Emergency Management of Chemical Burns PDF
Emergency Management of Chemical Burns PDF
Emergency Management of Chemical Burns PDF
HSOA Journal of
Emergency Medicine Trauma and Surgical Care
Review Article
Emergency Management of
Chemical Burns
Medhat Emil Habib*, Mazen Al-Samarrae, Fathy El Said
Shoeib and Gihan Adly Latif
Figure 1: (a) Chemical burn right side of the trunk, (b) Stomach acid leakage
Department of Plastic & Reconstructive Surgery, Mafraq Hospital, Abu around a PEG tube.
Dhabi, United Arab of Emirates
The history should also include the duration of contact with the
chemical agent, change of voice or difficulty in breathing in cases of
inhalation of a chemical agent, the medical condition of the patient
and past history of previous experience with chemical burns as in
industrial workers.
Introduction
Clinical Picture
Chemical burns can be caused by acids, bases, organic and
inorganic solutions. More than 25 000 products which can cause The patients may complain of itching, burning sensation, difficulty
chemical burns are available for use in agriculture, household, in breathing and coughing of blood as in inhalation of a chemical
industry and military forces [1]. Chemical burn accounts for 2.4%- gas and difficulty in swallowing in cases of ingestion of chemical
10.7% of the overall percentage of burns with a mortality rate of 30% agent by children and in suicidal attempts [8]. The patient may have
of all burn deaths [2,3]. The recognition of the causes, types and bleaching or darkening of the skin. The chemical burn can take the
mechanisms of tissue destruction of the chemical agents can help in shape of patches of skin burns in cases of immersion of part of the
the management of this type of burns. body in contact with a chemical agent. Streak lines going along the
gravity direction and patches of burn as a result of splash of a chemical
Patients History liquid are characteristic presentations of chemical burns (Figure 2).
Knowing the cause of the burn is of paramount importance in the
management. Sometimes this can be easily known if the patient or
rescuers bring the name of the causative agent as in industrial burns
in which a factory may be working on special types of chemicals or
in domestic burns in which the material used may be known. On
the other hand, the nature of the causative agent used may not be
known as in criminal attacks and wars [4]. In some cases of domestic
chemical burns a chemical material used for cleaning may be kept
in a different container which can be attractive to children. There is
another group of patients who know the chemical agent used but they
Figure 2: (a) Streak lines of flow of the chemical liquid, (b) Splash of the
do not declare it in the history as in suicidal actions and in some self chemical on the leg.
inflicted cases which makes the task difficult for the clinician [5].
The increased use of chemical peeling in the last few years created The burnt area may be superficial or deep depending on the type
a new category of chemical burn cases who can have serious of the chemical, its concentration, its duration of contact and its
complications [6]. Other causes of chemical burns can be due to penetration into the skin. Most acids produce a coagulation necrosis
extravasation of some drugs from the intravascular compartment to by denaturing proteins, forming a coagulum (eschar) that limits the
the surrounding tissues with the result of sustaining burns to these penetration of the acid. Bases typically produce a more severe injury
tissues [7]. known as liquefaction necrosis. This involves denaturing proteins as
well as saponification of fats which does not limit tissue penetration
Leakage of the hydrochloric acid around a PEG tube inserted in [8]. Depression of the burn area compared to the surrounding skin on
the stomach can cause burn in the surrounding skin (Figure 1). presentation to the emergency department is another characteristic
*Corresponding author: Medhat Emil Habib, Department of Plastic & sign of deep chemical burn (Figure 3).
Reconstructive Surgery, Mafraq Hospital, Abu Dhabi, United Arab of Emirates,
Tel: 00971505368188; E-mail: [email protected] Management
Citation: Habib ME, Al-Samarrae M, Shoeib FE, Latif GA (2014) Emergency Hazardous chemical materials can be harmful to the patients and
Management of Chemical Burns. J Emerg Med Trauma Surg Care 1: 001. to the emergency medical staff who attend them. Training of the
Received: June 11, 2014; Accepted: August 12, 2014; Published: August 26, emergency staff and the use of personal protective equipment in
2014 dealing with such situations can reduce that risk [9]. The ABC of
Citation: Habib ME, Al-Samarrae M, Shoeib FE, Latif GA (2014) Emergency Management of Chemical Burns. J Emerg Med Trauma Surg Care 1: 001.
