Unit 3 SUR 110, Unit 3- Physical Environment, Environmental Hazards, Emergency Situations

What are unrestricted areas in the hospital?

near the front of surgery department, allows patients, staff, doctors, as well as on occasion patients family, street clothes are acceptable, changing rooms, offices, classrooms, lounges, registration, preoparative holding, post anesthesia care unit

What are Semi-restricted areas in the operating room?

desginated by a red line, people should be in surgical attire, decontamination and assembly rooms, central sterile supply, scrub sink area, hallways outside each procedure room.

What are restricted areas in the OR?

Surgical room, sub sterile, full OR attire expected

What is the purpose of OR attire?

to protect the OR environment from outside contaminants

Why are OR doors kept shut?

to preserve positive air pressure and prevent contamination

When do we change OR attire?

scrubs are changed daily or when soiled

head covering are changed daily or when soiled

masks are changed after every case

Why do we wear head covers/hats?

to protect OR environment from hair and contaminations

What type of head covers can you as a student wear? what about an employee?

students wear hospital provided covers, employees can wear personal or hospital provided

Describe the three areas of the operating room and who can be wear.

Unrestricted- anyone can be here, street clothes

Semirestricted- OR attire

Unrestricted- full OR attire

What is the Post Anesthesia Care Unit?

patient is transferred here immediately after surgey to recover from aneasthesia, 130 min to a few hours, constant vital monitoring, pain management

What are the white boards used for in the OR?

used to write important information like items that are packed into surgical wounds, counts, patients allergies, medications being used on sterile field

What is the kick bucket used for?

soiled sponges

What is the mayo stand used for?

most needed surgical instruments, placed over patient

How many suction systems should be in the OR?

atleast two

Where are surgical booms mounted from?

the ceiling

What color is the oxygen gas outlet?

green

What color is the compressed medical air outlet?

yellow

What color is the nitrous oxide outlet?

blue

What color is the nitrogen outlet?

black

where are the emergency shut off valves located?

immediately outside of the OR and incase of a fire

What is the minimum number of air exchanges per hour in the OR?

15 air exchanges

What is the recommended range of air exchanges in the OR?

20-25

What percentage of air exchanges should come from fresh outside air?

20%

What type of air filter is used in the OR?

High efficiency particulate air filter (HEPA)

What should the temperature be in the OR?

68.8-74.8

What range should the humidity be in the OR?

20-60%

What type of air flow is in the OR?

Laminar airflow that is unidirectional

What type of pressure is used in the OR?

Positive pressure

What is the physical layout of a typical OR department? Why?

Ractrack and to keep dirty and clean areas seperate

What is proper OR attire?

hair cover, shoecover, hospital scrubs

What are the piped in systems and electrical outlets in the OR?

Outlets for air are green, black, yellow and blue. Electrical outlets that stay on in emergencies are red.

What is laminar airflow and explain the ventilation system within the or?

pushes airway from OR table and up into vents. Keeps pressure higher in OR

What are risk factors of ionizing radiation?

potentional development of bone, thyroid and gonadal cancers, cataracts, spontaneous abortions

What are the types of ionizing radiation in the OR?

portable x-ray machine, mini c-arm, c-arm

What are the three most important factors of prevention of physical radiation?

time: fluorscopy should be turned off when not being used

distance: stand atleast six feet away

shielding: lead apron, thyroid shield/screen

What are the three components that have to be present for combustion?

ignition source, fuel, oxygen

What are some ignition sources in the OR?

electrocautery, laser, fiberoptic light source, high speed burrs/drills, difibriliater

What are oxidizer sources in the OR?

oxygen, nitrous oxide

What are fuel sources located in the OR?

alcohol skin preps, drapes/gowns, guaze/spomges, patients hair and skin, endotracheal tube

What is the class a fire extinguisher used for?

wood, paper, textiles. is pressurized water. turns to ash

What is the class b fire extinguisher used for?

flammable liquids, oils and gas. Is made of carbon dioxide or dry chemicals

what is the class c fire extinguisher used for?

electrical or laser fires. made of halon

What are the three main concerns during a fire?

protect the patient, contain the fire, move the anesthesia equipment as far away as possible from fire

What should be used with lasers to prevent a fire?

non-reflective laser instruments, sterile water must be available, sponges and towels wet during procedure to prevent ignition, flame retard drapes, class c extinguisher

back injuries are usually a result of many factors except:

a. lifting with back bowed out

b. obesity

c. pushing heavy equipment

d. loss of strength and flexibility

c.pushing heavy equipment

what is not a physical hazard?

a. noise

b. fire

c. electricity

d. body fluids

d. body fluids

Which is not an ignition source?

a. bovie pencil

b. laser

c. oxygen

d. difibriliater

c. oxygen

What should you have on while in a procedure with lasers?

special googles, n-95

True or False- you should have reflective instruments when doing laser procedures

false

what percentage of healthcare workers are allergic to latex?

8-17%

what is type one latex allergy?

reaction occurs within a short time after exposure, hives, edema, respiratory arrest etc

what is type 2 latex allergy?

less serious, more common, localized reaction by contact dermatitis and irritant dermatitis, skin reaction, red, raw cracking, rash appears 6-48 hours after contact.

