Airway Fire Flashcards
(8 cards)
What are the primary actions for airway fire management?
- Call for help.
- Disconnect breathing circuit from the anesthesia machine.
- Stop oxygen flow and ventilation.
- Extinguish airway fire with sterile saline or water.
- Remove tracheal tube and anything else in the airway.
- Suction debris and fluids.
- Reestablish a patent airway and resume ventilation/oxygenation.
- Minimize FiO₂ by providing humidified O₂ to maintain saturation of >90%.
- Verify the extent of injury using a flexible intubating endoscope.
- Consider IV/inhaled corticosteroids and inhaled racemic epinephrine.
- Consult burn specialists for advanced treatment.
- Save all materials for investigation.
What are the primary actions for surgical fire management?
- Call for help.
- Disconnect breathing circuit from anesthesia machine.
- Immediately remove burning drapes or other materials.
- Extinguish fire with CO₂ extinguisher, sterile saline, or water.
- Activate fire alarm/notify surgical team members.
- Stop oxygen flow.
- Manually ventilate with a bag valve device.
- Verify that the fire is extinguished.
- Remove the patient from the OR and close doors.
- Turn off gas supply to the OR suite.
- Administer total IV anesthesia (if necessary) until surgery is completed.
- Report all fires in the OR to the hospital’s risk management department.
What are the prevention strategies for airway and surgical fires?
• Conduct a fire risk assessment before every surgery and discuss fire prevention strategies.
• Avoid open administration of supplemental O₂ and discontinue O₂ at least one minute before and during use of ignition sources.
• Use low FiO₂ (≤30%) and communicate FiO₂ changes.
• Reduce gas flow rates.
• Avoid nitrous oxide.
• Use manufactured laser-resistant ETT.
• Fill ETT cuff with saline and dye to visualize cuff rupture.
• Cover facial hair/body hair with water-soluble gel.
• Protect eyes with wet gauze and laser goggles.
• Avoid pooling of surgical prep solutions.
• Use flame-retardant drapes.
• Soak sterile towels in saline or water and place around surgical area.
• Avoid petroleum-based ointments.
• Ensure sufficient time for skin prep to dry (e.g., 120-180 seconds).
• Have fire extinguishers readily accessible.
What medications are used for airway fire management?
• IV corticosteroids (Hydrocortisone 100 mg IV or Dexamethasone 8 mg IV).
• Inhaled bronchodilators (Albuterol) every 4 hours PRN.
• Inhaled racemic epinephrine every 4 hours PRN for stridor or retractions.
What is the physiology and pathophysiology of surgical fires?
• Estimated 550-650 airway and surgical fires occur annually in the U.S.
• Fires can engulf the entire OR in seconds.
• Three components for fire: fuel source, oxidizer, ignition source.
• Oxygen and nitrous oxide act as oxidizers.
What are the commonly used lasers in the OR?
CO₂: General surgery, orthopedics, gynecology, urology, otolaryngology, plastic surgery.
Nd:YAG: Gastroenterology, pulmonology, urology, dermatology, ophthalmology.
Ho:YAG: Orthopedics, urology.
Diode: Dermatology, ophthalmology, otolaryngology, plastic surgery, pain management.
Argon: Ophthalmology, otolaryngology, plastic surgery, dermatology, gynecology.
What are the signs and symptoms of airway fire?
Respiratory:
• Decreased SpO₂.
• Evidence of charred or burned airway tissue.
Cardiovascular:
• Dysrhythmia.
• Hypertension.
• Tachycardia.
Other Considerations:
• Inability to sustain positive pressure ventilation.
• Large cuff leak during manual ventilation.
• Loss of ETCO₂ waveform.
• Machine alarms “low tidal volume.”
• Odor of burning drapes or gauze.
• Smoke or flame.
• Spark or popping sound.
What are the differential diagnoses for airway fire?
Respiratory:
• Bronchospasm.
• Endotracheal cuff rupture.
• Hypercarbia.
• Hypoxia.
• Inadvertent ETT removal.
• Stridor.
Cardiovascular:
• Cardiac arrest.
• Cardiac dysrhythmias.
Other Considerations:
• Acidosis.
• Circuit disconnect.
• Machine failure.
