ch 4/5 delmar

a method of monitoring blood oxygenation levels

a disease such as rheumatoid arthritis that attacks the bodys own tissue

the venous BP within the right atrium, indicating the efficiency of blood leaving the heart

disorder of th endocrine system that affects the production of insulin in the pancreas; either type one or type two

inflammation of small intestine and colon

concept that medical treatment of a trauma victim with in the first hour following injury improves patient outcomes

the virus that causes aquired immune dificiency

abnormally low body temp., typically defined as a core body temp that is below 35 degrees F

degree of function of an immune system thatis designed to keep a pt. from infection by pathogens

a method of ECG monitoring in which intra-arterial catheter is inserted directly into the artery

a cancer that produces painful external and internal lesions

an attempt to undestand the mechanism of injuy and the action and effect of a particular type of force on human body

an excess of bilirubin in the blood

a foriegn object that passes through tissue, such as a bullet of knife

abnormal accumulation of air in pleural cavity

a scoring system used to assess the severity of a traumatic wound and to determine the condition of a pt.

a state of shockproduced by septicemia, when the body is over whelmed by the pathogenic microorganisms and cannot adequately fight the infection

removal of the spleen

abnormal enlargement of the spleen

an abnormal contracted state of a muscle(s)

an amount of urine collected and measured from a pt. over a given amount of tme; indicator of kidney function

used for pts. who are prone to the development of thrombophlebitis

transported or spread by airway; the surgical tech is primary concerned with airborne bacteria

large movable table that is covered with a sterile, drape for placement of sterile instruments, supplies, and equipment

room that typically contains sinks for gross contamination an ultrasonic washer and washer-sterilizer to decontaminate instruments and equipment

mechanical device which produces an electric current that is converted into thermal energy for the purpose of cutting/coagulating

four-wheeled stand that can be lined with biohazardous bag for the collection of linen or trash

capable of removing bacteia as small as 0.5-5 um; utilized in the OR to aid in preventig the pt. from aquiring a post-op wound

abnormally high body temp.

process by which energy either directly or indirectly iduces ionization of radiation-absorbing ateial or tissues; x-rays

the unidirectional positive pressure flow or air that captures microbe to be filtered

small portable stand with a tray on top that is coveed with a sterile drape and onwhich instruments, equipment, and supplies that are most frequently used for surgical procedure

a chemical compound composed of a mixture of liquid and powder used for cementing prostheses during total joint arthropastics

federal organization that is dedicated to protecting the health of workes by establishing standards

department responsible for testing and processing specimens, tissues, and body fluids to obtain a diagnosis

individual responsible for running and maintaining the cardiopulmonary bypass machine during open heart procedures

attire worn to protect against exposure to physical and biological hazards

smoke produced by laser or electrocautery that has been shown to contain biological material

area where immediate post-operative care of the pt. takes place before transfer to the hosp. room

prevention of a disease or condition

areas of an operating department that require proper OR attire, including the wearing of a mask

quidelines established by the OSHA and CDC and prevention to reduce risk of disease transmission from blood and body fluids

a wall or ceiling connection for suction device

an infection of the surgical wound that was aquired during the course ofthe surgical procedure

one of two processes by which static electricity can build; occurs by friction between 2 surfaces

• birth
• 12 years

• hyprvolemic--dehydration is common cause in infants
• septic--most common type seen in infants and children

reverse trendelenburg

2nd

• roll or wedge
• right hip

• rheumatoid arthritis
• organ transplant
• HIV pts.

spleen

restricted

• blue
• green
• yellow
• white
• black

• neonate- 1st 28 days
• infant- 1-18 months
• toddler- 18-30 months
• preschooler- 30months- 5 years
• school age- 6-12 years

• neonates and infants are easily startled
• feel anxiety due to separation from parents
• allow them to bring a favorite toy to surgery
• conduct a pre-op visit, introduce team
• allow parents with child in holding room and in PACU once stable
• fear of anesthesia
• be truthful
• allow child to hold mask

