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An accident during emergency cardiac surgery that caused a fire in the chest cavity of a patient gave the doctors warning.
Dr. Ruth Shaylor – who works at Austin Health in Melbourne, Australia – presented the case at the Euroanaesthesia Congress in Vienna, Austria.
During the surgery, the right lung of the 60-year-old patient remained stuck to the overlying sternum, with areas of overhang and lung destruction.
One of the areas of excessive swelling of his lung was then accidentally perforated, causing an air leak requiring anesthetic gas flow at 10 liters per minute, the proportion of oxygen being set at 100%.
A spark from an electrical coagulation device (which uses heat to keep the blood vessels from bleeding) then ignited a dry surgical block, causing a fire in the man's chest.
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He was immediately extinguished without any injury to the patient and the operation was completed successfully.
But Dr. Shaylor said the rare incident showed the need for medical personnel to undergo fire training.
"Although there are only a few documented cases of chest cavity fires – three involving thoracic surgery and three involving coronary bypass surgery – all involve the presence of dry surgical packs," he says. Electrocautery, increased concentrations of inspired oxygen and patients with COPD or preexisting lung disease, "she said.
"This case highlights the continued need for prevention and fire training strategies and rapid interventions to prevent injury whenever electrocautery is used in oxygen enriched environments."
She added, "In particular, surgeons and anesthesiologists need to know that fires can occur in the chest cavity if a lung is damaged or there is an air leak for any reason, and that patients with COPD are at increased risk.
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