Chapter 8: Surgical Technology for the Surgical Technologist, Surgical Technology Chapter 8

vesicants

"blister agents", commonly known as mustard gas; causes skin blisters and burning of the skin and eyes, airway injury causing difficulty in breathing, conjunctivitis that varies in severity; necrosis of the epidermis, severe conjunctivitis, and if inhaled, injury to the muscosal tissues of the larynx and tracheobronchial tree

chain-of-survival, airway, breathing, circulation, definitive treatment

A ____________________ concept applied to both in-hospital and out-of hospital arrests addresses the ABCs- ____________, ____________, and ______________-as well as providing the "D", ____________________.

A-B-C (airway, breathing, chest compressions), C-A-B (chest compressions, airway, breathing)

A change in the sequence of BLS from _________________ to __________________ for adults, adolescents, and infants (excludes newborns).

wildfires

A consequence of heat waves can be ________________________.

regurgitation, aspiration

Excessive ventilation must be prevented in order to avoid the complications including _____________________ and ____________________.

complete recoil

Focus on delivering high-quality chest compressions at the appropriate rate and depth, including ____________________ of the chest after each compression.

head tilt-chin lift, jaw thrust

HCP should use the ___________________ maneuver to open the airway. If a spine injury is suspected, the airway should be opened using a ____________ without head movement.

chest compressions, rescue breaths

Immediately start ________________ before giving ___________________.

Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

In 2010 the AHA published the revised ___________________________ that includes significant changes from the 2005 version.

protect the sterile field

In the OR, the surgical technologist's primary function is to ______________________.

exsanguinations, thoracic injury, thoracotomy

In trauma patients, it has been shown that cardiac arrest is usually caused by ______________ or a critical _____________________. Most of these patients will require resuscitative ____________________.

sudden cardiac arrest (SCA), ventricular fibrillation (VF)

Many of the individuals who experience ____________________ exhibit __________________ at some point during the arrest.

hypothermia, frostbite, carbon dioxide

People stuck in cars on barren highways or mountain passes during a winter storm are exposed to ___________________ and _____________________, ______________________ poisoning can occur if they leave the vehicle running for heat.

difficulty breathing, chest pain, changes in skin color, changes in vital signs, open bleeding wounds or puncture wound, inability to move an extremity, misshapen/misaligned body part, disorientation/confusion, severe cephalagia (headache)

Prior to surgery, the surgeon or anesthesia provider should be notified immediately if these indications of an emergency situation arise:

10

Take no more than ____ seconds to check if a pulse is present.

chemical, biological, radiological, nuclear

Terrorists use many types of weapons to strike at the populace, including ____________________, ___________________, ______________________, and _____________________.

tap the shoulder

The HCP should no longer shake the victim, but rather __________________ and shout, "Are you all right?"

A-B-C, 3:1, 15:2

The ________ sequence for neonatal arrests is still retained since cardiac arrest are nearly always asphyxia; the ratio for chest compression to rescue breaths for newborns is ______; if the arrest is due to cardiac etiology, the ration should be______.

Emergency Operations Center (EOC)

The director of LEMA is responsible for activating the _____________________________; the location of the EOC is predetermined and communicated in the EOP.

asphyxial

The majority of pediatric cardiac arrests are _________________; resuscitation should be a combination of ventilation and chest compressions.

"push hard, push fast", 100

The new concept _____________________ is to be applied to CPR. The recommendation is at least _____ compressions per minute.

dehydration, severe sunburn, heat cramps, heat exhaustion, heat stroke

The number one heat-related complication is ____________________; however, other serious heat-related illnesses include ___________________, ____________________, _____________________, and _______________________.

30:2

The ratio of chest compressions to rescue breaths for infants, adolescents, and adults is _______.

avalanches, rock slides, asphyxiation, fractures, hypothermia

Throughout the Rocky Mountain region of the United States, ________________ are a concern and the types of _____________________ include snow during the winter season and __________________ during the spring and summer seasons; HCPs should be ready to treat the victim for ___________________, _______________________, and _______________________.

dropping blood pressure, cardiac dysrhythmia, and abnormal vital signs

What indicators should an entry-level ST be able to recognize during an emergency situation?

check for and provide an airway to ensure or restore respiratory status and breathing; cardiovascular status should be maintained or restored and hemostasis should be provided

What is the first priority in any emergency situation? The second?

2, five, 5

When two or more rescuers are available, it is recommended to switch chest compressors every ___ minutes, or about every ______ cycles of compressions an ventilations. The switch should be made in less than ___ seconds.

cold temperatures, low visibility, driving conditions

Winter storms bring life-threatening ______________________, __________________________, and dangerous _________________________________.

Males, sweating

_____________ are at a higher risk for heat-related illnesses due to _________________ more than females.

Clinical death, 4-6

___________________ begins the moment heart action and breathing stops; the patient has only ________ minutes before the cells of the brain begin to deteriorate.

