Laboratory Safety and Hazards PDF

SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER...

SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER LABORATORY SAFETY 2. The Clinical and Laboratory Standard Institute (CLSI)  Containment principles, technologies, and practices that are  Formerly National Committee for Clinical Laboratory implemented to prevent unintentional exposure to biological Standards agents or their inadvertent release  A non-profit educational organization that sets voluntary consensus standards for all areas of clinical DIFFERENT AGENCIES / DEPARTMENTS RESPONSIBLE FOR laboratories LABORATORY SAFETY  provides excellent general laboratory safety and infection control guidelines 1. Occupational Safety and Health Administration (OSHA) o If a laboratory is well-established, it can  Enacted in 1970-PL 91-596 contain or prevent an outbreak  The goal of this federal regulation body is to provide all o CLSI is updated annually employees with safe work environment.  Provides written manuals that define specific safety policies 3. Center for Disease Control and Prevention (CDC) and procedures for all potential hazards required in  A federal agency that carries out mandated public laboratories health laws and reporting requirements.  Provide guidelines for developing these written policies and procedures are provided in several Clinical and Laboratory 4. The Joint Commission (JC) Standards Institute (CLSI) documents  Ensure quality healthcare for patients, prevent harm, o CLSI is commonly applied in bacteriology section. and improve advocacy It provides procedures on how to process o In the Philippines, DOH oversees laboratory organisms and safety measures in case of safety. exposure to such. o In case of reemergence of organism, DOH will coordinate with RITM  OSHA PRIMARY STANDARDS i. Bloodborne Pathogens  Applies to all exposure to blood or other STANDARD PRECAUTION AND UNIVERSAL PRECAUTION POTENTIALLY infectious materials.  Universal Precaution  Mandates development of Control Plan.  All patients are considered to be possible carriers of o Control Plan is how an institution handle blood borne pathogens infectious agents  Wearing of Personal Protective Equipment when  Proper decontamination and safe handling handling/collecting blood and bodily fluids contaminated  HBV vaccine with blood. o a laboratory personnel should be fully vaccinated at least 10 days prior to work.  Body Substance Isolation Guidelines ii. Hazard Communication Standard  Consider all body fluids and moist body substances to  Intended to ensure that hazard of all be infectious chemicals used in the work place have been o Sweat and tears are the only body fluids that evaluated. are not infectious. These will only be  Development of SDS infectious if there is presence of blood  Safety Data Sheet’  Standard Precaution iii. Occupational Exposure to Hazardous Chemicals in  Combines major features of Universal Precautions and Laboratories BSI Guidelines  OSHA Lab Standards  Appointment of Chemical Hygiene Officer  Development of Chemical Hygiene Plan EMPLOYER’S and EMPLOYEE’S RESPONSIBILITY EMPLOYER’S EMPLOYEE’S o Made by CHO, with SDS from Know and comply with the manufacgturer, a CHP can be Establish laboratory work methods established laboratory safe work developed. and safety policies practices o It contains safety measures on how Provide supervision and guidance to Have a positive attitude toward to handle leak or chemical supervisors, coworkers, facilities, employees and safety training exposure Provide safety information, training, Be Alert and give prompt notification OTHER PRIMARY STANDARDS PPE, and Medical surveillance to of unsafe conditions and practices iv. Formaldehyde Standard employees. are corrected. v. Respiratory Protection Standard Provide and maintain equipment and vi. Air Contaminant Standard facilities that are free of recognized Engage in the conduct of safe work hazards and adequate for the task practices and use of PPE. vii. Protective Equipment Standard required. o Ensure that the laboratory is well-established and can provide appropriate PPE 1 JMM, JAC  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER DIFFERENT TYPES OF HAZARD  How to break a Chain of Infection? i. Biological  Disinfection ii. Sharps  Hand Hygiene iii. Chemical o Handwashing iv. Fire: NFPA  Sealed specimen container v. Electrical o Never accept unsealed specimen vi. Radiation  PPE vii. Ergonomics  Standard Precaution BIOLOGIC HAZARD BIOSAFETY CABINET  What is a Biological Hazard?  