Crazy Cases/odd Case Experience

[RUSD8D]

hey fellow OR dudes: havent been on in long time. Currently CA-2, had intresting case. I think we all should post these more and share....well here it goes.

10 pm , healthy- well fit portuguese speaking south american male comes in, no med/sgy hx, lean runner type with lots of oil pipeline veins......sweet.....for perforated bowel. FUN PART....he's of course....Jehova witness with INR 3 for unknown reason. Attending a little uncomfortable.......me , I learned to switch from white boxers to dark colors midway CA1 year, no sweat!.......put large iv holding area no prob(to replace crappy er one of course) or health probs. Well pt not clear about albumin, which I dont really like anyway. Ok, decide to give 10mg IM vitK holding area (ffp out of course....) even though wont work till much later....cant hurt, you agree? Rapid sequence likkity split mac 3, no probs mon......let the p lyte rip, a line, des/o2/air/fent.........sgn and res. come in, pt ok just behind on fluids, lets start...............bovie to abdomen and BOOM! ......holy %$#@! batman!...explosion with flames couple inches off incision site for split second!....drop a loaf, look around and everyone like a deer in headlights! I thought anesthesia machine canister or something blew up initially, but was ignition of bowel gas with bovie! I/ve read about this but wow! Maybe next time ill reccomend scalpel? anyone have similar experience?
anyway, only lost 150 cc blood, pt. extubated or fine, quick case...............but would really love feedback about case...similar experience,what to do with Jehovas in these situations/ and do you prefer boxers or briefs for those crapping yourself moments......figured going commando with university scrubs from machine was just too nasty to begin with! (p.s. as soon as stopped bovie all ok, no burns to pt. of excess nature)

Thanks....hope you old timers respond.
RUSD8D

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[nitecap]

Have seen some start IV and let blood drain into bag, then transfuse when ready though you cant break the line, it always must be connect to pt.

 

[jetproppilot]

bovie to abdomen and BOOM! ......holy %$#@! batman!...explosion with flames couple inches off incision site for split second!....drop a loaf, RUSD8D

HAHAHHAHAHAHAHAHAHAHAHAHHAHAHAHA

Thanks for the laugh. I needed it.

Anyway, never seen that one.....heres the next days newspaper headlines:

SURGEON, ANESTHESIOLOGIST KILLED BY LIGHTING FARTS

lmao....

 

[supahfresh]

dude, you gotta write this up!

 

[toughlife]

All the god damn methane ignited. !

 

[RUSD8D]

seriously.................i had read about this during med school sgy in schwartz text book but never thought it could happen.................

my attending that night wanted me to present it as M/M, but i fenagled my way out since anesthesia didnt do anything............not even provide the gas! ha ha..........but seriously.........wont forget that case.

Anyway guys.............since than ive done other Jehova cases, like ortho where you can use cell saver but with closed circuit connection............does this seem to be the norm?

thanks for input and maybe I will write it up...

RUSD8D

 

[cubs3canes]

So what if it was the volatile anesthetic and not the methane that ignited to flame? What do you do next (besides turn off the gas and put out the flame)?

 

[Noyac]

So what if it was the volatile anesthetic and not the methane that ignited to flame? What do you do next (besides turn off the gas and put out the flame)?

The volatile anesthetics are no longer flammable. Nitrous can support combustion as well as oxygen of course. The most common case that you would see this in is ENT cases involving the airway. What you would do is turn off the N2O and O2 disconnect the circuit ( some say it is important to turn off the gases b/4 disconnecting so that you don't disconnect the circuit and have flame torch) and then extinguish the flames.
On a side note, I have heard of those ETOH based skin preps igniting when the bovie was used on the skin.

 

[jetproppilot]

So what if it was the volatile anesthetic and not the methane that ignited to flame? What do you do next (besides turn off the gas and put out the flame)?

Throw a match into a puddle of des/sevo and it wont ignite.

 

[RUSD8D]

just for pointers................i wanted to both say that exactly, the new volatile agents wont ignite and that the ENT situation with airway fire is a common board scenario..........(hint...almost july!).....

 

[cubs3canes]

Throw a match into a puddle of des/sevo and it wont ignite.

I thought that was the case but I was not sure. Shouldn't we change the name from volatile anesthestics?

 

[coccygodynia]

I thought that was the case but I was not sure. Shouldn't we change the name from volatile anesthestics?

The "volatile" doesn't have to do with flammability - it's the property of a substance vaporizing into a gas at a relatively low temp.

 

[DenRock]

Off the subject of exploding bowel gas ...
Does this sound like a great time to use activated recombinant factor VII for correction of INR in a patient refusing FFP? Vit K might work, but not acutely.