Thermoregulation/Fire Safety/Electrical Safety

_____% OR fires are associated with serious injury or death.

5-10%

Many ORs are equipped with a fire hose that supplies pressurized water at a rate of _______

50 gallons / minute

Estimates suggest there are _____ OR fires each year

550-650

Readings greater than _____, likely a faulty piece of equipment is present in the operating room and connected to the Line Isolation Monitor circuit

5mA

Coulomb's Law constant (k) = ____ X109 N∙m2/C2

8.99

How much energy and power will it take to run a 900 watt air-conditioner for 10 hours straight?

9000 wats or 9kw

Voltages of the batteries add together. So if you had a 3v and 6v on the same pathway, you'd have __

9v

Why use Flexible metal tube that has two cuffs that can be inflated with saline colored with methylene blue?

(makes it easy to identify if the cuff has been penetrated)

All power supplied to most ORs is ________, providing an extra measure of protection from macroshock

ungrounded

If current is to flow in the electrical circuit, there has to be a _______ differential, or a _______ in the driving pressure across the impedance.

voltage differential, or a drop

________: bimetallic strip, (will bend enough to trip the system, but when cooled will return to original shape and can be put back to original position)

Circuit breaker

Laser Properties: _______ radiation - all waves have same frequency and phase

Coherent

Laser Properties: ________ - beam does not disperse as distance from source increases

Collimated

_________ (c) A greater concentration of the analyte increases the chance that a photon will encounter a molecule with which to interact

Concentration

______: Any substance that permits flow of electrons, establishes current

Conductor

SI unit of electrical charge is the _____ Often represented by 'Q'

Coulomb (C)

When a charge is placed in a location with a non-zero electric field, a force will act on it. The magnitude of this force is given by ________

Coulomb's Law

________: circuit elements that have a large conductance in one direction and a smaller conductance in the reverse direction. Can be used to control direction

Diodes

______Current (the flow of electrons) flows in one direction only. Commonly use batteries

Direct Current Circuits (DC)

Steps to Perform When an Airway Fire Occurs. If a tracheal tube is on fire:

Disconnect circuit from the tube or inspiratory limb of the circuit.Remove the burning endotracheal tube. (After fire is extinguished) Inspect airway via bronchoscopy. Reintubate the patient

________ (b) describes the light beam travels through a substance

Distance

Two major ignition sources for OR fires are the ___ and the ____. Ends of fiberoptic light cords can become hot enough to start a fire

ESU and the laser

In most modern _______, the power supply is from the ground protecting the patient from burns by eliminating alternative return pathways

ESUs

An electric field surrounds an electric charge, and exerts force on other charges in the field, attracting or repelling them is an _______

Electric Force Field (E)

Amount of work needed to move a unit of charge from a reference point to a specific point inside the field without producing an acceleration is ______

Electric Potential (V)

_______ Also called electric field potential or potential drop.

Electric Potential (V)

_______ is the rate of flow of electric charge past a point (or region), which produces no net loss or gain of electric charge.

Electric current (I)

______ is usually produced by electric generators but can also be supplied by electric batteries.

Electric power

_______ is the rate at which work is done or provides energy. It is the rate at which energy is supplied or converted by the appliance or circuit.

Electric power

An _______ is an interconnection of electric components such that electric charge is made to flow along a closed path (a circuit).

Electrical Circuits

The components in an ______ can take many forms, which can include elements such as resistors, capacitors, switches, transformers, and electronics.

Electrical Circuits

_______ occur when a person becomes part of, or completes, an electrical circuit.

Electrical shocks

________: a form of energy associated with the presence and motion of matter that has a property of electric charge.

Electricity

______: 1) to kill with electricity

Electrocute

ERASE

Extinguish. Rescue. Activate. Shut. Evaluate

Laser light can be reflected off any _______ surface

metal

Laser goggles may make it difficult to read certain _______

monitor displays

Atoms are ______ = # of protons in a atom's nucleus equal # of electrons in the electronic cloud

neutral

Detector in a spectrometer measures the intensity (_________) of the light before it encounters the sample (I0) and after (I).

number of photons per second per unit area

Blood pressure is real life _______

ohm's law

Resistors connected in _______, current has more than one path it can take. Unique current that flows through each resistor independently. So energy can flow to any appliance solely even if they are not all turned on

parallel

Diode Electrons will move toward the _____ junction and will continue to have current flow. Exothermic reaction and energy is released as a photon of light. Light-emitting diodes, LEDs

pn

_______: small amount of current, applies only to the electrically susceptible patient. This is an individual who has an external conduit that is in direct contact with the heart. Pacing wire, or a saline filled catheter such as a PA catheter, or a central venous catheter.

