Chemical burns | healthdirect

Many chemicals that are commonly used at home, school or work can cause serious burns to the skin. If you suspect you or someone else has a chemical burn, it is important to wash the chemical off as quickly as possible with a large quantity of water.

Many chemical burns are small, but they can be deeper than they look. It depends on the chemical, how strong it is, and how long it is in contact with the skin.

All chemical burns should be treated as a medical emergency. If you suspect a chemical burn, call triple zero (000) and ask for an ambulance. If you can, let them know what chemical caused the burn.

For help and advice about poison, call the poisons information hotline on 13 11 26 (24 hours a day, 7 days a week).

Chemical burn first aid

If the chemical is on the skin, wash it off immediately with a large quantity of water, continuing for up to 60 minutes. It’s best to do this in the shower as it washes chemicals away from the body.

Remove contaminated clothing or footwear – but do not pick off anything that is stuck to the skin. Make sure the person giving the first aid doesn’t come into contact with the chemical.

If the chemical is in the eye, tilt the head to the side and protect the other eye. Then gently flush the eye with cool water for 20 minutes.

Cover the burn with a sterile dressing that won’t stick to the skin.

Types of chemical burn

Most chemical burns are caused by either strong acids or strong bases, which can be found in products such as:

• bleach
• concrete mix
• drain or toilet bowl cleaners
• metal cleaners
• pool chlorinators
• phosphorous (found in fireworks and fertilizers)
• petrol

Chemical burns often happen by accident, but they can also result from an assault, self-harm or a suicide attempt. They are most likely to affect the face, eyes, limbs, hands or feet. Chemicals can also burn you inside if they are swallowed.

Chemical burn symptoms

A chemical burn is similar to a burn caused by heat. Symptoms of a chemical burn include:

• redness and burning at the site
• pain or numbness
• blisters
• blackened skin

A chemical burn to the eye can cause vision problems, and a chemical burn to the lungs can cause coughing or shortness of breath.

If the burn is very severe, symptoms can include:

Chemical burn diagnosis

Chemical burns should always be seen by a doctor, who will check the airways, breathing and circulation. They will also ask for as much information as possible about the type of chemical that caused the burn. They will ask how much there was, how long it was in contact with your skin, and what has already been done to care for the burn.

Chemical burn treatment

If you have a minor chemical burn, you probably won’t be admitted to hospital. You should follow your doctor’s instructions to keep the wound clean and prevent it from drying out. Your doctor will also advise you on appropriate pain relief and what creams and dressings are to be applied.

More serious burns will need treatment in hospital to control pain, prevent infection and manage any problems with breathing or circulation caused by the burn. The wound will be carefully monitored.

Chemical burn prevention

• Always read and follow the instructions when using products containing chemicals.
• Always wear safety gloves and eye protection when handling chemicals.
• Take note of any warnings on the package and make sure you understand them.
• Always wash your hands after using a product containing chemicals.
• Make sure all containers containing chemicals are labelled.
• Always store chemicals in a safe place, out of the reach of children.
• Have first aid supplies on hand to treat a chemical burn.

More information

For help and advice about chemical burns, contact the NSW Poisons Information Centre on 13 11 26.

a 2-year experience in the emergency department

J Multidiscip Healthc. 2011; 4: 349–352.

,¹,²,¹,¹,¹,¹,³,³,³,⁴ and ⁵

Panagiotis Touzopoulos

¹1st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Paul Zarogoulidis

²Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Alexandros Mitrakas

¹1st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Michael Karanikas

¹1st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Panagiotis Milothridis

¹1st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Dimitrios Matthaios

¹1st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Ioannis Kouroumichakis

³2nd Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Stella Proikaki

³2nd Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Paschalis Pavlioglou

³2nd Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

Nikolaos Katsikogiannis

⁴Surgical Department (NHS), University General Hospital of Alexandroupolis

Theodoros C Constantinidis

⁵Medical School, Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Regional Laboratory of Public Health (Eastern Macedonia-Thrace), Greece

¹1st University Surgical Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

²Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

³2nd Internal Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis

⁴Surgical Department (NHS), University General Hospital of Alexandroupolis

⁵Medical School, Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, Regional Laboratory of Public Health (Eastern Macedonia-Thrace), Greece

Correspondence: Paul Zarogoulidis, Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece, Tel +30 697 727 1974, Fax +30 231 099 2433, Email moc. liamtoh@gorazpCopyright © 2011 Touzopoulos et al, publisher and licensee Dove Medical Press Ltd.

This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Chemical burn injuries are a result of exposure to acid, alkali, or organic compounds. In this retrospective study, a total of 21 patients suffering occupational chemical burns, came to the emergency room at the University General Hospital of Alexandroupolis, from 2008 to 2010; 76.2% were workers, 19% were farmers, and 4.8% were desk officers. The majority of burns were due to exposure to acid (61.9%). Upper extremities were the most frequently injured area followed by the lower extremities and thorax. None of the patients needed further hospital care, but in the follow-up, four of the patients suffered keloid. Proper surgical treatment at the emergency room decreases the length of hospital stay for patients who suffer chemically induced burns.

Keywords: chemical burns, surgical treatment, labor accidents

Introduction

Chemical burn injuries are a result of exposure to acid, alkali, or organic compounds.1 Carelessness is the most common cause of chemical burns, and caution is the most effective form of prevention.2 To avoid occupational exposure, proper safety precautions should be taken by employees when working with hazardous materials. Employers must provide them with adequate training and protective equipment. Injury as a result of a chemical burn has greater potential for progressive tissue damage than other types of burn injuries.3 Chemical burns are less common than others,4 and their etiology differs depending on population, geography, presence of industry, social status, and education.4–6

The exact symptoms of a chemical burn depend on the chemical involved. Symptoms include itching, bleaching or darkening of skin, burning sensations, trouble breathing, coughing blood, and/or tissue necrosis. Common sources of chemical burns include sulfuric acid (H₂SO₄), hydrochloric acid (HCl), lye (NaOH), lime (CaO), and silver nitrate (AgNO₃). Chemical burns may occur through direct contact with body surfaces including skin and eyes, inhalation, and ingestion. Lipophilic substances that diffuse efficiently in human tissue, eg, hydrofluoric acid, sulfur mustard, and dimethyl-sulfate, may not react immediately, but produce the burns and inflammation hours after the contact. Chemical fabrication, mining, medicine, and related professional fields are examples of occupations where chemical burns may occur.

Prompt wound irrigation is the most critical aspect in preventing the extent of dermal burns from exposure to caustic substances. A burn center case series found that patients who received irrigation within 10 minutes had a 5-fold decrease in full-thickness injury and a 2-fold decrease in length of hospital stay.7 The key treatment to that kind of burn begins in the emergency room. The first priority is to ensure complete removal of the offending agent. If a question of airway compromise exists, the airway must be secured. Adequate irrigation is difficult to define and depends on the amount of exposure and the agent involved. Using litmus paper to measure the pH of the affected area or the irrigating solution is helpful. Complete removal and neutralization of concentrated acids and alkalis may require several hours of irrigation. Tap water is adequate for irrigation. Low-pressure irrigation is desired; high pressures may exacerbate the tissue injury.7–10 After initial decontamination, the full extent of the injury must be ascertained and the patient must be treated as a typical burn patient. Based on the degree of injury, adequate fluid resuscitation must be ensured and precautions should be taken to prevent complications (eg, hypothermia, infection, rhabdomyolysis). Burns to the hands, face, or perineum may require appropriate specialties. Ophthalmologic consultation is recommended for patients with ocular burns from acids or bases, if there is any significant degree of corneal or scleral injury. Caustic ingestions may require multiple specialties, including gastroenterology and otolaryngology. Medications have a limited role in the treatment of most chemical burns. Topical antibiotic therapy is usually recommended for dermal and ocular burns. Pain medications are important for subsequent burn care. There has been some use of aloe products on mild burns; however, currently, no definitive information on their use for chemical burns is available.11

In this retrospective study, we report our center’s experience in the emergency room.

Methods

We recorded all cases that came to the emergency room of Alexandroupolis complaining of chemical burns due to chemical substances during work time in 2008–2010. We recorded their age, their job, and the kind of chemical substance that caused the burn. During the clinical examination we took care of the total surface of the burn, the anatomical site, and the depth of the burn. We were concerned about therapy as well as the recovery of the affected areas. The study was authorized by the Investigational Review Board of our hospital.

Results

In the emergency room, 21 patients with chemically induced burns due to occupational exposure were admitted between 2008 and 2010. This number represents about 61.8% of all chemical burns, since 13 more presented with chemical burns caused by chemical substances in their home. Sixteen patients (76.2%) worked in industrial areas, four patients (4%) were farmers, and one (4.8%) had a desk job (). All patients had been working more than 10 years, and the median of their age was 52 years (38–65). The majority of the chemical burns were due to exposure to: (a) acid (61.9%), (b) to alkali (19.05%), and (c) to unknown substances (19.05%) (). The most common sites of exposure were the upper limbs, followed by lower limbs and the chest (). All burns were of second degree. All burns were treated conservatively, by water treatment at the site of injury, local and systemic antimicrobial therapy, analgesia, covering the burn site, and re-evaluation after 3 days. No patients were admitted to the clinic, because burn surfaces were very small. Four patients had facial burns and five at the lateral surface of the neck, with no evidence of respiratory burn, while none of them needed intubation. All dermal burns were rechecked every 3 days during the first 2 weeks and then once a week for 2 months. At the time of re-evaluation, four of the patients needed cosmetic surgery due to keloids, two on the upper extremities, one on the chest, and one on the earlobe.