Biosafety Cabinet (BSC) is a specialized containment device o Any patient specimane or body substance is considered designed to provide a safe working environment for infectious laboratory personnel and to protect the external environment  What are the different kinds of Nosocomial Infection? from exposure to potentially hazardous materials o Nosocomial infections are those acquired in the hospital setting KEY FEATURES BACTERIA VIRUS FUNGI  Containment Acinetobacter Hepatitis A, B, C Burkholderia cepacia HIV/AIDS  Airflow Control Clostridioides difficile  HEPA Filtration Clostridioides soredellii o 0.3 microns ESBL -  Work Area Enterobacterales Influenza Candida auris MRSA, VRSA, VISA Nontuberculous CLASSES OF BSC Mycobacteria CLASS II BSC CLASS III ASPECT CLASS I BSC TB (A1, A2, B1, B2) BSC Norovirus Complex pattern; Totally VRE Airflow From lab towards Recirculation and enclosed; all o Candida auris  most isolated organism that causes direction operator exhaust air exhausted nosocomial infection Highest level Operator and Operator and o VRE  Vancomycin-resistant Enterococcus for operator, Protection environment; environment and o Enterobacterialis CR  Carbapenemen-resistant limited product product environment, o VISA  Vancomycin Intermediate-Resistan Staphylococcus and product Handling of aureus (not yet totally resistant) Handling of low to Common Handling of low to high moderate risk Use high risk agents hazardous agents  CHAIN OF INFECTION agents  a continuous link in the transmission of harmful All air Open front; partial Depends to the exhausted microorganisms between a source and a susceptible Enclosure barrier to product type through HEPA host filters Handling of Cell culture, KEY COMPONENTS OF A CHAIN OF INFECTION Common Sample weighing, highly microbiology, Applications chemicals infectious Infectious Agent Bacteria, Viruses virology agents Reservoir Patient Portal of Exit Aerosols  BSC Class II: basic class used in the laboratory Mode of Transmission Inhalation  BSC Class II Type A2: most commonly used in COVID-19 Portal of Entry Respiratory Tract Susceptible Host HCW filters o If a laboratory handles COVID-19 or other viral panel, the environment should be of negative pressure so that the air will not be able to enter or exit the facility.  Positive pressure : Air can enter and exit CLASSES OF BSC CLASS II BSC CLASS TYPE A1 TYPE A2 TYPE B1 TYPE B2 II Inflow 75 100 100 100 Velocity Exhaust air % 30% 50% 100% Recirculation 70% 50% 0% on air % Exhaust air Internal Environment External Environment destination  Inflow velocity: the entry of air into the cabinet  Exhaust air: the exit of air from the cabinet 2 JMM, JAC  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER STERILIZATION  Process of eliminating or destroying all forms of microbial life, including bacteria, viruses, fungi, and spores.  The goal of sterilization is to render an object or surface completely free of viable microorganisms that could cause infection or contamination DISINFECTION  involves the reduction of the number of pathogenic microorganisms on surfaces, instruments, or in the environment to a level that is considered safe for public health o The 1% that couldn’t be killed by disinfection is the normal flora What to do in case of blood or bloody fluid spill:  Alert others in area of the spill.  Use mechanical devices to pick up broken glass  Absorb the spill with paper towels, gauze pads, or tissue.  Clean the spill site using a common aqueous detergent.  In case of accidental prick – What should we do?  Disinfect the spill site using approved disinfectant or 10%  Communicate with your supervisor. bleach, using appropriate contact time.  PEP and PrEP  Rinse the spill site with water. Given to those pricked within 72  Dispose of all materials in appropriate biohazard containers hours.  