Topical chemical burns
- Sangeeta Kaushik, MD
Sangeeta Kaushik, MD
- Attending Physician
- Georgetown University Medical Center
- Steven Bird, MD, FACEP
Steven Bird, MD, FACEP
- Associate Professor of Emergency Medicine
- University of Massachusetts Medical School
- Section Editors
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
Chemical burns, which are often work-related , are unique injuries that require individualized treatment and management depending upon the causative agent. They account for 4 percent of admissions to burn units in developed countries and up to 14 percent in underdeveloped countries .
A variety of chemicals are manufactured for household, agricultural, industrial, and military use, with an estimated 60,000 new chemicals produced each year . For management of toxic exposures, it is helpful to organize these chemicals into general categories, keeping in mind that some have overlapping properties or incompletely understood pathophysiology.
The evaluation and treatment of common topical chemical burns will be reviewed here with a focus on the basic principles of management. Thermal burns, chemical ingestions, chemical eye injuries, and agents used for chemical warfare are discussed elsewhere. (See "Emergency care of moderate and severe thermal burns in adults" and "Caustic esophageal injury in adults" and "Caustic esophageal injury in children" and "Corneal abrasions and corneal foreign bodies: Clinical manifestations and diagnosis" and "Chemical terrorism: Rapid recognition and initial medical management".)
PRINCIPLES OF MANAGEMENT
General approach — The potency and concentration of the toxic agent and the duration of contact primarily determine the degree of tissue destruction. Therefore, it is critical that treatment be started immediately. In the great majority of cases, the management of topical chemical burns consists of the following general steps:
●Ensure protection of rescuers and health care workers from exposure.
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- PRINCIPLES OF MANAGEMENT
- General approach
- Protection of providers
- Removal of chemical
- - Basic approach
- - Skin irrigation
- Eye exposure
- Chemicals NOT treated with immediate water irrigation
- Burn assessment
- Systemic toxicity
- Treatment of thermal burns from chemical exposure
- SPECIFIC AGENTS AND TREATMENTS
- - Hydrofluoric acid
- - Management of hydrofluoric acid burns
- - Systemic toxicity from hydrofluoric acid
- - Phenol (carbolic acid) and derivatives
- - White phosphorus
- - Anhydrous ammonia
- - Cement burns
- - Automobile airbag burns
- Tar and asphalt
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS