Licoricestick

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Same things that cause any fire - fuel, oxygen, ignition source.
Same thing you do with any fire - put it out.
 

AbbyNormal

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I understand the fire triangle but I am novice to the OR. That's why I am seeking information from the experts. I am here to learn.

I understand removing ntg patches before defib and using ground pads but I don't understand how a fire could literally melt an ETT and don't understand why the patient I linked to was so severely burned. I am not saying it was a person at fault rather I am asking what a reasonable prudent anesthesiologist would do.
 

core0

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I understand the fire triangle but I am novice to the OR. That's why I am seeking information from the experts. I am here to learn.

I understand removing ntg patches before defib and using ground pads but I don't understand how a fire could literally melt an ETT and don't understand why the patient I linked to was so severely burned. I am not saying it was a person at fault rather I am asking what a reasonable prudent anesthesiologist would do.
There are a couple of older posts on this:

http://forums.studentdoctor.net/showthread.php?t=298599&highlight=fire

http://forums.studentdoctor.net/showthread.php?t=451185&highlight=fire

Usually some combination of ignition source (Bovie or laser), flammable object (ET tube or drapes) and oxygen.

David Carpenter, PA-C
 

AbbyNormal

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Thank you.
 

Gern Blansten

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Think about the fact that the ETT is made out of plastic that melts easily. Think about if you have ever had melting plastic drip onto your skin, which is generally pretty tough. It burns and causes a mess (sticks to your skin). Now think of that scenario in your trachea burning through the fragile layers of tissue there. It only takes a few seconds of this occurring to cause devastating injuries.

Another scenario is using flammable skin preps and applying drapes before it has dried. There have been cases where this occurred and it was ignited under the drapes. It is difficult to extinguish, because the drapes are not permeable to water. You have to immediately get the drapes off. There may be a delayed recognition of the fire if it occurs under the drapes.

Fires may also occur in ophth cases under local mac sedation. It used to be common practice to create an almost tent like environment so that the patient would breathe an O2 enriched mixture under the drapes. Since O2 supports combustion, this led to a few serious explosions/fires and this practice is not as prevalent anymore.

Avoiding airway fires is a huge topic that is addressed well in most major texts. It is an important thing to know and I suggest you read and understand it.
 

AbbyNormal

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Think about the fact that the ETT is made out of plastic that melts easily. Think about if you have ever had melting plastic drip onto your skin, which is generally pretty tough. It burns and causes a mess (sticks to your skin). Now think of that scenario in your trachea burning through the fragile layers of tissue there. It only takes a few seconds of this occurring to cause devastating injuries.

Another scenario is using flammable skin preps and applying drapes before it has dried. There have been cases where this occurred and it was ignited under the drapes. It is difficult to extinguish, because the drapes are not permeable to water. You have to immediately get the drapes off. There may be a delayed recognition of the fire if it occurs under the drapes.

Fires may also occur in ophth cases under local mac sedation. It used to be common practice to create an almost tent like environment so that the patient would breathe an O2 enriched mixture under the drapes. Since O2 supports combustion, this led to a few serious explosions/fires and this practice is not as prevalent anymore.

Avoiding airway fires is a huge topic that is addressed well in most major texts. It is an important thing to know and I suggest you read and understand it.
Thank you. I aspire to be a CRNA if I can get my kid raised. I ordered a basics anesthesia text from Amazon to get an idea what level class would be starting at. I am chaffing at the bit ready to learn.
 

Sapdaddy

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There are a couple of older posts on this:

http://forums.studentdoctor.net/showthread.php?t=298599&highlight=fire

http://forums.studentdoctor.net/showthread.php?t=451185&highlight=fire

Usually some combination of ignition source (Bovie or laser), flammable object (ET tube or drapes) and oxygen.

David Carpenter, PA-C

N2O is as combustible as O2, and volatile anesthetics decompose into toxic agents with fire, so go with TIVA and lowest possible FiO2 if it's an airway surgery that poses a fire risk.
 

Jay K

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N2O is as combustible as O2, and volatile anesthetics decompose into toxic agents with fire, so go with TIVA and lowest possible FiO2 if it's an airway surgery that poses a fire risk.
I apologize for the presumption, but this sounds like an answer from someone who does not practice clinical anesthesia, nor has read the most recent literature regarding prevalence/incidence of airway fire and the types of cases they tend to occur in- the greater numbers actually involve MAC cases with non-secured airways supplementing o2 via mask or NC resulting in the "oxygen tent" situations previously mentioned.
 

pgg

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N2O is as combustible as O2, and volatile anesthetics decompose into toxic agents with fire, so go with TIVA and lowest possible FiO2 if it's an airway surgery that poses a fire risk.
Volatile agents really aren't combustible. Barash says sevo at 11% in oxygen can be a fuel for combustion ... but that's 5 MACs and a high FiO2.

Does anybody really do TIVAs for all airway surgeries? I never have and I don't think I've ever seen anyone else either.
 

IlDestriero

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Does anybody really do TIVAs for all airway surgeries? I never have and I don't think I've ever seen anyone else either.
All airway surgery (MLB, mitomycin, balloon, FB, etc.) no. Complicated airway surgery/reconstruction, yes. As for O2 concentration, I shoot for under 30%. It gives them some time to work and decreases the fire risk. Sometimes airway days are really a giant PIA. If they already have a trach, they may not need a TIVA, but the airway cases can be a bit unpredictable, so it never hurts (for long complex cases).
 

pgg

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All airway surgery (MLB, mitomycin, balloon, FB, etc.) no. Complicated airway surgery/reconstruction, yes. As for O2 concentration, I shoot for under 30%. It gives them some time to work and decreases the fire risk. Sometimes airway days are really a giant PIA. If they already have a trach, they may not need a TIVA, but the airway cases can be a bit unpredictable, so it never hurts (for long complex cases).
I can see how TIVA might make some airway surgeries easier because you avoid the potential problem of inadequate anesthesia from intermittent ventilation. I'm just surprised to see it cited as a fire risk reducing measure.
 

Sapdaddy

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I apologize for the presumption, but this sounds like an answer from someone who does not practice clinical anesthesia, nor has read the most recent literature regarding prevalence/incidence of airway fire and the types of cases they tend to occur in- the greater numbers actually involve MAC cases with non-secured airways supplementing o2 via mask or NC resulting in the "oxygen tent" situations previously mentioned.
thanks for the help. don't practice clinical anesthesia, but help fix anesthesia text. if you had a fire case, would it be better or worse to already have an ETT in place, for example the OP's reference to melted ETT during fire? i think my resource was on the topic of fire with laser surgery, but i can see why mask or NC would lead to greater incidence of fires.
 

Sapdaddy

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thanks for the help. don't practice clinical anesthesia, but help fix anesthesia text. if you had a fire case, would it be better or worse to already have an ETT in place, for example the OP's reference to melted ETT during fire? i think my resource was on the topic of fire with laser surgery, but i can see why mask or NC would lead to greater incidence of fires.

specifically, ENT using CO2 laser in airway. is it okay to use laserflex ETT, TIVA, and low FiO2? or jet ventilate? what would you do to reduce fire risk?

i'm not wanting to ever be anes doc, or AA, or CRNA, i just want to make sure what's written in the books matches up with what can be done, what is done, and/or what should be done.