As a 20+ year firefighter, I’ve extinguished many things I never thought I’d encounter on fire, but if someone told me there was a mouth on fire, I’d anticipate it was an accident involving a flame arts performer, not a surgical case!
That's why people on oxygen aren't allowed to smoke, should look up what happens when those tubes catch fire... Calling it a flamethrower isn't much of an exaggeration and the tubing burns as fast as a fuse, the flame just shoots down it in seconds and suddenly the whole tube is gone. Lotta old people end up burning their house down smoking while they're on oxygen, really huge danger and not only in operating rooms and I'd wager there have been a lot more house fires from covid with the whole oxygen tank shortage and all the sick people requiring tanks at home...
@@DrakeOola Any fire in an oxygen-rich environment is TERRIFYING. Our atmosphere is about 21% oxygen, and fires can already be quite violent, só if you increase the amount of oxygen in the air, you can burn stuff really quickly. And if you get something that is more oxidising than oxygen, then you can burn stuff you might expect to not be flammable, like stone.
In 35 years of practice I never experienced an airway or OR fire. However, a surgical group I worked with in Waco, TX, after I moved to another hospital, did have an OR fire. They insisted on prepping the patient with alcohol for their surgeries until they had a fire. Actually, the first episode did not change their behavior and they had another fire three months later. I hear that they finally went back to prepping with water based solutions.
@@23Butanedione I’m sure he probably got permission. I don’t think he would jeopardize his career for a TH-cam video. He not filming patients, so he’s not violating HIPAA.
Wow, thanks for that nightmare! 😅 Seriously though, thanks for all your education and advocacy. I had a really positive GA experience last month because I knew which questions to ask. My anaesthetist and I worked out a plan that avoided previous complications and let me recover much faster. You do such important work.
I'm currently recovering from lateral epicondylitis surgery. I'm about 15 hours into recovery an doing well. Just wanted to say that in the month leading up to my procedure I watched every video you have posted. Having a very basic understanding of Anastasia really helped with the anxiety yesterday. Thank you!
My cousin is a retired anesthesiologist and would love to regale the wonderful (read with dripping sarcasm) tales he experienced in the OR. He forgot to share this one with us!
When in your video you showed the location of a fire extinguisher, the moment I saw it I realized the nossel was damaged probably hit by a patients cart on the way into surgery. That should be replaced as it could throw fire retardant in a direction not intended to go if at all needed. Really enjoy your videos. THANK YOU
Once my colleague walks into the resident's room -Hey, surgeons just set "my patient's name" on fire -Oh okay... WAIT WHAT?.. Turns out one of them was in such a hurry he began electrocoagulation before op field was dry from antiseptic, promptly setting the patient, his scrubs and op field covers aflame. Everything was fine in the end, but gave us a whole new meaning to burnout
Wow; I cannot imagine how bad of an injury that would cause! Terrifying stuff! As an industrial worker, I deal with oxygen and flammable materials and other similar hazards. But I really can't fathom how bad it would be to have this happen INSIDE me.
I had my tonsils removed with electrocautery as a middle aged adult. I remember for a few days, I tasted smokey, then like rotting barbecue. I don't imagine an actual fire would be much better.
Thank you,this was very informative. I now plan to quiz every nurse anesthetist when he or she is taking me in to surgery, by saying, "Wait a second, tell me what you do if my airway catches on fire.". If he or she cannot answer to my satisfaction, I'm going to ask for someone else.
Well that is absolutely terrifying! I have had numerous surgeries, and never once was it brought to my attention that I might go up in flames! Holy Cow!
Some anesthetics used before are actually explosive and flammable, like ethyl ether, or vinyl/divinyl ether (Vinethene), ethylene gas, and cyclopropane. That was the old times.
Wow man! That was really awesome, I learned a lot about airway fires! That was really cool! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist! You rock man
Fascinating. Having had both oral (palate & teeth surgery) and a total thyroidectomy in my life, I'm guessing that was a potential I had no idea existed. Amazing to think it could happen.
I asked Dr. Kaveh (Harvard trained anesthesiologist out in San Francisco) about this yet didn’t hear back from him yet. This is great info! Glad its available here. Thanks
Thank you so much. Even though all of this were taught by our educators, you covered some major portions. I work as a nurse in a GI department!😊 Would be also nice if you could talk about grounding pad and the fire associated with it!
