Emergency surgery on a 60-year-old man in Melbourne took an extreme and unexpected turn when his chest cavity caught on fire.
The Australian senior was rushed to the operating theatre in August last year to undergo an emergency repair, having suffered a tear in the inner layer of the aorta wall in his chest. The unidentified patient had a history of chronic obstructive pulmonary disease (COPD) and he had undergone coronary artery bypass grafting one year prior.
However, after being taken down to theatre for his most recent operation, things took a turn for the worse when the man suffered a “flash fire” in his chest cavity as he lay unconscious on the table, with the blaze triggered by supplemental oxygen which was leaking from a ruptured lung.
Speaking about the strange turn of events at this year’s Euroanaesthesia Congress in Austria, Dr Ruth Shaylor from Austin Health in Melbourne relived the incident.
Shaylor revealed that as surgeons began to operate, they noticed the man’s right lung was stuck to the overlying sternum, finding areas of overinflated and destroyed lung. The quick thinking doctor made the decision to increase the flows of anaesthetic gases to 10 litres per minute and the proportion of oxygen to 100 per cent in a bid to prevent respiratory distress.
However things didn’t play out as expected and a spark from the electrocautery device – a heating device used to stop vessels from bleeding – ignited a dry surgical pack. Thankfully the fire was immediately extinguished without any injury to the patient and the rest of the operation proceeded uneventfully with the repair a success.
Addressing the room full of doctors at the international conference, Shaylor said it should act as a warning of the potential dangers of dry surgical packs in the oxygen-rich environment of the operating theatre where electrocautery devices are used.
“While there are only a few documented cases of chest cavity fires – three involving thoracic surgery and three involving coronary bypass grafting,” she said. “All have involved the presence of dry surgical packs, electrocautery, increased inspired oxygen concentrations and patients with COPD or pre-existing lung disease.
“This case highlights the continued need for fire training and prevention strategies and quick intervention to prevent injury whenever electrocautery is used in oxygen-enriched environments.”
Shaylor added: “In particular surgeons and anaesthetists need to be aware 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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