Table 1

	Number	%
Workers	16	76. 2%
Farmers	4	19%
Desk officers	1	4.8%
Businessmen	0	0

Table 2

	Number	%
Acid	13	61. 9%
Alkali	4	19.1%
Unidentified	4	19.1%

Table 3

	Number	%
Face	4	19%
Neck	5	23. 8%
Thorax	8	38.1%
Abdomen	3	14.3%
Back	3	14.3%
Upper extremities	16	76.2%
Lower extremities	7	33. 3%
Hand	14	66.7%
Foot	3	14.3%
Perineum	0	0

Discussion

Chemical burns can be caused by acids or bases that come into contact with tissue.1 Both acids and bases can be defined as caustics, which cause significant tissue damage on contact. Most acids produce a coagulation necrosis by denaturing proteins, forming a coagulum (eg, eschar) that limits the penetration of the acid. Bases typically produce a more severe injury known as liquefaction necrosis. This involves denaturing of proteins as well as saponification of fats, which does not limit tissue penetration. Hydrofluoric acid differs from other acids because it induces liquefaction necrosis. The severity of the burn is related to a number of factors, including the pH of the agent, the concentration of the agent, the length of the contact time, the volume of the offending agent, and the physical form of the agent. The ingestion of solid pellets of alkaline substances results in prolonged contact time in the stomach, and thus more severe burns. In addition, concentrated forms of some acids and bases generate significant heat when diluted or neutralized, resulting in thermal and caustic injury. The long-term effect of caustic dermal burns is scarring and, depending on the site of the burn, scarring can be significant. Ocular burns can result in opacification of the cornea and complete loss of vision. Esophageal and gastric burns can result in stricture formation.

These kinds of burns are less common than the others. 4 Their etiology differs depending on population, geography, presence of industry, social status, and education.4–6 According to literature, most burns (4%–13%) are due to criminal acts.12,13 An occupational chemical injury is hazardous,14,15 not only because of the inherent danger of the toxic materials, but also because of the problems posed by the physical management of these agents.16

Chemical burns are common in the lower socioeconomic classes (workers/farmers) and initial basic treatment does not always prevent further tissue damage. An important factor seems to be carelessness due to neglecting safety rules. Despite this, the knowledge of some hygiene rules protected workers from severe degree chemical burns, due to the fact that all of them cleared the traumatized area with plenty of water at the time of injury. Chemical substances traumatize tissues17 by destroying proteins with different mechanisms such as degradation, oxidation, and dehydration. Therefore instant clearing of the burn area with water lowers trauma depth, and morbidity. 18

The most common chemical substance is acid, which is commonly used in agriculture, industry, and general occupational use. The correct treatment of a chemical burn depends on recognition of the chemical substance.5 This recognition is not always possible, and the immediate therapy for patients in the emergency room is the same for all. This study was conducted in our hospital where there is no special unit for burn injury care, and these cases were treated by the surgical department. Therapy must be individualized for every kind of burn in relation to age, the traumatized area, the kind of chemical substance, the depth of the burn, and the presence of complications. Despite the existence of modern techniques in the treatment of burns, the ability of an experienced surgical team to provide instant surgical care is still ideal. The purpose of this study was to foster the development of special burn units at hospitals in industrial areas, and also knowledge of first aid in the general population.

Conclusion

A chemical burn can cause more tissue damage than any other type of burn. Working accidents related to chemicals can be very toxic due to the nature of the chemicals, and also due to their method of use. Carelessness is the most common cause of trauma with the upper extremities being the most commonly exposed anatomical area. However, all industries are required to inform employees of any dangerous materials they may encounter in the workplace, and are required to provide adequate training and protective equipment. The strict adherence to safety rules by employees can mean that such trauma is avoided, while good knowledge of first aid results in low morbidity.

Acknowledgments

All authors contributed equally in the preparation of the manuscript.

Footnotes

Disclosure

The authors report no conflicts of interest in this work.

References

1. Barillo DJ, Cancio LC, Goodwin CW. Treatment of white phosphorus and other chemical burn injuries at one burn center over a 51-year period. Burns. 2004;30(5):448–452. [PubMed] [Google Scholar]2. Xie Y, Tan Y, Tang S. Epidemiology of 377 patients with chemical burns in Guangdong province. Burns. 2004;30(6):569–572. [PubMed] [Google Scholar]3. Curreri PW, Asch MJ, Pruitt BA. The treatment of chemical burns: specialized diagnostic and prognostic considerations. J Trauma. 1970;10(8):634–642. [PubMed] [Google Scholar]4. Singer A, Sagi A, Ben Meir P, Rosenberg L. Chemical burns: our 10-year experience. Burns. 1992;18(3):250–252. [PubMed] [Google Scholar]5. Li YY, Liu Y. Analysis of 155 patients with chemical injury: a 5-year experience. Burns. 1993;19(6):516–518. [PubMed] [Google Scholar]6. Pitkanen J, Al-Qattan MM. Epidemiology of domestic chemical burns in Saudi Arabia. Burns. 2001;27(4):376–378. [PubMed] [Google Scholar]7. Leonard LG, Scheulen JJ, Munster AM. Chemical burns: effect of prompt first aid. J Trauma. 1982;22(5):420–423. [PubMed] [Google Scholar]8. Mozingo DW, Smith AA, McManus WF, et al. Chemical burns. J Trauma. 1988;28(5):642–764. [PubMed] [Google Scholar]9. Yano K, Hata Y, Matsuka K. Experimental study on alkaline skin injuries – periodic changes in subcutaneous tissue pH and the effects exerted by washing. Burns. 1993;19(4):320–323. [PubMed] [Google Scholar]10. Yano K, Hosokawa K, Kakibuchi M, et al. Effects of washing acid injuries to the skin with water: an experimental study using rats. Burns. 1995;21(7):500–502. [PubMed] [Google Scholar]11. Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956–2006. Clin Toxicol (Phila) 2007;45(4):402–408. [PubMed] [Google Scholar]12. Purdue GF, Hunt JL. Adult assault as a mechanism of burn injury. Arch Surg. 1990;125(2):268–269. [PubMed] [Google Scholar]13. Yeong EK, Chen MT, Mann R, Lin TW, Engrav LH. Facial mutilation after an assault with chemicals: 15 cases and literature review. J Burn Care Rehabil. 1997;18(3):234–237. [PubMed] [Google Scholar]15. Simmons JE. Chemical mixtures: challenge for toxicology and risk assessment. Toxicology. 1995;105(2–3):111–119. [PubMed] [Google Scholar]16. Saha A, Kumar S, Vasudevan DM. Factors of occupational injury: a survey in a chemical company. Ind Health. 2008;46(2):152–157. [PubMed] [Google Scholar]17. Townsend CM Jr, Beauchamp RD, Evers M, Mattox KL, editors. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia, PA: WB Saunders Co; 2007. Section III, chapter 22; pp. 635–637. [Google Scholar]18. Moran KD, O’Reilly T, Munster AM. Chemical burns. A ten-year experience. Am Surg. 1987;53(11):652–653. [PubMed] [Google Scholar]

Chemical Burns of the Eye in Children

Not what you’re looking for?

What are chemical burns of the eye in children?

Chemical burns happen when a
chemical gets into your child’s eye.

What causes chemical burns of the eye in a child?

Chemical burns of the eye are often caused by household cleaning products. Some common
products that cause this type of injury include:

• Toilet cleaner
• Battery fluid
• Pool cleaner
• Bleach
• Vinegar
• Glass polish

What are the symptoms of chemical burns of the eye in a child?

Symptoms may be a bit different for
each child. They can include:

• Severe eye pain
• Burning of the eye
• Tearing of the eye

The symptoms of chemical burns of
the eye may look like symptoms of other eye issues or health problems. Have your child
see his or her healthcare provider for a diagnosis.

How is a chemical burn of the eye diagnosed in a child?

Your child’s healthcare provider will ask about your child’s health history. He or
she will also give your child an eye exam. Your child may get local numbing (anesthetic)
eye drops for the exam.

How are chemical burns of the eye treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is.

A chemical burn to the eye is an
emergency. You should seek medical help right away if your child gets a chemical into
his or her eye.

Most children with a chemical burn
will be treated in the emergency room. An eye healthcare provider (ophthalmologist)
will
often care for your child.

Treatment includes washing out your
child’s eye with saline right away. This is done for about 30 minutes and sometimes
longer depending on the type of chemical burn. Your child may get local numbing
(anesthetic) drops into his or her eye to help ease the pain. The eye is often held
open
with a tool to make sure the saline gets into the eye. Some children may need to be
sedated or placed under general anesthesia. Depending on the severity of the chemical
burn, your child may need multiple eye drops several times each day for weeks or even
months.