I’m so glad I didn’t find this (or any of your vides) a week ago when I was having gallbladder surgery. Im pretty sure I would’ve just suffered the pain 😂
Reason #9,647 that surgery is terrifying. We didn’t need 9,646 reasons. But now we’re definitely all set. I never knew any of this. I needed to never know this. 😐 THIS is what I’m going to perseverate on if I ever need surgery. 😢
What about running a tiny thermometer line somewhere in the tube so you could immediately tell if line gets to the temperature that is present when a fire has begun likely before the tube itself has broken, also a tiny thermal sensor above the mouth to measure if the mouth is getting abnormally hot
i have surgery with mount sinai in may and never new about this phenomena, thanks for the video! i'm always trusting of my anesthesiologists, but knowing this is the quality of care sinai offers makes me feel really safe.
Please report the damage to the cone of that fire extinguisher you show at 3:53 to the team responsible for maintenance of the fire prevention equipment in your hospital. It was probably dented accidently by a patient bed when wheeling a patient into surgery. But it ought to be replaced since the shape of the cone is important to control and direct the flow of gas to effectively extinguish the fire. Having the cone dented like that may make it difficult to effectively aim and deliver the extinguishing agent to the fire in the event of an emergency which is absolutely not when you want to discover this the hard way, so best to report it and get it fixed as soon as possible.
Now, that was funny. I've watched many of your videos with admiration. The blend of humor and science in this one gave me a good laugh, not derisive laugh either. I guess you could say I was laughing with you.
I ve seen and watched some of your videos from time to time. My mom was a RN years ago then went back to anesthesia school in Charlotte NC . She finished and started in the OR in our hospital. She worked there 20 + years , loving her job and her co workers before retirement. She passed a few years ago. I cannot remember her mentioning a patient catching fire ( she was very professional and didn't mention too much) I do recognize most of your terms and materials used. Thanks for sharing.
I just hope that you were at least one of the anesthesia providers who has taken care of my nephew during his multiple procedures there. I just wanted to say thanks because we’ll never know because of HIPAA. Thanks! Peace, a concerned uncle and retired healthcare professional.
As rare as this is, it does happen. It even happens with animals. This happened with a cat that a friend of mine has at her animal rescue. She was getting spayed and the oxygen supply caught on fire. Poor baby’s face got burned. Thankfully it wasn’t a horrible burn and she healed fairly quickly. But it’s obviously something to watch for.
Oh, CRAP! Horror of horrors. I've been "under" several times but never considered such a thing. My best experience was when I woke up I felt like I had just finished a refreshing nap. I'd prefer that same anesthesiologist if I ever need to go under in the future.
Holy crap. Somethings are better left unknown. Seriously important knowledge for your field. Thank you for sharing knowledge and time and effort with this video.
Anaesthesia sounds a lot like being a pilot actually. Hours of tedium with a few minutes of intense focus sprinkled in. And a whooooole lot of practice for rare but extremely time sensitive problems.
thanks, I always wanted a new fear of surgery, I will put it right in between the percentage of things left inside patients and times the wrong surgery was performed
Very good point on the being how your job is to be ready for emergencies even very rare but extremely dangerous ones. This is a lot of what being a surgeon, airplane pilot, etc is all about. Most of the jobs preformed by these professionals could be done with much less training. Most of these jobs could be performed by someone with a month of 8 hour weekdays of training. However, that would only cover 90% of the work and you wouldn't know which jobs where going to need those extra years of study and training to insure a good outcome much less prevent sever injury and death. It's important for people with these jobs to remember that and to keep their recurrent training up but that most of the actual work will go smoothly. Remember, you're a professional because you're ready for 99.9+% of things that can go wrong not because you can do the job when it goes 99.9% right.
Thanks for another educational video. I have been meaning to ask , and the smoke made me think of my question. How much does a tobacco smoker and a cannabis user, affect your decisions on what procedures you would use and/or modify them?
You know Dr. Feinstein, the terror we pts have to begin with. Your last video was about how to keep a patients stress, panic down. Your killing us here. Pleeassee
@@Eman1900O I know, but this was the first time I was put under doing a surgery and I have pretty bad anxiety. But yeah I agree with you one hundred percent 😊
FYI, The 2018 NFPA 99 (which is only recently being enforced) requires a “clean agent” fire extinguisher in all OR’s. A “clean agent” is either a water type or CO2 type. Most prefer the CO2, like you mentioned. Other chemical extinguishers are not allowed. I don’t hear it referred to much in the past 20+ yrs, but, we often noted if flammable inhalation anesthesia is used, it would indicate the need for some other codes needing to be considered when constructing patient care/treatment areas. I assume that flammable inhalation anesthesia was not used any longer (thinking “ether”). I’m curious, are any other inhalation anesthetics used currently that are flammable? You mentioned the number of reported cases, but, it wouldn’t have hurt to include that number, compared to the total number of OR procedures, makes it an extremely rare event (and airway fires, even more rare). Also, thanks for noting that N2O is an oxidizer. I think that is often overlooked when considering the fire triangle. Thanks always for the video! Great content!