Microshock

Laser Properties: ________ - of a single color or wavelength

Monochromatic

_________ semiconductor: electron rich material composed of silicon doped with something like arsenic

N-type (negative)

______: Electromotive Force (Volts) = Current (amperes) X Resistance (ohms)

Ohm's Law

______ Products of combustion. When materials burn, a variety of compounds can result

Toxicants

_________ Carbon monoxide, ammonia, hydrogen chloride, and even cyanide

Toxicants resulting from OR fire

_______: two closely situated pn junctions, known as transistors. Useful for amplifying or switching currents

Triodes

In ________, Ohms law becomes more complex because flow of current is opposed by a more complicated form of resistance, known as impedance

alternating current circuits

Electric current is measured using a device called an ______

ammeter

An ______ is the smallest unit of ordinary matter that constitutes a chemical element.

atom

In ______ ESU, uses two closely spaced small electrodes. Devices such as forceps. Not necessary to attach a dispersive electrode to the patient. Generates less power than unipolar ESU

bipolar

Electric Potential Energy: if the charge is held in place so that it cannot move, the charge would have the _______

potential to move

Electric Potential Energy (U or UE) (Not to be confused with Electric _____ or Electric ______)

potential, power

Watt-second (joule) common designation for electrical energy expended in doing work (______)

defibrillator

Coulomb's Law provides the magnitude of the electrostatic force between two-point charges, not the _______

direction

Impedance _______ proportional to the frequency

directly

The movement of any of positively charged proton and negatively charged electron constitute an _______

electric current

An object may have _________ by virtue of two key elements: its own electric charge and its relative position to other electrically charged objects.

electric potential energy

The elements of the circuit converts this ______ into other forms of energy such as light, sound, thermal, and mechanical.

electric potential energy

Anesthesia provider should never touch a saline filled CVP catheter or external pacing wires and an ________ at the same time

electrical device

Various common phenomena are related to ________, including lightning, static electricity, electric heating, electric discharges, and many others.

electricity

The presence of charge gives rise to an ______ force: charges exert a force on each other.

electrostatic

Diode is said to be _______ biased if a voltage is applied to the diode so that the n-region is based negative compared to the p-region

forward

If a faulty piece of equipment is connected, this will change the system back to a conventional grounded system, but faulty device will continue to __________ Does not protect from microshock

function normally

____: metal strip, once melted must be replaced

fuse

Electrical circuit have _____ or _______ - designed to prevent too much current from flowing because of a short circuit or circuit overload

fuses or circuit breakers

Patient's eyes should be covered with wet ______ or ______

gauze or eye packs

There is No direct connection from the power on the secondary side to the ______

ground

Three pronged Grounded Plugs. 2 equal sized flat prongs, and a third, round dedicated ______ prong. Third prong provides a path for the current directly to the ground

ground

An intact ______ provides the major source of protection against microshock

ground wire

Modern wiring systems - added the third wire, green or uninsulated, serves as _______

ground wire

What if two 1,500 W hairdryers were used simultaneously in 1800 W outlet?

ground would trip

Potassium titanyl phosphate laser (KTP) or frequency-doubled yttrium aluminum garnet (YAG) Absorbed by ______, tissue penetration similar to argon.

hemoglobin

Polarized plugs: one wide and one narrow prong. Narrow opening is _____ potential. Wide opening: ____ potential

high, low

Neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is the most ______ of medical lasers. Tissue penetration is between 2 and 6mm, used for tumor debulking, particularly in tracheal and main stem bronchi, or upper airway.

