Hemostasis, Emergency Situations, and Hazard Preparation Chapter 8 (Nicola)

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1

From oneself

autologous

2

What refers to any type of abnormal heart rhythm

cardiac dysrhythmias

3

What is the act of manually providing chest compressions and ventilations to patients in cardiac arrest in an effort to provide oxygenated blood to the brain and vital organs, and reverse the processes that lead to death

cardiopulmonary resuscitation (CPR)

4

Compress

To apply pressure

5

What is the destruction of erythrocytes

hemolysis

6

What is the arrest of the escape of blood through natural or artificial means

hemostasis

7

What is a device or agent used as a coagulant

hemostat

8

What is it called if you are from the same species

homologous

9

Abnormally high body temperature

hyperthermia

10

What is a genetically determined blood group antigen that is present on the surface of erythrocytes of some individuals; if the antigen is present the individual is Rh1 (positive) and if absent Rh– (negative)

Rh (Rhesus) factor

11

What is the act of sucking up air or fluids through a device, such as a tonsil suction tip

suction

12

When does the body use the process of coagulation
to achieve

hemostasis. As soon as a vessel is injured, a period of vasoconstriction begins, in which the muscular walls of the vessel constrict to help slow the flow of blood

13

What is the most common congenital hemostatic defect that manifests itself as a clotting deficiency.

Hemophilia
Preoperative testing is useful in determining whether these conditions exist.

14

Patients may be requested not to take ...... for 1 week prior to surgery because of its anticoagulant properties.

aspirin

15

hemostasis can be achieved with the use of several types of devices to control bleeding until a clot forms

Mechanical Methods

16

What are used to compress the walls of vessels and to grasp tissue

clamps

17

What is the most commonly used clamp

Hemostat - curved and straight jaws

18

What are strands of suture material (or ties, referred to as “stick ties” when a needle is attached), used to tie off blood vessels.

Ligatures

19

What are made of either natural or synthetic material and are designed either to dissolve over a period of time or to remain in the body tissue permanently

Ligatures

20

What are often used in place of suture ligatures when many small vessels need to be ligated in a short period of time.

Ligating clips

21

What are made of a nonreactive metal, such as titanium or stainless steel, or plastic material and come in various sizes as well as absorbable or permanent varieties. They are applied either from a manually loaded applicator or from any of several preloaded disposable applicators.

Clips

22

What are used to apply pressure on bleeding areas or vessels and to absorb excess blood or body fluids

Sponges

23

What are 4 × 4’s (the size of the sponge)

Sponges (Raytec)

24

What is also referred to as lap sponges or “tape” sponges due to the radiopaque strand or tape that hangs from the sponge.

Sponges (Laparotomy Sponges)

25

What is a round sponge

Sponges (Tonsil)

26

What are cottonoids, are smaller compressed radiopaque sponges used for neurosurgical procedures.

Sponges (Patties)

27

What are dissecting sponges, which consist of small pieces of tightly rolled gauze

Sponges (Kitners and peanuts)

28

What is used when bleeding occurs through needle holes in vessel anastomosis, small squares of Teflon are used as buttresses over the suture line. Using suture, these are sewn over the hole in the vessel and exert outside pressure over the small needle holes to prevent bleeding and promote clotting. These are often used in peripheral vascular and cardiovascular surgery.

Pledgets
Not counted - stay in the patient

29

What is made of refined and sterilized beeswax, is used on cut edges of bone as a mechanical barrier to seal off oozing blood

Bone Wax

30

What is used for intraoperative aspiration of blood and body fluids by mechanical means to keep the surgical site clear

Suction

31

What are used postoperatively to remove blood and body fluids from the operative site to prevent edema and hematoma formation, and aid in removing air in order to prevent dead spaces within the surgical wound.

Drains

32

The application of external pressure to a vessel,
as with the use of a tourniquet, occludes the flow of blood until a clot has time to form.

Pressure Device (Stockings)

33

What may be used to prevent venous stasis and deep venous thrombosis

Prophylactically, pressure devices, such as sequential stockings,

34

What are often used on extremities to keep the operative site free of blood. The provision of a bloodless field makes visualization easier and reduces the operative time. Bleeding must be controlled prior to removal , however, because the use alone does not achieve hemostasis

Tourniquets

35

What is the maximum time a Tourniquets can be used in surgery to keep the operative site free of blood.

120 mins max - downtime of 10 mins

36

What is the most common means of obtaining hemostasis during a surgical procedure

Thermal Hemostasis

37

What is the most commonly used thermal hemostatic device. The components are the active electrode or Bovie pencil, electrosurgical or generator unit (ESU), and inactive or dispersive electrode, also called the grounding pad

Electrosurgery

38

What provides an intense and concentrated beam of light that is able to cut and coagulate tissue at the same time with very little surrounding tissue destruction.

