airway fires
DESCRIPTION
Airway Fires. A Hot Topic. Chris Bowen T? May 27 th 2011 Anesthesia Keyword Presentation. Quick Description. Reported in 0.4-1.5% of laser airway cases Believed to be grossly underreported Risk of laser contacting ET tube 1:2 Inception Direct illumination Reflected Particles - PowerPoint PPT PresentationTRANSCRIPT
Airway FiresA Hot Topic
Chris Bowen T?May 27th 2011
AnesthesiaKeyword Presentation
Quick Description Reported in 0.4-1.5% of laser airway cases Believed to be grossly underreported
› Risk of laser contacting ET tube 1:2 Inception
› Direct illumination› Reflected › Particles
3 things every growing fire needs:› Ignition source laser, electrocautery› Oxidant O2 , Nitrous Oxide› Fuel ET tubes, drapes, etc.
Potential Dangers
Seeding Cuff puncture releases more oxidant into
field The “blowtorch” effect Airway trauma
› Smoke and debris inhalation Death
In Case of Emergency… D/C oxygen and extubate Douse flames with saline Mask ventilation
› Assess feasibility of reintubation for… Bronchoscopy to assess extent of injury
› Supportive care› Consider leaving tube if not burning
Admit patient to ICU
An Ounce of Prevention… OR prevention
› Proper eye protection› Wet towels and minimal draping› Matte/dull finished or blackened
instruments› Signs posted› Extinguisher checked and in room› Laser set on pulse not continuous› Laser set on “standby” mode
…is Worth a Pound of Cure. Anesthesia Preventions
› Dentures and nasogastric tubes removed› Co-morbidities› Technique
Jet, apneic, spontaneous ventilation› Tube
Type Metal vs. rubber vs. PVC
Coverings› Cuff preparation
Tapes, Tips, and Tubes Tapes
› 3 major types› Inexpensive
Cuff filled with saline vs. air› Mini-extinguisher effect› Methylene blue dye
Tubes› Metal interlocking rings of stainless steel› Rubber soft, usually without cuff› PVC garden variety
Studies 46% prefer laser-safe ET, 26% prefer Jet Ventilation, 16% apneic, 12% spontaneous Sosis and Dillon Tapes
› Copper demonstrated no combustion at 60 sec.› Not FDA approved› Proper application is key
Limit flexibility Increase diameter Can come loose
Cuffs › Saline filled cuff perforation reduced combustion by 80%› Dye allows for quick assessment of cuff integrity› Dual cuffs made extubation problematic
Tubes› Metal is resistant not impervious
increased trauma upon insertion› PVC very resistant
Taping or covering recommended Application must be precise
› Rubber most flammable* Blood, mucus, and tissue increased combustion rates up to 60% The YAG laser ignited all materials within 6 sec
Conclusions Metal tubing is safe and effective
› Resistant not impervious Cuffs should be filled with saline and
dye Copper tape has superior resistance
when compared to other tapes and coverings
Nothing withstands the YAG
Food for Thought LMAs Increased muscle relaxants Are all lasers created equal? Metallic tape vs. laser-guard coverings FiO2 and inhaled anesthetic levels Tracheostomy
Thank You
Questions?
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