Liquid nitrogen

[Emtpbill]

Had a pretty interesting call this AM. Get hit out at 5am for an unconscious. The MDT just says 35 yom possibly exposed to liquid nitrogen.
After assuring that the scene was safe for us , we arrived to find a male lying supine who had been carried away from where the exposure took place.
Not sure how he was exposed but found an unresponsive male with snoring respirations. I was able to put the truck about 20 feet from
Where the pt was, so we loaded into truck. GCS 3. Upon exposing we found his left arm completely frozen solid with a huge laceration about 10 inches long down to the bone. He had decorticating posturing and the remainder of his extremities were very cold.
It was my partners turn to doc so I got up front and went warp speed to closest trauma center.

Has anyone else ever had a patient exposed to a liquid like nitrogen or oxygen?

I am sure his prognosis isn't good, we got a line in him and he was sinus on the monitor, blood sugar was 120. Due to vascular shut down we couldnt get a BP. Resps were 26 and snoring.
We didn't try to rapidly rewarm him, wasn't sure what kind of issues once be does warm up as far as blood crystallization or any thrombosis.

 

[mycrofft]

Can be nitrogen abuse.

I have heard of cases where people who were educated and should have known better have concentrated nitrogen for the "nitrogen narcosis" effect. Allegedly this happened at NASA-Ames lab but that is hearsay.

I think, at ambient pressures, that the primary effect is simple asphyxiation, sort of a "choking game" without the valsalva.

Then also accidental incidents can happen if the generation of gas is fast enough to overwhelm the ambient ventilation. It is heavier than air while it is cold, but it is not too different than air once it warms (and cools the air around it).

SIDEBAR: people who handle LN2 often work without gloves because the danger of LN2 down the glove is much much greater than it bouncing off your skin. What they really need are potholders to keep themselves from freezing to chilled metal or glass.

 

[mycrofft]

PS: frozen to the bone

Isn't even close to "instantaneous" as seen in movies.
Always remember that just because he was frozen didn't mean he hadn't had a CVA, MI, or other health issue. Good on you for checking blood glucose.

How was his fingertip pulse-ox? Just kidding.

 

[Farmer2DO]

I used to work with liquid nitrogen a lot. Was this an agricultural setting with animals (a farm)?

It would be interesting to know what happened to cause the situation, and what his outcome was.

 

[Emtpbill]

This was a chemical company in our local. I actually had no idea that they dealt with this.
He was removed from the actual scene, and 2 coworkers has carried him to an open loading dock.

Anyways my partner texted me after she followed up on him. Apparently the cold burns have extended. He is being transferred to a major city hospital.
If I get more info will post.

 

[WuLabsWuTecH]

Yeah, when I worked with liquid N2, I never used gloves. tongs or potholders sometimes. But when the N2 hits your skin, unless it's a lot, it just instantaneously vaporizes. 98 deg is a lot hotter than the vaporization point, so it takes a lot to cool your skin down to dangerous levels. However, in gloves, it has no where to go when it vaporizes and continues to cool the skin next to the glove. Bad stuff happens...

 

[Emtpbill]

Yeah, when I worked with liquid N2, I never used gloves. tongs or potholders sometimes. But when the N2 hits your skin, unless it's a lot, it just instantaneously vaporizes. 98 deg is a lot hotter than the vaporization point, so it takes a lot to cool your skin down to dangerous levels. However, in gloves, it has no where to go when it vaporizes and continues to cool the skin next to the glove. Bad stuff happens...

That's what I was thinking, that somehow a blast got inside his layers of jackets. Still waiting to hear when OSHA comes in.

 

[epipusher]

That is definitely an interesting run.

 

[mycrofft]

Used to throw LN2 on crickets and roaches.

They would get frosty, then wake up and groggily scurry off.

 

[WuLabsWuTecH]

That's what I was thinking, that somehow a blast got inside his layers of jackets. Still waiting to hear when OSHA comes in.

What was he wearing? I was always just in standard lab gear (closed toed shoes, pants, short sleeved shirt). It seemed to me that when it did splash (and that's a WHEN and not an IF) it'd not be that much and i would prefer it to get on my skin and vaporize than get under anything. For that same reason we never wore watches or rings.

If we spilt enough of it to cover the floor, it would dissapate pretty quickly. Protect your feet first when it;s in the liquid phase (my shoes were street shoes and not waterproof), and once it vaporizes, get out of the room (so you don't suffocate).

 

[Emtpbill]

He was wearing regular ****ies work pants, had a t-shirt, under a sweat shirt, under a thick wool/cotton coat. Also had leather work gloves. It was a pain cutting through the coat though. Trauma shears only cut so fast and when you are cutting through thick material, your hand gets tired and crampy.

 

[WuLabsWuTecH]

Sounds like he wasn't actually working with the stuff, but maybe just moving it or nearby when an accident occurred. I would never have been able to get any work done with all of that on!

I try not to cut through coats when I can avoid it--it makes a gigantic mess! (It doesn't sound like you would be able to avoid it ehre unless you could take it off of him)

 

[mycrofft]

Back to arm frozen solid...

Any fan of Mythbusters knows it takes many minutes of REAL contact to freeze a pig's head solid, a whole human arm would need more than a splash or the likely amount contained in a sleeve. (It doesn't soak in, it boils off).