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Blast injuries from glass bottles containing dry ice
CASE REPORT eye, injury, blast
Blast Injuries From Glass Bottles Containing Dry Ice We present three cases (two incidents) of severe blast injury from the explosion of covered glass bottles containing dry ice. The first patient sustained lacerations of the face, left eye, right wrist and forearm, and abdomen with protrusion of the small bowel. The second sustained a deep laceration to her anterior neck. The third sustained multiple lacerations to her lower extremities and one to the labia majora. All three patients were taken to the operating room for surgical exploration and repair and were discharged .without complications. [Inkelis SH, Smith M, Lubitz DS, Korber TE, Curran M: Blast injuries from glass bottles cotltaining dry ice. Ann Emerg Med October 1988;17:1087-I090.] INTRODUCTION The potential danger of dry ice (solid phase carbon dioxide) when placed in glass bottles was demonstrated by the cases of three patients seen at our institution in a one-month period in 1987. There have been several reports concerning blast injuries resulting from the explosion of glass bottles containing carbonated beverages, u9 In these cases, severe injuries usually involved the eye. To our knowledge, there are no previous reports outlining the explosive potential of dry ice placed in covered glass bottles and the resultant penetrating injuries. We report three cases (two incidents) of children who put dry ice in covered glass bottles and were injured significantly by the resultant explosions.
Stanley H Inkelis, MD*t Marc Smith, MD* Deborah S Lubitz, MD*t Timothy E Korber, MD* Margaret Curran, MD* Los Angeles, California From the Departments of Emergency Medicine* and Pediatrics,t Harbor-UCLA Medical Center, Torrance, California; and the UCLA School of Medicine, Los Angeles, California. Received for publication October 12, 1987. Revision received January 11, 1988. Accepted for publication July 1, 1988. Address for reprints: Stantey H Inkelis, MD, Department of Emergency Medicine, Box 21, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California 90509.
CASE REPORTS Case One A 12-year-old boy obtained dry ice from an ice cream vendor, put it in a 16oz glass soft drink bottle, and shook it vigorously while holding his hand over the mouth of the bottle. The bottle exploded, propelling glass fragments that struck him in the face, left eye, abdomen, and right wrist and forearm. On arrival in the emergency department, systolic blood pressure was 120 m m Hg; pulse, 84; respirations, 32; and temperature, 36.3 C. Physical examination revealed a small left scleral laceration as well as several small lacerations around the left orbit, an abdominal laceration with protrusion of small bowel, and numerous lacerations of the forearms and hands. Serial hematocrits were stable at 30%. In the ED, the patient was given 20 m L / k g of n o r m a l saline, IV antibiotics, and a dT i m m u n i z a t i o n . A nasogastric tube and Foley catheter also were placed. Radiographs showed an embedded glass fragment in the left wrist and multiple intra-abdominal glass fragments (Figure 1). The patient was taken to surgery, where three small bowel lacerations were repaired and the intra-abdominal and subcutaneous glass fragments were removed. The scleral laceration and the hand and forearm lacerations also were repaired. The hospital course was uneventful, and the patient was discharged on the seventh day after surgery. Case Two A 7-year-old girl and her cousin (patient 3) put dry ice that had been given to them by an ice cream vendor in a 16-oz glass soft drink bottle, replaced the screw-on cap, and put the bottle on the ground. The 7-year-old was stand17:10 October 1988
Annals of Emergency Medicine
1087/139
GLASS BLAST INJURIES Inkelis et al
FIGURE 1. Radiograph of abdomen
(patient 1) demonstrating multiple intra-abdominal glass fragments (arrows). FIGURE 2. Penetrating neck wound
(patient 2). FIGURE 3. Lateral neck radiograph
(patient 2) demonstrating air in prevertebral soft tissue of the neck (small arrows) and a submandibular foreign body (large arrow). FIGURE 4. Multiple lacerations in-
cluding one of the right medial thigh over the adductor canal (patient 3). ing about five feet away when the bottle exploded and propelled glass frag140/1088
ments into her neck, right arm, and left leg. On arrival she had a blood pressure of 120/80 m m Hg; pulse, 84; respirations, 24; and temperature, 37.2 C. Physical e x a m i n a t i o n revealed an oblique laceration of the anterior neck to the left of the midline (Figure 2). It was 4 cm in length and penetrated deep to the thyroid cartilage. There was minimal bleeding, carotid pulsations were normal, and there was no crepitance. The initial hematocrit was 38% and remained stable. Radiograph showed air in the prevertebral space and a metallic foreign body (possibly a fragment of the cap) lodged in the soft tissue below the mandible (Figure 3). Pressure was applied to the laceration and the patient was given 20 mL/ Annals of Emergency Medicine
kg of normal saline. An increase in bleeding from the wound precipitated surgical exploration, but there were no major vessel, airway, or neurologic injuries. The patient did well and was discharged on the fourth hospital day.
