Remember that Fires in the Operating Room Can Be Prevented By Minimizing Just One Component of the Fire Triad
Anne B. Haupt RN, BSN, CNOR
Catherine Marcucci MD
You are on call and are notified that a patient is coming to the operating room (OR) urgently for a stab wound to the neck. You make your way to the room that has been set up for cases from the emergency room, the standard OR table is already made up with a draw sheet. You know that this is actually a polyurethane foam mattress, covered with a synthetic fabric, covered with a cotton sheet, but of course, you are not really thinking about that right now. The patient arrives shortly in a cloth hospital gown and a paper hat. She is a young woman who ran into trouble while out clubbing; she is wearing both hair gel and perfume. After induction, the patient’s skin is quickly cleaned with an alcohol-based prep solution, with little or no time to place pads to catch drips.
Her head and neck are draped as quickly as possible with four cotton towels and a clear incise drape. Dry sponges are placed on the field. The patient is breathing high-concentration oxygen or perhaps a combination of oxygen and nitrous oxide. Of course, there was not time to check for frayed power cords or current inspection stickers, and that’s not something the anesthesia provider typically does anyway. You notice there are multiple foot pedals at the surgeon’s feet and wonder what the cases had been in that room during the day. The surgical case starts and you notice several times that the electrosurgical unit (ESU) pencil is not holstered when not in use; instead it is allowed to rest on the drapes. You see the ESU spark a bit the next time the surgeon picks it up, then suddenly, it “flashes” on you—this is the perfect setup for an OR fire.
Fire is the result of a chemical reaction between a fuel and oxygen. It will occur in any setting where the three elements that form the fire triad (fuel, oxygen, and heat) come together. Approximately 100 surgical fires are reported each year, resulting in about 20 serious injuries and one to two patient deaths, although these numbers may represent only a fraction of actual fires. Besides the devastating consequences of physical injury and death, OR fires can cause great psychological trauma to patients, family members, and staff. Unfortunately, there are also unfavorable public relations as well as potential legal ramifications.
The vast majority of fires ignite on or in the patient—34% in the airway (see Chapter 12), 28% on the head or face, and 38% elsewhere on or inside the patient. Thus, the most common injuries are airway burns, skin or internal burns, and burns to the patient’s unprotected eyes during laser surgery. Also, the volatile gases and toxic fumes and by-products that are produced as synthetic materials melt are caustic to both the skin and eyes and can be lethal if inhaled. Most flames have a temperature that is approximately 1,200°C, with ambient temperatures ranging from 90°F near the floor to 600°F. Smoke from an uncontrolled fire can fill a room in approximately 3 minutes.
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Do Not Underestimate the Difficulty of Reintubating a Patient Who Has Undergone Carotid Endarterectomy or Cervical Spine Surgery
Don’t Overflush Lines
Do Not Treat Lactic Acidosis with Bicarbonate
Beware the Antibiotic Bowel Prep
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