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