Case Three An 8-year-old girl, the cousin of patient 2, was also standing about five feet away from the bottle when it exploded and sent multiple glass fragments into her lower extremities. On arrival, her blood pressure was 120/80 m m Hg; pulse, 116; respirations, 20; and temperature, 37.4 C. Physical examination revealed 15 lacerations on her lower extremities and one on the left labia majora. They ranged in length from 2 to 7 cm, with 17:10 October 1988
the longest on the right thigh near the course of the femoral artery (Figure 4). The initial hematocrit was 34% and remained stable. Radiographs showed large fragments deeply embedded in the right thigh, the distal right lower leg anterior to the tibia, and the distal left lower leg posterior to the tibia (Figures 5 and 6). Pressure was applied to the lacerations that were bleeding. The patient was given IV antibiotics and a dT immunization. Attempts were made to explore the lacerations, but because of the extensive nature of the injuries, she underwent surgical exploration and repair, with removal of the glass fragments. There were no sequelae, and the patient left the hospital on day three.
DISCUSSION Dry ice is commonly used in the food, scientific, and manufacturing industries. Because of its physical properties, it is particularly useful for ref r i g e r a t i o n and t r a n s p o r t a t i o n of 17:10 October 1988
foodstuffs, lo Dry ice frequently is used for chilling ice cream products because it is conveniently available in blocks or thin slabs and leaves no liquid residue when it sublimates. In the two incidents described here, the children obtained dry ice from street vendors, presumably to play with. These descriptions of the explosions of soft drink bottles containing dry ice represent a p r e v i o u s l y u n r e p o r t e d cause of blast injuries. Reports of the explosions of glass bottles containing carbonated beverages were usually linked to defects in the glass bottles and/or warm e n v i r o n m e n t a l temperatures.I-9 Partly as a result of these reports and other consumer concerns, standards for the manufacture of glass bottles were developed. 11 It is not clear whether the returnable or the nonreturnable bottles are more prone to spontaneous or induced explosion when they contain carbonated beverages. 1 The nonreturnable bottles have thinner walls and require a lower internal pressure to explode Annals of Emergency Medicine
FIGURE 5. Radiographs of right lower extremity (patient 3) demonstrating large glass fragments in right medial thigh and anterior to the right tibia (arrows). FIGURE 6. Radiographs of both lower legs (patient 3) demonstrating glass fragments anterior to right proximal tibia and posterior to the left distal tibia (arrows). than do their thicker-walled counterparts. 1 Nevertheless, returnable bottles are more likely to acquire defects because they are recycled an average of 16 times. 1 Both of our incidents involved disposable 16-oz bottles, but the pressure created by dry ice sublimation would be high enough to cause explosion of returnable bottles as well.12 While the. patients stated that they placed only a small amount of dry ice chips in the bottles, it was far more than was actually needed to create an exploding container. With the ideal gas law (P = 1089/141
GLASS BLAST INJURIES Inkelis et al
n R T / V ) ( w h e r e P is t h e p r e s s u r e c h a n g e i n a t m o s p h e r e s , n is t h e number of moles of CO2, R is the universal gas constant [82.05 a t m - mL/ mole - °Kelvin], T is the temperature in degrees Kelvin, and V is the volume in ml), we can calculate the pressure that would develop in a 16-oz capped bottle. If only 22 g (0.5 mol) dry ice were put in a 16-oz capped bottle at a temperature of 20 C, there would be a theoreticar change in pressure of 25 atm. This pressure is in excess of the industrywide standard for m a x i m a l internal pressure in 16-oz disposable bottles of 14 a t m 11 and makes an explosion of these bottles inevitableJ 2 The short time interval between the sealing of the bottles and the explosions is evidence of the rapidity of the sublimation process. The rapid rise in pressure inside the bottles as dry ice s u b l i m a t e d produced small explosive devices from w h i c h the patients suffered significant secondary blast injuries (injuries t h a t result w h e n flying debris strikes the victim)33 There was no evidence of primary (resulting from the actual pressure wave) or tertiary (resulting from the propulsion of the body) injuries to these patients. T h e injuries we report are m u c h more serious and acutely life threatening than those injuries reported from exploding carbonated beverage bottles. 