powerful

Helium-Neon (He-Ne) laser produces an intense red light. Used for aiming the CO2 and the YAG lasers. Has very ______, presents no significant damage to OR personnel

low power

"let-go" current before sustained muscle contraction mA and A

macroshock

Current for threshold of perception in mA and A

macroshock

Pain, possible fainting, mechanical injury; heart and respiratory functions continue mA and A

macroshock

Sustained myocardial contraction, followed by normal heart rhythm; temporary respiratory paralysis; burns if the current density is high mA and A

macroshock

Ventricular fibrillation will start, but respiratory center remains intact mA and A

macroshock

accepted as maximum harmless current intensity in mA and A

macroshock

Damage occurs in one of 2 ways: Dissipation of electrical energy throughout the body's _____. Electrical current disrupts normal electrical function of _____

tissues, cells

The total amount of electrical energy used depends on the _____ used by all your electrical devices and the total time they are used in your home.

total power

Percentage of light that passes through a sample is called the percent _______ (%T)

transmittance

Amount of light absorbed by the sample, the _________

absorbance or A. beers lambert law

__% of electrical accidents in hospitals occur in the OR

40

__________ Current periodically changes direction . Most AC circuits get energy from wall

Alternating Current Circuits (AC)

_______: Materials in which charges cannot move freely (nonmetallic)

Insulators

One electron (e) = _____ X 10-19 C (represents magnitude, without regard to sign, of the charge on electron). Proton = +_______X 10-19 C . Neutron = no electrical charge

1.602, 1.602

Let go of 60hz is ______

10-20mA

Hot wire - color coded black, carries a _____ potential. Neutral wire - color coded white. Ground Wire - color coded green or uninsulated (bare wire)

120V potential

Readings between _______ indicate too many electrical devices are connected to the Line Isolation Monitor circuit, resulting in too much leakage current

2-5mA

Takes __ as much DC as AC to cause Ventricular fibrillation

3X

_________ (a) Describes the likelihood that a photon will excite the molecule, is a constant for each substance at a given wavelength

Absorptivity

3 factors affect how much light is absorbed by a sample ______ (a) _______ (b) ________ (c)

Absorptivity (a) Distance (b) Concentration (c)

______ laser - used in eye and dermatologic procedures. Absorbed by hemoglobin, modest tissue penetration between 0.05 and 2.0mm

Argon

Critically ill patient requiring tracheostomy. Oftentimes, require high concentrations of oxygen to maintain tissue oxygenation. A decrease in inspired oxygenation or interruption of ventilation will not be tolerated. What is the best option in this situation?

Avoid ESU. Tent the drape. Use sticky drape so the o2 cannot flow

___ laser - very little tissue penetration, used when great precision is needed. Absorbed by water, minimal heat is dispersed to surrounding tissues. Used primarily for procedures in the oropharynx and in and around the vocal cords

C02

Best fire extinguisher for OR is the ___ extinguisher generally for class B and C fires

CO2

_______: measure of substance's ability to store charge

Capacitance

_______: two parallel conductors that are separated by an insulator

Capacitor

______: either positive (protons) or negative (electrons)

Charge

Electric Current (I) = Electric ______ / _____

Charge (Q)/ Time (t)

_______: exerts the electric force on a test charge located at any point around a central charge

Force field

Name some fuel sources commonly found in the Operating Room??

Gowns. Co2 absorber. Et tube. drape

_______ designed to immediately disrupt the current in a circuit if an imbalance between the two currents is detected

Ground Fault Circuit Interrupter

_________ Prevents individuals from receiving an electrical shock in a grounded power system

Ground Fault Circuit Interrupter

________ Serves as extra protection, reduces the severity of a potential electrical shock. Provides an alternate, low-resistance pathway through which the current can flow to the ground

Ground wire

Electrical power is ______ in the home, it is usually ______ in the OR.

Grounded, ungrounded

Isolation transformer converts the _______ power on primary side to an _______ power system on the secondary side.

Grounded, ungrounded

Steps to Perform when Fire is on the Patient

If the fire is on the patient: Extinguish it with a basin of saline, towel or sheet. Remove drapes if, they are burning, Water will not help with drapes, they are waterproof

______ sum of the forces that oppose electron movement in an AC circuit Impedance

Impedance (Z)

______: an opposing EMF can be electromagnetically generated in the circuit (AC circuits)

Inductance

________ Occurs when electrons flow in a wire, a magnetic field is induced around the wire

Inductance

________: Substance that opposes the flow of electrons

Insulator

__________ in abdomen is another potential risk for a surgical related fire. insufflation with CO2 does not support combustion. However, nitrous oxide that is administered to patient as part of anesthetic can, over 30 minutes, diffuse into abdominal cavity and attain a concentration that can support combustion

Laparoscopic surgery

______: light amplification by stimulated emission of radiation

Laser

_______ "plume" may contain vaporized virus particles or chemical toxins

Laser plume

_______: material that the laser energy excites

Lasing medium

Electric charge is a conserved property; the total amount of electric charge in the universe is constant defines which law?

