PP002 FROSTBITE INJURY FROM AIR-CONDITIONING COOLANT: MORE THAN JUST FIRE AND ICE

Abstract

Frostbite injury or cold burns occur  due to  the acute freezing of tissues when exposed to temperatures below the freezing point of intact skin. Low  environmental  temperatures are  the  common  etiology. An uncommon etiology  however , is contact with  occupational cryogenic material like liquid nitrogen  or refrigerant / air conditioning coolants . We present a case of cryogenic injury in a patient exposed to air-conditioning coolant.

A 64 year old male presented to the emergency department with burn injury of both hands sixteen  hours prior to admission .He was a technician  cleaning an air-conditioning unit when his hands were  hit by a gush of coolant gas .Exposure time was less than ten seconds. He initially experienced numbness of his right hand  which quickly blistered and progressively became  swollen . On presentation to our emergency department , he was noted   to have second degree burns and swelling  of the dorsum of his right  hand and  fingers. Sensory and motor functions were preserved. Distal capillary  perfusion was  intact.He was administered analgesics and referred to the burn unit for further management.

The severity of  frostbite  injury is dependent on duration and surface area  of exposure .Heat injury causes protein denaturation .Cold burns however have  2 distinct mechanisms: direct cellular damage at the time of exposure to the cold; and postthaw arterial vasoconstriction. Mainstay of acute treatment is rapid rewarming, analgesia and tetanus prophylaxis. Systemic prostaglandin inhibitor , ibuprofen and the topical antithromboxane agent ,aloe vera are also used to inhibit localized thromboxane production which causes dermal ischaemia.Blister debridement is controversial. Early hyperbaric oxygen treatment has also proven beneficial.

Cold burns are uncommon and therefore inadequately managed by the clinician at presentation. A clinician should develop greater awareness on the pathophysiology of cold burns which will ultimately allow better evaluation,management and positive outcomes.