CHEMICAL BURN

Question 1

MANAGEMENT

Answer 1

EMS HANDOVER

Time of injury
Mechanism of burn:
Burning agents
Chemicals
Duration of exposure
Open or closed space
Inhalation injury
Concomitant injuries
First aid Provided

AIRWAY

PROMPT INTUBATION IF SIGNS OF AIRWAY INJURY OR DISTRESS:
Worsening throat pain
Change in phonation
Stridor
Neck pain / edema
Wheezing
Facial burns
Mucosal Burns
OR
TBSA > 20%

BREATHING

Risk of direct lung injury (ARDS, Pulmonary Hemorrhage):
Vesicant and blistering agents (mustards, lewisite)
Choking Agents (phosgene, ammonia, chlorine)

CIRCULATION:

Cardiopulmonary Monitoring
2 large bore IVs

1. 500 ml bolus LR
2. ADULT PARKLAND FORMULA
   LR 4 ml x weight (kg) x % TBSA over initial 24 hr
   Half over the first 8 hrs from the time of burn
   Other half over subsequent 16 hrs
   Target U/O: 0.5 - 1.0 ml / kg / hr
3. PEDIATRIC PARKLAND
   LR 3 ml x weight (kg) x % BSA over initial 24 hr plus maintenance
   Half over the first 8 hrs from the time of burn
   Other half over subsequent 16 hrs
   Target U/O: 1 ml / kg / hr
   Add 5% dextrose in maintenance fluids for children < 20 kg
4. CIRCUMFERENTIAL BURNS
   Assess circulation distal to burn with Doppler if needed
   Perform ESCHAROTOMY PRN

DISABILITY

1. PAIN

Toradol 10 mg IM. Avoid in renal disease, PUD, history of gastrointestinal bleed.

Ketamine 0.3 mg / kg slow IV push

Morphine 1-4 mg IV up to 10 mg q 4 hrs

Hydromorphone 0.2-0.5 mg IV up to 1 mg q 4 hrs

EXPOSURE: DECONTAMINATE

1. Remove all clothing
2. Brush off powders on skin PRIOR TO
3. water decontamination
   Soap and water low pressure irrigation: IRRIGATE IRRIGATE IRRIGATE
4. Occular irrigation for occular exposures

ANTIDOTE
Hydrofluoric Acid:
Calcium Gluconate

MONITORING
Continuous cardiopulmonary and capnography
Never underestimate a chemical burn - may be a rapid or insidious
Beware Hydrofluric Acid - hypocalcemia, hypomagnesemia, hyperkalemia
CAUSING ARRYTHMIAS

Question 2

Disposition: Small Burns, Superficial Burns

Answer 2

Discharge Home

Question 3

Criterial for Transfer to Burn Center

Answer 3

Third-degree (full-thickness) burns in any age group.

Partial thickness burns greater than 10% total body surface area (TBSA.)

Burns that involve the face, hands, feet, genitalia, perineum, or major joints.

Electrical burns, including lightening injury.

Chemical burns.

Inhalation injury.

Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality.

Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality.

Burned children in hospitals without qualified personnel or equipment for the care of children.

Burn injury in patients who will require special social, emotional or rehabilitative intervention.