Dispersive electrode: grounding pad applied to the patient that directs current flow from the patient back to the power unit h. Coagulation clotting of blood i. Carbonization same as fourthdegree burn; it occurs when the temp of the electrode tip exceeds 200 degrees Celsius j. Alternate site burn: patient burn at a site other than the target tissue 1. closed path where current flows- F(CirCLlit). 2. removal and destruction of tissue by erosion or vaporization = B (ablation)… 3. same as fourthdegree burn; it occurs when the temp of the electrode tip exce ds 200 degrees Celsius (Carbonization) 4. person who is knowledgeable in laser safety and use A Laser Safety Officer) 5. total effect of laser energy, which depends on the energy density of the laser beam, diamerter of the beam and exposure time = D(Radiant exposure) 6. an instrument or a device used in surgery to deliver concentrated electrical cu rrent to tissue (Active electrode). 7. highvoltage superficial tissue coagulation; the electrode does not touch the tis sue; aka spray coagulation C(Fulguration) 8. clotting of blood = H (coagulation). 9. rounding pad applied to the patient that directs current flow from the patie nt back to the power unit G(dispersive electrode) 10. patient burn at a site other than the target tissue J(Alternate site burn). case I The laser beam can injure tissue other than the site being treated. The laser s hould not be turned on until the surgeon is ready to start and turned off as soon as the procedur e is over. Areas near the site being treated should be cornered with wet towels to prevent accident al burns. The wet cloth absorbs the laser energy. Flammable paper drapes should not be near t e operating field. This material can be Set on fire by the laser. All instruments should be anodiz ed to prevent injuries to the patient.
Patient’s eyes should be protected at all times. Case 2 Monopolar electrosurgery – use of radio frequency current to cut tissue and c ontrol bleeding – has been employed for over 65 years. Most widely used cutting and coagulati on technique in minimally invasive surgery. Highly versatile, cost effective, and popular, mono polar laparoscopic electrosurgery can compromise patient safety under some circu mstances. The surgeon may burn nontargeted internal organs or tissue with the tip of the el ectrode through imprecise mechanical operation of an instrument.
Stray electrical currents em anating from the laparoscopic instruments can inadvertently burn nontargeted tissues beyond the surgeon’s limited field of vision, leading, on occasion, to the patient’s death. Such stray energy b urns can occur regardless of the surgeon’s skill and judgment Case I Listed are protective measures for the patient, list and describe some protecti ve measures for the surgical team: ase 2 List several alternatives to the use of monopolar electrosurgery that may prov ide less risk for injury to the patient.
Case Study With the patient in supine position, a McBurneys incision was made and deep ened through the subcutaneous tissue. Usingan ESU, the bleeders were cauterized. The extern al oblique muscle was incised along the length of its fibers using Metz. The internal oblique and transverse abd muscles were bluntly dissected using Kelly clamps. The peritoneum was gras ped with two Kelly clamps and raised and nicked with a scalpel. The incision of the peritoneum w as completed with Metz.
The appendix was identified, which was grasped with two Babcock clam ps and raised into the wound. In addition, another Babcock grasped the cecum, which was mobil ized toward the wound. The mesoappendix was serially clamped, Divided, and ligated with 20 chromic. The appendiceal base stump was cauterized with an ESIJ. The abdominal cavity was irrigated with antibiotic solution. The wound was cl osed in layers. Th peritoneum was closed in a continuous fasion, suing 20 Maxon. The external oblique poneurosis was closed in a continuous fasion, using 20 Maxon.