Laser

39

What involves the use of argon gas in combination with monopolar electrical energy in the form of a noncontact, white light beam. It provides rapid hemostasis that travels from a generator to a pencil-like hand-piece. There is little to no tissue adherence since the hand piece does not come in direct contact with the tissue that is bleeding. There is less charring of the tissue compared to the ESU.

Argon Plasma Coagulation

40

What consists of a single-use titanium blade attached to a hand piece and a portable generator that cuts and coagulates tissue.

Ultrasonic (Harmonic) Scalpel

41

What is a medical device, intended for application to bleeding surfaces as a hemostatic

Absorbable gelatin (Gelfoam®)
Pharmacological Agents

42

What pharmacological agent accelerates clot formation by enhancing platelet aggregation and the release of proteins to form fibrin, resulting in hemostasis.

Collagen (Avitene®)
Pharmacological Agents

43

What pharmacological agent are absorbable hemostats are composed of oxidized regenerated cellulose and are sterile, absorbable knitted fabrics that are flexible and adhere readily to bleeding surfaces

Oxidized cellulose (Nu-Knit®; Surgi-Cel®)
Pharmacological Agents

44

What pharmacological agent is used as a cauterizing agent, and is also used to cauterize superficial blood vessels in the nose to help prevent nose bleeds. Can also help with shaving cuts.

Silver nitrate
Pharmacological Agents

45

What pharmacological agent acts as a vasoconstrictor, antispasmodic, and sympathomimetic, and it is used as an emergency heart stimulant as well as to relieve symptoms in allergic conditions such as urticaria (hives), asthma and anaphylactic shock

Epinephrine
Pharmacological Agents

46

What pharmacological agent activates platelets and catalyzes the conversion of fibrinogen to fibrin, which are the steps that are essential for blood clot formation.

Thrombin
Pharmacological Agents

47

What is monitored by several means intraoperative to aid the surgeon and anesthesia provider

Blood loss

48

What are used between the suction tubing and the vacuum source to collect and monitor the amount of blood and body fluids suctioned from the field.

Calibrated suction devices (canisters)

49

Who should keep close track of the amount of irrigation fluids used; the amount of irrigation fluid used is subtracted from the total volume of fluid in the canister to give a more accurate measurement of blood loss.

The surgical technologist

50

What does the circulator do to keep track of blood loss?

Weigh bloody sponges

51

What involves the administration of whole blood or blood components such as plasma, packed red blood cells, or platelets via an intravenous (IV) line. This is used to increase the circulating blood volume, to increase the number of red blood cells, and to provide plasma-clotting factors.

Blood replacement

52

What do we call a blood product from the same species

homologous

53

What do we call a blood product from oneself

autologous

54

What do we call a blood product that is the patient’s own blood, which has been processed for reinfusion.

auto transfusion

55

What is important when using homologous banks to prevent transfusion reactions.

blood typing and cross-matching

56

What are the four main blood types

A, B, O, and AB
Due to these factors, blood is carefully typed and cross-matched prior to being administered.

57

If you have group O blood who can you donate blood to, and receive blood from

Universal donor

Can only receive blood from O

58

If you have group A blood who can you donate blood to and receive blood from

Can donate red blood cells to A's and AB's

Can only receive blood from O and A

59

If you have group B blood who can you donate blood to and receive blood from

Can donate red blood cells to B's and AB's

Can only receive blood from O and B

60

If you have group AB blood who can you donate blood to and receive blood from

Can donate to AB's but can receive from all others

Can receive blood from O, A, B, and AB

61

What is a genetically determined blood group antigen that is present on the surface of erythrocytes of some individuals; if the antigen is present the individual is Rh1 (positive) and if absent Rh– (negative)

Rh (Rhesus) factor

62

What could happen if blood given to an Rh-negative individual is Rh positive, .............occurs, leading to anemia

hemolysis

63

what should happen if the blood replacement products are not to be used immediately,

Stored in arefrigerator at a temperature between 1° and 6°C (33.8°–42.8°F).

64

How many individuals should perform the identification of blood replacement products. Qualified individuals are the surgical technologist, registered nurse, surgeon, and anesthesia provider.

two individuals

65

Which system may not be used if blood that has been exposed to collagen hemostatic agents and certain antibiotics cannot be used with these devices, as blood may coagulate in the system. If the procedure involves blood exposed to gastric or enteric contents or amniotic fluid, it may not be salvaged, and blood may not be used when the patient has a known local or systemic infection

Auto transfusion via a cell saver or cell salvager machine

66

What may develop if blood is not properly matched including Rh factor prior to transfusion

hemolytic transfusion reaction

67

What may be fatal and must be treated immediately.