What are possible complications of chemical burns of the eye in
a child?

If a chemical burn of the eye isn’t treated right away, your child could have vision
loss. Your child may even lose his or her eye.

Key points about chemical burns of the eye in children

• Chemical burns happen when a chemical
  gets into your child’s eye. These burns are often caused by household cleaning
  products.
• This is an emergency. You should seek
  medical help right away if your child gets a chemical into his or her eye.
• Treatment includes washing your
  child’s eye out with saline right away. This should be done for about 30 minutes and
  sometimes longer depending on the type of chemical burn.
• Depending on the severity of the
  chemical burn, your child may need multiple eye drops several times each day for
  weeks or even months.
• If a chemical burn of the eye isn’t
  treated right away, your child could have vision loss. Your child may even lose his
  or her eye.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
  or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child.
  Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose
  for that visit.
• Know how you can contact your child’s provider after office hours. This is important
  if your child becomes ill and you have questions or need advice.

Not what you’re looking for?

Chemical Burn – an overview

General principles of management

The most important aspects of first aid for chemical burn victims involve removal of the offending agent from contact with the patient. This requires removal of all potentially contaminated clothing and copious irrigation. Important principles in the irrigation of chemical burn patients involve protection of healthcare providers to prevent additional injuries. Further, the wounds should not be irrigated by placing the patient into a tub, thereby containing the chemical and spreading the injurious material. Irrigation should be large volume, and ‘to the floor’ or out an appropriate drain. Lavage of chemical injuries is meant to dilute the agent already in contact with the skin, and prevent additional agent from being exposed to the skin. Early, copious lavage has been shown to reduce the extent and depth of full-thickness injury.⁸ No measure of adequacy of lavage has been developed, but monitoring of the pH from the effluent can provide quantifiable information as to adequacy of lavage, but quite often after a period of 30 minutes to 2 hours of lavage may be necessary, and clinically the input of the patient is important to tell that the symptoms of the injury have been reduced signal the end of lavage. The adage ‘dilution as the solution to the pollution’ applies.

Material Safety Data Sheets (MSDS) are mandated to be available for all chemicals present in the workplace. These can be valuable resources for potential systemic toxicity and side effects of an agent. Plant safety officers should be available at all times to provide this information in cases of industrial accidents. Further assistance is available from regional poison control centers for household chemicals or unidentified agents.

One of the most controversial areas of chemical burn treatment involves the use of neutralizing agents. In theory, they should effectively remove the active chemical form in a wound and provide relief from further injury. However, because of the wide range of chemicals potentially involved, their correct use cannot be assured, so they are generally discouraged. The practical problems encountered with their use are exothermic reactions (i.e. when an acid is used to neutralize an alkali solution, the resulting reaction may liberate a large amount of heat), causing further thermal damage on top of the preexisting chemical injury. When the burning agent is known and an appriate antidote is known, there is some benefit demonstrated in its use.⁹ Despite this, no agent has been found to be more effective than plain water for irrigation.¹⁰

General principles of trauma management are followed (the ABCs). Airway patency is assured, followed by adequate air movement, and maintenance of hemodynamics. Despite the increasing awareness of chemical burns, no one center has undertaken a study of the resuscitative needs of a chemical burn victim, and hence we rely on the conventional thermal burn formulas for resuscitation. Monitoring of urine output remains paramount to assessment of adequacy of end-organ perfusion and hence resuscitation. Systemic disturbances of pH are potential complications and must be monitored until electrolyte trends are stabilized.

The typical large-volume lavage required to adequately dilute chemical exposures puts the victim at potential risk for hypothermia, both from evaporative cooling losses and the use of unwarmed lavage fluid. First aid performed in outdoor decontamination areas can compound the possibility of hypothermia. Recognition of these risks can prevent added complications.

Principles of wound care for chemical burns are typically the same as for thermal injuries. Early excision and grafting of obvious non-viable tissue is advocated, particularly in light of the observation that chemical burns tend to heal more slowly than thermal burns. Topical application of antimicrobials can be useful for partial thickness injuries. With the development of temporary wound coverings, such as Biobrane™, it is tempting to use this technology in the setting of chemical injuries, but there is no significant experience to support this use.

Chemical Eye Burns – Symptoms and Treatment of Chemical Eye Burns : Bausch + Lomb

Chemical eye burns can occur when the eye comes into contact with a solid, liquid, or gas chemical. The severity of the burn depends on the chemical, as well as the amount that comes into contact with the eye. The vast majority of burns are treatable but all should be taken seriously.

Chemical eye burns fall into three categories based on a measurement of pH. The pH scale ranges from 0-14 and indicates how acidic or alkaline a substance is. The pH of 7 is neutral; the pH of healthy tears is 7.5. A pH less than 7 is acidic while a pH greater than 7 is alkaline.

The three categories of chemical eye burns are:

• Alkali Burns: These burns involve high pH chemicals, and thus are the most dangerous. They are powerful enough to penetrate the eye, and cause damage to its vital inner components. In the worst cases, they can lead to conditions like cataracts and glaucoma and may cause vision loss or blindness. Examples include: ammonia, drain cleaners, oven cleaners and fertilizers.
• Acid Burns: Lower pH burns are less serious than alkali burns, but still dangerous. These burns don’t easily penetrate the eye, but still may cause significant damage to the cornea, with the potential to cause vision loss. Examples include: battery acid, vinegar, and nail polish remover. 
• Irritant Burns: These substances are neutral in pH. Examples include many household detergents and pepper spray.

What Causes Chemical Eye Burns?

Most commonly, they occur in industrial workplaces where chemicals are present, and at home with common household cleaning products.

Symptoms of Chemical Eye Burns

Vision loss is indicative of a severe chemical eye burn. Other signs and symptoms include:

• Eye redness
• Eye irritation
• Eye pain
• Swelling of the eyelid(s)
• Blurred vision
• Inability to keep your eye open
• Feeling of foreign objects in the eye

Treatments for Chemical Eye Burns

No matter the situation, the most important thing to do when experiencing an eye burn is to get the chemical out of the eyes. A special chemical eye wash station is the best way to do this, if available; however, tap water is a viable option. To treat a chemical eye burn:

• Flush the eyes out with cool water for at least 15 minutes
• As you rinse, use your fingers to hold your eye open as wide as possible and roll your eye to ensure  the greatest coverage
• Remove contact lenses, if applicable, if they do not come out during flushing 
• In cases of severe burns, go to emergency (if you can continue flushing the eye out) or call 9-1-1 and flush your eyes out until help arrives

It is important to know what chemical came in contact with your eye; any alkali and acid burns in the eye should be evaluated since both have the potential to cause vision loss. 

NPR.0422.USA.17

Cutaneous chemical burns: assessment and early management

Neiraja Gnaneswaran

Eshini Perera

Marlon Perera

Raja Sawhney

Background

Chemical burns are common and may cause significant physical, psychological, social and economic burden. Despite a wide variety of potentially harmful chemicals, important general principals may be drawn in the assessment and initial management of such injuries. Early treatment of chemical burns is crucial and may reduce the period of resulting morbidity.

Objective/s

This article reviews the assessment and management of cutaneous chemical burns.

Discussion

Assessment of the patient should be rapid and occur in conjunction with early emergency management. Rapid history and pri-mary and secondary survey may be required to exclude systemic side effects of the injury. Depth of wound assessment is diffi-cult given that necrosis caused by various chemicals can continue despite cessation of exposure. Early management should be conducted with consideration of clinician’s safety, and appropriate precautions should be taken. Excluding specific situations and chemical exposure, copious irrigation with water remains the mainstay of early management. Referral to a centre of higher acuity may be required for expert evaluation.

Burns are a common trauma that affects up to 1% of the Australian population and may be associated with significant physical, psychological, social and economic burden.¹ Chemical burns represents 3–5% of all burns-associated admissions.² Despite the small proportion, chemical burns account for 30% of burns-associated death,^3,4 most commonly occurring as a result of chemical ingestion. Given the nature of injury, hospitalisation tends to be prolonged and healing is delayed.

Many substances that are freely available in the community, either occupational or domestic items, have the potential to cause chemical burns. The immediate availability and poor labelling of these substances has accounted for an increase in unintentional chemical burns. Assault and suicidal attempts account for the remaining cases of chemical burns. The affected population is generally evenly distributed but an increase in paediatric chemical burns has been previously documented. ⁵ Areas affected tend to include the face, eyes and extremities. As such, the scope of this review is limited to the assessment and management of cutaneous chemical burns. Ocular burns should be urgently referred to an appropriate ophthalmic service.

More than 25,000 chemicals are used commonly in industrial and domestic settings. The diversity of harmful chemicals results in a vast array of clinical sequelae and a short review would not suitably cover the relevant treatments. The current publication is aimed to provide principals in the assessment and general management of chemical burns.

