This concept revolves around the idea that the injury would not have happened "but for" a specific action. For instance, if an airway fire breaks out during a tonsillectomy because oxygen is being administered at 70% while bovie cauterization is in use, the fire could be argued to have occurred "but for" the high oxygen level (FiO2 at 70%). Had the anesthesia provider communicated with the surgeon about the imminent use of cauterization and consequently reduced the FiO2 to 30%—and documented this action—would this be considered adherence to the standard of care?
Should an airway fire happen even with the FiO2 set at 25%, the focus then shifts to whether the anesthesia provider responded quickly and effectively to extinguish the fire. The ability to anticipate problems is important, but even when faced with unexpected complications, the key question is whether the healthcare provider acted within the standard of care by being prepared for emergencies and responding promptly to crises. In defending the anesthesia provider, emphasis may be placed on the unpredictability of the event and the adequacy of the emergency response provided.