These wastes must be placed in a yellow colored bag Used for HIV, not HPB In case o Infectious waste of prick, the person will undergo AST, ALT, Creatinine, Hepa B, What is the proper waste disposal of biologic hazard? Syphilis, and HIV and must test Post Exposure Prophylaxis  All biologic waste, except urine, must be placed in negative or normal. (PEP) PEP is an actual Anti-retroviral appropriate containers labeled with the biohazard symbol Drug (ARD) because it is  The waste is then decontaminated following institutional assumed that the person policy: incineration, autoclaving, pickup by a certified pricked contracted the virus. - A hazardous waste company. side effect of PEP is lucid  URINE: directly down a sink or toilet, with caution taken to dreaming avoid splashing. rinse the sink well with water after discarding specimens and at least daily with a 0.5% bleach usually given to individuals who (sodium hypochlorite) solution are sexually active Pre-Exposure Prophylaxis  Noninfectious glass such as empty reagent bottles and non- Two doses  event driven if (PrEP) hazardous waste such as emptied urine containers are sexual activity can be scheduled considered normal waste and require no special precautions and the daily if not (only for HIV) for disposal. CHEMICAL HAZARD SHARPS HAZARD  Refers to the potential danger or risk posed by a chemical  What is Sharp Hazard? substance that may cause harm to individuals, the  includes: needles, lancets, and broken glassware environment, or property.  What are the things to consider with Biohazard Sharp  Chemical hazards can arise from exposure to various types Container? of chemicals, including solids, liquids, gases, and vapors, in  Must be disposed of in a puncture-resistant, leak- different settings such as workplaces, homes, laboratories, proof container with the biohazard symbol. and industrial facilities  Must only be 3/4 full What are the Routes of Chemical Exposure? Route of Exposure Description Example Entry through the respiratory system Gases, vapors, Inhalation by breathing in dust, aerosols airborne substance Entry through the digestive system by Contaminated food, Ingestion swallowing water, or objects substances Absorption through Direct contact with Dermal the skin, the outer liquids, powders, layer of the body solution 3 JMM, JAC  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER Absorption through  Storage and transportation precautions. skin or mucous Contact with skin,  Chemical manufacturer’s name, address, and telephone Percutaneous membranes number eyes, nose, mouth (includes dermal  Special information sections exposure) o SDS is more recognized nowadays because MSDS What are the different types of Chemical Hazard? vary from country to country and is not globally Irreversible injuries to the skin or eyes by recognized. direct contact or to the tissue of the Corrosive Hazards o The Globally Harmonized System of Classification and respiratory and GI tracts if inhaled or ingested Global Chemicals GHS made a standard which is the Substances under certain conditions can SDS spontaneously explode or ignite or that o SDS has 16 sections, is more employer/employee- Reactive Hazards friendly, and has the proper order of sections. can evolve heat or flammable or explosive gases Carcinogenic Substances that have been determined Hazards to be cancer causing agents. Chemicals that can cause allergic Irritants reactions or sensitization in individuals upon exposure. Causes fire or explosion. They are classified according to flash point, which Flammable is the temperature at which sufficient Chemicals vapor is given off to form an ignitable mixture with air. FLAMMABLE CHEMICALS – Two Types Combustible Characteristics Flammable Material Materials Ignite easily and have FP 37.8°C (100°F) a low ignition temperature. Require higher Ignition temperatures to ignite. Temperature – FP 37.8°C (100°F) FP at or above 37.8°C (100°F). Have a low flash Have a higher flash point point Flash Point (below room (above room temperature) temperature). CHEMICAL HYGEINE PLAN Can easily form Tend to release vapors  Safety policies and procedures for all hazardous chemicals Vapor and Gas flammable vapors and gases less easily used in the laboratory and gases.  employee “right to know” requires chemical manufacturers, Gasoline, ethanol, Wood, paper importers, and distributors to provide safety datasheets Examples propane. (SDS) Require special Still pose fire hazards Handling precautions due to but with somewhat Safety Data Sheet (SDS) Content Areas Precautions their high lower risk. Section Content flammability. 1 Identification  Flash point  temperature at which the chemical is reactive 2 Hazard identification Composition or Information on 3 CHEMICAL SAFETY MSDS Ingredients  Product name and identification. 4 First-aid measures  Hazardous ingredients. 5 Fire-fighting Measures  Permissible exposure limit  Physical and chemical data 6 Accidental Release Measures  Health hazard data and carcinogenic potential. 