1-9 Excluding the severe ocular injuries, most of the injuries related to carbona t e d beverage b o t t l e e x p l o s i o n s are minor, requiring only ED t r e a t m e n t . Of c o n c e r n w i t h b o t t l e s e x p l o d i n g from dry ice s u b l i m a t i o n is the extreme force propelling the glass fragments, as evidenced by their depth of p e n e t r a t i o n . In p a t i e n t 1, f r a g m e n t s
142/1090
penetrated his a b d o m i n a l wall, causing protrusion of the small bowel and three small bowel lacerations. Patient 2 suffered a deep neck wound that fort u n a t e l y m i s s e d vital structures. Patient 3 required surgery because the larger glass fragments were so deeply embedded they could not be removed in the ED. Dry ice manufacturers and laboratories w o r k i n g w i t h h a z a r d o u s c h e m icals are aware of the explosive potential and threat of injury from placing dry ice in closed containers.12,14 Dry ice can also cause other injuries, such as serious burns. 14 T h e Los A n g e l e s C o u n t y Depart~ m e n t of H e a l t h S e r v i c e s h a s res p o n d e d to t h e s e i n c i d e n t s b y publicizing this hazard in its local public h e a l t h letter.~5 T h e p o t e n t i a l l y lifethreatening injuries experienced by these children are of great concern, and steps should be t a k e n to m i n i m i z e these risks. M a n u f a c t u r e r s and distributors of dry ice should stress the p o t e n t i a l h a z a r d s (both t h e explosive potential and the risk for ser i o u s burns) 14 to t h e i r c u s t o m e r s . Efforts to e d u c a t e b o t h p a r e n t s and children of the dangers of playing w i t h dry ice should be initiated by health care personnel.
SUMMARY We r e p o r t t h r e e cases of p a t i e n t s with blast injuries occurring from the explosion of covered soft drink bottles containing dry ice. These injuries are p o t e n t i a l l y life t h r e a t e n i n g b e c a u s e the rapid sublimation of dry ice in a closed c o n t a i n e r creates a large exp l o s i v e force. E d u c a t i o n r e g a r d i n g these hazards is needed to avoid se-
Annals of Emergency Medicine
rious future incidents.
REFERENCES 1. Hazard Analysis of Carbonated Soft Drink Bottles. US Consumer Product Safety Commis-
sion, Bureau of Epidemiology,Washington, DC, 1975, p 1-31. 2. Moyes DR, Andrews BF: Exploding bottles. JAMA 1962;182:969-970. 3. Taylor IB: Exploding bottles (letter). JAMA 1963;183:1054. 4. LeydheckerW: Augenver3etzungendutch explodierende Getrankeflaschen. Klin Monatsbl Augenheilkd 1963;142:929-934. 5. Bergeson PS, Sehring SA, Callison JR: Pop bottle explosions. JAMA 1977;238:1048-1049. 6. Bergeson PS, Sehring SA, Callison JR: Pop bottle explosions: Further information. JAMA 1978;239:2447-2448. 7. Sousa-LennoxIJ: Pop bottle explosions: Further information (letter). JAMA 1978;239:2448. 8. Mondino BJ, Brown SI, Grand G: Ocular injuries from exploding beverage bottles. Arch Ophthalmol 1978;96:2040~2041. 9. AI Salem M, Sheriff SMM: Ocular injuries from carbonated soft drink bottle explosions. Br J Ophthalmol 1984;68:281-283. 10. Ballou WR: Carbon dioxide, in Mark HF, Othmer DF, Overberg CG, et al (eds): Encyclopedia of Chemical Technology, ed 3. New York, John Wiley and Sons, 1978, vol 4, p 725-742. I1. Carbonated Soft Drink Bottles. Voluntary Product Standard, PS 73-77. National Bureau of Standards, US Department of Commerce, Washington, DC, 1977. 12. Material Safety Data Sheet for Carbon Dioxide (Solid) From Liquid Carbonic Carbon Dioxide Corporation. Filed with Occupational
Safety and Health Administration, US Department of Labor, I986. 13. 8tapczynski S: Blast injuries. Ann Emerg Med I982;11:687-694. 14. National Research Council, Committee on Hazardous Substances in the Laboratory: Prudent Practices for Handling Hazardous Chemicals in Laboratories. Washington, DC, Na-
tional Academy Press, 1981, p 69. 15. Department of Health Services, Los Angeles County: Public Health Letter 1988;10:18.