Pathophysiology and types of chemicals

The pathological end result of chemical burns, regardless of the type of chemical, is consistent with changes occurring during thermal burns. The external toxic stimulus causes denaturation of biological proteins and thus renders them physiologically inactive. This inactivation of essential proteins results in cell death. Thermal burns tend to cause rapid coagulation of protein due to protein crosslinking. By contrast, chemical burns cause denaturation of physiological proteins through six different processes including reduction, oxidation, corrosion, vesication, dessication and protoplasmic poisoning.^6,7 It should be noted that many chemicals cause injury through combinations of these processes.

Chemical agents can also be classified on the basis of the induced chemical reaction that the agent initiates. Such classification may be useful for consideration of early management options. Chemical agents may be classified into one of these categories despite slight variations in the resulting clinical sequelae.

• Acids: act as proton donors in the biological system. Acid injury causes a coagulative necrosis of the superficial tissue.
• Bases: chemicals are proton acceptors and tend to have greater capability of producing injury. ^7,8 These agents produce heat via reactions with fats, extract water from surrounding tissue and result in liquefactive necrosis (Figure 1). Such necrosis allows penetration deep to the superficial wound and continues to cause injury despite initial removal of the insult.⁹
• Organic solutions: cause injury by dissolving the lipid membrane, which results in disruption of physiological processes.
• Inorganic solutions: cause injury by denaturation mechanisms as outlined above.

Assessment

1. Personal protection equipment: it is vital that the treating clinician wears protective clothing to prevent injury (eg gloves, safety googles).
2. Primary and secondary survey: as with any clinical presentation, the patient must be stabilised using principals of primary survey. This should be completed in a rapid and systematic approach.
   1. Airways: ingestion of chemicals, particularly alkali agents, may result in upper airways obstruction. Stabilisation of airways and urgent medical support is required.
   2. Breathing: special considerations during chemical injury include the exclusion of inhalation injuries, particularly for aerosol chemicals or smoke.¹⁰ Such patients frequently require ventilatory support and thus early referral should be sought prior to clinical deterioration.
   3. Circulation: smaller chemical burns infrequently cause cardiovascular collapse. Occasionally, severe metabolic disturbances may result from chemical absorption and thus monitoring and stabilisation may be required.

3. History: a rapid history should be taken simultaneously during primary survey and initial care of the cutaneous burn. It is vital that such assessment does not delay the initiation of immediate treatment. Information regarding comorbidities and medication may be useful. Information regarding the chemical injury is important, particularly if the patient requires transfer to a higher acuity service. Pertinent information includes: insulting agent (and the associated mechanism of injury), phase of the chemical (gas, liquid or solid), concentration, quantity, duration of cutaneous contact, extent of penetration and initial emergency management.⁷

General prinicples of management

After primary survey and initial rapid assessment, the following care outlines the general principles for managing acute chemical burns.¹¹

1. Removal of the chemical: the duration of skin contact is the key determinant of injury severity.^12,13 Thus, prompt removal of chemical contact is mandatory.
1. This should be performed rapidly and generally requires removal of contaminated clothing at the scene of injury.¹⁴ Initially, residues or dust should be brushed off the skin.
2. Irrigation should then be performed with warm water under a tap with appropriate drainage to prevent further injury. Care should be taken to ensure the wash off does not occur across unaffected skin. Early irrigation dilutes the chemical concentration and has been shown to reduce the severity of the burn and hospital stay.⁸ No objective measure for appropriate irrigation has been defined in the literature but it is widely accepted that 0.5–2 hours may be required to maintain a cutaneous pH of 5–11.¹⁰
3. Neutralisation of chemicals is contentious but is generally not indicated because of the risk of further heat production and thus continuing injury. Several neutralising agents have shown some benefit,⁹ but irrigation with plain water remains the most efficacious, accessible and cost-effective treatment.^12,15–17

2. Complete wound evaluation: the microcirculation of the wound is evaluated by pinprick test for pain and capillary return time.^18,19 Assessment regarding the depth of the chemical burn is notoriously difficult, as burns may be deceptively superficial. ^11,20 The difference in surface temperature between the affected and unaffected skin may assist in depth assessment.^18,19 Re-assessment should be done at regular intervals as this may provide information about injury progression. As a general rule, unless the observer can be absolutely sure, chemical burns should be considered deep dermal of full-thickness until proven otherwise.
   1. Chemicals causing liquefactive necrosis, typically basic solutions, may cause continuing necrosis dispute removal of agent. Caution should be practised in such situations and expert opinion may be required.
   2. Debridement of blisters and non-viable tissue is advocated as early as possible via surgical or non-surgical approaches.^7,21

3. Systemic toxicity: the insulting chemical injury or subsequent treatment may produce systemic changes that require assessment and intervention.
   1. Metabolic disturbances: the most common disturbance is acid-base imbalance. Monitoring blood gases through venous sampling may be necessary to ensure metabolic stability.^10,22
   2. Electrolyte disturbances and associated sequel: various chemicals may cause biochemical disturbances. As such, patients may require biochemical analysis on admission to higher acuity centres. For example, hydrofluoric acid (HFA) may cause hypocalcaemia and resulting cardiac arrhythmia.
   3. Hypothermia: may occur from the prolonged duration of wound lavage. Water temperature should be maintained as close to body temperature as possible.¹⁰

4. Referral: Given the difficulty in assessing injury extent and depth, caution is generally advised. Chemical burns should be treated as full-thickness burns until proven otherwise.
   1. Unless full thickness burns can be explicitly excluded by the treating physician, referral to secondary or tertiary centres is required for formal assessment by specialist services. Full-thickness chemical burns may require admission for surgical debridement and grafting of non-viable tissue.
   2. Ocular chemical injury is beyond the scope of this review, but generally requires urgent ophthalmic review.

Specific agents

Management of specific chemical agents is complex and is generally advised in the emergency department following early management. Current Australian guidelines have been previously published.²³Table 1 outlines common domestic products and the harmful agents they contain, with more comprehensive lists easily accessible online.

• Cement: is a common cause of chemical burns. The main injury-causing agent in wet cement is calcium oxide and resulting hydroxyl ion.¹⁵ Cement has multiple mechanisms of action, but predominantly can be classed as an alkali. Injury is insidious, usually presenting several hours after injury.²⁴ Copious irrigation and periodic wound assessment should be performed to exclude the requirement of surgical debridement.²⁵
• Tar: in liquid form, tar is superheated and classically causes deep thermal and chemical burns. If not removed promptly, tar cools and causes liquefactive necrosis and adheres to skin. Adherent tar should not be removed in the pre-hospital setting and urgent referral is required as surgical debridement may be necessary. Various household items such as baby oil, mineral oils and butter may aid in tar removal.^7,26
• Hydrocholoric and sulphuric acids: burns caused by these agents are among the most commonly treated chemical burns. Common household goods contain moderate concentrations of such agents or their immediate precursors. On contact, these agents donate protons and cause coagulative necrosis of the affected tissue.^27,28 Immediate irrigation is recommended. Excision of non-viable tissue should be considered early in the course of injury.^6,10
• HFA: a large proportion of the population is at risk from HFA given its widespread use in the household setting. HFA has the potential to cause significant local and systemic effects despite a small contact wound.¹⁰ The onset of local effects are dependent on the concentration of the HFA.²⁹ The injury caused by HFA causes liquefactive necrosis and causes interruption in the surrounding cellular physiology. The injury results in hypocalcaemia and hypophosphataemia^30–32 and, potentially, cardiac arrhythmia. The fluoride component is a metabolic toxin affecting nerve transmission.³³ Haemodialysis and cation exchange resins have been reported for removal of absorbed fluoride.^33,34 Copious irrigation and early referral are essential. Inactivation of the fluoride ion is necessary by topical preparations (eg quaternary ammonium products or calcium gels) or infiltrative preparations (eg calcium gluconate).
• Phosphoric acids: such chemicals are found in fertilisers and explosives, thus generally causing injury in the industrial setting. White phosphorus ignites in the presence of oxygen and thus immediate removal is necessary. Particles may be identified with the aid of ultraviolet light or 0.5% copper sulphate solution and should be removed from the wound. Copious irrigation should be performed and the patient should be transported with a wet towel covering the injury. Systemic consequences including hypocalcaemia, hyperphosphataemia and cardiac arrhythmia have been previously reported.³⁵
• Alkali: act as proton acceptors and classically cause progressing injury despite the removal of the harmful agent. As discussed above, alkalis cause liquefactive necrosis, allowing progression to deeper tissues. Initially alkali burns seem superficial, but may progress to full thickness within 48–72 hours.³⁶ Brushing of residues and irrigation provides early control.¹⁰ Referral to a centre of higher acuity and consideration for wound debridement should be done given the nature of continuing injury.¹⁰ Common harmful alkali agents include sodium, ammonium, calcium and potassium salts.

Conclusion

Chemical burns are common and may cause significant physical, psychological and economic burdens on patients. Complete rapid assessment of the cutaneous injury and clinical status of the patient is essential in establishing the need for prompt referral to centres of higher acuity. Appropriate early management is crucial in reducing the period of patient morbidity. Current guidelines suggest water irrigation is the safest, most efficacious and readily available treatment option in the early stages of care of chemical burns.

Competing interests: None.
Provenance and peer review: Not commissioned, externally peer reviewed.

