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關於控制給氧濃度的最新建議

適用於頭臉頸及上胸部位之手術:
如果病人不用氧氣就可以維持安全的血氧濃度時,可以開放方式給予病人空氣。
如果病人不使用輔助氧氣就無法維持安全的血氧濃度時 ,請使用氣管內管或喉頭罩來保護氣道,以防止高濃度氧氣在手術鋪單下聚積。
傳統上以開放方式給予100%氧氣的習慣應該停止使用 (除了極少數特殊狀況除外)。

手術火災適用之滅火方法

水溶液:例如瓶裝的食鹽水、蒸餾水、甚或自來水都可用來滅火。

二氧化碳滅火器
雖然不是第一選擇,但在某些火勢失控的情況下可能必須使用到,所以每位同仁都須熟練使用的時機與方法。
建議的配置方式為在每一間手術室的入口處配掛一支五磅的二氧化碳滅火器,在手術室外的開刀房區域內則配置一支二十磅的乾粉滅火器,作為最後的滅火手段。

手術火災不適用之滅火方法

  • 防火毯絕對不適用於手術室內,也不應該配置在手術室內。
  • 以水為基礎之滅火工具例如水柱或水霧也不適用於病人火災,因此也不推薦使用。
  • 以海龍 (halon) 滅火器也不推薦使用。

文獻中提到的錯誤觀念

錯誤:手術火災發生時的對策,拿滅火氣滅火、警報、疏散。
哪裡錯:當病人著火時沒有時間去拿滅火氣,第一優先是迅速移除病人身上的著火物。

錯誤:進行氣管內手術時只能使用有適當防護的氣管內管。
哪裡錯:此建議忽略了不同的熱源。視氧氣濃度、雷射波長及內管材質,即使是抗雷射內管 (laser-resistant) 在某些情況下也會著火。何況抗雷射內管並不能防電燒熱源。

錯誤:建議使用防火 (fire-retardant) 的手術鋪單。
哪裡錯:考慮到高濃度氧氣及雷射的高能量,並沒有所謂的防火鋪單。沒有任何鋪單經過防火處理,也許某些拋棄式鋪單在空氣中可以有某種程度的抗燃性。

錯誤 :Betadine 及 iodine 都是可燃的。
哪裡錯:只有含酒精的溶液 (tinctures) 才是可燃的,標準的水溶性 Betadine 是不可燃的。

The Basic Steps of Conducting a Healthcare FMEA

  1. Identify the process to be examined.
  2. Assign FMEA team members, team leader and team facilitator.
  3. Explain the methodology to the team.
  4. Develop either a flowchart or detailed process flow (outline format) of the process under analysis. All steps in the process should be included.
  5. Designate which of the steps in the process constitute “Functions.”
  6. Determine which Functions represent potential “Failure Modes” or points of potential failure.
  7. Determine the worst potential adverse consequence or “Effect” of each of the Failure Modes.
  8. Determine the “Contributory Factors” for each Failure Mode. A One or more Root Cause Analyses may be necessary to complete this step. Note that we advocate the use of the term “Contributory Factor” rather than “Cause.”
  9. Identify any “Controls” in the process. Controls are components of the process which (a) reduce the likelihood of a Contributory Factor or a Failure Mode, (b) reduce the severity of an Effect, or (c) detect the occurrence of a Failure Mode or Contributory Factor before it leads to the adverse outcome (Effect).
  10. Rate the Severity of each Effect (usually on a scale of 1-10, with 10 being the most severe). The impact of Controls that ameliorate the severity of an Effect are reflected in this rating as well.
  11. Rate the Occurrence (likelihood) of each Contributory Factor (usually on a scale of 1-10, with 10 being the most frequent, or “certain to occur”). The impact of Controls that reduce the likelihood of occurrence of a Failure Mode or Contributory Factor are reflected in this rating as well.
  12. Rate the effectiveness of each “Detection Control (usually on a scale of 1-10, with 10 being the lack of a Detection Control, or the presence of a wholly ineffective one, and 1 being a 100% flawless detection system).
  13. Multiply the three ratings by one another for each Contributory Factor and the corresponding Effect and Detection Controls. The range of these products will be from 1 to 1,000. The resultant number is the Risk Priority number (RPN) for that Contributory Factor.
  14. Rank-order the Contributory Factors according to the Risk Priority Numbers.
  15. Use a Pareto Chart with the traditional 80% rule to determine which contributory Factors should be addressed first.
  16. Add to the above listing ALL Contributory Factors which result in an Effect with Severity of 10, irrelevant of RPN.
  17. Develop a plan addressing how the selected Contributory Factors will be addressed, by whom, when, how the improvement will be assessed, etc.
  18. Continue the improvement process.

    參考資料: CCD Health System