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Chem and Physics llb
Laser
| Question | Answer |
|---|---|
| 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 |
Created by:
eonaodow
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