Brief case : Airway Fire

Airway fires are an uncommon but real and devastating complication of tracheostomy.

Prevention
Use ETT resistant to laser ignition, low FiO2, no N2O, ETT cuff with blue dye/saline.
Limit laser duration.
Saline soaked pledgets in airway.
Have water to extinguish fire.

Treatment
Stop laser.
Stop ventilation.
Discontinue oxygen.
Remove burning ETT.
Douse airway fire with water (IV bag).
Suction debris from airway.
Ventilate with 100% oxygen by face mask.
Reintubate trachea.
Examine airway with bronchoscope to assess injury.
Consider steroids and antibiotics.