References

1. Goltsman D, Li Z, Bruce E, Maitz PK. Geospatial and epidemiological analysis of severe burns in New South Wales by residential postcodes. Burns 2014;40:670–82.
2. Wasiak J, Spinks A, Ashby K, Clapperton A, Cleland H, Gabbe B. The epidemiology of burn injuries in an Australian setting, 2000–2006. Burns 2009;35:1124–32.
3. Pegg SP. Burn epidemiology in the Brisbane and Queensland area. Burns 2005;31:S27–31.
4. Watson WA, Litovitz TL, Rodgers GC Jr, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2005;23:589–666.
5. Duke J, Wood F, Semmens J, et al. A study of burn hospitalizations for children younger than 5 years of age: 1983-2008. Pediatrics 2011;12:e971–77.
6. Jelenko C 3rd. Chemicals that ‘burn’. J Trauma 1974;14:65–72.
7. Elijah IE, Sanford AP, Lee JO. Chemical Burns. In: Herndon DN, editor. Total Burns Care. 4th edn. New York: Elsevier, 2012;455–60.
8. Leonard LG, Scheulen JJ, Munster AM. Chemical burns: effect of prompt first aid. J Trauma 1982;22:420–23.
9. Yano K, Hata Y, Matsuka K, Ito O, Matsuda H. Effects of washing with a neutralizing agent on alkaline skin injuries in an experimental model. Burns 1994;20:36–39.
10. Palao R, Monge I, Ruiz M, Barret JP. Chemical burns: pathophysiology and treatment. Burns 2010;36:295–304.
11. Cartotto RC, Peters WJ, Neligan PC, Douglas LG, Beeston J. Chemical burns. Can J Surg 1996;39:205–11.
12. Saydjari R, Abston S, Desai MH, Herndon DN. Chemical burns. J Burn Care Rehabil 1986;7:404–08.
13. Sykes RA, Mani MM, Hiebert JM. Chemical burns: retrospective review. J Burn Care Rehabil 1986;7:343–47.
14. Kuckelkorn R, Schrage N, Keller G, Redbrake C. Emergency treatment of chemical and thermal eye burns. Acta Ophthalmol Scand 2002;80:4–10.
15. Pike J, Patterson A Jr, Arons MS. Chemistry of cement burns: pathogenesis and treatment. J Burn Care Rehabil 1988;9:258–60.
16. Bromberg BE, Song IC, Walden RH. Hydrotherapy of chemical burns. Plast Reconstr Surg 1965;35:85–95.
17. Gruber RP, Laub DR, Vistnes LM. The effect of hydrotherapy on the clinical course and pH of experimental cutaneous chemical burns. Plast Reconstr Surg 1975;55:200–04.
18. Braue EH Jr, Graham JS, Doxzon BF, et al. Noninvasive methods for determining lesion depth from vesicant exposure. J Burn Care Res 2007;28:275–85.
19. Arturson G. Mechanism of injury. In: Settle JAD, editor. Principles and practice of burns managemen. New York: Churchill Livingstone, 1996.
20. Sawhney CP, Kaushish R. Acid and alkali burns: considerations in management. Burns 1989;15:132–34.
21. Eldad A, Weinberg A, Breiterman S, Chaouat M, Palanker D, Ben-Bassat H. Early nonsurgical removal of chemically injured tissue enhances wound healing in partial thickness burns. Burns 1998;24:166–72.
22. Holm C, Melcer B, Horbrand F, Worl HH, von Donnersmarck GH, Muhlbauer W. Haemodynamic and oxygen transport responses in survivors and non-survivors following thermal injury. Burns 2000;26:25–33.
23. Department of Health and Ageing. Australian Clinical Guidelines for Acute Exposures to Chemical Agents of Health Concern: A Guide for the Emergency Department Staff. Canberra: Australian Government, 2007.
24. Spoo J, Elsner P. Cement burns: a review 1960-2000. Contact Dermatitis. 2001;45:68–71.
25. Chung JY, Kowal-Vern A, Latenser BA, Lewis RW 2nd. Cement-related injuries: review of a series, the National Burn Repository, and the prevailing literature. J Burn Care Res 2007;28:827–34.
26. Harchelroad FP Jr, Rottinghaus DM. Chemical Burns. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, editors. Emergency Medicine: A Comprehensive Study Guide. 6th edn. New York: McGraw-Hill, 2004:200.
27. Reilly DA, Garner WL. Management of chemical injuries to the upper extremity. Hand Clin 2000;16:215–24.
28. Matshes EW, Taylor KA, Rao VJ. Sulfuric acid injury. Am J Forensic Med Pathol 2008;29:340–45.
29. Edelman P. Hydrofluoric acid burns. Occup Med 1986;1:89–103.
30. Bertolini JC. Hydrofluoric acid: a review of toxicity. J Emerg Med 1992;10:163–68.
31. Kirkpatrick JJ, Enion DS, Burd DA. Hydrofluoric acid burns: a review. Burns 1995;21:483–93.
32. Ohtani M, Nishida N, Chiba T, Muto H, Yoshioka N. Pathological demonstration of rapid involvement into the subcutaneous tissue in a case of fatal hydrofluoric acid burns. Forensic Sci Int 2007;167:49–52.
33. McIvor ME. Delayed fatal hyperkalemia in a patient with acute fluoride intoxication. Ann Emerg Med 1987;16:1165–67.
34. Yolken R, Konecny P, McCarthy P. Acute fluoride poisoning. Pediatrics 1976;58:90–93.
35. Vedder E. The medical aspects of chemical warfare. Baltimore: Williams and Wilkins, 1925.
36. Curreri PW, Asch MJ, Pruitt BA. The treatment of chemical burns: specialized diagnostic, therapeutic, and prognostic considerations. J Trauma. 1970;10:634–42.

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Chemical Burns: Definition & Symptoms

Symptoms

Tissue damage from chemical burns depends on three main factors: the chemical, the area of the body exposed, the amount of time of exposure. When the damage occurs only in the location the chemical contacted the body, it is called a local reaction.

A chemical burn on the skin can cause symptoms that range from mild redness to severe death of the tissue and loss of the skin.

Some chemicals cause symptoms like redness, itchy skin, or inflammation. Gasoline is a common irritant that causes a mild, local reaction. Others irritants cause a stinging or burning sensation. Still others can cause a discoloration or blistering of the skin. Some agents can cause deep tissue damage that is not seen on the surface of the skin.

a superficial burn caused by hydrogen peroxide

a partial thickness chemical burn as a result of prolonged contact with silver nitrate (AgNO3)

With some chemicals, as with some sunburns, the pain and redness may develop hours after the exposure. Wet cement is an agent that has a very high pH and presenting symptoms of a cement burn occur several hours after exposure.

A chemical exposure in the eye(s) can cause eye pain, redness, light sensitivity, a decrease or loss of vision, or inability to open the eyes. Chemical exposure to the eye is always a medical emergency.

An ingested, or swallowed chemical can cause a chemical burn to occur in the gastrointestinal tract. The mouth may seem discolored, from bright red to white or blue. The patient may have trouble swallowing or speaking. Some chemical burns may cause abdominal pain, nausea and/or vomiting.

There are some chemicals that, regardless of the part of the body with which it comes into contact, will cause a systemic, or whole body, response. Those symptoms can include dizziness, a feeling of faintness, headache, seizure, chest pain, irregular heart beat, coughing, and/or shortness of breath.

Lesson Summary

A chemical burn occurs when living tissue is damaged by an irritant. There are three classifications of burns that describe the extent of the injury. They are superficial or first degree, partial thickness or second degree, and full thickness or third degree. The symptoms of a chemical burn depend on several factors including the irritating agent, the area of the body that comes into contact with it and the amount of time of the exposure. Symptoms can be local, at the site of the exposure, or systemic, affecting the whole body.

90,000 Treatment of a chemical burn of the respiratory tract – all symptoms, diagnostics, doctors

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Causes and symptoms

A chemical burn is associated with the effect of 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-observance of safety measures at home and at work, mistakes in the choice of products, the use of chlorine-containing detergents.

When toxicants get on the skin or eyes, colliquation necrosis develops – the tissue melts, becomes flabby, moist, edema, redness, and purulent infiltration 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 it takes for the burn 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 vapors or ingestion of chemicals. The main reason is the mistaken or deliberate ingestion of toxicants, non-traditional treatment, and the use 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,

• a feeling of suffocation

• nausea and vomiting,

• rapid breathing

• swelling of the pharynx.

With severe burns of the pharynx, esophagus, the pathological process affects not only the mucous membranes, but also the submucosa and muscle layer. Chemicals penetrate into the deep layers, destroy erythrocytes, 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, the 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.

Substances causing burns

Chemical burns are 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 cleaning products;

• alcohol surrogate.

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 the age of 10. The intake of toxicants occurs unintentionally, but due to the absent-mindedness of children, natural curiosity, inattention of parents.

Classification

Taking into account the depth of the chemical lesion, the clinical picture, there are three degrees of skin burns:

• I degree. Incomplete damage to the skin or the surface layer of the epithelium caused by a short-term or weak in intensity exposure to the substance. Local signs are limited swelling, skin redness, burning sensation, and local pain. Healing occurs in 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 threat of infection is growing.

