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31 Cards in this Set
- Front
- Back
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three ingredients for fire to occur
dd |
*gas to support combustion/oxidizer
*source of ignition *flammable substance |
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what surgery highly susceptible?
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head and neck surgery
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gas that supports combustion
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*oxygen rich enviornment
*causes materail to ignite easier and burn more vigorously *lowers ignition threshold *drapes absorb and retain longer *nitrous causes increased heat |
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common source of ignition
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*electrocautery
*defibrillators *laser beams *OR lights *heat lamps *endoscopic light source *heated probes *drills and burs *argon beam coagulators *defective electrical equipment *static electricity |
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articles near pt that can serve as flammable material
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*tracheal and tracheostomy tubes
*tape *oxygen cannulae and tubing *breathing tubes and bags *sponges *eye patches *masks *NG tube *drapes *airways *disposable drapes (difficult to extinguish because difficult to extinguish) |
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measures to prevent fires
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*high pressure oxygen equipment should not be contaminated with oil, grease nd not cleaned with flammable material (alcohol)
*open cylinder slowly to allow dissipation of heat *oxygen should be administered slowly and in no higher concentration than is needed *use local scavenging system to remove gases from vicinity of surgery *hair near operative site made nonflammable by coating with water soluble lubricating jelly or soak with saline *use cuffed tracheal tube for oral surgery *use water bsed prep solution *nitrogen or air rather than o2 used to power surgical tools *tracheal tube cuff filled with saline |
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actions in case of fire
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*burning material on pt removed and extinguished
*if electrical the power supply should be disconnected *the oxygen, nitrous oxide, or air should be turned off *ventilate pt with air and iv anesthetics to maintain anesthesia *close cylinder valves and remove all cylinders from area *evacuate pt and staff from room *sound fire alarm *close door to room *evacuate and/or protect pts in adjacent rooms *direct fire fighters to site of fire |
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greatest fear during laser airway surgery
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tracheal tube fire
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how can airway fire be avoided
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use of technique of ventilation that does not involve flammable tube or catheter
i.e intermittent apnea jet ventilation through laryngoscope side port |
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disadvantages of wrapping a tracheal tube with metallic tape
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*no cuff protection
*adds thickness to tube *not FDA approved device *protection varies with type of metal foil *adhesive backing may ignite *may reflect lser onto nontargeted tissue *rough edges may damage mucosal surfaces |
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types of tubes available for laser surgery
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*flexbile stainless steel tracheal tubes that resist laser strikes
*double cuffed tubes that seal distal end of airway |
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precautions to be followed whenever laser airway surgery is being performed with tracheal tube in place
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*inspired oxygen concentration should be as low as possible
*nitrous oxide supports combustion nd should be replaced with air or helium *tracheal stube cuffs should be filled with saline dyed with methylene blue to dissipate heat and signal cuff rupture *laser inensity and duration should be limited as much as possible *saline soaked pledges should be placed in the airway to limit risk of ignition *a source of water (60 ml syringe) ahold be immediately available |
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airway fire protocol
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*stop ventillation nd remove tracheal tube
*turn off oxygen and disconnect circuit from machine *ventilate with face mask and reintubate *assess airway damage ith bronchoscopy, serial chest xrays, and abgs *consider bronchial lavage and steroids |
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What does LASER stand for?
D & D 32 |
light amplification by stimulated emission of radiation
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Name some possible ignition sources?
D & D 32 |
Lasers, electrosurgery unit, argon beam coagulator, fiber optic illumination system, defibrillator, pressure regulators, surgical lights, electrical faults
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What are some hazards involving lasers?
D & D 32 |
fires, atmospheric contaminations, eye damage, organ/vessel perforation, and embolism
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Which class of lasers are hazardous?
D & D 32 |
class 3 lasers, and even more so class 4 (these 2 can be ignition hazards)
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Most common ignition source in surgical fires? Why?
D & D 32 |
Electrosurgery units-high frequency of electric current passing through tissues to cut/coagulate
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The heat from a surgical light can contact and rupture what type of hoses?
D & D 32 |
those from a medical gas pipeline
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What is the definition of a fuel?
D & D 32 |
Anything that can burn
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Name some examples of fuels?
D & D 32 |
tracheal tubes, supraglottic airway devices (LMAs), surgical prodcuts, adhesive substances, skin prep soln.(espec. ETOH), intestinal gases, O2 cannulas, lubes and ointments, body hair
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Which types of breathing tubes are most likely to ignite w/ CO2 laser?
D & D 32 |
red rubber (although less likely to deform w/ fire) > polyvinyl chloride > silicone tubes > laser-resistant tubes
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What can you use to protect a tracheal tube from a laser beam?
D & D 32 |
wet sponges
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What can you put in a pt's hair to make it fire resistant?
D & D 32 |
water-based lubricant
*Note petroleum based are flammable |
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Most common oxidizers involved in fires?
D & D 32 |
O2 & N2O
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How are intraperitoneal fires started during laparoscopy?
D & D 32 |
usually when N2O as used as the insufflating gas
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How do you protect a pt's eyes when laser is going to be used near them?
D & D 32 |
close them and cover them w/ saline-soaked gauze or a non-metal shiny shield
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What type of unit should not be used during a tracheostomy?
D & D 32 |
electrosurgery unit
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What part of the breathing tube is most vulnerable to fires? What can you do to reduce the chance of ignition?
D & D 32 |
the cuff-fill it with saline or a lido jelly/saline mix (plugs holes in cuff)
*May add dye to soln. so surgeon can tell if cuff is perforated |
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If possible, how long before heat-producing surgical instruments are use should the O2 be discontinued?
D & D 32 |
at least 1 min
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What are two ways to reduce the amount of O2 that flows under the drapes?
D & D 32 |
tent the drapes and scavenge the space b/w the drapes w/ a suction device
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