• temp.
• urine output
• cardiac function
• oxygenation

• little subcutaneous fat
• poor thermal insulation
• increased ratio of skin surface to body mass
• in the OR skin temp is primary means of monioring

• keeping infant's extremeties wrapped and covered
• raise temp of room to 80
• use of radiant heaters for children less than 2 years old

neonates and infants are not usually catheterized--high risk of trauma to small urethra

least used rute of central venous catheter placement--saphenous vein

standard for monitoring oxygenation--ABGs , pulse oximetry has taken the plce of ABGs

• due to invasion of microbes
• most common in pediatric pts.
• usually caused by gram negative bacteria
• sulfonamides, bactrim, hloromycetin,tetracycline are all antibiotics

• low blood volume
• dehydration is the most common cause in pediatrics
• must monitor fluid and electrolytes
• usually NPO less amount of time

• accidents are the #1 cause of death in children
• usually blunt trauma (head) in MVA
• first priority: open airway
• pneumothorax
• bleeding must be controlled to prevent hypovolemia
• birth trauma: most common fracture is clavicle
• dystocia

• body weight is 100 pounds over ideal weight
• physiological disease conditions:
• myocardial hypertrophy
• coronary artery disease
• hypertension
• varicose veins
• pulmonary function complications
• liver and gallbadder disease
• osteoarthritis
• diabetes mellitus
• arteriosclerosis

• affects the production of insulin in the pancreas
• origin is often genetic
• type I: insulin dependent
• type II: noninsulin dependent
• complications: infection, poor circulation, ulcers won't heal, foot and leg amputations, nephropathy, retinopathy
• positioning concerns
• use of glucometer
• antiembolitic stockings/SCQs

• emergencies: ectopic pregnancy, appendicitis, trauma, incompetent cervix
• avoid surgery in first trimester
• abdominal procedure best in 2nd trimester
• abdominal organs displaced
• anesthesia affects fetus
• use short acting drugs, avoid nitrous
• --prevent preterm labor!

• multiple sclerois
• lupus erythematosus
• rheumatoid arthritis

• positioning concerns , difficult intubation
• IV placement, ESU pad placement
• spenectomy due to splenomegly
• antineoplastic agents
• multiple lesions due to kaposi's sarcoma

• hearing ipairments: hearing aid is removed
• communicate with hand signals, sign language, written commads, don't yell
• visual: contacts and glasses are removed
• isolation pts: routes of transmission; vector
• basic fundamntals: hand washin and PPE
• pt. with TB: N-95 respirator must be fitted

• usually over 65
• skin prone to shearing
• increased BP
• increased rigidity of chest wall
• decreased bladder capacity
• visual impairments
• hearing impairments
• prone to hypothermia
• slow circulation

• "golden hour"
• trauma centers: level I-IV
• blunt trauma
• spleen is #1 organ injured in MVA
• penetrating trauma
• order priority: head, chest, abdomen, extremities

• violent crime items must be preserved for law enforcement (clothes, knife, bullet, etc)
• physical evidence must be handled carefully
• facility policy must be strictly followed
• cut clothes at seam--give to police
• hands bagged and taped
• bullets not handled with metal instruments
• chain of custody must be documented in writing and is a legal document

• avoid hypothermia
• puls-lavage to irrigate wound
• emergencies case cart ready
• anesthesia provider directs all moves and guards the head and neck
• may have multiple mayos and back tables
• have adequate suplly of sponges, suture, hemostatic agents on table especially abd.
• may not have time to do counts--must document with post-op X-ray

40%

preg. pt

ptl (pre term labor)

physicalogical response -- bradycardia

• abd. catastrophies
• internal hernia
• acute gastric distention

a series of ORs around a clean central core

• location: easy access to support dpts.
• limited traffic--often a distal location
• controlled traffic supplies
• access to necessary supplies
• seperation of clean and dirty work area to prevent SSI

ORs are situated along a central corridor

• ORs are grouped by specialty (neuro, ortho) with its own storage area.
• supply room: sterile packs not stored close to floor ceiling

dressing rooms and main desk: street cothes are allowed

• hallways and storage: OR attire is required, scrub suits, hats, shoe covers
• **separated by red line on floor

