A FROSTY CASE OF FACIAL FROSTBITE IN THE FACE OF LIQUID OXYGEN

Abstract

SESSION TITLE: Medical Student/Resident Respiratory Care SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Long-term oxygen therapy (LTOT) is used by more than 1.5 million US adults and has been shown to both decrease mortality and increase quality of life in hypoxemic COPD. Many mechanical injuries involving LTOT are user directed and occur when a heat source ignites purified oxygen (O2), such as cigarettes. Here, we report the first English case of frostbite injury to the face due a malfunctioning liquid oxygen (LOx) canister. CASE PRESENTATION: Our patient was an 80-year-old female with a significant past medical history of COPD who presented to the emergency room with epistaxis and mucopurulent rhinorrhea after her nasal cannula (NC) was found frozen to her face. It was reported that LOx traveled up her NC. On physical exam, she had multiple second and third-degree burns on her nose, throat, lips, cheeks, and neck. She was placed on an open non-rebreather mask, and her facial frostbite was empirically treated with vancomycin and ampicillin-sulbactam for fourteen days to prevent cavernous sinus thrombosis. Otolaryngology was consulted to debride her wounds and open her nasal passages. A PEG tube was required to maintain her nutritional status. Towards the end of her fourteen-day hospital stay, her burns had shrunk and become more demarcated. However, the patient became febrile and complained of a painful headache. A CT of her head revealed acute sphenoid sinusitis, for which she was discharged on amoxicillin-clavulanic acid and doxycycline for an additional seven days. DISCUSSION: A cryogenic LOx tank consists of two vessels: an inner chamber where the LOx is kept cool by an insulated area around it from which air is removed, and an outer chamber which consists of a vaporizer that converts LOx into a gaseous state [1]. O2 is cooled to less than -183°C to achieve its liquid form for storage and transportation efficiency [1], as one liter of LOx offers 860 liters of gaseous O2. This large liquid-to-gas expansion ratio can generate an enormous amount of pressure. One case study describing frostbite injury due to a compressed gaseous O2 tank postulated that it was caused by pressure regulation failure, and showed that increasing amounts of pressure led to a significant decrease in temperature of the compressed air [1]. Similarly, we believe that our patient’s LOx pressure release system malfunctioned, driving a large outflow of unconverted LOx to penetrate the vapor chamber, enter her NC, and freeze her face. Unlike typical frostbite, burns involving LOx occur over seconds and are more likely to infiltrate underlying tissue compared to thermal burns. Removal of the LOx and rewarming as soon as possible should be done to prevent further damage [2]. CONCLUSIONS: The broad utilization of LTOT can invite extremely rare cases of hardware malfunction that may cause severe injury. Safety protocols and schedules should be strictly followed for refilling and handling O2 storage equipment. Reference #1: Jabbour, N., Heman-Ackah, S. E., Day, A. T., & Odland, R. (2011). Severe nasal frostbite injury from nasal cannula supplemental oxygen malfunction. American Journal of Otolaryngology, 32(4), 349–352. doi:10.1016/j.amjoto.2010.03.009 Reference #2: Uygur, F., Sever, C., & Noyan, N. (2009). Frostbite Burns Caused by Liquid Oxygen. Journal of Burn Care & Research, 30(2), 358–361. doi:10.1097/bcr.0b013e318198a769 DISCLOSURES: No relevant relationships by Olson Knight, source=Web Response No relevant relationships by munir shah, source=Web Response No relevant relationships by Parth Shah, source=Web Response No relevant relationships by Krupa Solanki, source=Web Response