Lawsuit for Botched Laser Vocal Cord Surgery

In February 2012, an ENT surgeon removed vocal cord polyps using a laser while the patient was asleep with a Medtronic Laser-Shield II endotracheal tube. Unfortunately, the laser perforated the endotracheal tube, ignited the 100% oxygen being used at the time resulting in catastrophic burns to the patient. [link]

Subsequent lawsuit resulted in favor of the patient who received an award totaling $30 million on 12/5/13.

What Happened?

Even though an endotracheal tube meant for use with laser procedures was utilized, if this specially designed tube sustains enough damage from the laser, it will either perforate or heat to a high enough temperature to ignite. Furthermore, 100% oxygen was administered by the anesthesiologist which just added gasoline to the flame.

Ideally, in such laser procedures, meticulous surgical technique is still required and care taken to avoid damaging the endotracheal tube, even if a "laser-safe" tube is used. The "weak" part of any laser-safe tube is the cuff that is inflated to make a tight seal between the trachea and the tube itself. As such, the cuff material is necessarily thin. Saline-soaked pledgets placed immediately above the cuff helps protect the cuff as well as use of a tube with two cuffs (in case one fails). Also, room air should have been administered to the patient in the event the tube fails in order to minimize oxygen in the area... and the patient placed temporarily on apnea whenever the laser is turned on.

The risk of fire among other reasons are why many ENT surgeons (myself included), have stopped using lasers for procedures done in the mouth and airway.

With vocal cord procedures, I still utilize cold steel techniques which has a zero risk of airway fire.

Sources:
Botched surgery will cost hospital. The Wenatchee World. 12/6/13.

Medtronic slips $18M verdict in surgical fire case. MassDevice. 12/10/13

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Tracheostomy Fire During Surgery Burning Patient

Image from Wikipedia

In early 2012, a surgeon was performing a trach (breathing hole in the neck) when the oxygen used during the procedure caught fire severely burning the patient. Apparently, the surgeon used an electrocautery device which most likely emitted a spark igniting the oxygen being given to the patient leading to the fire. [link]

What happened?

Tracheostomy procedures are performed typically in very sick patients who have been intubated for a prolonged period of time. Often, such patients require higher concentrations of oxygen than normal in order to maintain oxygen levels in the body.

Problem in this scenario is that higher concentrations of oxygen also mean a higher risk of accidental fire when using instruments that help stop bleeding like an electrocautery device.

During a tracheostomy, an opening is created in the windpipe (watch video below). This allows oxygen that is being given to the patient to leak out into the surgical field. If electrocautery is used in this oxygen rich environment, any spark from an electrocautery device can lead to ignition and a flash fire.

Typically, in order to minimize this risk of fire, the surgeon should avoid using any electrical instruments in the surgical field that may create a spark after entering into the airway. Cutting into the airway would allow oxygen to escape into the surgical field. That usually means meticulous surgical technique and controlling all bleeding BEFORE cutting into the airway. If possible, reducing the oxygen given to the patient as much as possible is also beneficial.

Nitrous oxide should be avoided as an anesthetic agent as it is also ignitable like oxygen.

If electocautery use is unavoidable after the airway is surgically entered, the endotracheal tube cuff should re-inflated and advanced past the tracheostomy incision. Vacuum suction should be applied to evacuate as much oxygen from the surgical field and if possible, a period of apnea while cautery is applied.


Source:
Revealed: The chief of surgery who set patient on fire when his electronic scalpel caused 'EXPLOSION' Mail Online. 5/6/12

References:
Airway fire during tracheostomy: prevention strategies for surgeons and anesthetists. Ann R Coll Surg Engl. 2001 November; 83(6): 376–380.

Fatal inhalation injury caused by airway fire during tracheostomy. Acta Anaesthesiol Scand. 2007 Apr;51(4):509-13.

Tracheostomal fire during an elective tracheostomy. Chang Gung Med J. 2005 Mar;28(3):186-90.

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Video of How Nasal Cauterization for Nosebleeds Is Performed (Silver Nitrate and Electric)

I made a nosebleed video a few years ago that was roundly criticized for being poorly made. The biggest complaint was the loud background music. As such, I have made a new video that I feel addresses many of the shortcomings levied on the original video. I also added additional footage of what different types of nosebleeds look like as well as adding bipolar cauterization as another method of cautery other than silver nitrate.

Check the new (upgraded) video!

For more info about nosebleeds, click here.

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Medical Translator Commercial...

I'm sure many patients would like a medical translator like this one shown in this humorous commercial. In case you haven't seen it yet...

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Why Does Burping after Drinking Soda Burn the Nose?

I do not believe this question has actually been scientifically studied... but I can hazard a guess.

Sodas are those flavored fizzy drinks like Coca-Cola and Pepsi.

The "fizziness" is due to carbonation or carbon dioxide dissolved within the drink. When sodas are made, carbon dioxide is forced into the liquid under pressure so that there's more gas dissolved in the liquid than at regular air pressure. The bubbles you see and feel is caused by the carbon dioxide gas being released back into the air when exposed to back into regular air pressure (a closed can or bottle keeps the carbon dioxide under pressure within the liquid).

Such machines can even be purchased to make sodas at home (see below).

A soda becomes flat when all the carbon dioxide has been released back into the air.

In any case, why the burn?

Carbon dioxide (CO2) and water (H2O) together undergo a chemical reaction to form a very weak acid  called carbonic acid (H2CO3).

CO2 + H2O <--> H2CO3

So, after drinking some soda, the CO2 that is released reacts with the water inside your mouth, throat, and belly. The resulting carbonic acid, some of which is aerosolized, can than be burped up into the nose.

The nasal lining is quite sensitive, and when in contact with carbonic acid, can cause a burning sensation.

Now... does this actually happen?

Well, sounds like a potential neat research project that can potentially even be done by a high school student.

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Working in a Salon Can Be Unhealthy for Your Nose and Throat!

We already know that small hair clippings from cutting hair can cause septal perforation and chronic sinusitis due to long-term inhalation. Worse case scenario, it can even lead to an external nasal deformity! (Read blog about this here.)

However, it seems that it's not just hair that can damage the nose, but also hair products especially to straighten/smoothen hair popularly known as "Brazilian" treatments.

In a report published by Washington Post on Oct 17, 2011, such Brazilian hair smoothing treatments often contain a known toxic chemical called formaldehyde and methylene glycol. The FDA has pronounced such products to be unsafe. These chemicals are most commonly used as a preservative to prevent dead tissue (ie, corpses) from decay.

And yet... these products are commonly used in hair salons to potentially unsafe levels resulting in health problems to not just workers, but also customers.

Common symptoms that can result from formaldehyde and methylene glycol exposure include:

• nose-running (rhinitis)
• eye tearing
• throat burning

It can also cause symptoms of chronic sinusitis, taste alteration, smell loss, dry nose, scabbing at the nose entrance, etc.

Best to avoid if at all possible!

Read the WP article here.

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