Chemical Burns

Question 1

Objectives

Answer 1

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

Question 2

Introduction

Answer 2

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

Question 3

Exposure Routes (slide 5)

Answer 3

• Skin and mucous membrane absorption
• Oral Ingestion
  Note: Oral ingestion (i.e. pediatric patient or patient with mental illness)
• Inhalation

Question 4

Severity of Injury (Slide 6)

Answer 4

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?

Question 5

Alkalis: Common Injuring Agents (Slide 9)

Answer 5

Lye
(oven, drain,
or toilet bowl cleaners

Cement
(wet or powder)

Ammonia (fertilizer, stain remover or refrigerant)

Methamphetamine production agents

Question 6

Alkalis: Mechanism of Tissue Injury (Slide 10)

Answer 6

• Liquefaction necrosis
• Denatures protein - affects the functioning of enzymes and proteins in the body.
• Chemical penetrates deeper into tissue
• Results in deeper injuries

Question 7

Acids: Common Exposure Agents (Slide 11)

Answer 7

Sulfuric acid

Hydrochloric acid (pool chlorine or cement cleaner)

Nitric acid (chemistry lab)

Oxalic/phosphoric acid (lime/rust remover)

Hydrofluoric acid (metal cleaner)

Question 8

Acids: Mechanism of Tissue Injury (Slide 12)

Answer 8

Coagulation necrosis
Protein precipitation
Causes leathery eschar
Leather is made by acid contact with dermis

> > > > > > Eschar on the back from sulfuric acid fertilizer spill

Question 9

Organic Compounds: Common Exposure Agents

Answer 9

*Phenols
*Creosote
*Petroleum products

Question 10

Organic Compounds: Mechanism of Tissue Injury (Slide 14)

Answer 10

Dissolves fat in cell membranes
Absorption can cause multi-system organ injury (pulmonary, renal, hepatic)

Question 11

Chemical Warfare Agents (15)

Answer 11

Vesicants
- Mustard agents
- Lewisite
- Chlorine gas
Nerve agents
- Sarin

Question 12

Initial Management

Answer 12

Pre hospital care - PROTECT YOURSELF - PPE

Question 13

Treatment Principles: Pre-hospital Care

Answer 13

Stop the burning
- Remove all clothing immediately
- Brush off powder chemicals
- Irrigate with water before transport

Question 14

Treatment Principles: In-hospital Care (Slide 19)

Answer 14

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

Question 15

Specific Treatments: Water Irrigation

Answer 15

• 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)

Question 16

Treatment Principles: In-hospital Care (Slide 22)

Answer 16

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

Question 17

Chemical Eye Injuries: Signs and Symptoms (Slide 23)

Answer 17

Severe pain, profuse tears, severe conjunctival inflammation, progressive corneal injury
An opaque cornea is a sign of severe injury

Question 18

Chemical Eye Injuries: Treatment Priorities (Slide 24)

Answer 18

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

Question 19

Chemical Eye Injuries: Treatment Priorities (Slide 25)

Answer 19

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

Question 20

Hydrofluoric Acid (HF) Burn: Mechanisms of Injury (Slide 30)

Answer 20

*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

Question 21

Hydrofluoric Acid Burn: Local and Systemic Treatment (Slide 31)

Answer 21

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

Question 22

Phenol Injuries (Slide 32)

Answer 22

Phenol is poorly soluble in water
Irrigate with water immediately
Remove with 50% polyethylene glycol or ethyl alcohol

Question 23

Methamphetamine Explosion Injuries

Answer 23

Multiple hazardous chemicals used in production
Injury is usually a combination of flame and chemical injuries

Question 24

SUMMARY

Answer 24

Decontamination is the priority
Irrigate with copious amounts of water but never attempt to neutralize
Chemical burns are an indication for burn center referral