Chemical Burns Flashcards
(24 cards)
Objectives
List distinct chemicals injurymechanisms
List the factors that contribute toinjury severity
Describe initial managementprinciples
Identify and describe thetreatment for special chemicalburns, including hydrofluoric acid, phenol, and petroleum exposure
Introduction
NOTES: As the use of chemicals increases, so does the likelihood of unintentional chemical releases
More than 80,000 chemicals are currently used in the US
Acute chemical releases (lasting <72 hours) pose great public health impact risk
Persons with serious exposures can in injury or death
NOTES: As the use of chemicals increases, so does the likelihood of unintentional chemical releases
More than 80,000 chemicals are currently used in the US
Acute chemical releases (lasting <72 hours) pose great public health impact risk
Persons with serious exposures can cause injury or death
Exposure Routes (slide 5)
- Skin and mucous membrane absorption
- Oral Ingestion
Note: Oral ingestion (i.e. pediatric patient or patient with mental illness) - Inhalation
Severity of Injury (Slide 6)
Its going to be dependant on these things:
Composition of the agent
Concentration
Temperature
Volume
Duration of contact
____ next slide
Stop the burning
Duration of contact is the one thing you can change
Start treatment in the field!
Whats worse? Alkali or Acid?
Alkalis: Common Injuring Agents (Slide 9)
Lye
(oven, drain,
or toilet bowl cleaners
Cement
(wet or powder)
Ammonia (fertilizer, stain remover or refrigerant)
Methamphetamine production agents
Alkalis: Mechanism of Tissue Injury (Slide 10)
- Liquefaction necrosis
- Denatures protein - affects the functioning of enzymes and proteins in the body.
- Chemical penetrates deeper into tissue
- Results in deeper injuries
Acids: Common Exposure Agents (Slide 11)
Sulfuric acid
Hydrochloric acid (pool chlorine or cement cleaner)
Nitric acid (chemistry lab)
Oxalic/phosphoric acid (lime/rust remover)
Hydrofluoric acid (metal cleaner)
Acids: Mechanism of Tissue Injury (Slide 12)
Coagulation necrosis
Protein precipitation
Causes leathery eschar
Leather is made by acid contact with dermis
> > > > > > Eschar on the back from sulfuric acid fertilizer spill
Organic Compounds: Common Exposure Agents
*Phenols
*Creosote
*Petroleum products
Organic Compounds: Mechanism of Tissue Injury (Slide 14)
Dissolves fat in cell membranes
Absorption can cause multi-system organ injury (pulmonary, renal, hepatic)
Chemical Warfare Agents (15)
Vesicants
- Mustard agents
- Lewisite
- Chlorine gas
Nerve agents
- Sarin
Initial Management
Pre hospital care - PROTECT YOURSELF - PPE
Treatment Principles: Pre-hospital Care
Stop the burning
- Remove all clothing immediately
- Brush off powder chemicals
- Irrigate with water before transport
Treatment Principles: In-hospital Care (Slide 19)
Primary survey
* Decontaminate:
- Brush off powder chemicals
- Irrigate with copious water
* Do not attempt to neutralize acid with base or vice versa
- This can cause an exothermic reaction and worsen the tissue injury by adding a thermal burn
Specific Treatments: Water Irrigation
- Goal: to normalize pH on the affected skin
Copious amount of water (30 minutes of irrigation or more)
Check skin pH before and after irrigation (pH test paper)
Treatment Principles: In-hospital Care (Slide 22)
Watch for toxic emissions and potential respiratory complications
Monitor for hypothermia
Identify agent
Contact poison control center
Chemical burns are an indication for burn center referral
Chemical Eye Injuries: Signs and Symptoms (Slide 23)
Severe pain, profuse tears, severe conjunctival inflammation, progressive corneal injury
An opaque cornea is a sign of severe injury
Chemical Eye Injuries: Treatment Priorities (Slide 24)
Remove contact lenses
Test pH (pH test paper)
Prolonged irrigation (≥ 30min)
Use Morgan lenses if available - medical device that helps irrigate the cornea and conjunctiva with sterile solution
Chemical Eye Injuries: Treatment Priorities (Slide 25)
Ensure if only one eye involved, the irrigation does not drain into uninjured eye
Eyelids may need to be forced open due to edema or spasm
Consult an ophthalmologist
Hydrofluoric Acid (HF) Burn: Mechanisms of Injury (Slide 30)
*Systemic absorption is more dangerous than local skin necrosis
*Fluoride binds free calcium in blood resulting in potentially life-threatening hypocalcemia
*For inhalation exposure, transport with patent IV and consider calcium infusion
Hydrofluoric Acid Burn: Local and Systemic Treatment (Slide 31)
Monitor ECG and
Calcium level
Topical calcium gel: limits absorption and relieves pain
Combine 1 amp calcium gluconate with 100 gm of water-soluble lubricating jelly. Cover with plastic dressing
Intravenous and/or intra-arterial calcium infusion is sometimes necessary for both pain control and systemic toxicity treatment
Phenol Injuries (Slide 32)
Phenol is poorly soluble in water
Irrigate with water immediately
Remove with 50% polyethylene glycol or ethyl alcohol
Methamphetamine Explosion Injuries
Multiple hazardous chemicals used in production
Injury is usually a combination of flame and chemical injuries
SUMMARY
Decontamination is the priority
Irrigate with copious amounts of water but never attempt to neutralize
Chemical burns are an indication for burn center referral