7 Handling and Storage  Primary routes of entry 8 Exposure Controls / Personal Protection  Fire and explosion hazards. 9 Physical and Chemical Properties  Reactivity data  Spill and disposal procedures. 10 Stability and Reactivity  PPE recommendations. 11 Toxicologic Information  Handling. 12 Ecologic Information (non-mandatory)  Emergency and first aid procedures. 4 JMM, JAC  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER Disposal Considerations (non- How to handle Chemical hazard? 13  Prohibiting pipetting by mouth or the sniffing of chemicals mandatory)  Appropriate use of PPE (gloves, gowns & goggles) 14 Transport Information (non-mandatory)  A fume hood or safety cabinet 15 Regulatory Information (non-mandatory) 16 Other Information Chemical Safety Tips  Never grasp a reagent bottle by the neck or top  always add acid to water  safety equipment: eyewash and shower FIRE HAZARD  Substances that can catch fire or explode under certain conditions o All must be present for fire to occur o Oxygen is the hardest to remove. NATIONAL FIRE PROTECTION ASSOCIATION (NFPA)  a bright, color-coded labels are divided into quadrants: BLUE Health RED Flammability YELLOW Reactivity Any special WHITE considerations 5 JMM, JAC  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER In case of Electrical Accident, what to do? 1. Ensure safety 2. Call for emergency help 3. Do not touch the victim o The human body is a good conductor of electricity o in rescuing / evacuating the body of the victim of the site use things that are poor conductor of electricity. 4. Check for responsiveness 5. Administer CPR RADIATION HAZARD  Potential danger posed by the emission of ionizing or non- ionizing radiation. ordinary combustibles, extinguished by  procedures using radioisotopes CLASS A pressurized water (A) and dry chemical (ABC flammable liquids, extinguished by dry How does radiation affect the body? CLASS B chemicals (ABC) and carbon dioxide (BC)  In molecular mechanism, radiation can affect the nucleic which limits oxygen supply acid. Radiation are free radicals which can cause mutations Electrical, extinguished by dry chemicals CLASS C (ABC), halon, and carbon dioxide (BC). Never to the assembly of DNA. Thus, it can cause cancer or use pressurized water on B nor C tumors. Flammable materials, extinguished by metal x CLASS D (special compound) or by sprinkling sand. Type of Approx. Protective Frequency Wavelength Source Measures 4 nm – 400 Ultraviolet (UV) UV lamps Thermal nm protective Visible 400 nm -750 clothing, Artificial lighting Spectrum nm barriers 780 nm – 1 Head lamps, Eye protection Infrared (IR) mm electronic devices Microwave ovens, Safe distance, Microwave 3 mm – 3m communication avoid direct devices exposure Safe distance, shielding, Radiofrequency Wireless > 1 cm minimize (RF) communication prolonged exposure  Some BSCs contain UV light which can pass beyond the cover of cabinet. RADIATION SAFETY TIPS! o The protection of individuals and the environment from the harmful effects of ionizing radiation. ELECTRICAL HAZARD ALARA PRINCIPLE  refers to a potential danger or risk associated with the  “As Low as Reasonably Achievable” presence, use, or handling of electricity.  Time, Distance, Shielding o Human body can conduct electricity, it is why we can feel tingling sensation when in contact with  PPE electrical leak o Lead Aprons, Thyroid Shield  Radiation Signs and Labels Things to consider to avoid this hazard:  Radiation Monitoring Devices  Use only explosion-rated equipment in hazardous o Geiger counter: check atmosphere  Radiation Safety Officer  Never operate electrical equipment with wet hands.  There are certain specialized laboratories that have radio  Promptly report any malfunction or tingle in equipment labelling, use of neutron activation analysis, and DNA protein  Have ground, polarity, and leakage checks and other labelling that uses different radioactive materials like phosphorus 32 and sulfur 35. periodic preventive maintenance  Know the exact location of the electrical control panel 6 JMM, JAC  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 2 LABORATORY SAFETY AND HAZARDS INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER HOW TO DISPOSE RADIOACTIVE MATERIALS  Identify and Classify the Radioactive waste  Contact Regulatory Authorities  Ship Waste According to Regulations o These wastes are specially contained ERGONOMIC HAZARD What is Physical Hazard?  