• III degree. Determined when 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. The crusts are rejected within 10-15 days, and complete healing of the burn injury takes 1-2 months. A rough scar forms at the site of skin damage.

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

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

• average – damage 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

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, depletion of the immune system, and intoxication.

With progressive burns, various complications arise:

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

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

• pericarditis – inflammation of the outer cardiac membrane;

• pneumonia;

• bronchitis;

• pulmonary edema;

• pleurisy;

• glomerulonephritis – immunoinflammatory kidney disease,

• pyelitis – inflammation in the renal pelvis.

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

Help! Exposure to any physical or chemical factor that causes incomplete damage to the surface layer of the skin in an adult results in 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,

• laryngeal stenosis – narrowing of the lumen,

• respiratory failure

• phlegmon of the neck,

• chronic pharyngitis,

• perforation of the esophagus.

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

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

First aid for chemical burns

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

How to provide emergency care:

1. Limit human contact with the chemical.

2. Rinse the burnt place 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, or the blisters should not be opened on their own.

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

5. In case of grade 3 burns, wrap the victim in a clean sheet, give an anesthetic, call for emergency help or take them to a specialized medical institution on their own.

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

Eye burn

It is important to provide first aid for chemical eye burns on the spot.

Urgent Action:

1. Rinse the conjunctival cavity with water or saline.

2. Remove pus and mucus, chemical residues.

3. Rinse the nasolacrimal canal with saline.

4. Instill or apply an antiseptic drug into the conjunctival cavity.

It is categorically contraindicated to independently use neutralizing solutions, since it is difficult to predict the reaction of substances to damaged tissue.

Burns of the esophagus and pharynx

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

Important! Rinsing is performed only in the first 5–6 hours after receiving a burn, then the procedure is inappropriate.

What not to do in case of chemical burns

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

It is not necessary to completely lay the victim in order not to provoke gastroesophageal reflux disease – a reverse reflux of the contents of the stomach. The optimal position is half-sitting.

Treatment of chemical burns

How to treat a chemical burn depends on the depth and area of ​​the damage. Burns of 1–2 degrees are superficial and can heal on their own.With progressive tissue damage, qualified medical care is required, the removal of dead tissue with subsequent correction of the scars. Treatment of burns is performed in special burn chambers.

At the first stage, the burn surface is treated to prevent the penetration of infection into the body:

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

2. They remove impurities, residues of toxicants, open and empty large bubbles, fill the wound with a solution of peroxide, 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 restoration, ointments, solutions and aerosols with analgesic, cooling and healing effects are used. If there is a scab, it is not removed, it is left until it is rejected on its own. 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 salt. To compensate for the loss of protein and water, to prevent dehydration, to normalize the acid-base balance, nutrient solutions, glucose, sodium chloride are injected through a dropper.

Treatment of burns of the esophagus

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.Anesthesia is preliminarily carried out.

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

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

Treatment of eye burn

In the hospital, anticholinergic drops are injected into the conjunctival cavity. They relieve pain well and minimize the risk of adhesion formation. To prevent infection, use antibacterial ointments or drops. Antioxidants are injected 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. If there is a threat of loss of vision in the early period, surgical treatment is performed on the eyelids, eyeball, conjunctiva, and cornea.

How to treat, where to start providing help?

If you are faced with a chemical burn of your eye, rather start rinsing it with water – without understanding,
it is caused by the ingress of acid, alkali or irritating substance. The purpose of this action is
first reduce the concentration of a hazardous substance in the eye tissues, and then completely remove
him from there.Further treatment of chemical eye burns should be carried out by healthcare professionals.

In this article, we will take a closer look at first aid and inpatient treatment. Let’s talk about the types
chemical damage: how to roughly estimate their degree and assume
effects. Consider what kind of treatment for eye burns – including
surgical – may be needed soon after the injury.

Types of chemical burns of the eye

Chemical burns can be caused by contact with the eye surface:

• acids;

90,057 irritating substances
;

• alkalis.

The most dangerous lesions are alkalis: these substances, melting the tissues of the eye, quickly get to deep
its structures. Moreover, the higher the concentration of alkali, the sooner tissue death occurs,
which is called colliquation necrosis in medicine.

Acid damage is slightly less dangerous: acid, causing the formation of a scab (crust), itself limits
further penetration. Basically, a chemical burn of the eye with acid damages only
the cornea without penetrating deeper.But concentrated solutions of sulfuric, hydrofluoric and nitrogen
acids can melt tissue down to the lens. Corneal lesion itself can also cause
loss of vision – through the formation of an eyesore.

A chemical burn of the eye can also occur as a result of the action of various irritating substances:
capsaicin from pepper spray, mustard or camphor oil, substances containing
arsenic or ketones, if sprayed into the air.PH of such substances is usually
neutral, so they do not inflict significant damage.

What determines the severity of the lesion?

The severity of lesions in a chemical eye burn depends on:

How to determine what caused a burn?

Unfortunately, to understand in appearance what caused the chemical burn of the eye, practically
impossible. In theory, acid damage should show crusts, but in reality
in fact, it is difficult to consider them.In addition, the eyelids of the sick eye will be so tightly closed.
reflexively, that it will be quite difficult to open them for a long time.

It will be necessary to draw a conclusion about the damaging substance on the basis of what the person worked with.
For example, if he has used ammonia bleaches, cleaners, lime, cement, or magnesia, it is –
alkaline lesion. If it was vinegar, acetone, peeling solutions or polish
for glass, the burn is acidic.

Actually, this is not very important at home.Of course, for acids and alkalis
there are special neutralizers, but their preparation or purchase will take away
precious time. In this regard, you should immediately consult a doctor.

How to assess the degree of burn damage?

The degree of chemical eye burns is determined by an ophthalmologist, based on examination using
special devices (that is, after assessing damage to all eye tissues). You can
roughly assume the severity of the damage – to understand, you will have to treat
the victim in the hospital or the assistance provided in the clinic or in the examination
the office of the eye department.

So, there are five degrees of chemical eye burn:

The skin of the eyelids is red, swollen, peeling. If the eyelids are opened, redness is visible.

Blisters are visible on the skin of the eyelids, peeling is noted. When the eyelids open, the eye is pale, on it
there are gray films.

The skin of the eyelids appears blackened. If the eyelids are opened, the eye is pale and very swollen.

The skin of the eyelids is black; death occurs throughout the entire thickness of the skin. The eye is red, edematous, on it
darker areas are visible, the cornea is gray.

Large area of ​​blackened tissue around the eye: necrosis extends to muscle and cartilage.
The eye is red, cloudy, the iris is gray, above the pupil can be seen as “porcelain
plate”.

Any degree of chemical eye burn is accompanied by the same subjective symptoms:

• pain in the eye;

90,057 lacrimation;

• inability to open
  eye;
• foreign body sensation.

First aid for eye contact with chemical

First aid should be provided as soon as possible. These actions can be performed by himself
victim, but it is better to have an assistant:

Please note: rinse for at least 20-30 minutes.
For this
time you can take a short break and drink your usual pain reliever. After careful
rinsing, to improve healing, you can gently inject an eye gel under the lower eyelid
Korneregel, which is a 5% solution of dexpanthenol – a derivative of pantothenic
acid.
There are contraindications. It is necessary to consult a specialist.

Important: rinsing should not be performed if the burn was thermochemical (for example,
lime when extinguished) and there is a penetrating wound on the eyelid!

It is imperative to call an ambulance, even if the assistant visually assesses the degree
chemical burn of the eye as the first.

What to do next?

Further treatment of eye burns is carried out by healthcare professionals:

The ophthalmologist decides on the tactics of treating eye burns after he determines
degree of damage.To do this, he needs to diagnose:

If grade 3 or 4 damage is established, the patient is hospitalized. At 1-2 degrees
treatment of chemical burns of the eye is carried out at home – according to the recommendations,
which are given after examination by an ophthalmologist. It usually consists of burying the eye
anti-inflammatory, antibacterial drops, introduction into the conjunctival cavity of the eye
gel Korneregel.

Complications of chemical burns

Sometimes, even despite timely treatment of the eye burn, complications may develop:

Surgical intervention

Surgical treatment of chemical burns of the eye in the first hours and days is carried out, if possible
affect the salvation of the organ.Basically, operations may be required or after 2-3 weeks,
when the process moves to the second stage, or in 12-24 months – if
a corneal transplant or similar intervention is required. This is necessary for complete
healing, which gives a greater chance for the graft to take root.

RUS-XXX-XXX-XXX-XX-XXXX-XXX

90,000 Signs of thermal and chemical burns – classification and symptoms of severity, first aid

05.03.2021

Burns are tissue damage caused by heat, electric current, acids, alkalis or ionizing radiation. Accordingly, a distinction is made between thermal, electrical, chemical and radiation burns. Thermal burns are the most common, accounting for 90-95% of all burns. The second most common type is chemical burns. These two types will be discussed in this article.

