chemical burns Flashcards
Chemical Burns most common
Alkalis, acids, organic compounds (petroleum products)
tx of burns from white phosphorous?
neutralization w/ 1% copper sulfate solution and administration of calcium gluconate gel to address the concomitant hypocalcemia
Alkalis
hydroxides, carbonates, caustic sodas of Na, K, ammonium, Li, Ba, Ca (oven cleaners, drain cleaners, fertilizers, industrial cleaners)
structural bond for cement
CF of alkali burn
worse than acid!! tissue damage by liquefaction necrosis and protein denaturation
Acids
HCl in bathroom cleaners, oxallic and HFl (rust removers) pool cleaners, sulfuric acid in drain cleaners,
Acid CF
tissue damage by coagulation necrosis and protein precipitation
Hydrofluoric Acid
Industrial use: o Etch glass o Teflon o Clean semiconductors o Home use – rust removers
*weak acid, but F- is very toci
CF of hydrofluoric acid
severe pain for 6-8 hours, tissue necrosis, hypocalcemia bc F binds to free serum calcium
Tx of hydoflouric acid
- Flood wound with water – require copious lavage for at least 30 minutes
- Neutralize with topical calcium gel
o 1 amp calcium gluconate in 100 gm lubricating jelly - Apply with gloved hand
what do you need to monitor in a hydroflouric acid poisoning?
HEART!
IV line to tx hypocalcemia, wound excision, burn center consult
some pts: intra-arterial calcium infusion or subeschar dilute calcium gluconate
Organic solvents
Phenols (chemical disinfectants), Petroleum (creosote, gasoline, kerosene)
- cutaneous damage due to fat solvent action (cell membrane solvent action)
- toxic effects on kidneys and liver
tx of chemical burns
removal of staruated clothing, brush off powder agents, continuoulsy irrigate w/ lots of water
use litmus pater to get pH to 7 (esp. in eyes
wounds may look superficiatl, but can develop to full thickness in 2-3 days
what is contraindicated for treatment of chemical burns?
neutralizeing chemical!!!–think heat generation
Ocular Burns tx
*** early irrigation is CRUC. USE 1-2 L OF SALINE OR WATER W/ MORGAN LENS UNTIL PH IS NEUTRAL
-can use topical anesthetic to aid in pain management!
Electrical injury
“tip of the Iceberg” the Grand Masquerader
types of electrical injury
high voltage= +/= 1000
low V= < 1000 V
Alternating Current Burn clinical feature
contact sites, but no true entrace/exit sites. causes flexion contraction-sticks to the source
**more dangerous=tetany, death from cardiace fibrillation, respiratory muscle paralysis
Direct Current burn clinical feature
sudden contractio of muscles, and then thrown off
will se entrance and exit sites
extent of electrical injury is dependent on?
type, pathway of flow, local tissue resistance, duration
Current =V/R
what in the body has high resistance?
Skin, bones, and fat!
current flows along bone surface-generated heat damages adjacent muscle
complications of electrical injury?
higher the R, the more heat is generated leading to heat damage of the muscle groups –> paralysis, LOC, dysrhythmias, Vfib, pulmonary arrest
management of electrical burn
fasiotomy of extensive muscle damage
Cardiac monitoring for the first 24 hours
1/3 of pts w/ significant electrical injury will require amputation
what if you see red pigment urine in a pt w/ an electrical burn?
muscle break down! myoglobinuria
tx by increaseing fluid to obtain an urine output of 100 ml/hr
alkalinize uring w/ NaCO2 50 mgEq/L
lightning strikes
riks is 1/ 280000
kills 80-100 ppl in US annually and associated with 30 % mortality
70% of survivors=serious complications