Severe hemolytic reactions

68

If the patient is conscious and starts to exhibit fatigue and complain of lack of energy, rapid pulse, shortness of breath, pounding of the heart, skin appearing jaundiced and pallor, especially in the palms of the hands they may be suffering from

Symptoms of Hemolytic Reactions

69

What refers to any type of abnormal heart rhythm

cardiac dysrhythmia

70

Prior to surgery, the surgeon or anesthesia provider should be notified immediately if any of these indicators of an emergency situation arise:

Difficulty breathing
Chest pain
Changes in skin color
Changes in vital signs
Open bleeding wounds or visible punctures not indicated on the patient’s chart
Inability to move an extremity
Misshapen/misaligned body part
Disorientation or confusion

71

The first priority in any emergency situation is to check for and provide a patent

airway to ensure or restore respiratory status and breathing

72

The second priority in any emergency situation is to check ............. it should be maintained or restored and hemostasis should be provided to maintain circulatory status

cardiovascular status

73

After the 1st & 2nd priorities in any emergency situation is taken care of these items should be next ......

Chest injuries
Shock
Wound protection/closure
Fractures
Vital sign monitoring
Provision of reassurance and comfort for the patient

74

What concept applied to both in-hospital and out-of-hospital arrests addresses the ABCs—airway, breathing, and circulation—as well as providing the “D,” definitive treatment. Successful resuscitation requires

A chain-of-survival

75

What is to be applied to CPR. The recommendation is at least 100 compressions per minute. The depth of compression for adults has changed from a depth of 1½ inches to 2 inches to a consistent depth of 2 inches

The new concept of “push hard, push fast”

76

The surgical tech must protect the sterile field from contamination during which emergency in the OR

resuscitation from cardiac arrest

77

What is a pathological process in the body that occurs when blood begins to coagulate within the body.

Disseminated intravascular coagulation (DIC)

78

What can cause Disseminated intravascular coagulation (DIC)

•Infection of the blood by bacteria or fungus
•Severe tissue trauma, e.g., head injury, shock, or burns
•Leukemia or cancer
•Severe liver disease
•Recent blood transfusion reactions
•Obstetric complications

79

What is an important symptom of an anaphylactic reactions

Hives or urticaria may be present on the skin with severe itching

80

What would cause the patient to die of respiratory failure if his airway was not protected, along with the symptoms of vascular collapse and shock to prevent death from cardiovascular failure.

Anaphylactic reaction (shock)

81

What is the first-line drug in the treatment of a severe anaphylactic reaction. Causes bronchodilation, reduces laryngeal spasm, and raises blood pressure.

Epinephrine

82

What is an all-encompassing term that refers to the many different emergencies

all-hazards preparation

83

What are defined as those that require the emergency response of outside assistance, which may be at the local, county, state, or federal levels.

Emergencies

84

What provides a template for generalized training and emergency preparation that can be applied to all disaster situations rather than training that is focused on a limited number of local or regional types of emergencies.

the term “all-hazards preparation” is used

85

What is the most common type of disaster?

Natural disasters

86

What is the term for the number in degrees Fahrenheit that tells you how hot it feels when relative humidity is added to the air temperature. Exposure to full sunshine can increase the heat index by 15 degrees F

Heat index

87

What are muscular pains and spasms due to activity; often first sign/reaction by the body to the heat.

Heat cramps

88

What is a result of exercising or working for a period of time in a hot, humid place and body fluids are lost at a great rate through sweating without replacement.

Heat exhaustion

89

What is a life-threatening condition where the patient’s internal temperature control system stops working. The body temperature can rapidly increase, causing neurological damage as well as leading to death if not immediately treated

Heat stroke

90

One of the more powerful natural disasters are ........... that produce an incredible amount of energy when two portions of the earth’s crust slide by one another

earthquakes

91

What can be created by a serious earthquake or by the underwater eruption of a volcano

Tsunamis

92

What can cause respiratory complications and damage the lungs as well as cause serious burns after a natural disaster

volcanic ash

93

Tropical storms can lead to hurricanes; a storm is officially classified as a hurricane when the sustained wind speed is

74 mph

94

What type of agent is a “Blister agents,” commonly known as mustard gas.

Vesicants

95

What type of agent is the most toxic of known chemical agents; often cause death in minutes due to respiratory obstruction and cardiac failure.

Nerve agent

96

What are these symptoms relating to Rhinorrhea, extreme difficulty breathing, apnea, seizure, paralysis, loss of consciousness

Nerve agent symptoms

97

What are these symptoms relating to Skin blisters and burning of the skin and eyes, airway injury causing difficulty in breathing, conjunctivitis that varies in severity

Vesicants symptoms

98

What is the most common agents are phosgene and diphosgene. Cause severe irritation of the upper and lower respiratory tracts.