17:10 October 1988
Blast Injuries From Glass Bottles Containing Dry Ice We present three cases (two incidents) of severe blast injury from the explosion of covered glass bottles containing dry ice. The first patient sustained lacerations of the face, left eye, right wrist and forearm, and abdomen with protrusion of the small bowel. The second sustained a deep laceration to her anterior neck. The third sustained multiple lacerations to her lower extremities and one to the labia majora. All three patients were taken to the operating room for surgical exploration and repair and were discharged .without complications. [Inkelis SH, Smith M, Lubitz DS, Korber TE, Curran M: Blast injuries from glass bottles cotltaining dry ice. Ann Emerg Med October 1988;17:1087-I090.] INTRODUCTION The potential danger of dry ice (solid phase carbon dioxide) when placed in glass bottles was demonstrated by the cases of three patients seen at our institution in a one-month period in 1987. There have been several reports concerning blast injuries resulting from the explosion of glass bottles containing carbonated beverages, u9 In these cases, severe injuries usually involved the eye. To our knowledge, there are no previous reports outlining the explosive potential of dry ice placed in covered glass bottles and the resultant penetrating injuries. We report three cases (two incidents) of children who put dry ice in covered glass bottles and were injured significantly by the resultant explosions.
Stanley H Inkelis, MD*t Marc Smith, MD* Deborah S Lubitz, MD*t Timothy E Korber, MD* Margaret Curran, MD* Los Angeles, California From the Departments of Emergency Medicine* and Pediatrics,t Harbor-UCLA Medical Center, Torrance, California; and the UCLA School of Medicine, Los Angeles, California. Received for publication October 12, 1987. Revision received January 11, 1988. Accepted for publication July 1, 1988. Address for reprints: Stantey H Inkelis, MD, Department of Emergency Medicine, Box 21, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California 90509.
CASE REPORTS Case One A 12-year-old boy obtained dry ice from an ice cream vendor, put it in a 16oz glass soft drink bottle, and shook it vigorously while holding his hand over the mouth of the bottle. The bottle exploded, propelling glass fragments that struck him in the face, left eye, abdomen, and right wrist and forearm. On arrival in the emergency department, systolic blood pressure was 120 m m Hg; pulse, 84; respirations, 32; and temperature, 36.3 C. Physical examination revealed a small left scleral laceration as well as several small lacerations around the left orbit, an abdominal laceration with protrusion of small bowel, and numerous lacerations of the forearms and hands. Serial hematocrits were stable at 30%. In the ED, the patient was given 20 m L / k g of n o r m a l saline, IV antibiotics, and a dT i m m u n i z a t i o n . A nasogastric tube and Foley catheter also were placed. Radiographs showed an embedded glass fragment in the left wrist and multiple intra-abdominal glass fragments (Figure 1). The patient was taken to surgery, where three small bowel lacerations were repaired and the intra-abdominal and subcutaneous glass fragments were removed. The scleral laceration and the hand and forearm lacerations also were repaired. The hospital course was uneventful, and the patient was discharged on the seventh day after surgery. Case Two A 7-year-old girl and her cousin (patient 3) put dry ice that had been given to them by an ice cream vendor in a 16-oz glass soft drink bottle, replaced the screw-on cap, and put the bottle on the ground. The 7-year-old was stand17:10 October 1988
Annals of Emergency Medicine
1087/139
GLASS BLAST INJURIES Inkelis et al
FIGURE 1. Radiograph of abdomen
(patient 1) demonstrating multiple intra-abdominal glass fragments (arrows). FIGURE 2. Penetrating neck wound
(patient 2). FIGURE 3. Lateral neck radiograph
(patient 2) demonstrating air in prevertebral soft tissue of the neck (small arrows) and a submandibular foreign body (large arrow). FIGURE 4. Multiple lacerations in-
cluding one of the right medial thigh over the adductor canal (patient 3). ing about five feet away when the bottle exploded and propelled glass frag140/1088
ments into her neck, right arm, and left leg. On arrival she had a blood pressure of 120/80 m m Hg; pulse, 84; respirations, 24; and temperature, 37.2 C. Physical e x a m i n a t i o n revealed an oblique laceration of the anterior neck to the left of the midline (Figure 2). It was 4 cm in length and penetrated deep to the thyroid cartilage. There was minimal bleeding, carotid pulsations were normal, and there was no crepitance. The initial hematocrit was 38% and remained stable. Radiograph showed air in the prevertebral space and a metallic foreign body (possibly a fragment of the cap) lodged in the soft tissue below the mandible (Figure 3). Pressure was applied to the laceration and the patient was given 20 mL/ Annals of Emergency Medicine
kg of normal saline. An increase in bleeding from the wound precipitated surgical exploration, but there were no major vessel, airway, or neurologic injuries. The patient did well and was discharged on the fourth hospital day.