People who walk through fire and high temperature areas without protective equipment put themselves at a very high risk of severe burns.Inhalation of hot air, steam, smoke can cause burns of the respiratory tract, laryngeal edema, and respiratory failure. This leads to hypoxia – oxygen starvation of body tissues, and in critical cases – to paralysis of the respiratory tract and death. The general condition of the victim also depends on the extent of the burn surface, if the burn area exceeds 10-15% (in children more than 10%) of the body surface, the victim develops a so-called burn disease, the first period of which is a burn shock.That is why it is so important to provide first aid in the event of thermal or chemical burns.

Chemical and thermal burns, their signs and classification

To understand how to help the victim, you need to be able to determine which case of burn we will deal with. We will understand the causes of burns and tell you how burns are classified by severity.

Thermal burns are caused by exposure of the skin to hot air, steam, open flames, incandescent objects, hot liquids, etc.NS.

The severity of burns is determined by the area and depth of tissue damage.

Depending on the depth of the lesion of the skin and underlying tissues, burns are divided into four degrees (Fig. 1): mild (1st degree), moderate (2nd degree), severe (3rd degree) and extremely severe (4- i degree).

Rice. 1. Classification of degrees of thermal burns

First degree burns are damage to the stratum corneum of the skin cells, which are manifested by redness of the burned areas of the skin, slight swelling and burning pains that pass quickly.

Second-degree burns completely damage the stratum corneum. Burned skin becomes intensely red, bubbles filled with transparent liquid appear, and a sharp pain is felt.

Third degree burns are formed when the deeper layers of the skin are damaged. In addition to blisters, crusts – scabs – form on the skin.

Carbonization of the skin, subcutaneous tissue and underlying tissues down to the bones is typical of fourth degree burns .The course and severity of burns, as well as the recovery time, depend on the origin of the burn and its degree, the area of ​​the burned surface, the characteristics of first aid to the victim and many other circumstances.

Chemical burns . Chemical burns of the skin result from contact with the skin of acids (acetic, hydrochloric, sulfuric, etc.), alkalis (caustic soda, ammonia, quicklime). The depth of the burn depends on the concentration of the chemical agent, temperature and duration of exposure.If first aid is not provided in a timely manner, chemical burns can significantly deepen in 20-30 minutes. Clothing soaked in acid or alkali also contributes to the deepening and spread of burns.

The classification of chemical burns also includes four grades:

I degree – consists in damage to the surface layer of the skin. This degree is characterized by redness, swelling, and slight soreness.

II degree – accompanied by damage to the deep layers of the epidermis and the appearance of white blisters with transparent contents on the skin.

III degree – it is diagnosed when the lesion reaches the deep layers of the skin, bubbles with a cloudy or bloody fluid are formed, and the site of the lesion is painless.

With IV degree burns, the lesion affects soft tissues, muscles, bones.

Burns with chemicals are most often III and IV degrees. Superficial burns under favorable conditions heal on their own. Deep burns affect, in addition to the skin, deep-lying tissues, therefore, with such burns, skin transplantation is required.Most of those affected usually have a combination of burns of varying degrees.

First aid for thermal and chemical burns

First aid for thermal burns consists in stopping the action of the damaging factor. In case of a fire burn, extinguish the burning clothing and take the victim out of the fire zone. In the event of burns from hot liquids or molten metal, quickly remove clothing from the burn area.

IMPORTANT! The pieces of clothing adhering to the body are not ripped off, but cut around and left in place.Do not cut off and pluck the formed bubbles, touch the burn with your hands.

In case of burns of individual parts of the body, the skin around the burn is wiped with alcohol, cologne, water, and a dry sterile bandage is applied to the burned surface.

To stop the effect of the temperature factor, it is necessary to quickly cool the affected area of ​​the body by immersion in cold water, under a stream of cold water or irrigation with chloroethyl.

When providing first aid for chemical burns, it is important to determine the cause of its occurrence.When concentrated acids come into contact with the skin, a dry, dark brown or black scab with well-defined edges quickly develops on the skin and mucous membranes, and when concentrated alkalis gets in, a wet, greyish-dirty scab without clear outlines appears.

In any case, it is necessary to quickly remove the scraps of clothing impregnated with the chemical agent. It is necessary to reduce the concentration of chemicals on the skin. For this, the skin is rinsed abundantly with running water for 20-30 minutes.

In case of acid burns after washing with water, you can use alkaline solutions (2-3% solution of baking soda – sodium bicarbonate, soapy water) or apply a sterile napkin moistened with a weak alkaline solution.

In case of burns with sulfuric acid, it is not recommended to use water, because in this case, heat is generated, which can intensify the burn.

In case of burns with alkali, also after washing with water, weak solutions of acids (1-2% solution of acetic or citric acid) can be used to treat the burned surface.

It is advisable to give pain relievers and be sure to send the victim to the burn department.

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Thermal and chemical burns: Causes, Symptoms, Treatment | doc.ua

Reasons

The classification of burns is carried out depending on various factors – the area and depth of the lesion, the degree of damage, the phase of the process, etc.d.

Depending on the effect of one factor or another, thermal and chemical burns, electrical and radiation burns are distinguished. Directly thermal burns occur when exposed to steam or boiling water, and chemical burns – molten metal, flame, acid, alkali, metal salts. At the same time, alkali burns are much more dangerous than those caused by acids, since acids do not penetrate into deep tissues, and alkali can form gelatinous tissue necrosis. Therefore, the treatment of chemical burns must be approached carefully, while paying attention to the degree of damage to body tissues.Electrical burns occur due to electric shock, and radiation burns due to ionizing or ultraviolet radiation.

Depending on the cause of the burns, different degrees of damage and the nature of the course of burns are distinguished. But usually there is destruction of epithelial cells and protein coagulation.

Usually there are superficial burns, if they make up about 10–12% of the surface of the cover, then they proceed with a moderately pronounced symptomatology. But there can also be extensive lesions that disrupt the activity of organs and systems, they can be characterized as a burn disease, the development of which is accompanied by burn shock.At the same time, the increased destruction of proteins reduces the protective functions of the body and can lead to the accumulation of toxins. Also, with a burn disease, there may be a disruption in the work of the gastrointestinal tract, a decrease in physical activity, a disruption in the performance of the cardiovascular system and kidneys. That is, a burn disease can complicate the patient’s condition with concomitant diseases.

Burns in children

Burns in children are characterized by rapid healing, since the child’s body is able to quickly regenerate cells.However, improper rendering of the first degree can lead to scarring. The way children are treated does not differ from the way adults are treated. But there are some burns in which you must definitely see a doctor – this can be a burn in the groin area or on the bends of the joints, as well as second or more degree burns on the face.

Symptoms

Depending on the degree of skin lesion, several degrees of damage are distinguished:

• I. An epidermal burn that heals on its own in a few days.With this burn, only the epidermis is affected, and the affected surface turns red and burns, in some cases there is swelling. The symptoms usually disappear after a couple of days and do not leave scars.
• II. A superficial dermal burn that heals within two weeks. Not only the first layer of the skin is affected, but also the second – the dermis. The surface where the burn appeared quickly turns red, blisters appear on it. Local preparations are used, and if the area of ​​the lesion is more than 10%, then at this degree, burns are treated in stationary conditions.
• III. A deep dermal burn, the healing of which is a long stage, since with such a burn, the subcutaneous fat is also affected. The pain with such burns is quite significant. Long-term, non-healing cicatricial ulcers can often form, the recovery of which is usually accompanied by skin grafting. Sometimes skin grafts are also possible. Treatment of burns is carried out only in a hospital.
• IV. Subfascial burn – healing takes place for a long time under the supervision of a doctor in a hospital.This burn is characterized by damage to the entire structure of the skin, down to the muscles and bones. The burn is deep and is accompanied not only by characteristic pain, but also by shock. With this degree, the separation of necrotic tissue is carried out by surgical intervention. Subsequent treatment may include a dermal grafting. In addition, if you do not provide assistance in time for such burns, then intoxication of the body is possible, since some particles from the wound can enter the bloodstream. Typically, these burns are caused by fire or electric shock.First aid for this degree of burns is ineffective.

The phases of the course of the wound process can be varied and depend on the nature of the lesion, but they are conventionally classified into three phases. The first is the period of inflammation, during which biochemical and pathophysiological processes are carried out, aimed at the restoration of dead tissues. The second is the period of regeneration, which consists in the appearance of newly formed tissue. The third is the period of wound epithelialization

Diagnostics

The degree of burn, depth and area of ​​the lesion is determined by a specialist in the field of combustiology (the branch of surgery that studies burn lesions) during a personal examination of the patient.

Treatment

After a burn, timely help is important, especially with deep and extensive lesions. If a skin burn can be treated on its own, then going to the hospital is not necessary. But in the event of a serious deep burn, you must apply a special bandage and see a doctor immediately. In the hospital, the primary treatment of burns with antiseptic solutions (miramistin, dioxizol, chlorhexidine) and the further appointment of treatment methods are carried out.

Treatment of thermal burns of the first degree can be carried out at home – cool the affected area, treat with 30% alcohol and local anesthetics (oflokain, luan, dioxizol).If necessary, seek medical advice.

Immediate help should be provided for these types of burns:

• from contact with electrical charge;
• from radiation or exposure to ultraviolet radiation;
• from chemical contact.

