- Joined
- Aug 4, 2007
- Messages
- 53
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I know this has been discussed and there was some debate regarding whether the ETT should be removed, and should the O2 be stopped first vs removing the burning ETT first.
We had a grand rounds talk recently. I believe these recommedations are being reviewed by the ASA and will be incorporated into their formal guidelines:
-Simultaneously stop the O2 and disconnect the tubing.
-Remove the ETT. I believe the rationale is that there could be burning bits of the ETT or the ETT could be clogged with matter. There was some disucssion whether the ETT should be kept in place because a reintubation attempt may be impossible.
-BVM.
-Intubate/Bronchoscopy to remove particulate matter from the burned ETT.
Another recommendation was to go over with the staff for each case exactly what the responsibilities are in event of a fire (Who throws water on it, who pulls down the drapes, who gets the extinguisher).
There were some pretty frightening cases that were presented. One was an emergency crani that was prepped with Duriprep (0.7% Iodine, 74% alcohol). Seems that the prep was not completely dry and when the surgeon started using the bovie, the patient caught on fire.
The riskiest cases seemed to be ENT or facial plastics during MAC, where the cannula is close to the surgical field and electrocautery.
Take home messages -
Go over roles preop, especially in risky surgeries.
Smoke = Fire
Remove drapes, turn off O2, extubate, get extinguisher, 911
We had a grand rounds talk recently. I believe these recommedations are being reviewed by the ASA and will be incorporated into their formal guidelines:
-Simultaneously stop the O2 and disconnect the tubing.
-Remove the ETT. I believe the rationale is that there could be burning bits of the ETT or the ETT could be clogged with matter. There was some disucssion whether the ETT should be kept in place because a reintubation attempt may be impossible.
-BVM.
-Intubate/Bronchoscopy to remove particulate matter from the burned ETT.
Another recommendation was to go over with the staff for each case exactly what the responsibilities are in event of a fire (Who throws water on it, who pulls down the drapes, who gets the extinguisher).
There were some pretty frightening cases that were presented. One was an emergency crani that was prepped with Duriprep (0.7% Iodine, 74% alcohol). Seems that the prep was not completely dry and when the surgeon started using the bovie, the patient caught on fire.
The riskiest cases seemed to be ENT or facial plastics during MAC, where the cannula is close to the surgical field and electrocautery.
Take home messages -
Go over roles preop, especially in risky surgeries.
Smoke = Fire
Remove drapes, turn off O2, extubate, get extinguisher, 911