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AUTHORS:
Robert H. Demling, M.D.
Leslie DeSanti R.N., Dennis
P. Orgill, M.D. PhD.
Section
6a
Other
Common Chemicals Causing Burns
Phosphorus
Phosphorous
is an incendiary agent used in a variety of weapons.
Burns are mainly seen in military personnel but may
be encountered by manufacturers of fireworks and
fertilizers. White phosphorus ignites in the
presence of air. On contact with skin it causes a
burn which will progress until all the agent is
oxidized or by immersion in water. The wounds are
typically severely painful, necrotic, yellowish in
color and have a characteristic smell of garlic.
Embedded phosphorus must be expected if an explosion
has occurred. Clothing may ignite and so must be
removed.
Immediate
treatment involves removing all of a victim’s
clothing, irrigating the area with water and
removing any easily identifiable particles. The
burns should then be covered in saline- or
water-soaked dressings. Specific therapy is
irrigation with copper sulfate in a 0.5% solution.
This causes the formation of a black film of cupric
oxide on the surface above the embedded agent which
impedes oxidation and facilitates identification and
removal of white phosphorus.
Phenol
Phenol
is an aromatic hydrocarbon derive from coal tar.
Following absorption through skin, phenol is bound
to albumin irreversibly. In acute phenol exposure, a
rapid rise in phenol levels is seen followed by a
sudden fall after the exposure ceases.
In cases
of ingestion, Phenol (carbolic acid) toxicity is
most frequently noted following acute ingestion or
chronic skin application. Ingestion of as little as
1 g may cause death. Skin damage may result after
prolonged contact. Copious irrigation with water is
the initial treatment. A small amount of water
increases the area of exposure. After irrigation
placement of undilated polyethylene glycol is
considered to be the best antidote.
TREATMENT
| Agent |
Pathophysiology |
Treatment |
| General
category of acids |
Deep
skin burn caused by tissue desiccation
and protein denaturation. Injury may
extend well below skin with
concentrated acids. Acids, such as
sulfuric, nitric, hydrochloric, cause
local damage. Appearance tan to gray
discoloration with extreme pain, a
common finding. |
Vigorous
water lavage up to 60 minutes after
injury using warm water with extensive
exposure to avoid hypothermia.
Treatment should be based on the
assumption that the burn will be much
deeper than initial appearance
indicates. Standard fluid
resuscitation principals.
|
| Hydrofluoric
acid |
Deep
skin burn, which can be extensive.
Systemic effects due to hypocalcaemia
as a result of complex of Ca++ to F1
anion. |
Vigorous
water lavage along with local
injection of calcium gluconate as well
as topical use of 2.5% calcium
gluconate gel. Infusion of calcium
with a local artery feeding the
injured tissue is now a recommended
treatment.
|
| General
category of alkali |
Deep
skin burn caused again by tissue
desiccation and protein denaturation
from chemical reaction of alkali
exposed to hydrated tissue. Alkali
burns tend to be worse than acid
burns, but systemic Effects from
absorption are not common. |
Vigorous
water lavage for at least 60 minutes
after injury and longer for lye burns,
avoiding hypothermia during the lavage.
Treatment should be based on the
assumption that the burn will progress
in depth. Standard fluid resuscitation
principles.
|
| Gasoline
immersion |
- Superficial
skin injury: erythema
- Systematic
injury: from absorbed hydrocarbons
- Renal:
lipid degenerative changes to proximal
tubules
- Lung:
surfactant denaturation, atelectasis,
lipoid pneumonia
- Central
nervous system: edema producing
seizures, coma
- Liver:
lipid degenerative changes, hepatitis
|
Water
Immersion
Aggressive
maintenance of hydration & pulmonary
support along with general care support
|
| Phenol |
-
Partial Thickness burn: dull tan to gray
color
- Systematic injury absorption, which is
usually rapid with the rate and amount
being surface.
- Directly proportional to surface area of
exposure
- Renal: Direct glomercular and tubular
damage increase as well as indirect damage
from precipitated hemoglobin
- Hematologic: red cell hymolysis,
decreased erythropoiesis
- Central nervous system: seizures,
comatose state
- Liver: centrolobular necrosis |
Spray
or pour large volumes of water on
Do
not swab or use small amounts of water,
which will only surface area of exposure.
After
lavage, use a quick skin wipe with
polyethylene or propylene glycol.
Maintain
urine alkaline with bicarbonate to
decrease hemoglobin precipitation.
Maintain
excellent hydration and blood volume to
support injured kidney and other organs
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