Exposed O2 flush hazard
At the end of an outpatient dental anesthesia using a Dupaco Compact 75 machine, as the drapes were being removed, the telethermometer was dislodged accidentally from the shelf above the machine. The box fell directly onto the vertically mounted O2 flush knob jamming it into the mechanism. Fortunately, the anesthesiologist was just then loosening the tape fixing the tracheal tube. He immediately turned and saw the O2 flush was jammed, and realizing the danger, disconnected the Y piece from the tracheal tube. So by prompt action the patient came to no harm, but the machine continued to discharge a high flow of O2 until the O2 supply was cut off. Had this accident occurred earlier when the patient's head was draped, it is doubtful whether the response could have been quick enough to prevent serious damage to the patient's lungs.