Fire in the operating room during tracheotomy: a case report.

Veterans Affairs Medical Center, Minneapolis, MN, USA.
AANA journal 05/2005; 73(2):97-100.
Source: PubMed

ABSTRACT We describe a patient who sustained facial burns during a tracheotomy. The electrosurgical unit indirectly started the fire during monitored anesthesia care when a high inspired oxygen concentration was being delivered to the patient by simple face mask. This case points out the need for prevention strategies, intraoperative vigilance, and quick intervention to prevent further patient injury any time the electrosurgical unit is used in an oxygen-enriched atmosphere.

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    ABSTRACT: Laser generated operating room fires have been reported ever since lasers have been used for therapeutic indications. This occurs because, when an ignition source such as the laser, is used in the vicinity of high oxygen concentrations, and materials, such as the endotracheal tube (ETT), can then be easily ignited. This paper shows examples of ETTs after such a fire, together with the severe injuries incurred. Even though over the years a great deal of experience has been collected in the management and handling of these patients, accidents with ETT fires still occur.Many different materials have been tested for ETTs with regard to their incendiary characteristics, and special constructions of ETTs for use with lasers have been developed accordingly. Whereas wrapping the ETT with metal foil gives a false sense of safety, the so-called ‘laser-tubes’ exhibit an increased resistance to damage by laser radiation. However, even using these, ETT fires have still occurred due to contamination with blood or because the laser has hit the connection of the cuff with the shaft of the tube. These particular aspects have recently been investigated, and international standards are being prepared, which will hopefully promote the development of proven laser-suited ETTs in an effort to reduce the frequency of these severe accidents.ZusammenfassungDurch Laser erzeugte Feuer im Operationssaal wurden in der Literatur beschrieben, seit Laser für therapeutische Indikationen angewendet werden. Der Grund für solche Brände ist die Situation, in der eine Entzündungsquelle in der Nähe hoher Sauerstoffkonzentrationen angewendet wird, unter der viele Substanzen, wie die eines Trachealtubus’ (Endotracheal Tube, (ETT)), leicht entflammt werden können. In dieser Arbeit werden einige durch Feuer beschädigte Tuben demonstriert, ebenso wie die schweren Verletzungen, die Patienten dadurch davontragen. Im Laufe der Jahre wurden viele Erfahrungen im Umgang und der unmittelbaren Versorgung der betroffenen Patienten gesammelt. Jedoch kommt es auch heute noch zu Unfällen durch Tubusbrände.Viele verschiedene Materialien für ETTs wurden hinsichtlich ihrer Entflamm-Eigenschaften getestet und spezielle Konstruktionen von ETTs für den Einsatz mit Lasern entwickelt. Während die Umwicklung des Tubus mit Metallfolie zu einer vermeintlichen Sicherheit führt, erreichen die sogenannten Lasertuben einen verbesserten Widerstand gegen Zerstörung durch Laserstrahlung. Allerdings kann es auch bei Lasertuben zu einem Feuer kommen, bspw. durch Kontamination mit Blut, oder indem die Verbindungsstelle zwischen Cuff und Tubusschaft getroffen wird. Diese speziellen Aspekte werden in jüngster Zeit untersucht, und internationale Normen werden erarbeitet, die hoffentlich die Entwicklung nachweislich lasergeeigneter ETTs anregen, um die Häufigkeit solcher schweren Unfälle zu verringern.
    Medical Laser Application 04/2010; 25(2):118-125.
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    ABSTRACT: Occupational hazards associated with medical laser applications remain poorly understood and uncharacterized. A literature search was performed using PubMed, and all articles relevant to beam and nonbeam medical laser hazards were reviewed. The Rockwell Laser Industries Laser Accident Database was searched for medical laser injuries and abstracted. Eye injuries, skin burns, injuries related to the onset of fires, and electric shock have been reported in relation to medical laser use. It is probable that both acute and chronic health effects have been experienced by medical personnel as the result of exposure to laser generated air contaminants. Because of the clinical benefits they provide, the growth of laser technologies and applications are anticipated to result in an increase in the number and type of medical personnel with future exposure to laser hazards.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 11/2011; 53(11):1302-9. · 1.88 Impact Factor
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    ABSTRACT: INTRODUCTION: Electrosurgery technology is known in a long time ago, and has gained increasing prominence. Nevertheless, it still presents many risks as to its use. Several lesions can be caused by electrocautery, and burns are the most frequent complications. There is not always patient's cooperation regarding preventive measures. METHOD: Review of relevant literature on the basis of legal questioning of a patient who refused to remove their ornaments at the beginning of surgery, being already in the operating room. CONCLUSION: It is essential to have the knowledge of the fundamentals of electrosurgery, its correct use, safety equipment, constant monitoring and immediate investigation to minimize the risk of accidents in patients with metal ornaments, and patient cooperation in obeying the preventive measures of accidents should be mandatory.
    ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 09/2010; 23(3):183-186.


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