CHEMICAL BURN

Overview
Chemical burns can be caused by : Acids: defined as
proton donors
Acids (H+), Bases: are
contact with tissue
Bases defined as proton
acceptors (OH -)
Both defined as caustics, which cause
.(Alkali)
significant tissue damage on contact.
Strength:
Acid: how easily it gives up the proton
Base: how avidly it binds the proton.
The strength of acids and bases is
defined by using the pH scale.
 Pathophysiology Hydrofluoric acid is
somewhat different
from other acids in
ACID that it produces a
liquefaction necrosis

forming a
Denaturing limits the coagulation
coagulum (eg,
proteins penetration necrosis
eschar)
severity of the burn
is related to :
pH of the agent
concentration of
BASES the agent
Length of the
contact time,
denaturing of
not limit tissue Volume of the
proteins as well as liquefaction necrosis offending agent,
penetration
saponification of fats
physical form of
the agent
 The long-term effect is scarring,-depending on the
site of the burn
Ocular burns can result in opacification of the
cornea and complete loss of vision.
Esophageal and gastric burns can result in stricture
formation.
Acid Base
Sulfuric acid is commonly used in Sodium and calcium hypochlorite are
toilet bowl cleaners, drain cleaners, common ingredients in household
metal cleaners, automobile battery bleach and pool chlorinating solution.
fluid, munitions, and fertilizer Pool chlorinators also contain NaOH
manufacturing. Ammonia is used in cleaners and
Nitric acid is commonly used in detergents
engraving, metal refining, Phosphates commonly are used in
electroplating, and fertilizer many types of household detergents
manufacturing. and cleaners.
Hydrofluoric acid is commonly used Silicates include sodium silicate and
in rust removers, tire cleaners, tile sodium metasilicate.
cleaners, glass etching, dental work Sodium carbonate is used in
detergents.
 HISTORY
vary depending on the route of exposure &particular substances involved.
hydrofluoric acid- may present without immediate pain and slow-onset
deep pain occurring after exposure
Patient history should include:
Offending agent, concentration, physical form, pH
Route of exposure
Time of exposure
Volume of exposure
Possibility of coexisting injury
The timing and extent of irrigation
 PHYSICAL EXAMINATION
In dermal exposures:
Size periorbital dermal lesions:
Depth Scleral and corneal
Location lesions (eg, ulcerations, ocular
fluorescein uptake) exposure:
Circumferential
Leakage of vitreous Visual
burns humor acuity

For ingestions,:
Presence of oral burns or edema, drooling
Dysphagia, stridor, wheezing, dyspnea,
tachypnea
Abdominal tenderness, guarding, crepitus,
subcutaneous air (Hamman crunch)
 Treatment
Prehospital care

Remove contaminated clothes.

Prompt wound irrigation -limiting the

extent of dermal burns from exposure to

caustic substances.
 If contamination with metallic lithium, sodium, potassium, or magnesium
has occurred, irrigation with water can result in a chemical reaction that
causes burns to worsen.

In these situations, the area should be covered with mineral oil and the
metallic pieces should be removed with forceps and placed in mineral oil.

If contamination with white phosphorus has occurred, thoroughly irrigate

the area with water then cover the area with water-soaked gauze

If eye exposures- Immediate removal of caustic substances in the eye is

critical
Treatment
Emergency
ABCs, monitoring
Remove any
chemical from the
patient.
Always brush dry
chemicals off the
skin and clothing
before flushing
with water.
 Treatment
For liquid chemicals, immediately begin to flush the
burned area with lots of water.
Continue flooding the area for 15 to 20 minutes after
the patient says the burning pain has stopped.
If the patients eye has been burned, hold the eyelid
open while flooding the eye.
Correct metabolic abnormalities and tetanus
prophylaxis if necessary
local wound care and debridement
 Medication
Topical antibiotic therapy is usually
recommended for dermal and ocular
burns.(eg; Silver sulfadiazine, Erythromycin
ophthalmic)
Calcium or magnesium salts are used for
hydrofluoric acid burns.
Pain medications are important for
subsequent burn care(eg;NSAID, morphine)
Further Outpatient Care
Dermal burns treated on an outpatient
basis should be rechecked every 2-3
days.
Any ocular burns treated as on an
outpatient basis should be rechecked
in 24 hours.
Endoscopic examination of all
transmucosal or transmural
esophageal burns should be repeated
in 2-3 weeks.
Further Inpatient Care
Admission is recommended :
large surface area
Circumferential dermal burns
Pain control.
oral burns
patient who is symptomatic; or any
patient who ingested a strong acid, or
base, hydrofluoric acid, or other highly
caustic substance.
Significant dermal burns require adequate
IV fluid resuscitation and analgesics (eg,
morphine sulphate).
Consider the use of patient-controlled
analgesia pumps.
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