Chemical Burns

Chemicals continue to destroy tissue as long as they are in contact with the skin. Death from a chemical injury, although rare, can occur due to extensive burns, or the systemic toxicity of absorbed chemicals.

Full thickness burn caused by cement

During the secondary survey it is important to ascertain the extent of tissue damage by determining:

The type of agent involved and how much
Strength and concentration of the agent
Site of contact and whether swallowed or inhaled
Manner and duration of contact
Mechanism of action of the chemical

Appropriate medical management includes decontamination of the burn injury (likely water irrigation) and on occasions, administration of a buffer or neutralising agent (where appropriate) to counteract the chemical.

First Aid

Prolonged irrigation with water flow is the mainstay of immediate treatment of most chemical burns. Irrigation should occur as soon as possible and continue while pain persists.

Protective clothing for first aid givers
Remove contaminated clothing from patient
Powdered agents should be brushed from the skin whilst protecting care giver
Areas of contact should be irrigated with copious amounts of cool running water
Avoid washing chemical over unaffected skin
Always ensure the unaffected eye is uppermost when irrigating to avoid contamination

Ocular Chemical Exposure

Topical anaesthetic can be used to aid saline or water irrigation for chemical ocular burns.
Topical anaesthetic must not be used chronically for pain relief.
The use of specific neutralising solutions is not recommended for ocular chemical burns.
Always ensure the unaffected eye is uppermost when irrigating to avoid contamination
Where there has been a burn with particulate matter (e.g. lime or cement) it is important to evert the eye lids and remove any residual particulate matter.

Specific Agents

Agent	Characteristics	Treatment
Hydrofluoric acid	An acid and metabolic poison. Very painful. Contact with very small amounts of industrial strength acid can be fatal. Can cause arrhythmias.	Irrigate with water. Treatment is designed to neutralise the fluoride ion and prevent systemic toxicity. Neutralise with topical calcium gluconate burn gel or local injection with 10% calcium gluconate Treatment for Injury to the eyes with HF is with copious water irrigation not calcium gluconate. Once the acute phase is over calcium gluconate can be used to the irrigate the eyes 3/24.
Cement(alkali)	Cement powder penetrates clothing, combines with sweat and creates an exothermic reaction. Acts as a dessicant and alkali. Pain and burning sensation do not occur immediately.	Prolonged irrigation with water.
Phosphorous	More common in military, but present in fireworks and fertilizers. White phosphorus ignites in presence of air and will continue until oxidation of the agent is complete or the oxygen source is removed.	Water irrigation Debride visible particles Apply 0.5% copper sulphate solution to turn particles black for easier identification and removal.
Petrol	Immersion or extensive skin contact usually causes a partial thickness injury	Irrigate with water