@@Stepclimb Unfortunately, Halon was discontinued and is no longer produced, although it can be sold. The datacenters I've worked in all had the Halon systems removed some years ago.
@@repro7780 I’m not sure that is true. Halon 1211 is still widely used in the aviation industry currently. New aircraft are rolling of the assembly line and serviced with Halon 1211 in large quantities in the extinguishing systems for engine fires as well as hand held extinguishers in the cockpit and cabin. By weight, Halogenated Fluorocarbon extinguishing agents are vastly superior to CO2 for many classes of fires. Maybe Halon 1211 production is has only been curtailed in the US, but it can still be purchased in the US.
@@Stepclimb As per the EPA: "On January 1, 1994, production and import of virgin halons were phased out in the United States. Since that time, recycled halons are the only supply of halons in the United States for specialty fire suppression applications."...Just like I said.
@@repro7780 Thanks for the link. It sounds like with regards to aircraft manufacturers in the US, there is still a robust enough supply via domestic and imported “recycled” Halons. A separate discussion could be had about how the US enforces EPA policy with regards to determining whether an imported Halide extinguishing agent is “virgin” or “recycled”.
Never knew people caught on fire during surgery. That’s wild… and a new fear I have now. I guess I wasn’t afraid of hospitals enough this guy had to up it a notch
I can imagine dousing a patients throat with a fire extinguisher, just a lovely scenario. Do realize I’ll be extremely pissed off if I wake up and find my throat was on fire and I had to deep throat a fire extinguisher to put it out.
Just a point of clarification. Dropping the concentration prior to removal of the ETT will not reduce FiO2 due to the time constant. Best is to disconnect circuit and pull ETT.
I never thought this was even remotely possible until it was on the news recently in my home city. This happened to a patient during a routine procedure. The patient was later transferred to intensive care.
I know some one that this happened too.. She was young, very popular in her community and greatly missed by everyone. She lived a few hours after the event but passed.. Nancy.
It never occurred to me the possibility of a fire but it makes sense with all the equipment and flammable objects in an operating room. It is rather a nightmare scenario. How often does a fire require fire department assistance?
I was reading about robotic abdominal surgery where several different devices, Including cautery but also other instruments are inserted into small incisions in the abdomen. In all sorts of engineered systems there is something called "Ground loop" where parts assumed to be at the same electrical potential actually are not and so current flows between those two points. This can cause internal burning in the patient. What I saw was cautions by the robotic engineers on this and mentioning that novel ways of positioning the instruments need to be thought through for this aspect. Ground loops, could even be a problem elsewhere, with sensors and other electrical connections. Ever encounter this kind of thing?
Doctor: Are there any more questions about the procedure? Patient: I think that just about covers everything. Thank you! Doctor: Perfect!...... .... .... By the way... You could be a human flame thrower.🤪 Take care. *Walks out*
The title of this video brought to mind a warning I recall from long ago: In the 1970s TV series Emergency! we saw many times a placard on the wall of the Rampart Hospital treatment room which read 'Flammable Anesthetics Shall Not Be Used In This Room'. I concluded that flash fires in the O.R. have since been eliminated by ending the use of diethyl ether as general anesthesia, but it appears this is not the case.
If the only goal is to control the fire, maybe. People interested in delivering healthcare may take exception to the word “appropriate”. The primary reason they are in an operating room is to deliver health care, hence the restriction (by NFPA 99) on any extinguisher that leaves a residue.
😂 I am sorry, but when I read that a patient is a Class A fire, I started laughing. I will be sure to ask my anesthesiologist this when I have my surgery, just to see what he/she says to assure me they can put me out if I combust!
3:27 I was joking hoping he would say "piss"; but then I noticed he has a golden chain around his neck, there is nothing inherently wrong with such an accessory but just imagine your eye catches _that_ as you are about to black out.
Welp, add that to my list of irrational fears I could've been happy never learning about. This did get me thinking though, how are patients ventilated during surgeries in the airways? E.g. a simple tonsillectomy, wouldn't the tubes get in the way?
This video just added additional fear for anyone who is scared silly about an upcoming surgery. What is the positive/negative outcome for endotracheal fires? How many live or die.
