Scalpel! Suture! Fire Extinguisher!

July 29, 2006 4:20 PM

Just when you thought it was safe to go into the operating room: surgical fires. Virtually all operating room fires ignite on or in the patient. These fires typically result in little damage to equipment, cause considerable injury to patients, and are a complete surprise to the staff.
posted by Wet Spot (31 comments total)

I worked in a hospital when there was a case like this. The patient's hair lacquer caught on fire, during a laparoscopy. I've also heard of cases in which oxygen is used to insufflate the abdomen during a laparoscopy, instead of CO2, and the patient actually explodes when the diathermy is switched on. The lesson should be, never have an operation if you can possibly avoid it.
posted by roofus at 4:43 PM on July 29, 2006

It seems like a lot of medicine is a complete surprise to the staff...
posted by blacklite at 4:47 PM on July 29, 2006

Most of the gaseous anesthetics used in surgery are explosive. I shudder to think of what would happen if there were a spark in the respirator: the explosion could travel down into the lungs and destroy them.
posted by Steven C. Den Beste at 4:50 PM on July 29, 2006

If they're so common, then why would they be a complete surprise to the staff?
posted by runehog at 4:51 PM on July 29, 2006

I'm vacation host this weekend to two doctors, one the assisant director of emergency-medicine research at a major NYC hospital, and the other his former residency director. Neither one of them has heard of ECRI or ever had a "surgical fire".
posted by nicwolff at 5:05 PM on July 29, 2006

Next on Fox: When Patients Explode!
posted by blue_beetle at 5:05 PM on July 29, 2006 [1 favorite]

HAHAHAH! This is cool: April fool jokes when it isn't April. Spontaneous patient combustion... love it!
posted by Decani at 5:08 PM on July 29, 2006

I love surgical fire. Their last album was great.
posted by bob sarabia at 5:08 PM on July 29, 2006

Dave Barry: "Now, before I get a lot of irate mail from the medical community, let me stress that not all surgical patients catch fire. Some of them also explode."
posted by Wolfdog at 5:08 PM on July 29, 2006

Neither one of them has heard of ECRI or ever had a "surgical fire".
They might be familiar with the technical medical term, kablamoplasty.
Interesting post, Wet Spot.
posted by weapons-grade pandemonium at 5:12 PM on July 29, 2006

In recent kiwi news ...

'Gas' leak causes fiery end to surgery

"Flatulence is being blamed for bringing a hospital patient's operation to a fiery end.

The man suffered minor burns in a brief but 'dramatic' operating theatre fire. He had gone into the Southern Cross Hospital in Invercargill to have haemorrhoids, or piles, removed and was singed in the 'exceedingly rare' incident involving his own gas.

'This was thought to be flatus containing methane igniting,' a health source told the Weekend Herald. 'There was a sort of flashfire and that was it, but it was fairly alarming at the time.'

...The incident follows two cases of patients being burned in Auckland hospitals in 2002 when, it was thought, diathermy machines accidentally ignited alcohol-based skin disinfectant.

A man having his appendix removed suffered burns to 5 per cent of his body and a woman undergoing a caesarean operation suffered more severe burns, although her baby boy was unharmed. After an investigation, hospitals were warned to tighten controls on the dangerous mix of alcohol disinfectants and electrical gear."

posted by ericb at 5:17 PM on July 29, 2006

Thanks, wgp, I couldn't remember the technical term kablamoplasty. Tag added!
posted by Wet Spot at 5:21 PM on July 29, 2006

Most of the gaseous anesthetics used in surgery are explosive.

That is absolutely not true. It has not been true since ether was used 40 years or more ago. I am sitting at an anesthesia machine as I write this and these are the gasses available to me: Air (we all know what this does), Nitrous oxide (often used as an adjunct to more potent anesthetic gasses; not flammable but like oxygen does support combustion) and oxygen (also not flammable but also supports combustion). Next are three anesthetic vaporizers containing sevoflurane, isoflurane, and halothane; all of these are non-flammable halogenated anesthetics. Other non-flammable anesthetics currently in use in the United States include desflurane and enflurane. Drugs like these have been the standard inhaled anesthetics since halothane became widely used in the 1950s.

On the other hand, airway fires are very well known among anesthesiologists and otolaryngologists. They occur when a patient is administered a high concentration of oxygen or nitrous oxide while doing surgery in the throat with either lasers or electrocautery. The pvc endotracheal tubes that are commonly used can ignite and cause a jet of flame to go down into the lungs with the potential for severe injury. This is avoided first of all by keeping the oxygen concentration in the airway less than 30% and avoiding the use of nitrous. There are also special fire-resistant endotracheal tubes available that provide an additional measure of safety. Of course none of this is a substitute for vigilance.