Refers to a type of danger or risk in the environment that can cause harm to individuals, property, or the surrounding area due to its physical characteristics. THINGS TO TAKE NOTE:  avoid running in rooms and hallways  watch for wet floors  bend the knees when lifting heavy objects  maintain a clean, organized work area  closed-toed shoes 7 JMM, JAC  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 3 -: STRESS TESTING INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER What is Stress Testing? o Any physical activity that makes you tired  It is a tool used to evaluate and manage patient with known because it might cause erroneous result to or suspected heart disease. ECG  Measurement of stress that results from exercise.  Wear comfortable clothes and shoes  Measures the stress of the heart.  For Nuclear Stress Test do not apply Oil lotion or cream  Evaluates how fast or if the blood circulation flows correctly to your skin that day since it used radionuclide to the heart o Because it might react to the radioactive o If the doctor suspected a shortness of breath or a material that will be injected intravenously family history of hypertension, he might suggest stress testing  THINGS TO CONSIDER FOR THIS TEST o If an athlete wants to know the limit of his high  No eating or drinking until the test are completed intensity workout, the doctor might suggest stress  Follow the instructions of Medical Professionals testing  Stop the test anytime if you’re too uncomfortable to continue PARAMETERS USED IN STRESS TESTING o Suffering to moderate to severe chest pain,  Breathing and short breath,  Blood pressure o Hypertension, hypotension  Heart rate or flow in the heart through ECG o Dizziness, fatigue, arrythmia, changes in o Measure the signal transmitted during exercise ECG o Measures signal or impulses coming from the o Breathing, heart rate and blood pressure are heart because of stress caused by exercise the parameters to be checked o If patient is having a difficulty breathing/ short breath, you have to gradually decrease the difficulty of the treadmill.  CONTRAINDICATIONS OF STRESS TEST  If you have this contraindication, you are not candidate for stress test  AMI (acute myocardial infarction) – a heart attack within 2-3 days  Unstable angina - chest pain *not previously stabilized by medical therapy  Uncontrolled cardiac arrhythmias – irregular heart beat or rhythm of the heart o Tachycardia o Bradycardia o We usually employ the use of treadmill - As preparation,  Acute myocarditis – inflammation of the lining of the patient will have a fasting period of 2-4 hours. heart o It the patient has a hairy chest, it needs to be shaved to  Pericarditis make sure that electrodes or patches will stick during  Endocarditis exercise  Severe hypertension o Electrodes will be attached to chest and will be connected to  Inability to exercise (Physical, mental impairment, and a machine called ECG/ EKG obesity)  Acute Pulmonary embolus or infarction  PREPARATION BEFORE THE STRESS TEST  Acute Aortic dissection  Inform your doctor about any medicines that may  High Grade of AV blocks interfere with the test.  Systole – 20mmHg (less than 120mmHg is normal) – o Beta blockers (ex. Propranolol, carvedilol) pumping of the heart o Calcium blockers (ex. Amlodipine)  Diastole- 110 mmHg (less than 80mmHg is normal) – o Not recommended to take before stress relaxation of the heart testing because it might give inaccurate result  Systole and diastole – is a very dangerous o If given to patient, he/she might not reach measurement of the blood pressure the target heart rate  NPO suggest 2-4 hour (fasting period) RISK AND PRECAUTIONS OF STRESS TESTING o For nuclear stress test – 12 hours fasting  There’s very little risk for treadmill stress test because we are employing the use or o According to American heart association, 1 out of radioactive tracers that has an affinity to 10,000 develops a condition that is related to lipids cardiac illnesses.  Stop smoking a day or before the procedure.  Medical professional are on-site in case of any unusual  Unusual physical exertion must be avoided. situations that may happen during the test o Patients need to rest for a minimum of 12 o should be one patient per Medtech hours straight. 