A spray bottle like you use for your BBQ filled with sterile water might be handy. I use it when my grill flares up too much, you could use it when your patient flares up..both smell bad if the meat burns..
As a licensed independent practitioner, what is your defined role in the event of a surgical suite fire that requires evacuation? Do you participate in CMS/NFPA required fire drills that simulate fire scenarios and is your participation documented?
Um that is very horrific! Both times I had surgery intubated under general anesthesia my larynx was very beat up, it hurt so much for weeks and it wasn't on fire to my knowledge. :O
🌬💕I love your channel anything to do with Medical I love. Thank you for sharing your thoughts and journey. Stay STRONG We are all stronger together 💪🤍💙💪
In over three decades, I never witnessed an airway fire but twice have seen patient abdomens on fire when diathermy ignited pooled alcohol-based surgical preparation spirit on the surgical drapes.
Hey Max, Thank you for your videos. Would you speak on potential aftermath of anaesthesia? I had a loss of taste after surgery when I was younger. In the past few years, I was given Propofol 2 times a week for an ostomy change as my intestines healed. At the time, it was super painful. My memory was fuzzy, and my dreams were very detailed. I would live to know what other side effects people have had. Thank you so much for the way you present your content.
Bet airway fires were even more common before fluorinated anaesthetics got good (as in, before the 1950's when halothane started to take over), cause diethyl ether is REALLY flammable and in the overlapping era of rebreathing anaesthesia and diethyl ether usage, you had an airway full of extremely flammable vapor mixed with highly enriched oxygen. ESPECIALLY because this was about the time Bovie cauteries were starting to catch on...
I’d love to hear this explained to the patient…. “Surgery is all done , all went well …except you were briefly on fire”
Worse when the patient responds with "Again?"
@@Puddingskin01 fair point…😂
@@Puddingskin01
That happens a lot, actually...
Thank you for the new fear.
If you like to acquire new fears, give the channel Brew a try :)
@@Kitsudote oh you’ve pointed out the gold mine there 😂
Literally 😟
Right....thinking next time I need a surgery, might just die myself instead 😊
Reassuring it's all trained for.
As a 20+ year firefighter, I’ve extinguished many things I never thought I’d encounter on fire, but if someone told me there was a mouth on fire, I’d anticipate it was an accident involving a flame arts performer, not a surgical case!
Word.
I knew that surgical fires were a thing, didn’t know they happened _inside_ people 😨
That's why people on oxygen aren't allowed to smoke, should look up what happens when those tubes catch fire... Calling it a flamethrower isn't much of an exaggeration and the tubing burns as fast as a fuse, the flame just shoots down it in seconds and suddenly the whole tube is gone. Lotta old people end up burning their house down smoking while they're on oxygen, really huge danger and not only in operating rooms and I'd wager there have been a lot more house fires from covid with the whole oxygen tank shortage and all the sick people requiring tanks at home...
I had heard of patients catching fire because of intestinal gas. Never heard of an airway fire.
@@DrakeOola Any fire in an oxygen-rich environment is TERRIFYING. Our atmosphere is about 21% oxygen, and fires can already be quite violent, só if you increase the amount of oxygen in the air, you can burn stuff really quickly. And if you get something that is more oxidising than oxygen, then you can burn stuff you might expect to not be flammable, like stone.
In 35 years of practice I never experienced an airway or OR fire. However, a surgical group I worked with in Waco, TX, after I moved to another hospital, did have an OR fire. They insisted on prepping the patient with alcohol for their surgeries until they had a fire. Actually, the first episode did not change their behavior and they had another fire three months later. I hear that they finally went back to prepping with water based solutions.
This is a cool workplace that lets you film in a room with millions of dollars in equipment.
Chocolate flames
justin y 2
I’d move to NY to work with him. I’m sure he covers plenty of neurosurgeries. 😉
Honestly this dude is probably not allowed to be doing this shit
@@23Butanedione I’m sure he probably got permission. I don’t think he would jeopardize his career for a TH-cam video. He not filming patients, so he’s not violating HIPAA.
Thanks for this video! It's unlocked a new fear for surgery I had never considered before!
Heh. I was thinking, maybe just ask for a nice bullet to bite.
Wow, thanks for that nightmare! 😅 Seriously though, thanks for all your education and advocacy. I had a really positive GA experience last month because I knew which questions to ask. My anaesthetist and I worked out a plan that avoided previous complications and let me recover much faster. You do such important work.
