Caustics and Corrosives Exam 1 Flashcards
acid burn
produce a coagulation necrosis by denaturing proteins, forming a coagulum (also known as an eschar)
alkali burn
cause liquefaction necrosis -> Fats in the tissue are saponified, and an eschar does not form
When assessing for gastric burn….
the absence of oropharyngeal burns does not reliably exclude esophageal or gastric burns
Clinical complications of chemical burns: Vital Signs
Tachypnea
Clinical complications of chemical burns: HEENT
effects range from corneal burns to opacification and blindness
Clinical complications of chemical burns: Dermatologic
Dermal toxicity ranges from irritation to full‐thickness burns
Clinical complications of chemical burns: Cardiovascular
Cardiovascular collapse is a rare complication of severe exposure
Clinical complications of chemical burns: Pulmonary
- 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
Clinical complications of chemical burns: Gastrointestinal (with acid)
- 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
Clinical complications of chemical burns: Gastrointestinal (with alkali)
- 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
Clinical complications of chemical burns: Gastrointestinal (in general)
vomiting, drooling, and stridor
Clinical complications of chemical burns: Renal
Renal failure is a rare complication of severe burns, generally caused by hypotension due to shock.
Clinical complications of chemical burns: Fluids and Electrolytes
- 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
Clinical complications of chemical burns: Hematologic
- Hemolysis has occurred after severe formic, acetic, or sulfuric acid exposure
- Disseminated intravascular coagulation (DIC) is a rare complication in severe cases
treatment for chemically-burned patient
- 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
treatment for chemically-burned patient: Dermal exposure
Exposed mouth, skin, and eyes should be irrigated copiously with water for at least 15 minutes
treatment for chemically-burned patient: Ocular exposure
- 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
treatment for chemically-burned patient: Oral exposure
- NO emesis
- NO neutralization
- NO gastric lavage
- NO activated charcoal
- dilute ingestion with SMALL amount of liquid (like 4 oz)
supportive treatment for chemically-burned patient: oral exposure
- 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
supportive treatment for chemically-burned patient: Dermal exposure
- 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
supportive treatment for chemically-burned patient: Inhalation exposure
- 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
supportive treatment for chemically-burned patient: Ocular exposure
- 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
Clinical complications of chemical burns: Hydrofluoric acid
- 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
treatment for chemically-burned patient: Hydrofluoric acid
- 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
