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Chemical burn: classification, first aid, treatment

The article was checked by a doctor: Yury Igorevich Kan

Causes and symptoms of a chemical burn

A chemical burn is associated with exposure to highly concentrated aggressive compounds on the skin and mucous membranes. The main cause of burn damage to the skin and eyes is accidental or deliberate contact with chemicals, non-compliance with safety precautions at home and at work, errors in the choice of means, and the use of chlorine-containing detergents.

When toxicants come into contact with the skin or eyes, colliquation necrosis develops – the tissue melts, becomes flabby, moist, edema, redness, and purulent infiltrate form around. There is a risk of secondary infection.

At the site of the burn, an area of ​​wet necrosis appears, covered with a white or black crust (scab). After rejection of the scab, an ulcer is formed, then a scar. How long a burn takes to heal depends on the chemical, the area, and the depth of the injury.

Chemical burns of the mucous membranes of the pharynx, larynx, esophagus and stomach occur after inhalation of toxic fumes or ingestion of chemicals. The main reason is the erroneous or deliberate ingestion of toxicants, unconventional treatment, and the intake of alcohol surrogates.

Aggressive components get on the mucous membranes of the oral cavity, pharynx, esophagus, and damage the epithelium, provoke necrobiosis – irreversible cell death.

When exposed to small doses of toxicants, only signs of chemical irritation and mild intoxication appear:

• soreness in the abdomen,

• burning and sore throat,

• feeling of suffocation,

• nausea and vomiting,

• rapid breathing,

• throat swelling.

In severe burns of the pharynx, esophagus, the pathological process affects not only the mucous membranes, but also the submucosal and muscular layers. Chemicals penetrate into the deep layers, destroy red blood cells, and disseminated vascular coagulation (DIC) develops – massive internal bleeding.

Help! Alkalis cause a more pronounced burn of the stomach, acids – the esophagus.

At the stage of recovery and regeneration, necrotic tissue is rejected, a healthy mucous membrane is restored, and a scar is formed at the site of necrosis. With severe burns of internal organs, complete recovery does not occur – stenosis is formed, the patient suffers from chronic inflammatory diseases.

Burning substances

Chemical burns provoked by various chemicals:

• alkalis: sodium hydroxide, sodium hydroxide, caustic soda;

• concentrated acids: acetic, hydrochloric, sulfuric;

• other substances: hydrogen peroxide, iodine, ammonia, acetone, silicate glue, potassium permanganate, phenol;

• household cleaners;

• substitute for alcohol.

More than 85% of chemical damage to the pharynx and esophagus in adults is caused by the intake of acetic acid, in children – potassium permanganate.

Reference! Most patients with esophageal burns are children under 10 years of age. The intake of toxicants occurs unintentionally, but because of the distraction of children, natural curiosity, carelessness of parents.

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Classification of chemical burns

Taking into account the depth of chemical damage, the clinical picture is divided into three degrees of skin burns:

• I degree. Incomplete damage to the skin or surface layer of the epithelium, caused by a short-term or weak intensity of the active substance. Local signs are limited swelling, redness of the skin, burning sensation and local pain. Healing occurs on 3-5 knocks on its own without scarring.

• II degree. Accompanied by damage to the epidermis, with the formation of blisters filled with liquid transparent contents. After 2-3 days, the liquid becomes thick and jelly-like. Pain, swelling and redness at the site of injury are more pronounced. Tissue repair continues for 12–15 days. The risk of infection is growing.

• III degree. Determined for damage to the lower and superficial layers of the skin. There are two types: III degree A – the cells of the deepest basal layer are preserved, III degree B – necrosis of the entire thickness of the skin and the inner layer occurs. At the site of the burn, an area of ​​wet necrosis is formed, covered with a crust. Rejection of the crusts occurs after 10–15 days, and complete healing of the burn injury takes 1–2 months. A rough scar is formed at the site of damage to the skin.

With chemical damage to the mucous membranes of the organs of the respiratory and digestive systems, three degrees of severity are also distinguished:

• light – damage to the surface layer of the epithelium;

• medium – lesion to the level of the mucous layer;

• severe – injury to the mucous membrane and underlying tissues at different depths.