1  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 3 -: STRESS TESTING INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER  Allergic reaction is extremely rare (Allergy to radioactive a. Cardiology technologist cleans your skin, and if necessary, substance) shaves or clips hair so the patches stick well  Except for a bit of fatigue from performing the exercise, you b. Sticky patches (electrodes) leading to an EKG are attached should expect no side effects at all. to the leg, arms, and chest to record the electrical signal that  If you have any unusual symptoms after the test, you should create heart rhythm bring them to the doctor’s attention c. The Treadmill starts slowly at first and then gradually gets faster and steeper every 3 minutes MAIN TYPES OF STRESS TEST d. And if there’s a problem with the test, the tech will stop the  Exercise Stress Test test right away.  Pharmacologic Stress Test e. Average for most patients is 8-12 minutes on the treadmill  Nuclear Stress Test a. Between 8-12 minutes we should achieve target heart rate because it indicates that the circulation  EXERCISE STRESS TEST in the blood has pass through the heart.  used primarily to assess the etiology of chest pain and for f. While you exercise the Cardiologist takes your BP and detection of coronary heart diseases. monitors your vital sign g. The patient is encouraged to exercise for as long as they  Also called Treadmill stress test – most commonly used can, because this increase the accuracy of the test. h. After type of stress test that the difficulty of the test will start to go back to normal until the treadmill stops. TWO MAJOR PURPOSE h. Digoxin – strengthens or will pump more blood for the heart 1. To determine the capability of the coronary circulation to reach the target heart rate to increase oxygen delivery to myocardium in response a. if the patient is still capable of doing the actual to increase demand exercise but can’t achieve the target heart rate a. Primary purpose of stress test is for patients or elderly. It is ordered by the physician because they suspect that there is a certain problem with the circulation of the PHARMACOLOGIC STRESS TEST blood in the myocardium of the heart 2. To assess the exercise capacity  Reserve for Patients who are unable to exercise adequately a. Also to assess the exercise capacity of certain  Done after exercise stress test. individual like players/athletes that wants to know how  Induced by pharmacologic agent – which is demonstrated in long can they last during high intensity workout and to patients with decreased functional capacity or in patients know the limit who cannot exercise  Always first perform exercise test before pharmacologic TWO TYPES OF EXERCISE STRESS TEST agent because exercise is the most accurate to determine Most commonly used type of how well our heart can pump blood Treadmill exercise stress test (Bruce and Modified Bruce) DRUGS USED Stationary bike, saddle, pedals,  Regadenoson -adenosine analog handlebars ADENOSINE  Preferred drug for asthma and a. In case the patient COPD (chronic obstructive Upright bicycle can’t withstand a long pulmonary disease period of standing Vasodilating agent (increase the blood and walking DYPYRIDAMOLE flow) Positive inotropic agent (Strengthen the DOBUTAMINE  TARGET HEART RATE force of the heartbeat) o Refers to the desired heart rate that the patient should achieve during the test. SIDE EFFECTS  Basis of our stress test  Flushing  It will give us an information kung gano  Chest discomfort or pain lang natin dapat pagurin si patient o  Shortness of breath Rough estimate only  Headache  If the patient reach this target heart rate,  Nausea or vomiting you have to fully observe the patient  Dizziness or lightheadedness because later on he will develop shortness of breath and chest pain FORMULA NUCLEAR STRESS TEST / MPI Maximum Heart Rate (HRmax) 220-Age  a nuclear medicine technique that enhances the sensitivity, (HRmax)(Fitness level) specificity, and diagnostic accuracy of exercise ECG stress Fitness Level = 0.70 testing in patients with suspected or known cardiac disease Target Heart Rate (THR) (inactive/sedentary) and 0.85  Exercise stress test should be perform before MPI (active) (myocardial perfusion imaging). Example: Px Age: 25, WFH = 136.5 BPM o Only an additional method used by the cardiologist o Exercise stress test should be done first before nuclear stress test because we are using 2  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 3 -: STRESS TESTING INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER radioactive materials