Surgical Fires

Surgical fires do not happen often, but patients can be seriously injured or killed when they do. Most can be avoided if surgical personnel learn to recognize and control the elements that combine to cause fires. Ensure devices that could serve as ignition sources—most commonly electrosurgical 

In addition, surgical booms housing electrical cables and oxygen hoses should be inspected regularly. 

Ensure each staff member knows the identification and location of medical gas, ventilation, and electrical systems including controls. Educate everyone how to use the hospital s alarm system 

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Emergency Care Research Institute (ECRI). Educational Videos on Surgical Fires. Health Deiices, 2000, 29, 7-8. 

Organizations should report any instances of surgical fires as a means of raising awareness and ultimately preventing the occurrence of fires in the future. 

Describe seven actions that can help prevent surgical fires. 

Earnest, R.E. Characteristics of proactive reactive safety systems. ASSE Professional Safety, November 1997. ECRI. A clinician s guide to surgical fires How they occur, how to prevent them, how to put them out. Health... 

Candidates must be in excellent health and have no conditions that would restrict their ability to safely do fire suppression and rescue work. Weight (body fat content) must be proportionate to height for men and women. Uncorrected distance visual acuity of at least 20/100 in the poorer eye and 20/40 in the better eye, correctable to at least 20/40 in one eye and 20/20 in the other eye, is required. Regarding refractive surgery, most persons who have had these procedures will be passed. However, some may be deferred for several months or disqualified based on an individualized assessment of the surgical outcome. Color vision Candidates must be able to accurately and quickly name colors and must be free of other visual impairments that would restrict the ability to perform firefighter duties. 

Following fires in which endotracheal tubes became ignited by surgical lasers or electrocautery in atmospheres enriched by oxygen and/or nitrous oxide, the flammability of PVC, silicone rubber and red rubber tubes in enriched atmospheres was studied [1], Ozonised oxygen was reacted with hydrogen at low pressure to generate hydroxyl radicals. Pressure in the apparatus was maintained by a vacuum pump protected from ozone by a tube of heated silver foil. On two occasions there was an explosion in the plastic vent pipe from the vacuum pump. The vent gas should have been outside explosive limits and the exact cause is not clear the editor suspects peroxide formation. 

The effects of DBS on the cortex-basal-ganglia-thalamus-cortex motor loop appear to be more complex than initially believed. The paradox of DBS is that electrical stimulation of brain tissue (which presumably induces brain activation), has a similar effect as that of a surgical lesion of that same structure (which effectively destroys brain tissue). These two realities are hard to reconcile. As indicated by [64] the ultimate elucidation of this paradox depends on the nature of the complex and interactive neural connections in the brain that communicate through electrical and chemical processes. There is an emerging view that DBS has both excitatory and inhibitory effects on how brain circuits communicate with one another depending on the distance from the electrode, the cell structures activated and the direction of the activation (ortho- versus anti-dromic). The effect appears to modulate the activity of a network as well as neural firing patterns. Long term effects on neurotransmitters and receptor systems cannot be excluded [64]. 

Typical uses of martensitic steels are cutlery, surgical instrumentation blades (turbine engines) bearings, aerospace equipment petroleum production and refining fire arms, valves and stems and food processing equipment. 

Specialty polymers achieve very high performance and find limited but critical use in aerospace composites, in electronic industries, as membranes for gas and liquid separations, as fire-retardant textile fabrics for firefighters and race-car drivers, and for biomedical applications (as sutures and surgical implants). The most important class of specialty plastics is polyimides. Other specialty polymers include polyetherimide, poly(amide-imide), polybismaleimides, ionic polymers, polyphosphazenes, poly(aryl ether ketones), polyarylates and related aromatic polyesters, and ultrahigh-molecular-weight polyethylene (Fig. 14.9). 

Dr Gilmore indicated the surgical table with a muddled gesture. "Electricity, Admiral. Equip our marines with guns that fire a dart that contains a small electron matrix cell and simply push a current into them. Such weapons were in widespread use from the midtwentieth century right up until the twenty-third. We ve already produced a modem chemical-powered design with a range over five hundred metres."... 

Improper use of electrosurgery may expose both the patient and the surgical staff to various hazards. By far, the most frequent hazard is an undesired burn. Less frequent are undesired neuromuscular stimulation, interference with pacemakers, or other devices, fires, and gas explosions [1,3]. 

The intentional sparks produced by these machines have also been blamed in a number of surgical drape fires. The high-frequency nature of these therapeutic electrical waveforms also makes it easier for them to become capacitively coupled to other tissue or conductive pathways. Burns due to such coupling and/or insulation failures during laparoscopic procedures are often the result. Since such burns are usually outside the surgeon s visual field, they often go untreated. 

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