Camper with Dry Ice Burn

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    First time camp nurse here! I have a camper who came to me with dry ice burns from two days ago. A cabin-mate had received cupcakes packed in dry ice and this camper put some dry ice on left wrist and hand. The burn on her wrist is about 1.5cm long, reddened, skin intact, painful. The burn on her hand is about 1cm rounded, reddened edges, white/yellow in middle with a tiny intact blister, and numb. She had been pushing on the dry ice on top of her hand, trying to make it melt faster.

    My standing orders for burns are "rinse with cool water, apply cool compresses then topical antibiotic ointment and dsd. administer tylenol for pain. seek medical attention if signs of infection develop." I cleansed areas, applied antiobiotic ointment, dsd.

    My question is whether I should call the on-call physician. There are no signs of infection but I am concerned about the burn on her hand. Also would you telephone the parents? She's an older camper and has now learned her lesson but I don't want her to head home with a scar and have upset parents.

    Thanks in advance for any help anyone can give me! :-)
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  4. 9 Comments so far...

  5. 0
    I have a good relationship with our on call so I would call. I would also call the parents it wouldn't hurt to call them most parents would be greatful to receive a phone call
  6. 1
    Hand burns fall under 'critical burns' especially with numbness and a blister. Call the on call MD. This may involve a trip to ED/urgent care for formal evaluation of a chemical/thermal burn.

    As a parent I would expect at least a call about such an injury.

    ETA since this is an older child I'd say have them nearby so mom/dad can speak to their child.

    Now she knows why dry ice is classified as a hazardous material and requires dangerous goods declaration for shipping. I'm surprised the camp permitted the camper to have the package in the living quarters. Perhaps as camp nurse you can work with camp admin for developing a policy regarding safe handling of dry ice/haz. Mat.
    Last edit by JustBeachyNurse on Jul 25, '13
    Esme12 likes this.
  7. 1
    As dry ice burns are atypical (my first thought was to classify them as chemical burns) I would have called the Med Dir/oncall MD for further consultation. And the parents as others posters said. Didn't even think of the 'rules of 9's for burns' as JustBeachyNurse brought up.

    I was reminded of that information bit, long buried. TY for dusting out the cobwebs!

    Do have a question for anyone - what is ETA??????? Have seen it couple of times today and have no idea! Am computerly challenged so I'm a bit behind...
    Esme12 likes this.
  8. 0
    ETA = edited to add.
  9. 0
    Quote from JustBeachyNurse
    ETA = edited to add.
    TY TY TY
  10. 0
    See and I am old school I thought estimated time of arrival....LOL

    Dry Ice burns are considered frost bite....white/yellow skin indicates a "severe burn" deep second degree
    Deep partial thickness (Second degree) Extends into deep (reticular) dermis Yellow or white. Less blanching. May be blistering. Fairly dry Pressure and discomfort
    I would call the MD and the parents ....have the child near the phone a possible trip to the urgent care might be in your future

    American Burn Association severity classification

    Minor Moderate Major
    Adult <10% TBSA Adult 10-20% TBSA Adult >20% TBSA
    Young or old < 5% TBSA Young or old 5-10% TBSA Young or old >10% TBSA
    <2% full thickness burn 2-5% full thickness burn >5% full thickness burn
    High voltage injury High voltage burn
    Possible inhalation injury Known inhalation injury
    Circumferential burn Significant burn to face, joints, hands or feet
    Other health problems Associated injuries
  11. 0
    The blister isn't a big deal but the numbness is.

    Your issue here is that I doubt the camper would be admitted (at least to a burn unit) for anything. They won't (usually) graft something that small. But you really should pop the blister and clean off the dead skin on the partial thickness burn which is what it sounds like the palm one is. HOWEVER. That's gonna hurt, esp. where the burn is. And as a camp nurse, I doubt you have access to potent narcotics.

    Did you wash the burns thoroughly? With running water? Dry ice particles can stick and cause further/"retroactive" burns.
  12. 0
    Hello all...thanks for your help! It's been quite the experience...anyways I had washed the burns, checked for particles, and monitored for infection. However the camper had still been complaining of pain at the burn site so I sent her to the walk-in clinic. They diagnosed 2nd degree burns, will take approx 8-9 months to heal and to just leave both burns open to air. And I did call the parents and let them know.

    Thanks again! Much appreciated!
  13. 1
    I think the parents who sent the package should be called too. They need to know that sending such a hazardous substance to a children's camp is unacceptable. What an over-the-top indulgence!
    Esme12 likes this.


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