in the form of radioactive  Electrically driven and should tracers through IV accommodate a variety of body weights o We usually use two kinds of radioactive tracer  For patients' safety and stability, padded Preferred because it has a half- front and side rails are recommended life (reduced to half  Must have an emergency stop button concentration) 6 hours (easily visible and readily accessible) TREADMILL TC-99  From no elevation to 20% elevation 12 hours you can assume maximum: at least 350 pounds (157.5 that Tc-99 has been discarded kilos) totally in the system Speed 1 mph- 8 mph (1.6km to 12 km) Has a half-life of 73 hours Length 127cm / 50 inch Thallium- Width 40.64 / 16 inch 201 7 days before it ca be totally discarded  Alternative to treadmill testing (patient that has an orthopedic peripheral vascular or o If there is blockage, it will not emit radiation neurological limitation that restrict weight because radioactive tracer will combine with the bearing) red cell and go to your heart; if there is blockage, it  Less expensive will not pass through  Maximum oxygen uptake: 5 – 20% lower that the treadmill  Typically uses a radioactive tracer—IV  Portable substitute for testing must have BICYCLE o Tc-99 - will expose Px to 11 millisieverts of handlebars, chairs is adjustable (based on ERGOMETER radiation height), adaptable metals strips o Technetium (TC) 99 eliminated through feces  Ideal chairs  height knee flex in full o Tc element (less radiation exposure, 6 hours extension half-life) o Thallium -201 (TI-201) Specific cycling rate to Mechanically maintain difficulty is  Gamma camera  captures images break manually adjusted Electronically More expensive and less Patient Preparation IV prep (fasting for 12 hours) break portable, but automated Inject radioactive tracer  nuclear Rest (First phase) imaging Stress test (Second phase) When the patient is near the THR a. 1 minute before we allow THR – Inject Radioactive patient to stop walking in tracer via IV the treadmill after the administration of the radioactive tracer Before going back to nuclear TWO TYPES imaging  The action of listening to a. 30-60 minutes rest so sound from the heart, 30 minutes rest that the radioactive tracer lungs or other organs, has combined with RBC typically with a and will be circulated to stethoscope, as a part of the heart Manual medical diagnosis Compare the results of 1st phase and 2nd phase Auscultation  Also known as the Riva Rocci Korotkoff or (manual method for blood TWO PARTS pressure measurement) is RESTING PORTION EXERCISE PORTION the listing of Korotkoff  Electrodes placed on the sounds in brachial artery chest for ECG. BLOOD  An expensive device that  Radioactive tracer may perform erratically at  Begin walking on treadmill PRESSURE high exercise intensities delivered through IV  Vitals records every 3 EQUIPMENT Automated BP because of motion (Not  Lie under a gamma camera minutes as a treadmill advisable: result of for 15-20 minutes while Diastolic BP may not be intensity increases images are taken of blood  Near maximum heart rate, accurate.) to heart  Unit millimeter of mercury radioactive tracer is (mmHg) delivered through IV  Contain cuff, sphygmomanometer or EQUIPMENTS FOR STRESS TEST mercury manometer Others  Treadmill (instead of aneroid  Bicycle ergometer manometer; less accurate)  Manometer should be  Blood Pressure equipment placed level of patient's  ECG / EKG hearts 3  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 3 -: STRESS TESTING INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER  Mercury manometer is recommended but it’s been phased out due to mercury content.  Essential for continuous monitoring of heart rhythm an evaluation of ischemic ECG changes during exercise and recovery.  Has Silver-silver chloride electrodes (recommended) ECG / EKG  There is also commercial disposable ECG electrodes. 