I'm currently recovering from lateral epicondylitis surgery. I'm about 15 hours into recovery an doing well. Just wanted to say that in the month leading up to my procedure I watched every video you have posted. Having a very basic understanding of Anastasia really helped with the anxiety yesterday. Thank you!
Having a basic understanding of the lost Russian princess Anastasia reduced your anxiety? Haha
I'm glad to see spell check doesn't mess up only me.
On a serious note, I hope you have a full & speedy recovery:)
My cousin is a retired anesthesiologist and would love to regale the wonderful (read with dripping sarcasm) tales he experienced in the OR. He forgot to share this one with us!
Selective memory? 😏
Maybe he never saw one
When in your video you showed the location of a fire extinguisher, the moment I saw it I realized the nossel was damaged probably hit by a patients cart on the way into surgery. That should be replaced as it could throw fire retardant in a direction not intended to go if at all needed.
Really enjoy your videos.
THANK YOU
Once my colleague walks into the resident's room
-Hey, surgeons just set "my patient's name" on fire
-Oh okay... WAIT WHAT?..
Turns out one of them was in such a hurry he began electrocoagulation before op field was dry from antiseptic, promptly setting the patient, his scrubs and op field covers aflame.
Everything was fine in the end, but gave us a whole new meaning to burnout
Wow; I cannot imagine how bad of an injury that would cause! Terrifying stuff! As an industrial worker, I deal with oxygen and flammable materials and other similar hazards. But I really can't fathom how bad it would be to have this happen INSIDE me.
I had my tonsils removed with electrocautery as a middle aged adult. I remember for a few days, I tasted smokey, then like rotting barbecue. I don't imagine an actual fire would be much better.
Thank you,this was very informative. I now plan to quiz every nurse anesthetist when he or she is taking me in to surgery, by saying, "Wait a second, tell me what you do if my airway catches on fire.". If he or she cannot answer to my satisfaction, I'm going to ask for someone else.
Well that is absolutely terrifying! I have had numerous surgeries, and never once was it brought to my attention that I might go up in flames! Holy Cow!
I know some anesthetic gas are flammable so I’ve been wondering about this for a long time. Thanks for the info!
Some anesthetics used before are actually explosive and flammable, like ethyl ether, or vinyl/divinyl ether (Vinethene), ethylene gas, and cyclopropane. That was the old times.
Wow man! That was really awesome, I learned a lot about airway fires! That was really cool! I really enjoy donating to the anesthesiologist Foundation, since it was hard for me to go to college because of my cerebral palsy, I really wanted to be a anesthesiologist! You rock man
Rarely talked about but educating everyone is so important. Thank you👍
Fascinating. Having had both oral (palate & teeth surgery) and a total thyroidectomy in my life, I'm guessing that was a potential I had no idea existed. Amazing to think it could happen.
I asked Dr. Kaveh (Harvard trained anesthesiologist out in San Francisco) about this yet didn’t hear back from him yet.
This is great info! Glad its available here. Thanks
Thank you so much. Even though all of this were taught by our educators, you covered some major portions. I work as a nurse in a GI department!😊 Would be also nice if you could talk about grounding pad and the fire associated with it!
I’m so glad I didn’t find this (or any of your vides) a week ago when I was having gallbladder surgery. Im pretty sure I would’ve just suffered the pain 😂
Reason #9,647 that surgery is terrifying. We didn’t need 9,646 reasons. But now we’re definitely all set. I never knew any of this. I needed to never know this. 😐 THIS is what I’m going to perseverate on if I ever need surgery. 😢
What about running a tiny thermometer line somewhere in the tube so you could immediately tell if line gets to the temperature that is present when a fire has begun likely before the tube itself has broken, also a tiny thermal sensor above the mouth to measure if the mouth is getting abnormally hot
This just happened . I shared this video with all my coworkers.
Spontaneous combustion during surgery.....this is just wonderful!
In thorax surgery they use lasers sometimes. You have to reduce your FiO2 to 0,4 and then say "you may fire when ready"
i have surgery with mount sinai in may and never new about this phenomena, thanks for the video! i'm always trusting of my anesthesiologists, but knowing this is the quality of care sinai offers makes me feel really safe.
Please report the damage to the cone of that fire extinguisher you show at 3:53 to the team responsible for maintenance of the fire prevention equipment in your hospital. It was probably dented accidently by a patient bed when wheeling a patient into surgery. But it ought to be replaced since the shape of the cone is important to control and direct the flow of gas to effectively extinguish the fire. Having the cone dented like that may make it difficult to effectively aim and deliver the extinguishing agent to the fire in the event of an emergency which is absolutely not when you want to discover this the hard way, so best to report it and get it fixed as soon as possible.
