FIRE IN THE OR. Frequency n 2250 per year in the US n 20 serious injuries n 2 deaths per year n 95%...
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Transcript of FIRE IN THE OR. Frequency n 2250 per year in the US n 20 serious injuries n 2 deaths per year n 95%...
Frequency
2250 per year in the US
20 serious injuries 2 deaths per year 95% involved surgery of the
head and face
17% were MAC cases with nasal O2
Alcohol-New rules
Wicking on hair lines and in drapes Prolonged drying time Draping before drying leads to vapor
pooling
Fire prevention
Packaged to avoid excess Supplier instructions and warnings No soaking or pooling Complete dryness before draping Time out to verify dryness
LASERS
5 Major laser hazards:
-eye injuries
-skin and tissue burns
-fire
-toxic fume and smoke inhalation
-electrical injuries
LASERS
Make fire safety part of the time out Be sure cautery devices / laser probes are
fully intact and clean (or can arc) Communicate with the surgeon as to when
O2 is in use near the laser O2 off at least 60 sec before the use of the
laser Non-functioning equipment out of service
PREVENTION
Lowest possible Oxygen concentration < 30% Don’t tent Non-flammable gasses Avoid endo tube leakage No pooling of liquids
PREVENTION
Avoid alcohol preps Light sources off when not using No lotions, make-up, or creams No hairspray Water based lubricant around hair Oxygen off if near bovie
PREVENTION
Know where the pulls are Know where the extinguishers are Know where the Oxygen shut offs are Know the number to call
Evacuation
O2 OFF IMMEDIATELY-TO ROOM AIR Close doors Mark area as searched Stop all elective surgery when alarm
sounds
Evacuation of Surgery in Progress
Stop all that can Base decisions on cases in progress Move with Diprivan drip if needed
Airway Fire
Laser surgery risk Fill cuff with methylene blue so detect
early rupture-see on laser beam O2 to < 30 % (N20 and 02 support
combustion)
Airway Fire
Disconnect O2 source Remove tube quickly:
-removes flame, retained heat
-interrupts O2 supply to patient
-keeps distal end of tube from collapsing
Airway Fire
Place burning tube into pre-established bucket of water
Mask ventilate with 100% O2 until able to re-intubate
Re-intubate with a smaller tube (laryngeal edema)
Maintain anesthetic state-possibly TIVA
Airway Fire
Stabilize once airway is reestablished Rigid bronchoscopy-remove large FB
and assess Saline lavage to mainstem bronchus
and trachea Flex bronch-smaller particles Direct laryngoscopy-fine FB
Airway Fire
May need tracheostomy- fear is laryngeal edema
30-60%O2 post-op that is humidified (loss of cilia & strong chance of mucous plug)
PEEP to decrease atelectasis from loss of surfactant