Choking agents

99

What are these symptoms relating to Pulmonary edema; eye, nose, and throat irritations; choking; coughing; tightness in the chest; development of fatal pulmonary edema during 2- to 24-hour period

Choking agents symptoms

100

What term refers to the intentional use of infectious agents, or germs, to cause illness

Bioterrorism

101

Which six diseases has the CDC identified as the highest risk to nations

Botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers

102

Which two diseases did the CDC identified as the two most likely biological agents to be uses as bioweapons

Anthrax and smallpox

103

Who provides a national model for coordinating the emergency response of governments, public health sector, private agencies, and nongovernmental organizations to any type and size of disaster.

National Incident Management System (NIMS)

104

What is the name of the Community agency that has the lead management and coordinating authority in response to an emergency

Local Emergency Management Agency (LEMA)

105

What is the name of the management system set up by LEMA to coordinate the response to a disaster; ensures all responders know their roles and duties, and whom to report to

Incident Command System (ICS)

106

Who is a division of the U.S. Department of Homeland Security (DHS) and is the lead federal agency during a nationally declared emergency and coordinates providing treatment to victims and food and shelter at the emergency scene.

Federal Emergency Management Agency (FEMA)

107

What system is responsible for sending medical equipment, supplies, and teams to the disaster scene. Also assists with the transportation needs (e.g., transport injured and sick patients to hospitals).

National Disaster Medical System (NDMS)

108

Who requires health care facilities to practice their EAP at least twice a year, and to have an Emergency Action Plan (EAP) in place

The Joint Commission

109

What mirrors the local ICS; it has a chain of command that specifies the roles of HCPs

Hospital Incident Command System (HICS)

110

The ........... should include memorandums of understanding (MOUs) that are agreements with other health care facilities to receive patients during an evacuation situation

EAP Emergency Action Plan

111

What is the process of sorting victims according to their injuries and physiological status in order to maximize the medical resources that are available

Triage

112

Surgical technologists may complete training in performing triage and/or serve in support roles such as providing ......

BLS/CPR, first aid treatment, and transporting patients.

113

•The individual performing the triage of patients should follow some basic guidelines

•She or he does not provide patient care
•Assessment take no longer than 1 minute
•Patients will need to be constantly reassessed
•The triage person will have difficult decisions to make

114

What is a popular system of triage

“Simple Triage and Rapid Treatment” (START)

115

What four categories in which to place patients does START use

DIME (Delayed, Immediate, Minimal, Expectant).

116

What color tag is
•“Walking wounded”
•Minor injuries—sprains, minor cuts
•Self-care
•Physiologically stable and will remain so

Minor—Green Tag

117

What color tag is
•Airway is patent
•Bleeding has been treated and controlled
•Patient is physiologically stable
•Injuries may be serious, but transport can be delayed

Delayed—Yellow Tag

118

What color tag is
•Quick, short immediate treatment intervention can stabilize the patient, such as establishing an airway and treating bleeding
•Treatment must be given during the “golden hour”
•Once stabilized, the patient may be re-categorized to delayed depending on extent of injuries; if it involves head or spine injury, penetrating wound, or fracture(s), patient should be transported as soon as possible

Immediate—Red Tag

119

What color tag is
•Injuries are so extensive patient is not expected to survive; use of medical resources is not advisable in order to use for the other three categories of patients
•Victim is made as comfortable as possible and pain relief given

Expectant—Black Tag

120

Which type of triage of chemical and nuclear disaster is a central area where the disaster occurred. Level A PPE should be worn. Patient is quickly assessed for airway patency and severe hemorrhage

Hot zone

121

Which type of triage of chemical and nuclear disaster is a zone where patients are quickly triaged into the four categories.

Warm zone

122

Which type of triage of chemical and nuclear disaster is a zone where patients are evaluated for injuries secondary to severe injuries and transported to a facility

Cold zone

123

What is a temporary site for providing vaccines and medicines to a large population, called mass prophylaxis.

Point of Distribution (POD)

124

What is the name for the storage of medications and vaccines that are divided into push packs; push packs are containers with the medications and vaccines that can be quickly shipped to the disaster scene

Strategic National Stockpile (SNS)

125

What is the name of the system to pre-register health professional volunteers who can respond to an emergency within their state and out of state

Emergency System for the Advanced Registration of Volunteer Health Professionals (ESAR-VHP)

126

What is the name for local emergency teams that can provide preparation and basic response such as fire safety, basic first aid, and search and rescue.

Community Emergency Response Team (CERT)