Laser
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| What is a laser | A laser is a device that controls the way that energized atoms release protons.
🗑
|
||||
| What is the acronyms for laser | Light amplification by Stimulated Emission of Radiation
🗑
|
||||
| Laser-light | Laser light - very different from normal light. Laser light has other properties.
🗑
|
||||
| Monochromatic light | It contains one specific wavelength of light ( one specific color). The wavelength of light is determined by the amount of energy released when the election drops to a lower orbit.
🗑
|
||||
| Coherent light | It is "organized" --- each photon moves in step with the others. This means that all of the photons have wave fronts that launch in unison
🗑
|
||||
| Directional light | A laser light has a very tight beam and is very strong and concentrated. A flashlight is contrast releases light I'm many directions, the light is very weak and diffused.
🗑
|
||||
| Energy emitted as photon (1) or | absorbed by O2 (2)
🗑
|
||||
| Do you need protective eyewear when laser light are in use | yes. and they have to be laser protective eyewear.
🗑
|
||||
| Do you look into a laser with remaining eye | NO. do not look into laser with remaining eye.
🗑
|
||||
| Medical lasers | Carbon dioxide, Nd-Yang, KTP and Argon laser.
🗑
|
||||
| Carbon Dioxide laser | this laser is invisible ( marked w/helium-neon aiming beam.) Widely used for upper airway surgery
🗑
|
||||
| ND-Yang laser | Neodymium-yttrium aluminum-garnet laser. this is a short wavelength allows transmission by fiber optics. Used on distal tracheobronchial tree and retina surgery.
🗑
|
||||
| KTP laser- | Potassium-titanylphosphate laser. Can be transmitted by fiber optics. Used in neurosurgical and otolaryngeal surgeries
🗑
|
||||
| Argon Laser | Can be transmitted by fribroptics. useful in neurological, retinal and otolaryngological procedures.
🗑
|
||||
| Laser wavelength to power | The longer the wave length the lower the energy. and the shorter the wave length, the higher the energy
🗑
|
||||
| Long wave length | low frequency, and low energy
🗑
|
||||
| Short wave length | High frequency and high energy
🗑
|
||||
| Short wave length , high frequency and high energy | Argon ( blue/green), KTP green
🗑
|
||||
| Longer wave length, low frequency and low energy | Dye laser ( Red), Nd:YAG (infra red) CO2 (far infrared) and He-Ne (red)
🗑
|
||||
| CO2 Laser | Longer wavelength = low frequency =lower energy.
Greater wavelength =greater absorption by water
Co2( Far infrared) - Relatively weak laser works on superficial tissues
🗑
|
||||
| Nd-YAG | Shorter wavelength = Higher frequency = higher energy.
Nd-YAG- Powerful laser. Coagulates and necrosis deeper tissues
🗑
|
||||
| Laser Surgeries of airway | Lasers are frequently used for airway surgery including:
-laryngeal papillomas
-tracheal scaring
-vascular malformations
-neoplasms
-idiopathic subglottic stenosis
🗑
|
||||
| Associated risks | loss of airway
fire
burns
eye damage
🗑
|
||||
| Preoperative preparation | Antisialagogue
Eye protections for OR personnel and patient
Laser tube or ETT wrapped with laser tape
🗑
|
||||
| Airway concerns | shared airway surgeon and anesthetist
Airway obstruction
foreign body
Airway edema
Obstructive mass/less
🗑
|
||||
| Induction | Know airway patency!
RSI vs smooth iv or mask induction
-sevo? irritable airway
OSA?
-Unique concerns
🗑
|
||||
| Obstructive sleep apnea | Floppy upper airways
Redundant fat deposits lateral pharyngeal wall
Sleep and Anesthesia = increased pharyngeal musculature relaxation and posterior tongue displacement
Airway narrowing d/t startling resistor mode and Bernoulli effect
🗑
|
||||
| Considerations with OSA | Denitrogeneat and hyperoxygenate
Head of bed up
Aware of pharyneal relaxing agents
Sedatives, inductions agensts (propofol), VAAs, NMBA ( including low level residual effects)
Intubation technique back ups
🗑
|
||||
| Maintenance of OSA | Prevent loss of airway
Shared airway :
-Keep in close communication with surgeon
-Closely monitor breath sounds and EtCo2
🗑
|
||||
| Prevent Burn injury | Be aware of when laser are in use
Do not look into laser
Confirm laser in standby mode when not in use
-Aiming beam vs power beam
Do not allow laser to lay on drapes
🗑
|
||||
| Prevent eye injury | Yours and the patient's
-Lube pt eyes and tape shut
Saline soaked eye pads to pt
Laser goggles, not glassess on patient
Appropriate laser glassess on all OR personnel
Do not look into laser
🗑
|
||||
| Prevent inhalation injury | Your and the patient's
-Continually assess integrity of cuff
-Do not breath laser plume
-carcinogenic, toxic and contagious
🗑
|
||||
| Maintenance - anesthetic | General anesthesia
-VAA (sevo) or TVA
-FiO2 40% or less. 21 % preferable
-Avoid N2O- it supports combustion
-Complete neuromuscular blockade
-routine monitoring
---Precordial stethoscope?
-Bottle saline/water immediately available
🗑
|
||||
| Maintenance in regards to laser | Use "Laser" or protected endotracheal tube
use laser tubes specific for laser use
or wrap endotracheal tube in laser foil
use smallest allowable tube for surgical exposure and ventilation
usually 5.5 - 6.5 mm tube
fill ET tube cuff with saline (dye?)
🗑
|
||||
| In case of airway fire what to you do? | in case of fire
Be prepared to Extinguish and treat
Be prepared to emergently extubate patient in case of airway fire
🗑
|
||||
| If there is airway fire what to you do | Immdediately stop all gas flow, cut pilot tube and extubate pt
Extinguish with water and saline
Re-intubate pt, ventilate with air only until no remaining fire confirmed.
Ventilate with 100% oxygen
Assess (DL & FOB) larynx, trachea bronchiole tree for
🗑
|
||||
| What are oxidizer | N2O and oxygen
🗑
|
||||
| Ignition source | boviies
🗑
|
||||
| Fuels | drapes, ETT, oxygen tubing
🗑
|
||||
| In case of airway fire and you have extinguish the fire what do you do | Assess larynx, trachea, bronchiole tree for damagegive
give corticosteroids to decrease inflammation,
give antibiotics for infections
continued intubation/ventilation
🗑
|
||||
| Extubation | Surgeon may request "deep " extubation
Aireway blood may remain despite suctioning and laryngospasm
Be sure any saline pledgets and throat packs have been removed by surgeon
🗑
|
||||
| Postoperative | Laryngospasm risk due to irritation or remaining blood
Observe for stridor, excessive coughing, and or bronchospasm
intervene quickly
🗑
|
||||
| Laryngospasm | Caused by vocal cord irritation
Cricothroid muscle spasm
Treatment: CPAP bymask. Attemp positive pressure ventilation <20 cm H2O.
Jaw thrust at angle of Ramus-accupressure point
succinylcholine if needed
🗑
|
||||
| What does cricothyroid muscle do? | It increases the tension on the cord
🗑
|
||||
| Is the cricothyroid muscle the primary muscle responsible for laryngeal spasm? | Yes
🗑
|
||||
| What are the two most common reasons why one will have difficulty ventilating | Obstructions and Laryngeal spasm
🗑
|
||||
| If you are able to move air but not sufficient enough what should be your next move | Place an LMA
🗑
|
||||
| How much suc should you give for laryngospasm | 10 to 20 mg iv
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
eonaodow
Popular Nursing sets