Now, that was funny. I've watched many of your videos with admiration. The blend of humor and science in this one gave me a good laugh, not derisive laugh either. I guess you could say I was laughing with you.
I ve seen and watched some of your videos from time to time.
My mom was a RN years ago then went back to anesthesia school in Charlotte NC . She finished and started in the OR in our hospital. She worked there 20 + years , loving her job and her co workers before retirement. She passed a few years ago. I cannot remember her mentioning a patient catching fire ( she was very professional and didn't mention too much) I do recognize most of your terms and materials used. Thanks for sharing.
I just hope that you were at least one of the anesthesia providers who has taken care of my nephew during his multiple procedures there. I just wanted to say thanks because we’ll never know because of HIPAA. Thanks! Peace, a concerned uncle and retired healthcare professional.
He was my anesthesia when I got my gallbladder and was like 😯
Wow! I never knew about such surgical risks. Thank you. Dr Feinstein
There are many.
you mean Dr. Frankenstein, right?
I thought clickbait but boy was I wrong this can never be undone what I have heard now thank you, you have scared the crap out of me
As rare as this is, it does happen. It even happens with animals. This happened with a cat that a friend of mine has at her animal rescue. She was getting spayed and the oxygen supply caught on fire. Poor baby’s face got burned. Thankfully it wasn’t a horrible burn and she healed fairly quickly. But it’s obviously something to watch for.
Never, ever heard of these things! I was a Nurse for 16 years, but not in hospital environment. New feather in my cap, today!
I came here thinking it was a discussion on inflammation. 😮 I’m glad to know there’s a plan in place in case of a fire during surgery.
This is one of those things I didn't need to know was a thing as a non medical professional ...
Oh, CRAP! Horror of horrors. I've been "under" several times but never considered such a thing. My best experience was when I woke up I felt like I had just finished a refreshing nap. I'd prefer that same anesthesiologist if I ever need to go under in the future.
I will never joke about the "Gas Man" ever again after watching your channel.
Holy crap. Somethings are better left unknown. Seriously important knowledge for your field. Thank you for sharing knowledge and time and effort with this video.
Up for surgery in 3 weeks. Ok, I am duly terrified! Thanks doc!
Anaesthesia sounds a lot like being a pilot actually. Hours of tedium with a few minutes of intense focus sprinkled in. And a whooooole lot of practice for rare but extremely time sensitive problems.
Oh boy - I'm heading to surgery in a couple of weeks under a general. This makes me even more nervous - thanks :(
What surgery are you having?
thanks, I always wanted a new fear of surgery, I will put it right in between the percentage of things left inside patients and times the wrong surgery was performed
Very good point on the being how your job is to be ready for emergencies even very rare but extremely dangerous ones. This is a lot of what being a surgeon, airplane pilot, etc is all about. Most of the jobs preformed by these professionals could be done with much less training. Most of these jobs could be performed by someone with a month of 8 hour weekdays of training. However, that would only cover 90% of the work and you wouldn't know which jobs where going to need those extra years of study and training to insure a good outcome much less prevent sever injury and death. It's important for people with these jobs to remember that and to keep their recurrent training up but that most of the actual work will go smoothly. Remember, you're a professional because you're ready for 99.9+% of things that can go wrong not because you can do the job when it goes 99.9% right.
Thanks for another educational video. I have been meaning to ask , and the smoke made me think of my question. How much does a tobacco smoker and a cannabis user, affect your decisions on what procedures you would use and/or modify them?
Cannabis, apparently quite a bit, please let anaesthesia know!
You know Dr. Feinstein, the terror we pts have to begin with. Your last video was about how to keep a patients stress, panic down. Your killing us here. Pleeassee
I am more Anxious having to Go Under than Ever after watching your VIDS!! Can't watch anymore!
Good thing I didn’t know about this two months ago when I had surgery on my foot
Foot surgery would extremely low risk of this since the surgery is so far away from the face or head
@@Eman1900O I know, but this was the first time I was put under doing a surgery and I have pretty bad anxiety. But yeah I agree with you one hundred percent 😊
FYI, The 2018 NFPA 99 (which is only recently being enforced) requires a “clean agent” fire extinguisher in all OR’s. A “clean agent” is either a water type or CO2 type. Most prefer the CO2, like you mentioned. Other chemical extinguishers are not allowed.
