Abstract
We describe the presentation and management of a patient who presented to our institution with severe nasal frostbite from nasal cannula supplemental oxygen malfunction. This rare complication has not previously been reported in the English Literature. We describe the physical properties of compressed oxygen release that may contribute to these malfunctions and the role of the otolaryngologist in the management of the resulting injuries.
1
Introduction
Supplemental oxygen is used by more than 800,000 Americans . However, accidents associated with supplemental oxygen equipment are rare. Accidents reported in the literature involving oxygen associated fires, including nasal fires, are often related to smoking while using supplemental oxygen .
Here we present a patient who presented to our institution following a severe nasal frostbite injury from a nasal cannula supplemental oxygen malfunction. There has never been a report of such an injury in the English language literature.
We describe the physical findings and the management of the injuries. In addition, we developed a theory for how a supplemental oxygen malfunction may cause such severe nasal frostbite injury and tested this theory by measuring variation of temperature with increasing releasing pressure of compressed air.
2
Materials and methods
2.1
Chart review
After obtaining Institutional Review Board approval, the medical records of a patient who had undergone severe nasal frostbite injury from a presumed nasal cannula supplemental oxygen malfunction was reviewed. Initial physical findings, operative reports, and hospital course were reviewed. Photos for which consent had been obtained were selected for presentation.
2.2
Temperature vs pressure
Compressed air stored at room temperature was released at increments of increasing pressure beginning at 0 pounds per square inch (PSI) and increasing to 15 PSI. A Smith Equipment 150 PSI regulator (Watertown, SD) was used to measure the releasing pressure of the compressed air. A temperature probe was placed at the tip of the compressed air outlet and connected to a Fluke 52 II thermometer (Everett, WA) to measure temperature at increasing releasing pressures. The results were recorded in degrees Celsius ( Fig. 1 ). This procedure was performed five times, allowing adequate time between trials for the system to return to ambient temperature. The temperature (°C) at each pressure (PSI) was averaged and 95% confidence intervals were calculated.
2
Materials and methods
2.1
Chart review
After obtaining Institutional Review Board approval, the medical records of a patient who had undergone severe nasal frostbite injury from a presumed nasal cannula supplemental oxygen malfunction was reviewed. Initial physical findings, operative reports, and hospital course were reviewed. Photos for which consent had been obtained were selected for presentation.
2.2
Temperature vs pressure
Compressed air stored at room temperature was released at increments of increasing pressure beginning at 0 pounds per square inch (PSI) and increasing to 15 PSI. A Smith Equipment 150 PSI regulator (Watertown, SD) was used to measure the releasing pressure of the compressed air. A temperature probe was placed at the tip of the compressed air outlet and connected to a Fluke 52 II thermometer (Everett, WA) to measure temperature at increasing releasing pressures. The results were recorded in degrees Celsius ( Fig. 1 ). This procedure was performed five times, allowing adequate time between trials for the system to return to ambient temperature. The temperature (°C) at each pressure (PSI) was averaged and 95% confidence intervals were calculated.