Depending on the spread of the pathological process, burns are isolated and combined.

Complications of chemical burns

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• Pediatric dermatologist

Extensive and deep local burn injuries lead to the development of burn disease, which is accompanied by a violation of the water-salt balance, circulatory disorders, exhaustion of the immune system, and intoxication.

Various complications occur with progressive burns:

• intestinal paresis – paralysis of the muscles of the intestinal wall;

• myocarditis – inflammation in the muscular membrane of the heart;

• pericarditis – inflammation of the outer lining of the heart;

• pneumonia;

• bronchitis;

• pulmonary edema;

• pleurisy;

• glomerulonephritis is an immunoinflammatory disease of the kidneys,

• pyelitis – inflammation in the renal pelvis.

The defeat of deep tissues is aggravated by the formation of limited or diffuse purulent-inflammatory changes in the muscles, subcutaneous fat, the occurrence of sepsis, arthritis. The undesirable consequences of burns include the formation of coarse inelastic scars.

Help! Exposure to any physical and chemical factor that causes incomplete damage to the surface layer of the skin in an adult leads to deep trauma in children.

Burns of the eyes, esophagus, respiratory tract are more severe, disrupt important vital functions.

Among the complications of chemical damage to the respiratory and digestive organs, the most common are:

• swelling of the larynx and pharynx,

• stenosis of the larynx – narrowing of the lumen,

• respiratory failure,

• neck phlegmon,

• chronic pharyngitis,

• perforation of the esophagus.

With chemical damage to the deep layers of the mucous and submucosal membranes, toxic substances enter the systemic circulation and cause damage to the liver, kidneys, and brain.

The outcomes of severe eye burns include a decrease in visual function, atrophy of the eyeball, and the formation of a thorn.

First aid for chemical burns

The further prognosis of a burn injury depends on how timely and competently measures of emergency assistance were provided to the victim.

How to provide emergency care:

1. Limit human contact with the chemical.

2. Rinse the burned area with plenty of water, a weakly concentrated solution of soda or citric acid.

3. A fresh wound should not be treated with ointment, cream, spray, vegetable oil, and blisters should not be opened on their own.

4. For shallow burns limited to a small area, carefully remove clothing, apply a sterile dressing or bandage.

5. In case of burns of the 3rd degree, wrap the victim in a clean sheet, give painkillers, call emergency help or take him to a specialized medical facility on his own.

Before the ambulance arrives, it is important to solder with warm water to prevent dehydration.

Eye burn

First aid for a chemical eye burn is important to provide on the spot.

Urgent measures:

1. Rinse the conjunctiva with water or saline.

2. Remove pus and mucus, chemical residues.

3. Rinse the nasolacrimal canal with saline.

4. Drop or apply an antiseptic preparation into the conjunctival cavity.

It is strictly contraindicated to use neutralizing solutions on your own, since it is difficult to predict the reaction of substances to damaged tissue.

Burn of the esophagus and pharynx

First aid is provided at the prehospital stage or in the intensive care unit. To neutralize acids, a soda solution is used, alkalis – a weakly concentrated solution of acetic acid with oil. If the exact toxicant is not known, the oral cavity is washed with a large amount of clean water at room temperature, two glasses of milk are given to drink.

Important! Washing is performed only in the first 5-6 hours after the burn, then the procedure is not advisable.

What not to do with a chemical burn

When swallowing aggressive chemical compounds, it is strictly forbidden to induce vomiting, as the risk of rupture of the esophagus increases. Do not give activated charcoal – solid tablets additionally injure the esophagus.

It is not necessary to completely lay the victim down so as not to provoke gastroesophageal reflux disease – the reverse reflux of stomach contents. The optimal position is semi-sitting.

Chemical burn treatment

How to treat a chemical burn depends on the depth and area of ​​the injury. 1st-2nd degree burns are superficial and may heal on their own. With progressive tissue damage, qualified medical care is needed, removal of dead tissue, followed by correction of scars. Burns are treated in special burn wards.

At the first stage, the burn surface is treated to prevent infection from entering the body:

1. Treat the skin around the burn surface with an antiseptic.

2. They remove impurities, the remnants of toxicants, open and empty large blisters, pour a peroxide solution on the wound, and dry it.

