Case Study

A 22-year-old man was running a hose from an anhydrous ammonia tank to a water standpipe to allow the ammonia to bubble into the irrigation water to fertilize crops. As the worker turned on the ammonia, the hose ruptured, spraying the worker on his leg with a stream of ammonia and releasing a cloud of ammonia vapor. The worker collapsed to the ground. A coworker who witnessed the release approached the tank from upwind, and shut the spray off at the valve on the top of the tank. The coworker drove the worker to the emergency room where the exposed worker was found to have a large part of his left trousers leg frozen to his thigh. His eyes were erythemic, but his lungs were clear to auscultation. Immediately, his eyes were irrigated with copious amounts of normal saline and the frozen area of his thigh gently warmed with tap water until the cloth fell off on its own and without tugging. The freeze-burns were copiously irrigated and left open to the air to off-gas (Figure 14.1).

Figure 14.1. Chemical freeze-burn on a thigh caused by anhydrous ammonia. (Photo by James E. Lessenger.)

A week later, the eye complaints were resolved. It took a full 2 months for the freeze-burns to resolve, but the patient was left with areas of permanent hyperpigmentation where the burns had been.

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