5-10 minutes  Electrocardiographic system/ electrocardiogram  Measures the waves or electrical signal for stress testing 4  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 4 ECG and EKG INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER ELECTROCARDIOGRAPHY A standard 12-lead EKG contains 10 electrodes (the patches attached to the patient) ELECTROCARDIOGRAM (ECG / EKG)  Electrocardiography - It is the measure of the electrical PURPOSE OF ECG signals or the conduction of the heart through the use of a  Detects the patient’s heart's electrical rhythm and produces special machine which is called ECG. what's known as tracing Electrokardiogram (EKG) – from Dutch or German word. o Measurement of the electrical signals produce by Electrocardiogram (ECG) – currently used in the US. - Both terms are cardio or the heart. interchangeable o The tracing is based on the waves produced by the heart  An electrocardiogram records the electrical signals in your heart. It's a common and painless test used to quickly detect heart problems and  This TRACING consist of representations of several waves monitor your heart's health. that recur with each heartbeat.  Electrocardiograms — also called ECGs or EKGs — are often done o The tracing is the one we see as a BEAT or in a doctor's office, a clinic or a hospital room. CARDIAC CONDUCTION  Process or method of graphic tracing or recording of the electric current o It is the recorded signals produced by the heart generated by the heart muscle during a heartbeat.  The device or machine that records your heartbeat through electric o It is interpreted by a type of machine which is the current is called electrocardiogram. ECG  ECG/Electrocardiography-process; electrocardiogram – machine or  The wave pattern should have a consistent shape. If the device waves are not consistent, or if they do not appear as standard waves – it is an indicative of heart disease HISTORY / TIMELINE OF ECG (Coronary vascular disease)  Overall, the main purpose of the ECG is to detect the presence or the absent of the waves produce by the heart.  Overview of the normal tracing of the heart: it started with a negative charge or no wave going to the top and another plateau going down and a peak that will go down again and another peak going to a normal and another wave.  In cases if there’s an absence of these waves it is an indicative of a heart disease. Practically if the 1st wave or the P wave is absent (arterial attack/ fibrilization). First animal that utilize to check CLINICAL SIGNIFICANCE OF ECG 1842 the electrical signals of the heart  Important diagnostic tool in the evaluation of CVD: is a FROG, which is discovered o Abnormal heart rhythm (arrhythmias, bradycardia by Mattecucci or brachycardia, & tachycardia) Walter recorded first electrical o Myocardial ischemia/infarction 1887 activity from human heart o Chamber enlargement Most significant. o Electrolyte abnormalities (especially hyperkalemia, hypokalemia, hypocalcemia) Einthoven started the principle or the ECG/EKG which started 1901  Overall, If the ECG was not able to detect or the doctor wants 3-lead EKG machine. the patient to undergo more examination, they will suggest to take MPI / Nuclear Stress Test because the ECG is only He built a string-galvanometer limited to the detection of the said above. based-3 lead EKF machine.  Nuclear Stress Test – Fasting will last for 12 hours because 1906 EKG entered the US the radioactive tracer has an affinity to lipids. Einthoven won the Nobel o Because ECG only checks the electrical through 1943 this test it will exhibit the specific parts of the heart Prize through the use of the radioactive tracer. Wilson invented the central 1934-1938 terminal. Precordial leads are born DIFFERENT TYPES OF ECG Goldberg used the central 1. RESTING ECG TRAINING terminal with augmentation.  Standard test for measuring heart’s electrical 1942 function records patient’s heart’s electrical activity from Augmented unipolar leads are 10 electrodes (sticky patches) on the chest, arms, and born legs at the same time. The 3-lead EKG from 1901 has 4 electrodes been standardized to become LIMB Both right and left of the arms 12-Lead EKG by American and legs 1954 Heart Association (AHA) CHEST 6 electrodes which is now being used. These 10 electrodes will be reduced to 9 because one of them only contains a neutral charge (Ground state) 1 JAC, JMM  SPDX311: SPECIAL DIAGNOSTICS PROCEDURES LECTURE – WEEK 4 ECG and EKG INSTRUCTOR: RICH KING VALDEZ, RMT– COLLEGE OF MEDICAL LABORATORY SCIENCE, 3RD YEAR-2ND SEMESTER  Patient walks on a treadmill or pedals a stationary bicycle Breathing and blood pressure rates are also monitored.  Use to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery. o Used for the patient who undergone surgery, to know how long can they maintain the heartbeat during workout and know their limit, and it can also be used for athletes. o It is usually attached to the chest part 60-100 beats per minute NORMAL HEARTBEAT (bpm) >100bpm Tachycardia