconds
33
Electrons flowing in the same direction; an electric current flowing in one direction only.
Direct Current
34
Alternating Current
The flow of electrons reverses at given intervals
35
Impedance
the sum of forces that impede (oppose) electron movement in an AC circuit. (Z). Resistance to flow
36
What two factors affect Impedance?
Capacitance and Inductance
37
Inductance
magnetic field that is created as electricity flows thru a coiled wire. .resists the flow of electrons.
38
.the ability to store a charge .facilitates the flow of electrons. .In AC capacitors allows continuous current to travel along the circuit even if no completed circuit exists.
Capacitance
39
What substance opposes the flow of electrons?
Insulator
40
Conductor
Substance that facilitates the flow of electrons
41
What is Frequency ?
Rate in 1 second, in alternating current (AC) | changes direction. Commonly 60 Hz.
42
What do you need for current to flow ?
1. you need a circuit ( electrons flow from high to low concentration) 2. Consist of 2 wires Hot( carries voltage ) neutral ( returns the current to the source )
43
What happens if an individual becomes part of the circuit ?
Completes the circuit and receives an electric shock.
44
Name two types of grounding ?
Electrical power grounding | Electrical Equipment grounding
45
When and why is Electrical Power grounded ?
when a wire is intentionally connected to ground (earth). | Prevents build up of electricity in the wiring of the house preventing electrical shock
46
Why ground electrical equipment?
Prevents electrical shock to patients and staff if the equipment happens to have a short in it. the current will be carried by the ground wire and reduce the electric shock.
47
How is the electrical power in the OR supplied ?
Via Isolation Transformer Which separates the ES rom the OR system no ground risk for electrical shock greatly reduce since no circuit is created.
48
What is the maximum current leakage in OR equipment?
10µA
49
What cable serves as a ground when connected to the hospital grade plugs?
The first cable connected into the plug.
50
What does ungrounded means ?
No connection between the ( HOT) and ground of the household electrical supply. Preventing completion of the circuit and thus preventing electrical shock
51
Why u need a Line Isolation Monitor (LIM)?
Monitors electrical supply and warns if there is a grounded connection. LIM= protects staff and patients from shock Placed between live wires and ground to measure impedance
52
What is a Macro shock ?
shock applied to the surface of the body, different tissues have different conduction properties current that reaches the heart is very low with Macro Shock Effects body through intact skin high voltage or current through direct skin or other tissue contact.
53
What are some things that could make a patient more electrically susceptible to micro-shock?
patients with : pacer wires fluid filled catheters direct connection to the heart to the external environment very small amounts of current, in the order of milliamps. Effects through the electrically susceptible patient Electrical current is delivered directly to the heart
54
Importance of grounding the patient ?
ensures that the current density is low and thereby avoiding injury.
55
Properties of Laser
mono-chromatic (one color, one wavelength) light energy used to achieve a surgical goal. Power described in Watts. wavelength is specified by the medium used for lasing (gas, solid, liquid) Laser most common caused injuries are (thermal ).
56
What organ is most affected by the use of Laser in the OR?
The eyes. Protect patients eyes Protect staff eyes Use recommended eyewear
57
Invisible Ultraviolet
Lasers operating in the ultraviolet spectrum (315 nm to 390 nm) absorbed by the eye lens. ultraviolet laser Example: excimer laser used in eye surgery
58
Visible
Laser radiation in the visible region ( 400 to 700 nm) absorbed within the retina. An eye can focus a collimated visible beam by as much as 100,000 times. Visible laser Example: Argon and KTP lasers
59
  Invisible Near-Infrared
Laser radiation, in the near-infrared region (700 to 1400 nm), absorbed by the retina. An eye can concentrate a laser beam on the retina as much as 100,000 times. Eye don't have an aversion response in the near- or far-infrared portion. Victims usually do not know that they have been overexposed until injury occurs. invisible near-infrared lasers are very dangerous.
60
Far-Infrared
``` Laser radiation in the far-infrared region of 1400 nm to 1 mm the midultraviolet (180 to 315 nm) affects the cornea. Far-infrared Example: A CO2 laser ```
61
Mention other hazards caused by Laser not related to the eyes ?
Airborne contaminants Fumes Particulate Matter Bio- aerosols
62
Injuries caused by laser ?
Eye damage | respiratory infections
63
PPE for laser exposure
Special mask and eyewear
64
Challenge to anesthesia provider when laser use in the airway
Surgical fire can occur | use designated ETT coverings reduce FIO2 as low as 30% if tolerated by patient.
65
Fluoroscopy
Most significant source of radiation in the OR
66
How to protect yourself and patients from radiation risk ?
Wear appropriate protection | Reduce prolonged exposure
67
2 reasons the LIM could alarm?
1. A faulty piece of equipment plugged into the system, converting it to a grounded system 2. Many pieces of equipment w/ small amounts of leakage current plugged into the isolated power system
68
With Micro shock
As little as 10-100 microamps can cause v-fib in the electrically susceptible patient.
69
How do you fix a LIM alarm?
The last piece of equipment plugged in may have a fault or that too much equipment is being used simultaneously- unplug the last piece of equipment plugged in to get rid of alarm and follow safety measures.
70
Current can only travel through what kind of circuit?
Closed circuit
71
Circuit has 3 wires, what do they do?
1) Hot wire- supplies current 2) neutral wire - return path 3) ground wire- safety, provides a low resistance path for leakage current to flow away from electrical equipment and avoid harm.
72
LASER definition
Light Amplification through Stimulated Emission of Radiation
73
3 factors affecting Laser hazard
1. capability to injure people 2. environment where the laser is used 3. personnel using or exposed to laser
74
The unit of measure that is equal to the product of the voltage and the amperage (E x I).
A Watt
75
The SI unit of electrical or mechanical work, defined as the amount of energy spent by one watt for one second in a resistance of one ohm.
A joule

Anesthesia Technology (10 decks)

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