Page 2 of 3
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exposure to the inciting pain. Chemical agent should be identified but 6. Nikalji N, Godse K, Sakhiya J, Patil S, Nadkarni N, et al. (2012) Complications
this should not delay the onset of the treatment. Immediate treatment of medium depth and deep chemical peels. J Cutan Asthet Surg 5: 254-260.
should include copious irrigation prior to ophthalmic evaluation and 7. Sharma R, Yoshikawa H, Abisaab J (2012) Chemical Burn Secondary to
pH testing [18]. Litmus paper is an easy way of determining the pH Propofol Extravasation. West J Emerg Med 13: 121122.
of the conjunctiva [19]. Early involvement of toxicologist or Poison
8. Touzopoulos P, Zarogoulidis P, Mitrakas A, Karanikas M, Milothridis P, et al.
Control Center is essential in such cases. (2011) Occupational chemical burns: a 2-year experience in the emergency
In initial ocular examination, there should be an examination of department. J Multidiscip Healthc 4: 349-352.
the fornices to ensure that there is no remaining alkaline material 9. Kirk MA, Cisek J, Rose RS (1994) Emergency Department Response to Haz-
such as ammonia or lime. This can be done by sweeping the fornices ardous Materials Incidents. Emergency Medicine Clinics of North America
with a glass rod. Irrigation with isotonic saline or lactated Ringers 12: 461-469.
solution should be performed to change the pH to a physiologic level. 10. Palao R, Monge I, Ruiz M, Barret JP (2009) Chemical burns: Pathophysiology
Then ocular examination will proceed to visual acuity, intraocular and treatment. Burns 36: 295-304.
pressure and perilimbal blanching/ischemia. If the injury is minor,
11. Klein MB (2007) Thermal, Chemical and Electrical Injuries. In: Charles H
preservative free artificial tears is used to promote reepithelization. Thorne (eds.). Grabb & Smiths Plastic Surgery, (6thedn). Lippincott Williams
A bandage contact lens may provide the patient with more comfort. & Wilkins, Philadelphia, USA. Pg no: 132-149.
Fourth generation topical antibiotic such as Fluoroquinolone can be
12. Cartotto RC, Peters WJ, Neligan PC, Douglas LG, Beeston J (1996) Chemi-
used in large epithelial defect as prophylaxis. Aqueous suppression
cal Burns. Can J Surg 39: 205-211.
may be also used in elevated intraocular pressure. Close follow up is
required. In severe cases in addition to conservative therapy, active 13. Vance MV, Curry SC, Kunkel DB, Ryan PJ, Ruggeri SB (1986) Digital hydro-
surgical intervention may be required [18]. fluoric acid burns: Treatment with intraarterial calcium infusion. Ann Emerg
Med 15: 890-896.
Conclusion 14. Eldad A, Weinberg A, Breitermanb S, Chaouatb M, Palankerc D, et al. (1998)
Although chemical burns constitute a small percentage of the Early nonsurgical removal of chemically injured tissue enhances wound heal-
ing in partial thickness burns. Burns 24: 166-172.
overall burn affecting the human body, their morbidity and mortality
rates are high. Proper history taking, clinical examination and early 15. Morgan SJ (1987) Chemical burns of the eye: causes and management. Br
management of such cases can greatly reduce the morbidity and J ophthalmol 71: 854-857.
mortality rates of these patients. 16. Kuckelkorn r, Shrang N, Keller G, Redbrake C (2002) Emergency treatment
of chemical and thermal eye burns. Acta Ophthalmol scand 80: 4-10.
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