Law of Conservation of Energy:

What is the ideal percentage of inspired oxygen when using laser?

Less than 30%

________: current above which sustained muscular contraction occurs and at which an individual would be unable to let go of an energized wire.

Let - go current

_______ is actually measuring the impedance to the ground on each side of the IPS

Line Isolation Monitor

_________ Continuously monitors the integrity of the isolated power system

Line Isolation Monitor

___________ Has a meter than displays a continuous indication of the integrity of the system - indicates in mA the total amount of leakage in the system resulting from capacitance, electrical wiring, and any devices plugged into the IPS

Line Isolation Monitor

When do most surgical fires occur??

MAC and Regional anesthesia of Head, Neck

______: large amount of current flowing through a person, can cause harm or death

Macroshock

"fire time out" Risk factors include:

Open delivery of oxygen / oxygen enriched environment. Ignition / heat source (Electrocautery, laser). Surgery in the head, neck, or upper chest area. Presence of an alcohol prep solution . If three or more of these factors are present, then a high risk fire situation exists

_______: electron poor material composed of silicon doped with something like boron

P-type (positive)

Electrical Energy = _____ X _____ = (Kilowatt-hours)

Power X Time

Beer's Law is used clinically _______

Pulse ox and blood work paneling

Like charges ____ each other and unlike charges _____ each other.

Repel, attract

______: reverse the polarity of the DC supply, create a volume called depletion region

Reverse bias

________: materials with electrical conducting properties between insulators and conductors

Semi-Conductors

______: the sensation and muscular spasm caused by an electric current passing through the body

Shock

______. White light passes through a colored substance, certain wavelengths are absorbed

Spectroscopy

______ dye laser has a wavelength that is easily changed, used for dermatologic procedures

Tunable

_____can be produced by a current below the threshold of human perception in an electrically susceptible patient

V-Fib

Power = ______ x ______ = (Volts x Amperes)

Voltage x Current

Endotracheal tube emits a _______ type of flame. Results in severe injury to trachea, lungs and surrounding tissues

blowtorch

Dissipation of electrical energy throughout the body's tissues. Electrical current passing through any resistance raises the temperature of that substance. If enough thermal energy is released, the temperature will rise sufficiently to produce a _____

burn

Stray _______ may result in significant amounts of charge buildup on the case of an instrument

capacitance

_______ and _________ are influenced by the frequency (cycles per second or hertz, Hz) at which the AC reverses direction

capacitance and inductance

consists of resistance (ohms) while accounting for _______ and ________

capacitance and inductance

Change in potential energy results when a ______ moves across a potential difference V.

charge ΔQ

Ground Fault Circuit Interrupter AKA _______

circuit breaker

Electrical current disrupts normal electrical function of cells. Can _______ muscles, ______ brain function, _______ respiration, or disrupt normal heart function, leading to _______

contract muscles, alter brain function, paralyze respiration, or disrupt normal heart function, leading to ventricular fibrillation

Net effect of inductance is to increase ______

impedance

recommended maximum 60-Hz leakage current

in mA

ventricular fibrillation with microshock

in mA

Casual contact (AC or DC) can cause ______ and ______

injury and death

Impedance ______ proportional to the product of frequency (f) and the capacitance (CAP)

inversely

Modern patient monitors are designed to electronically ______ direct patient connections from the power supply of the monitor

isolate

The 120-V potential difference exists only between the two wires of the ________

isolated power system (IPS)

Supplying ungrounded power to the OR requires the use of an _________

isolation transformer

ESU cannot be safely used unless energy is properly routed from the unit through the patient and back to the unit via a _______ dispersive electrode

large surface area

All OR personnel should wear protective goggles specific to the type of _____ being used

laser

All AC electrical circuits experience '__________' where small amounts of current (mA) flow to the ground

leakage current

________ Produce injury by damaging airways and lung tissue, can cause asphyxia

result of toxicants from OR fire

When batteries are connected together, they create a ______

series circuit

OR fires can produce significant amounts of smoke and toxicants but fail to activate _________

sprinkler systems