What should happen if the patient has an allergy to latex?

pt chart must be marked signifying the allergy and they wear a red ID bracelet

where does surgical plume come from?

cauterized or coagulated tissue

how many micrometers of particles should a laser mask filter out?

0.1 to 0.3 micrometers

what device is most effective for removing surgical plume?

smoke evacuation devices

what can happen when chronic exposure to chemical hazards occur?

cancer, hepatic and renal complications, nerve and brain damage, spontaneous abortion

What is polymethyl methacrylate (PMMA)?

chemical compound composed of a mixture of liquid and powder (bone cement)

What is formalin?

used to preserve specimens being sent to pathology

what is formalin known to be?

a mutagen, carcinagen and toxic to liver

What is the encompassing term that refers to all types of emergencies?

all hazards

What is the national incident management system?

NIMS proides national model for coordinating emergency response from government, pubic health sector, private agencies to any type and size of disaster

What is the local emergency management agency (LEMA)?

community agency responsible for coordinating local agencies to and emergency

What is the incident command center (ICS)?

management system set up by LEMA to coordinate the response to a distaster and make sure all responders know their roles and duties

What is the federal emergency management agency (FEMA)?

lead agency during a nationally declared emergency, provides food, treatment and shelter

What is the National Response Framework (NRF)?

guide for coordinating disaster relief activities

What is the National Disaster Medical System (NDMS)?

responsible for sending medical equipment and supplies to disaster scene

What is the Disaster Medical Assistance Teams (DMATS)?

a specialty team within NDMS and theyre sent to rapidly deploy to emergency scene to help hospitals. CSTS can be apart of this team

What is the Disaster Mortuary Operations Respose Team (DMORT)?

a specialty team within NDMS and they are medical examiners, pathologists, radiographers and dental assistants to identigy victims

What is the National Pharmacy Response Team (NPRTS)?

a specialty within NDMS and is pharmacists and techs to dispense drugs and vaccinations

What is the component of a emergency action plan (EAP)?

mitigation: identification of hazards and plan to prevent emergencies

Prepardness: development of an eap and eoc

Recovery: activities performed to restore community in bacl to normal as possible

What is a hot zone?

central area where disasters occurred, assessed quickly for airway patency and severe hemmorrhage

What is a warm zone?

Triage area 300 feet or more from hot zone, patients quickly traged into one of the fou DIME categories

What is DIME?

delayed, intermediate, minimal and expectant

What is a cold zone?

near warm zone, patients are evaluated for injuries secondary to severe and transported to a healthcare facility

What is a green tag?

walking wounded, minor injuries, physiologically stable and will remain so

What is a yellow tag?

Delayed, bleedin has been treated and controlled, airway is patent, patient is physiologically stable, injuries may be serious but transport can be delayed

What is a red tag?

immediate, quick, short treatment intervention can stabilize patients, treat bleeding, treatment must be given during the “golden hour” for patient to survive

What is a black tag?

expectant, injuries are so extensive pt will not survive

What are indications of emergency situations?

chest pain, difficulty breathing, change in skin color and vital signs, rapid hemorrhageing. etc

What are the objectives in emergency situations?

preserve life, prevent further deterioration of patient condition, provide whatever care necessary to restore patient to previous lifestyle

what is the first priority in emergancy situations?

maintaining airway

what is the second priority in emergancy situations?

cardiopulmoary status

Amount of time before cells in brain begin to deteriorate during cardio pulmonary resuscitation

4-6 minutes

What are signs of cardiac arrest?

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

What is CAB in resusciation?

C- compressions

A- airway

B- breathing

What is the CSTs role during a cardiac arrest in the OR?

protect the sterile field, keep track of counted items, assist as necessary

How deep should compressions bed?

2 inches

When should HCPS switch when giving compressions?

every 2 minutes or after five cycles

Where should the bump be placed when a pregnant patient is in cardiac arrest?

under right hip tilting abdomen left

What causes aortic compressions in pregnant patients?

gravid uterus by left lateral uterine displacement

What are the two priorities during an emergancy situation?

airway, cardiopulmonary status

What are signs of cardiac arrest?

chest pains, skin color, vitals

Who provides chest compressions during cardiac arrest in the surgical setting?

surgeon, PA

What is malignant hypothermia (MH)?

life threatening acute disorder, gentically inherited, usually triggered by an anesthetic agent (halothane, enflurane, or isoflurane. Also triggered by muscle relaxants such as succinylcholine

How can maligant hyperthermia be diagnosed before surgery?

muscle biopsy

what is the first sign of maligant hyperthermia?

tachycardia

What is ended immediately after malignant hyperthermia occurs?

discontinue of anesthetic gases and oxygenate patient to 100%

What is given to patient during a maligant hyperthermia situation?

dantrolene is mixed with sterile water and administered

How is the body cooled during maligant hyperthermia?

chilled saline lavage of the body cavities, patient packed with ice along heat transfer points (axilla, base of skull,groin area