Flash blindness

_______________________ may occur as a result of peripheral vision of the intense light energy that is produced by a blast.

Radiation exposure

________________________ because of a nuclear power plant leakage can cause mutations to occur in the cells of the body, resulting in various types of cancer.

Radiological injuries

_____________________________ decrease the body's hematopoietic and immune systems, contributing to the morbidity and mortality of patients who cannot fight of bacterial and viral infections.

heat stroke

a life-threatening condition where the patient's internal temperature control system stops working; the body temperature can rapidly increase, causing neurological damage as well as leading to death if not immediately treated

malignant hyperthermia (MH)

a life-threatening, acute pharmacogenic disorder, developing during or after anesthesia; usually triggered by an anesthestic agent

disseminated intravascular coagulation (DIC)

a pathological process in the body that occurs when blood begins to coagulate with the body; the body's blood clotting mechanisms are activated throughout the body instead of being localized to a specific area of injury, which leads to the consumption of coagulation factors and platelets, and the overstimulation of fibrinolytic degradation products that act as anticoagulants

cardiopulmonary resuscitation (CPR)

a technique of manually providing chest compression and ventilations to patients in cardiac arrest in an effort to provide oxygenated blood to the brain and vital organs and reverse the processes that lead to death

storm surge

an abnormal rise of the ocean waters due to the high winds that sweep forward inland

anaphylactic reaction

an exaggerated allergic reaction to a substance or protein (drugs such as local anesthetics, codeine, antibiotics, animal-derived drugs such as insulin, contrast media and in some cases latex)

heat wave

an extended period of abnormally hot weather that may be accompanied by high humidity

tropical storm

an intense thunderstorm accompanied by sustained high wind speeds, but not as high as a hurricane; winds must be between 39 and 73 mph

volcano

an opening in the Earth's crust that allows poisonous gases and magma to escape; the magma and gases build up in the Earth's interior, creating an enormous amount of pressure, and eventually explode outward, releasing the poisonous gases and the flow of lava

biological agents that are used as bioweapons

anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers

AED

automated external defibrillator

explosions

bombs and other weapons of mass destruction, various types of factory explosions, gas tank explosions, and explosions inside mines; cause penetrating wounds, blast soft tissue injuries, fractures, burns, and injuries unique to the disaster

biological agents

can enter the body through the respiratory tract or can be absorbed through the mucous membranes, eyes, skin, or open wounds

tsunami (tidal wave)

caused by serious earthquakes or by the underwater eruption of a volcano; immense wave of incredible force that can travel for many miles before dissipating

transportation accidents

causes severe lacerations, fractures, crushing injuries, burns and eye injures

warning signs of impending cardiac arrest

chest pain, unstable blood pressure, tachycardia, cardiac dysrhythmias, respiratory changes, hypovolemia, laryngospasm

Local Emergency Management Agency (LEMA)

community agency that has the lead responsibility for managing and coordinating local agencies in response to an emergency

definitive treatment

control of dysrhythmias by cardiac defibrillation or the use of IV drugs and post-resuscitation care; arterial lines are used to monitor blood pressure and blood gases

terrorism

defined by the U.S. Department of Defense Dictionary of Military and Associated Terms as the "unlawful use of violence or threat of violence to instill fear and coerce government or societies. Terrorism is often motivated by religious, political, or other ideological beliefs and committed in the pursuit of goals that are usually political"

emergencies

defines as those that require emergency response of outside assistance, which may be local, county, state or federal levels

treatment of DIC

determining the underlying cause of the disorder and providing appropriate measures; transfusion of fresh-frozen plasma to replace the coagulation factors; cryoprecipitate may be initiated if fibrinogen is extremely low; heparin is sometimes prescribed in combination with replacement therapy

heat exhaustion

due to exercising or working for a period of time in a hot, humid place and body fluids are lost at a great rate through sweating without replacement; mild form of shock because the body increases the blood flow to the skin, thus reducing blood flow to the vital organs

tornadoes

due to humidity, changing wind directions, and wind speed, which all contribute to the formation of a funnel

flooding

due to large amount of rainfall that causes streams and rivers to overflow their banks, or causes a levee or dam to give away

successful resuscitation requires:

early recognition/activation/CPR/defibrillation/advanced cardiac life support (ACLS)

3.5-5.4 (Richter scale)

earthquake felt; rarely causes damage

<3.5 (Richter scale)

earthquake may be felt, but not recorded by a seismograph

EOP

emergency operations plan

symptoms of an anaphylactic attack

first shows only mild inflammatory symptoms such as itching, swelling, and, in some cases, difficulty breathing; hives or urticaria may be present; as the reaction progresses, the patient experiences further difficulty breathing due to bronchospasm and laryngeal edema; vascular collapse due to shifts in body fluid and hypotension, tachycardia, and diminished urine output

hurricane (health complications)

fractures, lacerations, and head and eye injuries due to falling trees, fly debris, and collapse of structures, burns and electrical shock

tornadoes (health complications)

fractures; head, spine, and eye injuries due to flying debris or collapse of a structure, or a person who was picked up and thrown a distance by the high winds

floods (health complications)

gastrointestinal illness due to contaminated water supply

anesthestic agents that trigger MH

halothane, enflurane, isoflurane, and succinylcholine (muscle relaxant)

