OR Fire

Three-element fire: oxidizer (O₂/N₂O) + fuel (drape, ETT, sponge, hair) + ignition (ESU, laser, fiberoptic). Greatest risk: head/neck surgery with open O₂.

Recognition

•Visible flame, smoke, flash, audible pop
•Burnt-hair smell during ESU near drapes/airway
•ETT fire: pop + smoke from circuit, sudden ↑PIP

Steps

1
Stop the gas — disconnect circuit / stop O₂ + N₂O
2
Remove burning material — ETT, drapes, sponge
Pour saline; do not use water-based extinguisher near electronics until depowered.
3
Pour saline on patient + airway
If ETT fire, remove ETT, ventilate by mask after smoke clears.
4
Re-intubate via direct laryngoscopy
Inspect for thermal injury, soot, mucosal burn.
5
Bronchoscopy + ICU + steroids/antibiotics for inhalation injury
6
Do NOT use FiO₂ > 30% for ESU near airway in future cases

Drugs + doses

Drug	Dose	Note
Methylprednisolone	1–2 mg/kg IV (controversial for inhalation)
Albuterol	2.5 mg nebulized for bronchospasm

Pitfalls

!Open O₂ via nasal cannula + ESU on the face = fire setup. Use ≤30% FiO₂.
!ETT cuff fire — even momentary — needs full airway evaluation.
!Halogenated drapes burn hot; use flame-retardant drapes only.

Sources

ASA Practice Advisory: Operating Room Fires 2013
AANA Position Statement

Anatomy reference

Sourced reference images. 4 matches for "respiratory airway oxygen".

Wikimedia · CC BY 4.0

Anatomytool_Alveolar_exchange_of_oxygen_English_labels

Wikimedia · CC BY 4.0

OpenStax · CC BY 4.0

Servier · CC BY 3.0

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Education only — not a substitute for facility protocols, MOC certification, or clinical judgment. Always follow your institutional crisis algorithm and confirm doses against current package inserts.