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has anyone actually seen this happen, or know of someone that this has happened to?
you pull it out first, right?
you pull it out first, right?
Yank it - the fire's already there. And yank means yank - don't carefully withdraw the tube - get it out.Noyac said:Some books and experts (?) say that you turn the gas (mostly O2 ) off b/4 pulling the tube. With O2 flowing the end of the tube acts like a blow torch and scalds everything in its path. I'm not sure how I would react if I saw a fire in the ETT but I wouldn't be surprised if I just pulled the sucker immediately.
I would hope that I would disconnect the circuit first then pull the tube all in one swoop. This would accomplish both.
Noyac said:Some books and experts (?) say that you turn the gas (mostly O2 ) off b/4 pulling the tube. With O2 flowing the end of the tube acts like a blow torch and scalds everything in its path. I'm not sure how I would react if I saw a fire in the ETT but I wouldn't be surprised if I just pulled the sucker immediately.
I saw it happen once in the cath lab. I just happened to be walking by and it DID look like a blowtorch coming of the dude's mouth. Scary $hit!
dogbone65 said:I saw it happen once in the cath lab. I just happened to be walking by and it DID look like a blowtorch coming of the dude's mouth. Scary $hit!
bubalus said:The online miller has an impressive picture of the ETT blowtorch. Flame shooting out about the length of the ETT tube. I've heard both--pull it immediately or stop the fire then pull. I think in the end, you do several things at once. As for what the people wanted on the boards last Saturday, I've got no idea. I've seen the after effects of an airway fire. Not pretty.
if it's not against copyright infringement or anythign could you post the pic on here?bubalus said:The online miller has an impressive picture of the ETT blowtorch. Flame shooting out about the length of the ETT tube. I've heard both--pull it immediately or stop the fire then pull. I think in the end, you do several things at once. As for what the people wanted on the boards last Saturday, I've got no idea. I've seen the after effects of an airway fire. Not pretty.
VolatileAgent said:sequence is thus:
1.) fire out.
2.) tube out.
3.) bag/reintubate.
4.) change pants (i.e. yours).
5.) pray.
6.) everything else you do after a (suspected) airway burn.
any questions/disagreement/best way to accomplish this sequence, we can discuss.
VolatileAgent said:sequence is thus:
1.) fire out.
2.) tube out.
3.) bag/reintubate.
4.) change pants (i.e. yours).
5.) pray.
6.) everything else you do after a (suspected) airway burn.
any questions/disagreement/best way to accomplish this sequence, we can discuss.
bubalus said:The post-fire airways looked horrible--scorched and charred. Very bad.
I'm still not convinced whether you put out the fire or pull the tube first. I've asked several anesthesiologists I respect and heard both answers. I think the important thing is to get the fire out and get the tube out then reintubate and bronch to evaulate damage. If you pull the tube first, you risk blowtorching the airway as you pull the tube. On the other hand, the ETT is the fuel and will burn the airways and leave ash and molten plastic behind. I do think it is important to disconnect the circuit before pulling the tube since that will decrease the flow of oxidizer and shorten the flame.
One of the problems with ETT fires is that you may actually get 2 flames, an intraluminal that travels toward the flow of oxidizer vaporizing volatile combustible products from the tube, and a secondary flame at the downstream end of the tube which ignites those products and shoots them out like a blowtorch.
You can see a picture of the ETT on fire at ETT fire. rn2936, the cuff is still inflated in that picture. It's also inflated in the Miller picture. I don't know whether the cuff stays inflated in vivo or not.
This is a little different from the picture in Miller. The Miller picture has an oxygen line entering the tube, so the flame is longer, more like a blowtorch.
bubalus said:ETT fire. rn2936, the cuff is still inflated in that picture. It's also inflated in the Miller picture. I don't know whether the cuff stays inflated in vivo or not. .
ericL said:I'm just a paramedic, premed, who happened to be exploring and wandered in here, but I had a question: what would be the ignition source for thes fires?
proman said:Curious what the ignition source was in a cath lab?
Laryngospasm said:Tube out first, it is the source of the fire. I wouldnt give that answer during oral boards, unless i was looking for a return trip.
VolatileAgent said:"In conclusion, it seems prudent to specify the circumstances in which the ETT should be removed immediately after the occurrence of airway fire. It is necessary to consider the benefits and the risks involved in removing the ETTs in patients with potentially difficult airways. Because the most common cause of anesthesia-related morbidity and mortality is hypoventilation and hypoxemia from difficult airway management [19] and a severe and extensive burn injury seems unlikely with airway fire during tracheostomy, further critical review of the airway fire management protocol is warranted."
link
like i said, put the fire out first.
Laryngospasm said:You seem to have defined the rule with the exeption, interesting tactic. While in some specialized situations such as tracheostomy pulling the tube may be incorrect, both Miller et al and Niels Jensen Big blue say to pull the tube first. Miller says specifically to remove the source of the fire and extinguish it in a bucket of water. Since both of these sources are very knowlegeable, and board examiners I will go with them. I guess well agree to disagree.
VolatileAgent said:i think the whole point is that this has not been extensively studied. the "best practice" guidelines have only been cobbled together from case reports.
Trisomy13 said:i've been trying to put together a RCT for this problem but i get stopped by the institutional review board everytime with pesky details about how i'll create a fire in the ET tubes of the test subjects. something about ethics, they say.
VolatileAgent said:did you read my whole post, or were you just being sarcastic for sarcasm's sake?
You seem to have defined the rule with the exeption, interesting tactic. While in some specialized situations such as tracheostomy pulling the tube may be incorrect, both Miller et al and Niels Jensen Big blue say to pull the tube first. Miller says specifically to remove the source of the fire and extinguish it in a bucket of water. Since both of these sources are very knowlegeable, and board examiners I will go with them. I guess well agree to disagree.