OR fires are well-documented in the literature and often discussed in the OR where I work. The use of extra oxygen, the presence of flammable drapes, and the use of electrocautery and lasers all make it a real risk. By being aware of that risk, at least where I work, we are able to take steps to minimize it. In the nearly 20 years I have been here we have had a few close calls but no serious OR fires.
posted by TedW at 5:25 PM on July 29, 2006 [6 favorites]

Criminy, the mother of the person in the second link was repeated pwned. The lesson should be, assisted suicide is your friend.
posted by jewzilla at 5:27 PM on July 29, 2006

Neither one of them has heard of ECRI

I have been familiar with them for at least 15 years. They do a lot of good safety-related work as well as evaluating medical equipment. Despite their name, they seem to concentrate a lot on the OR. Your guests might enjoy looking into them.
posted by TedW at 5:30 PM on July 29, 2006

Metafilter: A complete surprise to the staff.
posted by MythMaker at 5:45 PM on July 29, 2006

What's with all of the Dave Barry quoting going on here? I feel like I'm conversing with my hip US History teacher from high school.

Interesting links and discussion, but I very much doubt the implied regularity of these sort of accidents.
posted by inoculatedcities at 5:51 PM on July 29, 2006

ABC actually did a segment on this? Honestly, the danger is so damn remote, it's not even worth thinking about it.

From the ABC site:

Surgery Pointers

Head/Neck Surgery the Riskiest: You should be most concerned if you are having head or neck surgery because that's when the surgical tools and oxygen are closest together.

Know Your Doctor: As with any surgery, choose a doctor and a hospital that perform the procedure a lot.

Ask About Oxygen: Ask the anesthesiologist whether he or she administers pure oxygen throughout the surgery. It's better if the anesthesiologist uses it only as needed or uses a diluted formula.

Ask If the Team Is Trained to Deal With Fires: And finally, ask the surgical team if it has training in putting out operating room fires.

That is some fine journalism.
posted by davebush at 6:08 PM on July 29, 2006

If they're so common, then why would they be a complete surprise to the staff?

Well, the first link says that they're aware of about 10 per year, and the second link says that there's about 100 per year. There are about 600,000 hysterectomies alone every year in the United States. Even if we take the higher number and pretend that the only operations worldwide were hysterectomies in the United States, there would only be a 0.017 percent chance of a fire occurring in any given surgery. I sure am glad that Good Morning America is informing people of this very important risk.
posted by LittleMissCranky at 6:21 PM on July 29, 2006

Please tell me I'm not the only one who's slightly concerned that if TedW is sitting next to an anesthesia machine whilst browsing the internet, could he also be sitting next to an unconscious patient?
posted by dogsbody at 6:25 PM on July 29, 2006

It has not been true since ether was used 40 years or more ago.

You're definitely the expert and I defer to your knowledge. But didn't they used to use cyclopropane as an anesthetic?

Which, I would think, would burn really well in a rich oxygen environment. (Maybe that's why they stopped using it as soon as non-flammable alternatives became available.)
posted by Steven C. Den Beste at 6:36 PM on July 29, 2006

Right on, TedW!
posted by Slarty Bartfast at 7:13 PM on July 29, 2006

Cyclopropane is indeed flammable, although less so than ether, but to a degree that is unacceptable today. It generally fell out of use in the 1960s although a few places outside the US continued to use it until the 1980s
posted by TedW at 7:15 PM on July 29, 2006

Dogsbody, I was in an unused OR at the time I posted that; my resident was next door in the room with the unconscious patient.
posted by TedW at 7:19 PM on July 29, 2006

Ah anesthesia...

hours of boredom punctuated by moments of sheer terror. Can't say I loved that rotation during medical school.

It wouldn't surprise me at all if TedW was behind the drape and posting on MeFi.
posted by i_am_a_Jedi at 8:42 PM on July 29, 2006 [1 favorite]

Ironically, I once needed surgery because of a blue flamer gone horribly wrong.
posted by Astro Zombie at 11:23 PM on July 29, 2006

My wife tells a story of a surgical fire from her nurse training days, almost thirty years ago.

Apparently, the surgeon was cauterizing the patient's stomach when it burst into flame.

Panicked, he reached out and used a kidney bowl full of water to attempt to douse the fire.

Unfortunately, the bowl was actually full of alcohol.

Major kablamoplasty ensues.
posted by PeterMcDermott at 12:22 AM on July 30, 2006

The second link (and the post) misquote the first link. As I read the first link, they said
1: "Virtually all operating room fires ignite on or in the patient"
2: "about 10 surgical patient fires a year come to ECRI's attention"
3: "These fires [that are brought to our attention] typically result in little damage to equipment, cause considerable injury to patients, and are a complete surprise to the staff. "

Therefore they are saying that the fires they hear about are the ones that injure patients, and were a surprise to staff (possibly contributing to the worse outcome).

The quote used reads differently, like this:
1: "Virtually all operating room fires ignite on or in the patient."
2: " These fires [all operating room fires] typically result in little damage to equipment, cause considerable injury to patients, and are a complete surprise to the staff."

To me this is a blatant misquote, communicating a completely different set of facts, and the second link is therefore not likely to contain anything but some scaremongering hyperbole.
posted by jacalata at 4:35 AM on July 30, 2006

The spleen, the spleen, the spleen is on fire
We don't need no water, let the motherfucker burn
Burn, motherfucker, burn.
posted by Eideteker at 8:11 AM on July 30, 2006

innoculated: google for "Flaming Booty Moth Treatment"
posted by baylink at 5:48 PM on July 30, 2006

Only YOU can prevent surgical fires!

Oh, and some interesting information about farts.
posted by Pinback at 8:28 PM on July 31, 2006