Airway fire
4 E's
Eliminate (oxygen)
- Stop ventilation
- Disconnect O2 source
Extract (ETT)
- Take out ETT
Extinguish (fire)
- Flood area with saline
Evaluate (damage)
- Assess damage
Prevention
- Airway choice
- Gas choice
- Limit laser duration
- Water
Choice of airway
- Use resistant ETT if possible
- Inflate cuff with blue dye/saline
Choice of gas
- Low FiO2
- Avoid N2O
- N2O will support fire
Water
- Saline-soaked pledgets in airway
- Water availabe to extinguish fire
Rx
Stop fire
In this order:
- Stop laser
- Stop ventilation
- Discontinue circuit from ETT
- Remove burning ETT
- Douse airway fire with water (if needed)
- Suction debris from airway
NB:
Always disconnect before removing ETT
Disconnection...
- Immediately stops the fire
- Easier to do
- See the video on airway fire!!!
Resuscitate
- B&M with 100% oxygen
- Reintubate
- Commence TIVA
Follow-up
- Assess injury
- Examine with bronchoscope
- Steroids
- Antibiotics
Postop
- Monitor in ICU / HDU for 24 hours
- Keep intubated unless very mild