chemical burns

Question 1

Chemical Burns most common

Answer 1

Alkalis, acids, organic compounds (petroleum products)

Question 2

tx of burns from white phosphorous?

Answer 2

neutralization w/ 1% copper sulfate solution and administration of calcium gluconate gel to address the concomitant hypocalcemia

Question 3

Alkalis

Answer 3

hydroxides, carbonates, caustic sodas of Na, K, ammonium, Li, Ba, Ca (oven cleaners, drain cleaners, fertilizers, industrial cleaners)

structural bond for cement

Question 4

CF of alkali burn

Answer 4

worse than acid!! tissue damage by liquefaction necrosis and protein denaturation

Question 5

Acids

Answer 5

HCl in bathroom cleaners, oxallic and HFl (rust removers) pool cleaners, sulfuric acid in drain cleaners,

Question 6

Acid CF

Answer 6

tissue damage by coagulation necrosis and protein precipitation

Question 7

Hydrofluoric Acid

Answer 7

Industrial use: 
o	Etch glass
o	Teflon
o	Clean semiconductors
o	Home use – rust removers

*weak acid, but F- is very toci

Question 8

CF of hydrofluoric acid

Answer 8

severe pain for 6-8 hours, tissue necrosis, hypocalcemia bc F binds to free serum calcium

Question 9

Tx of hydoflouric acid

Answer 9

• Flood wound with water – require copious lavage for at least 30 minutes
• Neutralize with topical calcium gel
  o 1 amp calcium gluconate in 100 gm lubricating jelly
• Apply with gloved hand

Question 10

what do you need to monitor in a hydroflouric acid poisoning?

Answer 10

HEART!
IV line to tx hypocalcemia, wound excision, burn center consult
some pts: intra-arterial calcium infusion or subeschar dilute calcium gluconate

Question 11

Organic solvents

Answer 11

Phenols (chemical disinfectants), Petroleum (creosote, gasoline, kerosene)

• cutaneous damage due to fat solvent action (cell membrane solvent action)
• toxic effects on kidneys and liver

Question 12

tx of chemical burns

Answer 12

removal of staruated clothing, brush off powder agents, continuoulsy irrigate w/ lots of water

use litmus pater to get pH to 7 (esp. in eyes

wounds may look superficiatl, but can develop to full thickness in 2-3 days

Question 13

what is contraindicated for treatment of chemical burns?

Answer 13

neutralizeing chemical!!!–think heat generation

Question 14

Ocular Burns tx

Answer 14

*** early irrigation is CRUC. USE 1-2 L OF SALINE OR WATER W/ MORGAN LENS UNTIL PH IS NEUTRAL

-can use topical anesthetic to aid in pain management!

Question 15

Electrical injury

Answer 15

“tip of the Iceberg” the Grand Masquerader

Question 16

types of electrical injury

Answer 16

high voltage= +/= 1000

low V= < 1000 V

Question 17

Alternating Current Burn clinical feature

Answer 17

contact sites, but no true entrace/exit sites. causes flexion contraction-sticks to the source

**more dangerous=tetany, death from cardiace fibrillation, respiratory muscle paralysis

Question 18

Direct Current burn clinical feature

Answer 18

sudden contractio of muscles, and then thrown off

will se entrance and exit sites

Question 19

extent of electrical injury is dependent on?

Answer 19

type, pathway of flow, local tissue resistance, duration

Current =V/R

Question 20

what in the body has high resistance?

Answer 20

Skin, bones, and fat!

current flows along bone surface-generated heat damages adjacent muscle

Question 21

complications of electrical injury?

Answer 21

higher the R, the more heat is generated leading to heat damage of the muscle groups –> paralysis, LOC, dysrhythmias, Vfib, pulmonary arrest

Question 22

management of electrical burn

Answer 22

fasiotomy of extensive muscle damage

Cardiac monitoring for the first 24 hours
1/3 of pts w/ significant electrical injury will require amputation

Question 23

what if you see red pigment urine in a pt w/ an electrical burn?

Answer 23

muscle break down! myoglobinuria

tx by increaseing fluid to obtain an urine output of 100 ml/hr

alkalinize uring w/ NaCO2 50 mgEq/L

Question 24

lightning strikes

Answer 24

riks is 1/ 280000

kills 80-100 ppl in US annually and associated with 30 % mortality

70% of survivors=serious complications

Question 25

lightning strike chemical features

Answer 25

DC, not associated with deep burns, cardiac and neruological damage

Question 26

lichtenberg?

Answer 26

fern like dendritic pattern on skin