Caustics and Corrosives Exam 1

Question 1

acid burn

Answer 1

produce a coagulation necrosis by denaturing proteins, forming a coagulum (also known as an eschar)

Question 2

alkali burn

Answer 2

cause liquefaction necrosis -> Fats in the tissue are saponified, and an eschar does not form

Question 3

When assessing for gastric burn….

Answer 3

the absence of oropharyngeal burns does not reliably exclude esophageal or gastric burns

Question 4

Clinical complications of chemical burns: Vital Signs

Answer 4

Tachypnea

Question 5

Clinical complications of chemical burns: HEENT

Answer 5

effects range from corneal burns to opacification and blindness

Question 6

Clinical complications of chemical burns: Dermatologic

Answer 6

Dermal toxicity ranges from irritation to full‐thickness burns

Question 7

Clinical complications of chemical burns: Cardiovascular

Answer 7

Cardiovascular collapse is a rare complication of severe exposure

Question 8

Clinical complications of chemical burns: Pulmonary

Answer 8

• bronchospasm, upper airway edema or obstruction, or laryngospasm
• Upper airway edema may develop abruptly after inhalation or aspiration
• In severe cases adult respiratory distress syndrome may develop
• Young children are at greater risk of severe upper airway edema after ingestion

Question 9

Clinical complications of chemical burns: Gastrointestinal (with acid)

Answer 9

• Esophageal injury is usually maximal in the middle and lower thirds of the esophagus; gastric burns are more common
• Gastrointestinal bleeding or perforation may occur acutely after grade III (full‐thickness) injury

Question 10

Clinical complications of chemical burns: Gastrointestinal (with alkali)

Answer 10

• Esophageal burns are most common, occurring in 5 to 35% of patients
• Exposure to concentrated alkalis may cause esophageal burns in up to 100% of patients, even after accidental ingestion
• Gastric burns are less common, and intestinal burns are unusual except after large ingestions

Question 11

Clinical complications of chemical burns: Gastrointestinal (in general)

Answer 11

vomiting, drooling, and stridor

Question 12

Clinical complications of chemical burns: Renal

Answer 12

Renal failure is a rare complication of severe burns, generally caused by hypotension due to shock.

Question 13

Clinical complications of chemical burns: Fluids and Electrolytes

Answer 13

• Metabolic acidosis may develop in patients with severe GI bleeding or massive tissue necrosis after corrosive ingestion.
• Extensive gastrointestinal injury may result in massive fluid loss.
• Hyperphosphatemia has occurred secondary to phosphoric acid ingestion

Question 14

Clinical complications of chemical burns: Hematologic

Answer 14

• Hemolysis has occurred after severe formic, acetic, or sulfuric acid exposure
• Disseminated intravascular coagulation (DIC) is a rare complication in severe cases

Question 15

treatment for chemically-burned patient

Answer 15

• Initial treatment should focus on hemodynamic support and evaluating the injury.
• Aggressive airway management after aspiration or inhalation exposure is indicated because airway edema may develop rapidly.
• Emergency surgical evaluation is needed for patients with signs of perforation
• small amounts of fluid only; too much fluid can stimulate N/V

Question 16

treatment for chemically-burned patient: Dermal exposure

Answer 16

Exposed mouth, skin, and eyes should be irrigated copiously with water for at least 15 minutes

Question 17

treatment for chemically-burned patient: Ocular exposure

Answer 17

• exposed eye(s) should be immediately irrigated with sterile saline solution
• use pH paper to test pH of eye; keep irrigating until pH is neutral
• after irrigation begins, instill drop of anesthetic for comfort
• if alkaline exposure -> extensive irrigation (30 min)
• can use Morgan lens or eye irrgator

Question 18

treatment for chemically-burned patient: Oral exposure

Answer 18

• NO emesis
• NO neutralization
• NO gastric lavage
• NO activated charcoal
• dilute ingestion with SMALL amount of liquid (like 4 oz)

Question 19

supportive treatment for chemically-burned patient: oral exposure

Answer 19

• steroid use is controversial
• dilate esophagus (esp every 2-4 wks if strictures present)
• antibiotics only used if suspected infection
• packed RBC and fresh frozen plasma if severe hemorrhage or hemolysis develops

Question 20

supportive treatment for chemically-burned patient: Dermal exposure

Answer 20

• Early excision of significant burns and grafting has been recommended to avoid recurrent skin breakdown
• Patients with second or third degree burns involving significant body surface area, hands, feet, face or genitalia should be referred to a burn center

Question 21

supportive treatment for chemically-burned patient: Inhalation exposure

Answer 21

• Maintain a patent airway
• Administer oxygen as necessary
• For bronchospasm, administer beta‐2 adrenergic agonists such as albuterol
• Consider systemic corticosteroids in patients with significant bronchospasm

Question 22

supportive treatment for chemically-burned patient: Ocular exposure

Answer 22

• consider ophthalmologic consultation
• it may take 48 to 72 hours after the burn to assess correctly the degree of ocular damage
• if ocular damage is minor, topical mydriatic‐cycloplegic (e.g., atropine, scopolamine, homatropine) drops and antibiotics may be all that are needed
• Mydriatic‐cycloplegics (e.g., atropine, scopolamine, homatropine) are used to guard against development of posterior synechiae (adhesions) and ciliary spasm
• antibiotic ophthalmic ointment or drops should be used for as long as epithelial defects persist

Question 23

Clinical complications of chemical burns: Hydrofluoric acid

Answer 23

• pain and injury may not occur for several hours
• Systemic effects such as hypocalcemia, hypomagnesemia, hyperkalemia, and dysrhythmias may occur with both dermal and oral exposure

Question 24

treatment for chemically-burned patient: Hydrofluoric acid

Answer 24

• thorough irrigation
• Following irrigation, fluoride can be neutralized by either calcium or magnesium. For small superficial burns, topical calcium or magnesium gels can be applied
• Calcium gluconate gel can be compounded by combining 20 ml of calcium gluconate 10% solution with 60 ml of KY jelly
• The calcium gel is smeared over the affected hand, then covered with a surgical glove
• Deeper burns may require subcutaneous injections of calcium gluconate (NO CaCl)
• Hand burns can be difficult to manage; these burns can be treated with subcutaneous injections of calcium, intra‐arterial calcium infusions, or intravenous infusions of magnesium