OR: OR attire is worn, including mask when opening supplies and during surgery

• 400-600 square feet --average size
• electrical outlets: 5 feet above floor
• suction outlets: at least 2, 1 for sterile field and 1 for anesthesia provider
• lights: not on tracks, sterile handle
• X-ray viewing box

• positive air pressure
• laminar air flow: unidirectional, up to 600 air exchanges per hour
• minimum of 20 air exchanges per hour
• HEPA filters
• OR temp: 65-75
• OR humidity between 50-55% to prevent static electricity and reduce microbial growth

• workroom located outside the OR:
• contains a sink, flash sterilizer, blanket and solution warmer
• located so the circulator and STSR can remove instruments from the flash sterilizer without carrying down hall

• preop holding area: where the pt waits before enteringthe OR. IVs are started
• PACU: located adjacent to OR where pt recovers from effects of aneshesia
• each cubicle has: BP cuff, suction, oxygen, EKG, pulse oximeter, emesis basin

• laboratory: provides lab valves
• radioloy: radiologic pt studies
• pathology: where specimens are sent
• enviornmental services: cleans OR
• sterile processing: reprocesses instruments

• physical: noise, ionizing radiation, eectricity, injury to body,fire, explosion
• biologic: laser/electrosurgical plume, pathogens, latex sensitivity, sharps injury

proper posture andgood body mechanics

• source of ignition: RED--lasers, esu, fiberoptics
• oxygen: GREEN
• fuel: YELLOW

• --Light Amplification by the Stimulated Emission of Radiation
• fire prevention is critial when using laser
• sterile water to wet towels around incision
• during oral surgery- flame resistant ET tube
• can't prep with flammable agent(alcohol)
• care around head & hair
• for anorectal surgery: water soaked sponge in rectum to prevent methane gas explosion

• eye safety
• use non-reflective insturments
• warning signs posted
• appropriate eye protection

• fiber optic beam of scopes not on drapes
• no extension cords or power stirps
• plug and unplug with the plug not the cord
• keep movement around head to a min.
• cotton blankets to prevent static electricity
• cover pts hair
• don't use towel clip to attach bovie pencil

• class A: water for wood, paper, textiles
• class B: dry chemical for flammable liquids and gas
• class C: halon for electrical and LASER fires
• in OR: protect pt, contain fire, move anestesia equipment--RACE
• **carbon deoxide--used on pts only

• follow manufacture's instructions
• use of 3 prong ground plug
• static electricity
• prevent friction between 2 surfaces
• avoid rubbing drapes together

• x-rays, c-arm fluroscopy
• lead lined gloves, lead aprons, lead sheilds, thyroid collar and glasses
• protect the pt and surgical team
• 3 most important factors: time, distance, shielding
• use of film badge
• lead aprons should be laid flt or hung on racks to avoid cracks
• floroscopy turned off when not in use

• standard precautions: bood and body fluids
• wear gloves at all times
• sharp injuries
• use of PPE
• neutral zone
• never recap needles
• use on handed tech.
• sharps in central location and in same place
• sharps container
• bloody sponges in red biohazard bags

• post exposure prophylaxis
• sharps injury in OR:
• remove glove to inspect
• wash area with soap and water
• flush with water if exposure to eye,oral,nasal
• report
• evaluate pt and worker

• target tissue can become aerosolized
• wear special laser mask and eye protection
• use of smoke evacuator
• care when changing filiter
• position the evacuation tip within 1 cm of tissue
• 98% of plume is captured

• 2 types:
• type I- most serious
• type IV-is less serious and more localized
• individuals at risk include health care workers, pts who have had multiple surgeries.
• schedule first case of the day
• label chart and wear special bracelet
• no cure or desnsitization

• MSDS
• waste anesthetic gases: scavenging system
• polymethyl methacrylate (PMMA) bone cement using self contained evacuation system
• formalin: preservative for specimens
• use in well ventilated area with mast and glove
• EtO: gas sterilization
• cidex: liquid disinfectant
• keep in covered container