Case Three An 8-year-old girl, the cousin of patient 2, was also standing about five feet away from the bottle when it exploded and sent multiple glass fragments into her lower extremities. On arrival, her blood pressure was 120/80 m m Hg; pulse, 116; respirations, 20; and temperature, 37.4 C. Physical examination revealed 15 lacerations on her lower extremities and one on the left labia majora. They ranged in length from 2 to 7 cm, with 17:10 October 1988
the longest on the right thigh near the course of the femoral artery (Figure 4). The initial hematocrit was 34% and remained stable. Radiographs showed large fragments deeply embedded in the right thigh, the distal right lower leg anterior to the tibia, and the distal left lower leg posterior to the tibia (Figures 5 and 6). Pressure was applied to the lacerations that were bleeding. The patient was given IV antibiotics and a dT immunization. Attempts were made to explore the lacerations, but because of the extensive nature of the injuries, she underwent surgical exploration and repair, with removal of the glass fragments. There were no sequelae, and the patient left the hospital on day three.
DISCUSSION Dry ice is commonly used in the food, scientific, and manufacturing industries. Because of its physical properties, it is particularly useful for ref r i g e r a t i o n and t r a n s p o r t a t i o n of 17:10 October 1988
foodstuffs, lo Dry ice frequently is used for chilling ice cream products because it is conveniently available in blocks or thin slabs and leaves no liquid residue when it sublimates. In the two incidents described here, the children obtained dry ice from street vendors, presumably to play with. These descriptions of the explosions of soft drink bottles containing dry ice represent a p r e v i o u s l y u n r e p o r t e d cause of blast injuries. Reports of the explosions of glass bottles containing carbonated beverages were usually linked to defects in the glass bottles and/or warm e n v i r o n m e n t a l temperatures.I-9 Partly as a result of these reports and other consumer concerns, standards for the manufacture of glass bottles were developed. 11 It is not clear whether the returnable or the nonreturnable bottles are more prone to spontaneous or induced explosion when they contain carbonated beverages. 1 The nonreturnable bottles have thinner walls and require a lower internal pressure to explode Annals of Emergency Medicine
FIGURE 5. Radiographs of right lower extremity (patient 3) demonstrating large glass fragments in right medial thigh and anterior to the right tibia (arrows). FIGURE 6. Radiographs of both lower legs (patient 3) demonstrating glass fragments anterior to right proximal tibia and posterior to the left distal tibia (arrows). than do their thicker-walled counterparts. 1 Nevertheless, returnable bottles are more likely to acquire defects because they are recycled an average of 16 times. 1 Both of our incidents involved disposable 16-oz bottles, but the pressure created by dry ice sublimation would be high enough to cause explosion of returnable bottles as well.12 While the. patients stated that they placed only a small amount of dry ice chips in the bottles, it was far more than was actually needed to create an exploding container. With the ideal gas law (P = 1089/141
GLASS BLAST INJURIES Inkelis et al
n R T / V ) ( w h e r e P is t h e p r e s s u r e c h a n g e i n a t m o s p h e r e s , n is t h e number of moles of CO2, R is the universal gas constant [82.05 a t m - mL/ mole - °Kelvin], T is the temperature in degrees Kelvin, and V is the volume in ml), we can calculate the pressure that would develop in a 16-oz capped bottle. If only 22 g (0.5 mol) dry ice were put in a 16-oz capped bottle at a temperature of 20 C, there would be a theoreticar change in pressure of 25 atm. This pressure is in excess of the industrywide standard for m a x i m a l internal pressure in 16-oz disposable bottles of 14 a t m 11 and makes an explosion of these bottles inevitableJ 2 The short time interval between the sealing of the bottles and the explosions is evidence of the rapidity of the sublimation process. The rapid rise in pressure inside the bottles as dry ice s u b l i m a t e d produced small explosive devices from w h i c h the patients suffered significant secondary blast injuries (injuries t h a t result w h e n flying debris strikes the victim)33 There was no evidence of primary (resulting from the actual pressure wave) or tertiary (resulting from the propulsion of the body) injuries to these patients. T h e injuries we report are m u c h more serious and acutely life threatening than those injuries reported from exploding carbonated beverage bottles. 