CNOR: Electrosurgery & Fire Safety

When turning over an OR, the presence of visible soil dictates the immediate first step. You must always clean away gross organic material, like blood, before you can effectively disinfect the surface. Option A is best because it addresses the visible blood splatter directly; applying a disinfectant over blood (Option B) renders the chemical ineffective because organic matter blocks the active ingredients. While a MRSA wound infection requires thorough disinfection, the sequence of cleaning must always flow from top to bottom and clean to dirty. Therefore, mopping the floor (Option C) should occur only after the higher surfaces are cleaned, preventing debris from falling onto a freshly mopped floor. Option D is incorrect because aerosolized sprays are not recommended in the OR due to inhalation risks and uneven coverage.

To perform effective CPR, the patient must be supine. When removing a patient from lithotomy, it is critical to lower both legs simultaneously to prevent hip dislocation and minimize sudden hemodynamic instability. Option B is the safest and most effective action. Option A is incorrect because lowering one leg at a time creates uneven pelvic stress, risking musculoskeletal injury. Option C is a common misconception; while elevating legs can transiently increase venous return, leaving them in high stirrups severely impedes the physical mechanics of chest compressions and restricts diaphragmatic movement. Option D is incorrect because keeping the legs elevated without stirrup support risks dropping the extremities and still fails to provide the flat, supine posture required for high-quality resuscitation.

When dealing with a patient who has severe dementia and is unable to state their name, you must rely on objective, established identifiers. Cross-checking the attached identification band with the signed surgical consent provides two reliable, independent identifiers. Requesting the transport technician to verify identity is unsafe because they are not a primary source and may not know the patient accurately. Utilizing a bed number is a direct violation of Joint Commission standards, which strictly prohibit using physical locations for identification. Postponing the assessment until a family member arrives is unnecessary and delays care, as the attached physical band and medical record are legally and clinically sufficient for verification when the patient cannot actively participate.

A sudden flash of light and smoke indicate an active airway fire. The absolute priority is to halt the fire triad by removing the fuel and oxidizer. The team must disconnect the circuit and remove the tube immediately, followed by stopping the flow of airway gases. Option A is incorrect as a primary step; while saline may be poured into the airway to extinguish residual smoldering after extubation, leaving the burning tube in place causes severe thermal injury. Option B is dangerous because increasing oxygen feeds the fire. Option C is a potential post-event medical management step to reduce edema, but it does nothing to extinguish the active fire.

During an operating room fire, shutting off medical gases is critical to prevent fueling the flames. However, this action must be carefully coordinated because it immediately removes life-sustaining oxygen from the patient. Option B is correct because the circulating nurse (or charge nurse) typically shuts off the zone valves, but only after coordinating with anesthesia to ensure the patient is transitioned to a self-inflating manual resuscitation bag on room air. Option A is incorrect because the scrub nurse must remain focused on the sterile field and patient. Option C is incorrect because the anesthesia provider must focus entirely on managing the patient's airway and ventilation during the transition. Option D is incorrect because the fire alarm must be sounded immediately, long before shutting off medical gases is considered or executed.