During a procedure using a CO2 laser, an endotracheal tube ignites. Which action should be taken first?

• A. Call for Assistance
• B. Remove the ETT
• C. Pour Saline into the Patient Airway
• D. Turn Off the CO2 Laser

Answer: (B)

When a laser ignites material in the airway, the most urgent action is to remove the endotracheal tube from the airway. The ETT is the fuel source feeding the flame and, with the high oxygen in the airway, keeping it in place allows the fire to continue advancing rapidly. By taking the tube out, you immediately deprive the flame of both fuel and oxygen, which helps halt the fire at its source and protects the airway from further thermal injury. After the tube is removed, you then turn off the laser to stop energy delivery and irrigate with saline to cool and extinguish any remaining flames, followed by securing the airway again with a laser-resistant tube or alternative method as needed.