3. Apply an ointment, cream or spray on top.

4. With extensive and deep lesions, the treatment of burn wounds is performed under anesthesia.

5. The wound surface is protected with a bandage or left open.

At the first stages of tissue repair, ointments, solutions and aerosols with analgesic, cooling and healing effects are used. In the presence of a scab, it is not removed, left until self-rejection. Solutions with wax and paraffin are applied to the wound surface so as not to damage the growing epithelium during dressings. Salicylic ointment and proteases break down the dry crust formed during severe burns.

At the second and third stages, drugs are prescribed to activate metabolism, improve blood circulation, and protect against infections.

With deep burns and large areas of tissue damage, a person loses a lot of fluid and salts. To compensate for the loss of protein and water, to prevent dehydration, to normalize the acid-base balance, nutrient solutions, glucose, and sodium chloride are administered through a dropper.

Esophageal burn treatment

To remove the irritating substance, a gastric tube treated with petroleum jelly is installed, and the stomach is washed with an antidote – water, soda solution, a non-concentrated solution of vinegar and oil. Preliminary anesthesia is carried out.

An antibiotic is given to prevent infection. Further, taking into account the patient’s condition, analgesic, anti-shock, detoxification therapy is prescribed.

In the subacute phase, after 7–10 days, bougienage of the esophagus is performed daily – expansion of the lumen using an endoscopic device. The procedure allows you to normalize the patency of the body, reduce scarring. With stenosis and complete obstruction of the esophagus, the formation of rough scars, surgical treatment is carried out in a planned manner.

Eye burn treatment

In the hospital, the patient is injected with anticholinergic drops into the conjunctival cavity. They are well anesthetized, minimize the risk of adhesions. Antibacterial ointments or drops are used to prevent infection. Antioxidants are administered intramuscularly. With increased intraocular pressure, antihypertensive drugs are prescribed.

In case of severe eye burns, hormonal therapy is connected – subconjunctival injections (in the area of ​​​​the transitional fold of the conjunctiva) and parabulbar (through the skin of the lower eyelid to the edge of the orbit).

In combination with pharmacotherapy, eyelid massage and physiotherapy have a good effect. With the threat of loss of vision in the early period, surgical treatment is performed on the eyelids, eyeball, conjunctiva, cornea.

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degrees, first aid and treatment at different stages

Types of burns

• Thermal
• Chemical
• Electrical
• Solar

Thermal burns

Thermal burns are the most common ² . They occur when the skin comes into contact with hot liquids, boiling water, steam, with hot surfaces and from intense thermal radiation, as well as when interacting with a flame.

Thermal skin burn

Thermal burn occurs as a result of high temperature exposure to the skin and underlying tissues. How to provide first aid, and how are such injuries treated?

Read more

Chemical burns

Chemical burns ² occur as a result of acid, alkali solutions coming into contact with the skin. The damaging effect begins from the moment the aggressive liquid hits the skin until the completion of the chemical reaction. The boundaries of chemical burns are clear. Under the influence of nitric acid, a scab (crust) of a yellow-green hue is formed, sulfuric acid – black, hydrochloric acid – light yellow.

Household chemicals must be kept out of the reach of children!

Electrical burns

Electrical burns – local manifestations of electrical injury ² . As a rule, electrical burns and electrical trauma are combined. The damaging effect of electric current on the skin and soft tissues occurs in response to the action of converted electrical energy into heat.

Keep electrical appliances, sockets and exposed wires away from small children.

Sunburn

Sunburn , or solar dermatitis, results from long-term exposure of the skin to ultraviolet (UV) radiation. The degree of damage to the skin depends on the duration of exposure to radiation and the phototype of the skin. The lighter the skin, the faster sunburn can occur. Therefore, before going out into the sun, it is very important to treat delicate baby skin with special protective agents.

Degrees of severity of burns

Burns of the 1st degree

Immediately after contact with the damaging factor, pain, burning, the skin turns red, and swelling of the skin that has been exposed to aggressive effects occurs.