I don’t hear it referred to much in the past 20+ yrs, but, we often noted if flammable inhalation anesthesia is used, it would indicate the need for some other codes needing to be considered when constructing patient care/treatment areas. I assume that flammable inhalation anesthesia was not used any longer (thinking “ether”). I’m curious, are any other inhalation anesthetics used currently that are flammable?
You mentioned the number of reported cases, but, it wouldn’t have hurt to include that number, compared to the total number of OR procedures, makes it an extremely rare event (and airway fires, even more rare). Also, thanks for noting that N2O is an oxidizer. I think that is often overlooked when considering the fire triangle.
Thanks always for the video! Great content!
I wonder if Halon 1211 would also be an appropriate extinguishing agent. It also leaves no residue behind, and has better effectiveness and range.
@@Stepclimb Unfortunately, Halon was discontinued and is no longer produced, although it can be sold. The datacenters I've worked in all had the Halon systems removed some years ago.
@@repro7780
I’m not sure that is true.
Halon 1211 is still widely used in the aviation industry currently.
New aircraft are rolling of the assembly line and serviced with Halon 1211 in large quantities in the extinguishing systems for engine fires as well as hand held extinguishers in the cockpit and cabin.
By weight, Halogenated Fluorocarbon extinguishing agents are vastly superior to CO2 for many classes of fires.
Maybe Halon 1211 production is has only been curtailed in the US, but it can still be purchased in the US.
@@Stepclimb As per the EPA: "On January 1, 1994, production and import of virgin halons were phased out in the United States. Since that time, recycled halons are the only supply of halons in the United States for specialty fire suppression applications."...Just like I said.
@@repro7780
Thanks for the link.
It sounds like with regards to aircraft manufacturers in the US, there is still a robust enough supply via domestic and imported “recycled” Halons.
A separate discussion could be had about how the US enforces EPA policy with regards to determining whether an imported Halide extinguishing agent is “virgin” or “recycled”.
Never knew people caught on fire during surgery. That’s wild… and a new fear I have now. I guess I wasn’t afraid of hospitals enough this guy had to up it a notch
Hi doctor 🙋 to New York City's Mount Sinai hospital 😊
I was working as a volunteer in Toronto's Mt. Sinai hospital 😊
Patient spitting fire!
I can imagine dousing a patients throat with a fire extinguisher, just a lovely scenario. Do realize I’ll be extremely pissed off if I wake up and find my throat was on fire and I had to deep throat a fire extinguisher to put it out.
Thats terrifying! Imagine going in for a simple surgery only to find out you caught on fire 😳💀
Seen that happen in a movie. Wasn't sure it was a real thing. Prevention please! This and waking up during surgery are both terrifying thoughts.
Just a point of clarification. Dropping the concentration prior to removal of the ETT will not reduce FiO2 due to the time constant. Best is to disconnect circuit and pull ETT.
I never thought this was even remotely possible until it was on the news recently in my home city. This happened to a patient during a routine procedure. The patient was later transferred to intensive care.
Back in the old days the main general anesthetic used was ether and it was extremely flammable and volatile!!
I know some one that this happened too.. She was young, very popular in her community and greatly missed by everyone. She lived a few hours after the event but passed.. Nancy.
Googled this as my first day volunteering at a hospital there was an alert of a fire in an OR and never thought that could happen until now
It never occurred to me the possibility of a fire but it makes sense with all the equipment and flammable objects in an operating room. It is rather a nightmare scenario. How often does a fire require fire department assistance?
And oxygen is there as well.
That adds a whole new perspective for a patient being “smoking hot.”
New fear unlocked. Move over Chubbyemu 😅
Quite informative.
When I tell you my jaw HIT the floor! New fear unlocked. Thank you for the nightmares 😅
Max: “My name is Max Feinstein and I’m an anestesi-“
Doctor: “Shut up and take out the damn tube!”
I was reading about robotic abdominal surgery where several different devices, Including cautery but also other instruments are inserted into small incisions in the abdomen. In all sorts of engineered systems there is something called "Ground loop" where parts assumed to be at the same electrical potential actually are not and so current flows between those two points. This can cause internal burning in the patient. What I saw was cautions by the robotic engineers on this and mentioning that novel ways of positioning the instruments need to be thought through for this aspect. Ground loops, could even be a problem elsewhere, with sensors and other electrical connections. Ever encounter this kind of thing?
Doctor: Are there any more questions about the procedure?
Patient: I think that just about covers everything. Thank you!
Doctor: Perfect!......
....
.... By the way... You could be a human flame thrower.🤪 Take care. *Walks out*
This guy is why I’ll choose to go out on my own!
