Anaes Cases · Electricity, diathermy & theatre safety
Airway fire during a tracheostomy
Hot case — airway fire (oxygen-rich gas, endotracheal tube, diathermy). Stop gas flow, remove burning tube, douse with saline, mask-ventilate with room air, re-intubate, bronchoscope for damage.
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ANZCAFRCAABAEDAIC
Prompt
During an emergency tracheostomy under general anaesthesia with 100 per cent oxygen and the surgeon using monopolar diathermy to enter the trachea, a flame ignites in the surgical field and travels into the airway. Manage.
Presentation
An emergency surgical tracheostomy is performed on an intubated, ventilated patient in ICU for failure to wean. The anaesthetist is delivering 100 per cent oxygen via the endotracheal tube (pushed up but still in the trachea). The surgeon uses monopolar diathermy to divide tissues and enter the trachea. As the trachea is opened, a flame erupts in the wound and flashes into the airway. Manage immediately.[38158892]
References2ShowHide
- [4]Mortada H, et al. Preventing and Managing Operating Room Fires in Plastic Surgery: A Review of Incidence, Risk Factors, and Recommendations With Case Experiences. J Burn Care Res, 2024.PMID 38158891
- [38158892]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.