Second degree burn

Second degree burns result in the death of the surface layer of the skin – the epidermis. The skin acquires a bright red color, puffiness appears, blisters form with a transparent yellowish content. The blisters break open, exposing a bright pink wound surface.

A feature of a second degree chemical burn is the absence of blistering. A crust is immediately formed from the dead layer of the epidermis, or the surface layer of the skin is completely torn off.

III degree burns

Not only the epidermis dies, but also the upper layers of the dermis. Bubbles may also form.

When scalded with steam or hot water, a sign of III degree burns is a whitish-gray coating, a wet crust.

Dry light brown crust on contact with flame.

III-b degree burns

Characterized by the death of the entire thickness of the skin and sometimes subcutaneous fat.

When burned with steam or hot water, the skin becomes soft, resembling a pale gray dough in consistency.

Flame burns form a hard, dark brown crust.

IV degree burns

At this stage, not only the skin and subcutaneous fat die, but also the underlying muscle membranes (fascia), muscles, tendons and bones. The scab (crust) is thick, dense with signs of charring.

In case of severe burns with acid, a dry dense crust is formed, in case of burns with alkali, the crust is soft for the first few days, then either undergoes purulent melting or dries up.

First aid for burns

Depending on the type of burn received, the first aid algorithm will be slightly different.

First aid for thermal burns

Interrupt exposure to the thermal agent.

Upon contact with a hot object, steam or hot liquid, immediately stop the damaging effect. If clothes caught fire from an open flame, they douse them with water, throw in a tarpaulin or blanket.

Cool the affected area.

After thermal exposure, it is recommended to cool the burnt tissue (cold water, snow, ice). This event reduces the temperature of the tissues and weakens the damaging thermal effect.

Clothing should not be removed from the burned area, it should be cut open and carefully removed . At the pre-medical stage , clothes adhering to the burn are not removed before dressing is applied, the blisters are not pierced.

First aid for electrical burns

Electrical burns are characterized by sooting and metallization of the burnt areas due to the combustion of conductor particles. Electrical burns are often combined with thermal burns due to the ignition of clothing.

If the skin is damaged by electricity:

Stop the electric current.

Disconnect the device or wire from the power supply, discard the conductive wires from the victim, pull them away from the exposed wires. The person providing first aid must take care of his own safety. Before performing the manipulation of de-energizing, it is necessary to wrap your hands with a dry cloth, stand on a board, rubber mat or any other object that does not conduct electricity ¹ .

After isolating the victim from the power source, if necessary, perform artificial respiration and chest compressions . Bring a cotton swab with 10% ammonia solution ¹ to the victim’s nose.

Cover the burned area with a sterile dressing.

First aid for chemical burns

As soon as possible remove clothing soaked with an aggressive substance.

Wash the affected area.

For 10-15 minutes, the affected areas are washed with plenty of running cold water. If the contact of the chemical with the skin lasted for some time, then the washing time is increased to 40 minutes.

Neutralize chemicals.

For acid lesions, use a 2-3% solution of sodium bicarbonate (baking soda), for exposure to alkalis, use a 2-5% solution of acetic or citric acid.

Apply to the lesions with a dry aseptic dressing.

First aid for sunburn

First aid for sunburn consists of applying soothing and healing agents to the skin. If blisters occur, wet-dry dressings with tannin solution or oak bark decoction can be recommended ² . Dermatologists also recommend taking allergy medications (antihistamines) ² .

Treatment of burns

To determine the tactics of treatment and predict the recovery of affected tissues except cause of burn must be determined:

• Depth of injury . To do this, evaluate the condition of the skin. Redness of the skin and blisters are interpreted in favor of II degree burns.
  Absence of pain when pricked with a needle, pulling out hair, touching the burn site with an alcohol-containing substance, absence of “play of capillaries” after pressing with a finger – in favor of severe damage, not less than III-a degree.
• Damage area . Doctors in practice use the “rule of nines” and “palms”. So, the head and one upper limb make up 9% of total body surface. One lower limb, anterior and posterior surfaces of the body 18% each, genitals and perineum 1%. According to the “palms” rule, the entire surface of the body can be measured with the palms, taking the size of 1 palm as 1% of the total body area.
• On the basis of the depth and area of ​​damage, doctors calculate an index of the severity of the lesion .