The title of this video brought to mind a warning I recall from long ago: In the 1970s TV series Emergency! we saw many times a placard on the wall of the Rampart Hospital treatment room which read 'Flammable Anesthetics Shall Not Be Used In This Room'. I concluded that flash fires in the O.R. have since been eliminated by ending the use of diethyl ether as general anesthesia, but it appears this is not the case.
Thanks for this video Dr. Max sir
A patient is a class A fire (solid combustible), therefore using AFFF foam, ABC powder or a water mist extinguisher is appropriate.
If the only goal is to control the fire, maybe. People interested in delivering healthcare may take exception to the word “appropriate”. The primary reason they are in an operating room is to deliver health care, hence the restriction (by NFPA 99) on any extinguisher that leaves a residue.
😂 I am sorry, but when I read that a patient is a Class A fire, I started laughing. I will be sure to ask my anesthesiologist this when I have my surgery, just to see what he/she says to assure me they can put me out if I combust!
3:27 I was joking hoping he would say "piss"; but then I noticed he has a golden chain around his neck, there is nothing inherently wrong with such an accessory but just imagine your eye catches _that_ as you are about to black out.
Thanks Doc! Glad I keep putting a 14th surgery off. Think I’ll just die now not on fire instead of going out by fire on the OR table. Wow! 😱
Low risk of fire
200 out of millions
Wonderful information. Heck of a topic!!
Wow! And I thought I had a bad experience with anesthesia! How do you explain THAT to your patients and family.
😱 Was never afraid of surgeries. Now I am.
Welp, add that to my list of irrational fears I could've been happy never learning about. This did get me thinking though, how are patients ventilated during surgeries in the airways? E.g. a simple tonsillectomy, wouldn't the tubes get in the way?
I'm pretty sure they just intubate and move the tube when needed.
@@sinkfire nasal intubation is commonly used in throat/jaw-operations, or like already mentioned, the tube may just be moved away.
This video just added additional fear for anyone who is scared silly about an upcoming surgery.
What is the positive/negative outcome for endotracheal fires? How many live or die.
Congratulations on hitting 100k subscribers!
A spray bottle like you use for your BBQ filled with sterile water might be handy. I use it when my grill flares up too much, you could use it when your patient flares up..both smell bad if the meat burns..
Excellent video
I never even thought about this lol but now I think about it, it's definitely possible. New fear unlocked lol
Thank god for Florine.
Would it be wrong to just disconnect your circuit instead of turning down the O2?
This is why they made me stop smoking in the OR
LOL
This sounds serious Dr Max! 😮
I never thought I would here Ana anesthesiologist use the world flame thrower in the same sentence as ET tube. Cannot under that image. 🤣
As a licensed independent practitioner, what is your defined role in the event of a surgical suite fire that requires evacuation? Do you participate in CMS/NFPA required fire drills that simulate fire scenarios and is your participation documented?
Um that is very horrific! Both times I had surgery intubated under general anesthesia my larynx was very beat up, it hurt so much for weeks and it wasn't on fire to my knowledge. :O
An ET flamethrower? Sounds like a great secret/hidden weapon in a video game. Haha
🌬💕I love your channel anything to do with Medical I love. Thank you for sharing your thoughts and journey. Stay STRONG
We are all stronger together
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In over three decades, I never witnessed an airway fire but twice have seen patient abdomens on fire when diathermy ignited pooled alcohol-based surgical preparation spirit on the surgical drapes.
Excelente video mi amigo!!!!
Hey Max,
Thank you for your videos. Would you speak on potential aftermath of anaesthesia? I had a loss of taste after surgery when I was younger.
In the past few years, I was given Propofol 2 times a week for an ostomy change as my intestines healed. At the time, it was super painful. My memory was fuzzy, and my dreams were very detailed. I would live to know what other side effects people have had. Thank you so much for the way you present your content.
What is the overall survival rate for these patients who become involved?
Can a fire occur in other places in the patient besides the airways?
Yes, especially in abdomen surgery. We have methane being produced in the stomach. We usually purge the gas with carbon dioxide to avoid any fire
Bet airway fires were even more common before fluorinated anaesthetics got good (as in, before the 1950's when halothane started to take over), cause diethyl ether is REALLY flammable and in the overlapping era of rebreathing anaesthesia and diethyl ether usage, you had an airway full of extremely flammable vapor mixed with highly enriched oxygen. ESPECIALLY because this was about the time Bovie cauteries were starting to catch on...
Be continuously
Love from india 💜💛💙🧡