6.1-6.9 (Richter scale)

heavy damage and destruction up to 62 miles from the epicenter

DIC may be stimulated by:

infection of the blood by bacteria or fungus, severe tissue trauma, leukemia or cancer, severe liver disease, recent blood transfusion reactions, obstetric complications

earthquakes (health complications)

lacerations, fractures, serious head injuries, eye injuries, crush injuries

hurricane

large storm that produces heavy rain, storm surges, and high winds; wind speed is at least 74 mph

chemical release accidents

life-threatening event that can cause severe damage to the environment; chemicals can be flammable, toxic, and/or caustic; causes permanent respiratory tract damage, skin burns, diseases, and permanent damage to the eyes

treatment of an anaphylactic attack

maintain the airway and provide supplemental oxygen; epinephrine is the first-line drug in the treatment (cause bronchodilation, reduces laryngeal spasm, and raises blood pressure); steroids are administered to stabilize mast cells and slow or stop the chain of events that caused the reaction; IV fluids and plasma may be used to restore fluid volume, and vasopressor agents such as Levophed are given to increase blood pressure

7.0-7.9 (Richter scale)

major earthquake that causes heavy damage and destruction over a very large area

role of ST in the OR

may be required to assist by providing artificial respiration (bagging the patient)

Richter scale

measures earthquakes

choking agents

most common agents are phosgene and diphosgene (cause severe irritation of the upper and lower respiratory tracts); causes pulmonary edema, eye, nose and throat irritations, choking, coughing, tightness in the chest, fatal pulmonary edema develops during 2- to 24-hour period; absorbed by inhalation, reactions occur at the level of the alveolar-capillary membrane

radiological injuries

most likely occurs due to detonation of an improvised nuclear device or radiological dispersal device referred to as a "dirty bomb" or because of a nuclear power plant accident; causes blast injuries, thermal/flash burns, and ionizing radiation injuries

natural disaster

most occurring type of disasters that can affect large populations; often unique to the area where it occurs, and the severity can vary

nerve agents

most toxic of known chemical agents, often cause death in minutes due to respiratory obstruction and cardiac failure; causes rhinorrhea, extreme difficulty breathing, apnea, seizure, paralysis, loss of consciousness; binds with acetylcholinesterase thus not allowing it to act on the myoneural junction of muscles, causing paralysis of the muscles

heat cramps

muscular pains and spasms due to activity; often fist sign/reaction by the body to the heat

heat index

number in degrees Fahrenheit that tells how hot it feels when relative humidity is added to the air temperature

earthquakes

produce an incredible amount of energy when two portions of the earth's crust slide by one another along a fault line; the energy travels outward from the epicenter in seismic waves, causing a violent shaking of the ground

National Incident Management System (NIMS)

provides a national model for coordinating the emergency response of governments, public health sector, private agencies, and nongovernmental organizations to any type and size of disaster

role of the circulating nurse in the OR

provides support to the patient and physicians and brings necessary supplies, including the "crash cart" when necessary

MH is characterized by

rapid increase in body temperature, unexplained tachycardia, unstable blood pressure, muscle rigidity, tachypnea, and cyanosis

man-made disasters

refer to transportation accidents and acts of terrorism or industrial incidents

all-hazards preparation

refers to many different emergencies; a template for generalized training and emergency preparation that can be applied to all disaster situations rather than training that is focused on a limited number of local or regional types of emergencies

CPR or Basic Life Support (BLS)

renewed every 2 years

volcano (health complications)

respiratory complications and damage to the lungs from volcanic ash, serious burns

<6.0 (Richter scale)

slight damage to well-designed, earthquake-resistant buildings; major damage to poorly constructed buildings

wildfires (health complications)

smoke-related complications, respiratory and cardiovascular conditions worsened by smoke, risk for burns

8 or greater (Richter scale)

strongest of earthquakes, with serious damage and destruction for hundreds of miles

Category 3 (Hurricane)

sustained winds 111-130 mph

Category 4 (Hurricane)

sustained winds 131-155 mph

Category 1 (Hurricane)

sustained winds 74-95 mph

Category 2 (Hurricane)

sustained winds 96-110 mph

Category 5 (Hurricane)

sustained winds >155 mph

infrastructure incidents

the collapse of roads, bridges, and structures; can be caused by natural disasters or be due to poor construction; causes crushing injuries and severe lacerations

bioterrorism

the intentional use of infectious agents or germs, to cause illness

role of anesthesia personnel in the OR

to manage the cardiopulmonary arrest situation or "code"; they provide IV access and arterial pressure and blood gas monitoring as well as airway management and respiratory and cardiac support, including defibrillation