Severe 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. 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.
Specific agents
Some chemicals require special or slightly different treatment than other. Select the chemical that caused the burn below for treatment information.
What it is
An acid and metabolic poison. Very painful. Contact with very small amounts of industrial-strength acid can be fatal. Can cause arrhythmias.
How to treat it
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.
What it is
Cement powder penetrates clothing, combines with sweat, and creates an exothermic reaction.
Acts as a desiccant and alkali.
Pain and burning sensations do not occur immediately.
How to treat it
Prolonged irrigation with water.
What it is
More common in the military, but present in fireworks and fertilizers.
White phosphorus ignites in the presence of air and will continue until oxidation of the agent is complete or the oxygen source is removed.
How to treat it
Water irrigation and debride physical particles.
Apply 0.5% copper sulphate solution to turn particles black for easier identification and removal.
What it is
Immersion or extensive skin contact usually causes a partial thickness injury.
How to treat it
Irrigate with water.
Ocular chemical exposure
How to treat it:
- A 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
- In the case of burns from particulate matter (e.g. lime or cement) it is important to evert the eyelids and remove any residual particulate matter