1-9 Excluding the severe ocular injuries, most of the injuries related to carbona t e d beverage b o t t l e e x p l o s i o n s are minor, requiring only ED t r e a t m e n t . Of c o n c e r n w i t h b o t t l e s e x p l o d i n g from dry ice s u b l i m a t i o n is the extreme force propelling the glass fragments, as evidenced by their depth of p e n e t r a t i o n . In p a t i e n t 1, f r a g m e n t s
142/1090
penetrated his a b d o m i n a l wall, causing protrusion of the small bowel and three small bowel lacerations. Patient 2 suffered a deep neck wound that fort u n a t e l y m i s s e d vital structures. Patient 3 required surgery because the larger glass fragments were so deeply embedded they could not be removed in the ED. Dry ice manufacturers and laboratories w o r k i n g w i t h h a z a r d o u s c h e m icals are aware of the explosive potential and threat of injury from placing dry ice in closed containers.12,14 Dry ice can also cause other injuries, such as serious burns. 14 T h e Los A n g e l e s C o u n t y Depart~ m e n t of H e a l t h S e r v i c e s h a s res p o n d e d to t h e s e i n c i d e n t s b y publicizing this hazard in its local public h e a l t h letter.~5 T h e p o t e n t i a l l y lifethreatening injuries experienced by these children are of great concern, and steps should be t a k e n to m i n i m i z e these risks. M a n u f a c t u r e r s and distributors of dry ice should stress the p o t e n t i a l h a z a r d s (both t h e explosive potential and the risk for ser i o u s burns) 14 to t h e i r c u s t o m e r s . Efforts to e d u c a t e b o t h p a r e n t s and children of the dangers of playing w i t h dry ice should be initiated by health care personnel.
SUMMARY We r e p o r t t h r e e cases of p a t i e n t s with blast injuries occurring from the explosion of covered soft drink bottles containing dry ice. These injuries are p o t e n t i a l l y life t h r e a t e n i n g b e c a u s e the rapid sublimation of dry ice in a closed c o n t a i n e r creates a large exp l o s i v e force. E d u c a t i o n r e g a r d i n g these hazards is needed to avoid se-
Annals of Emergency Medicine
rious future incidents.
REFERENCES 1. Hazard Analysis of Carbonated Soft Drink Bottles. US Consumer Product Safety Commis-
sion, Bureau of Epidemiology,Washington, DC, 1975, p 1-31. 2. Moyes DR, Andrews BF: Exploding bottles. JAMA 1962;182:969-970. 3. Taylor IB: Exploding bottles (letter). JAMA 1963;183:1054. 4. LeydheckerW: Augenver3etzungendutch explodierende Getrankeflaschen. Klin Monatsbl Augenheilkd 1963;142:929-934. 5. Bergeson PS, Sehring SA, Callison JR: Pop bottle explosions. JAMA 1977;238:1048-1049. 6. Bergeson PS, Sehring SA, Callison JR: Pop bottle explosions: Further information. JAMA 1978;239:2447-2448. 7. Sousa-LennoxIJ: Pop bottle explosions: Further information (letter). JAMA 1978;239:2448. 8. Mondino BJ, Brown SI, Grand G: Ocular injuries from exploding beverage bottles. Arch Ophthalmol 1978;96:2040~2041. 9. AI Salem M, Sheriff SMM: Ocular injuries from carbonated soft drink bottle explosions. Br J Ophthalmol 1984;68:281-283. 10. Ballou WR: Carbon dioxide, in Mark HF, Othmer DF, Overberg CG, et al (eds): Encyclopedia of Chemical Technology, ed 3. New York, John Wiley and Sons, 1978, vol 4, p 725-742. I1. Carbonated Soft Drink Bottles. Voluntary Product Standard, PS 73-77. National Bureau of Standards, US Department of Commerce, Washington, DC, 1977. 12. Material Safety Data Sheet for Carbon Dioxide (Solid) From Liquid Carbonic Carbon Dioxide Corporation. Filed with Occupational
Safety and Health Administration, US Department of Labor, I986. 13. 8tapczynski S: Blast injuries. Ann Emerg Med I982;11:687-694. 14. National Research Council, Committee on Hazardous Substances in the Laboratory: Prudent Practices for Handling Hazardous Chemicals in Laboratories. Washington, DC, Na-
tional Academy Press, 1981, p 69. 15. Department of Health Services, Los Angeles County: Public Health Letter 1988;10:18.
17:10 October 1988