- Most recent (2010) estimates: 550–650 occurrences per year in the United States
- Oxygen-enriched atmosphere (OEA) involved in 72–74% of fires; alcohol prep solutions and drapes are most common fuels
- Most fire-related burn claims involved plastic surgery performed on the face under MAC with supplemental O2 where electrosurgical unit (ESU) comes in contact with drapes/gauze wet with alcohol prep solution
Three elements must exist for fire to occur: ignition source, fuel and oxidizer. The APSF Fire Prevention Algorithm recommends securing the airway with ET tube or LMA if >30% oxygen is required to maintain oxygen saturation.
Table 63-1 Examples of Elements of Fire Triad in an OR Setting |Favorite Table|Download (.pdf)
Table 63-1 Examples of Elements of Fire Triad in an OR Setting
|Ignition source (heat)||Fuel||Oxidizer|
- Electrosurgical units (ESU)
- Fiber-optic light source
- Laser beams
- External defibrillation
- Prep solutions: alcohol, chlorhexidine, benzoin, Mastisol, acetone, petrolatum products
- Surgical drapes, gowns, sponges, packs, sutures, mesh
- Plastic/PVC/latex products (ETT, masks, nasal cannulas, tubings)
- Intestinal gases (CH4, H2)
- Hair, other bodily tissues
Table 63-2 Elements of Fire in the OR: Mechanisms and Prevention |Favorite Table|Download (.pdf)
Table 63-2 Elements of Fire in the OR: Mechanisms and Prevention
- FiO2 ≥21% → ⇑ ignition, temperature, combustion
- O2 heavier than air → collects under drapes
- O2 at 3 L/min via NC → FiO2 70–80% under drapes
- D/C NC O2 → FiO2 ⇓ to 30% in 30 s
- Provide lowest FiO2 consistent with adequate SaO2
- Use O2 “for rescue only”
- Tape NC in place to avoid blowing O2 into surgical field
- Discontinue O2 60 s before use of ESU
- FiO2 25% + N2O 75% ≈ FiO2 100% in ability to support combustion
- N2O ⇑ risk of fire when combined with intestinal gases (CH4 + H2), which act as fuels
- Avoid N2O during cases where ESU is used on gas-filled intestines (GI obstruction)
- Sevoflurane + desiccated Baralyme may → fire
- Replace Baralyme regularly, especially on Monday morning
- Retains prep solutions longer, ignites easily
- Clip hair in operative site or render it nonflammable by heavy coating with water-soluble lubricant jelly
- Instruct patients not to use petroleum-based facial creams and hair products
|Drapes and towels:|
- Absorb O2 and alcohol → facilitate ignition
- Fire-resistant cotton towels → “surface fiber flame propagation,” that is, fire underneath drapes without drapes being on fire → ignition of materials at some distance from operative site with no intermediate fire (“mysterious spark”)
|Drapes and towels:|
- Thoroughly moistened gauze in operative field
- Minimize drape tenting to prevent entrapment of O2 and alcohol vapors
|Skin prep solutions:|
- Alcohol-based solutions ...
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