Airway Fire
Management
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Inform team & call for help
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Simultaneously remove the endotracheal tube (ETT) & stop gases/disconnect circuit
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Pour saline or water into airway
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Remove airway foreign bodies (ie: ETT pieces, sponges)
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When fire is extinguished: re-establish ventilation; avoid supplemental oxygen if possible
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Consider prompt reintubation prior to swelling & coordinated with bronchoscopy
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Examine entire airway (including bronchoscopy) to assess injury & remove residual debris
Prevention
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For high risk procedures:
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Discuss fire prevention & management with team during time-out
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Avoid FiO2 > 0.3 & avoid N2O
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For laser surgery of vocal cord or larynx:
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Use laser resistant ETT (single or double cuff)
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Assure ETT cuff sufficiently deep below vocal cords
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Fill proximal ETT cuff with methylene blue-tinted saline (acts as a marker if cuff perforated by laser)
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Ensure laser in STANDBY when not in active use
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Surgeon protects ETT cuff with wet gauze
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Surgeon confirms FiO2 < 0.3 & no N2O prior to laser use (may require several minutes to dilute FiO2 & FeO2 to <0.3 depending on fresh gas flow & initial FiO2)
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For non-laser surgery in oropharynx:
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Regular PVC ETT may be used
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Consider packing wet gauze around ETT to minimize O2 leakage
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Consider continuous suctioning of the operating field inside oropharynx
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