Severe burns should be treated in a hospital, burn unit.
In some cases, primary surgical debridement is required to remove dead tissue, grafting a skin flap.

Algorithm for the treatment of minor burns and wounds in a child. Watch a short video with surgeon Fyodor Yanovich Kraskovsky.

Treatment of burns at different stages of healing

During the restoration of burned skin, the same processes occur
as in the healing of any wounds: the stage of inflammation, regeneration,
maturation (epitalization and reorganization of the scar).

Phases of burn healing

For the treatment of first degree burns, soothing creams and ointments containing dexpanthenol and tannin are used. Healing occurs in a few days.

Burns, starting from the II degree of severity, are susceptible to infection, because the skin barrier is broken. For the treatment and prevention of wound infection, antiseptic agents are prescribed.

Inflammatory phase

The choice of antiseptic preparation for the treatment of burn wounds must be approached with particular care. The agent must have a broad antibacterial spectrum of action, be safe when applied, and not cause burning or pain during processing.

For this purpose, since the 1970s, povidone-iodine preparations have been used, which have antibacterial, antifungal and antiviral effects ^4.7 . Iodine in combination with povidone does not cause tissue burning when applied even to open wounds. The use of povidone-iodine solution and ointment for superficial injuries leads to rapid and high-quality wound healing without significant inflammation and infection ⁵ .

Based on povidone-iodine for decontamination of wound surfaces 10% solution for external use Betadine ^® and 10% ointment for external use Betadine ^® .

Apply a thin layer to damaged skin several times a day. When treating infected wounds under napkins soaked in solution or ointment Betadine ^® , during the first 5-7 days edema and the amount of purulent discharge decrease, pain decreases ⁶ . Betadine ^® solution and ointment are approved for use in children from the age of one month ⁷ .

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Povidone iodine

Characteristics and properties of povidone-iodine. What is povidone-iodine used for? Instructions for use of the solution, ointment, suppositories Betadine ^® with povidone-iodine.

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Regeneration phase

Regenerating ointments and creams are used during the regeneration phase, for example, products based on lanthanum salts, water extract of wheat, dexpanthenol.

Maturation phase

The maturation of scar tissue occurs in the third phase of wound healing. Depending on the severity of the burn, scarring may remain. At this stage, to prevent the development of rough scars, it is recommended to use creams and gels based on silicone, hyaluronidase.

How to prevent burns in children

In children, burn injuries are more common before the age of 5 years ¹ . Inquisitive kids can pull a pot of boiling water towards themselves, put their finger into a socket, touch a hot iron, pour or spray household chemicals. The high risk of burns in young children is associated with their inability to independently assess the danger of fire, hot liquids, chemicals.

Therefore, to prevent children from getting burn wounds, it is recommended: , pots, pans with hot contents in the area of ​​direct reach of children

children under 3 years of age are not recommended to stay in the open sun without clothes. It is recommended to use sunscreens with SPF 50+

Frequently asked questions

What should not be done in case of a burn in children?

• A fresh burn must not be lubricated with oil or vaseline; You can wash the burnt area with plenty of water.
• Do not use sour cream, kefir or other folk remedies for sunburn. It is recommended to use special products, for example, with dexpanthenol.

Can blisters be punctured after a burn?

To prevent infection after a burn, it is better not to pierce the blisters yourself, but to consult a doctor for proper treatment. If, nevertheless, the blisters burst, then the wound surface must be washed with a solution of chlorhexidine or treated with a solution of Betadine ^® .

How long does it take for burns to heal?

Depending on the depth of the burn injury, the duration of healing will be different. With a first degree burn, the skin will recover in a few days.

For second-degree burns, if the wound does not become infected, the skin will heal within two weeks, and a temporary change in skin color (pigmentation) may remain.

With III and IV degree burns, healing can take up to 1.5 months or more. Usually there are scars and a violation of skin pigmentation.

Moshkova Elena Mikhailovna

Dermatovenereologist, Head of KDO for the provision of paid services, St.0003

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Polyvinylpyrrolidone (povidone): application, use in the povidone-iodine complex.

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