In order to prevent further development of the burn and to accelerate the recovery stage, intensive care is carried out based on:

• protection against infection and suppression of microflora growth;
• restoration of microcirculation in order to preserve tissues;
• stimulation of regeneration processes;
• , if necessary – prompt restoration of the skin.

Treatment of burns is usually based on topical medications in liquid, solid and aerosols. Antiseptic, hypertonic, colloidal, chlorine-containing solutions or aerosol solutions, foaming sprays, ointments, creams, pastes, gels are often used. The method of modern treatment depends on the phase of the wound course.

If a person has burns, treatment is simply necessary. And when providing first aid, it is necessary to use antiseptic solutions (Betadin, Vokadin, Dioxizold-Darnitsa, Dimexid and others).Also often used are foam preparations in aerosols, ointments on a hydrophilic basis, and a bandage is applied on top to avoid infection. However, it is absolutely impossible to apply ice, as this can cause frostbite of the damaged layers of the skin. Also, you can not smear wounded skin with oils or creams that are not intended for this. It is also not worth breaking the integrity of the affected skin and opening the blisters – this can lead to infection.

Preparations for the treatment of burns

As the best option, you can choose a combined type of ointment on a hydrophilic basis: Levosin, Oflokain-Darnitsa, Nitatsin-Darnitsa, Miramistin-Darnitsa and others.They are good because dressings can be done once a day. In this case, the dressings do not stick to the affected areas and do not dry out the tissues. Also, the advantage is that when they are removed, the surface with the wound is less injured and bleeds.

Fat-based preparations containing petroleum jelly or lanonin impair healing, due to which the rejection of necrosis is delayed, the outflow of purulent exudate and the wound is sealed.

Aerosols (Panthenol, Livian, Olazol) are highly effective in wound healing, especially when there is a sunburn.With their help, it is convenient to spray a small amount of the drug on the affected area, since it is completely painless and does not injure the skin. The greenhouse effect with the use of aerosols is not observed, since heat exchange with the environment is carried out in a normal way. But the treatment with their help is quite expensive.

causes, symptoms, diagnosis, treatment, prevention

Damage to human tissues and skin, which occurs under the influence of chemical reagents.Most often, chemical burns are the cause of an accident or work injury.

Causes of chemical burns

The most common cause of chemical burns is contact with acids (sulfuric, sulfate, nitric), alkali (sodium hydroxide, potassium hydroxide), heavy metal salts, gasoline poisoning, kerosene, phosphorus, bitumen. The higher the concentration of the chemical and the longer the period of exposure to the skin, the more severe the tissue damage.

Symptoms of a chemical burn

Symptoms may vary depending on the nature of the chemical.When exposed to acids and alkalis on the skin, a scab forms. The scab, which forms after burns with alkalis, has a loose structure, with burns with acids, the scab forms a dry and hard crust.

Diagnostics of a chemical burn

Examination of damaged areas of the skin and mucous membranes is performed, the degree of chemical burn is determined, the depth and degree of damage. Direct or indirect laryngoscopy, ECG, ultrasound and chest x-ray, general blood and urine tests are performed.

Treatment of chemical burns

First aid for chemical burns is very important. To perform the treatment of damaged areas, solutions of aseptic preparations are used, as well as a number of special tools that provide an oxygen flow to the damaged areas. Ointments and creams on a fat and oil base should be used only in the final period of treatment, when the damaged area has renewed the skin, their use in the first stages of treatment can cause tissue suppuration.The duration of treatment and the recovery process depends on the extent of the affected area and the depth of the burn. The most dangerous complication of the disease is sepsis.

Prevention of chemical burns

Preventive measures should include, first of all, sanitary and educational work among workers of chemical enterprises and the population. In specialized enterprises and laboratories, it is mandatory to label hazardous substances and their correct storage, compliance with all technical rules and regulations by employees of industrial enterprises and laboratories.It is also important to train and regularly re-certification of employees in the rules for working with hazardous chemicals and methods of first aid in case of chemical burns.

BURNS OF THE ESOPHAGUS IN CHILDREN

The sight of a one-year-old toddler examining an unfamiliar object is touching. Inspect, touch, sniff, taste – all this the kid does, learning about the world around him. However, there are times when objects and substances that are completely not intended for him fall into the hands of the baby.As a result, more than 60% of those affected by chemical burns of the esophagus are children aged from one to 3 years old who have tasted aggressive chemicals.

Of the total number of victims of chemical burns of the esophagus, about 70-75% are children under the age of 10, 25-30% are adults. The frequency of chemical burns of the esophagus in children is explained, on the one hand, by the habit of children (especially young children) to take everything by mouth, on the other hand, by the negligence of adults when storing caustic chemicals used in everyday life; in some cases, burns occur when these substances are accidentally taken instead of drugs or drinks.

Burns of the esophagus in children occur when accidentally swallowing hot liquid, caustic chemicals that contain acid or alkali. In rare cases, poisoning is possible in children when taking caustic chemicals, more often it happens when acids are swallowed.

Seasonality can be traced in burns: in the spring, as a rule, in March, they begin to prepare seedlings for the dacha. Sometimes, for better growth, various liquid fertilizers and “potassium permanganate” are used. In the fall, they make blanks.Caution, vinegar essence!

The severity of a burn of the esophagus depends on many factors: the type and amount of the chemical, its concentration, the duration of exposure to the mucous membrane, the age of the child.

Household chemicals have firmly entered our life. In any home, there are hazardous chemicals that pose a threat to an inquisitive toddler. Today, a burn of the esophagus in children is becoming more common.

Here is a conditional “rating” of the most dangerous chemicals in our house:

1. Vinegar essence
2. Caustic soda (caustic soda)
3. Crystals of manganese
4. Ammonium
5. Office glue
6. Turpentine
7. Battery fluid.
8. Means for cleaning clogged pipes, for example, “Mole”.

As you can see, the chances of getting a burn of the esophagus in children are the widest. Even the most harmless, at first glance, substances can cause burns.

In case of burns with caustic chemicals, the localization, extent and depth of the lesion depend on the amount and type of chemical, its concentration, duration of exposure and the age of the child. Burns are more severe in younger children.Alkalis penetrate deeper into tissues than acids, therefore, when passing through the esophagus, they cause deeper lesions, especially in places of functional narrowing. Acids, having a cauterizing property when exposed to tissue proteins, form a scab, which prevents them from deep penetration into the wall of the esophagus. However, high concentrations and significant amounts of potent acids also cause profound changes in the esophageal wall.

There are 3 degrees of esophageal burn. With a 1-degree burn, only the surface layers of the esophageal mucosa are affected; with a grade II burn, the lesion extends to its muscular membrane; with a grade III burn, all layers of the esophageal wall are affected, as well as paraesophageal tissue and surrounding organs.With a third degree burn, in addition to local ones, general phenomena caused by intoxication and shock are also expressed. With burns of II and especially III degree (if the patient can be saved), cicatricial changes in the esophagus, strictures, cicatricial shortening of the esophagus, in some cases – chronic ulceration of the esophageal wall develop.

It’s hard to imagine a picture of a mom or dad calmly watching their child examine a bottle of a dangerous chemical. Therefore, the fact that trouble has happened, they will be informed by children’s crying.How to understand that the baby has received a burn of the esophagus?

Here are the first signs of a chemical burn of the esophagus:

• Vomiting
• Foam on lips
• Profuse salivation
• The child cries and rushes
• Temperature rises
• During examination of the child, a burn to the skin around the mouth can be detected. On the mucous membranes of the lips, tongue, palate, back wall of the pharynx, redness, swelling, plaque is determined (the color of the plaque is different, depending on the swallowed substance).
• Burning pain in the mouth, behind the breastbone, in the upper abdomen
• Pain when swallowing

The further clinical picture of a burn of the esophagus depends on the concentration and amount of aggressive liquid taken, the degree of damage to the pharynx, larynx and esophagus.

A number of children develop laryngeal edema, which leads to the development of respiratory failure: shortness of breath, shortness of breath, cough.

In the first 3-4 days, the clinical picture is due to an acute inflammatory process.In patients, the temperature rises, there is anxiety, salivation, difficulty or inability to swallow. Food intake, and sometimes water, is limited or impossible. From the 5-6th day, even in patients with severe burns of the esophagus, the condition improves, the temperature decreases, salivation and impaired swallowing of food disappear, children begin to drink and eat freely. With burns of I and II degrees, clinical improvement is parallel to the restoration of the normal structure of the esophagus.

The clinical picture of cicatricial narrowing of the esophagus develops gradually.At first, it becomes difficult to soak dense food products, and then – and liquid. Depletion is observed in more than half of the patients admitted to the clinic with cicatricial esophageal narrowing.

In the acute period, on the basis of clinical symptoms, it is impossible to assume or deny the presence of a burn of the esophagus, and even more so the degree and extent of the lesion.

It is almost never known whether a child has ingested a chemical or has just taken it in his mouth and spat it out. With an isolated burn of the oral cavity and a burn of the esophagus, the same symptoms may be noted.The absence of plaque in the oral cavity also does not exclude a burn of the esophagus, therefore, the diagnosis of burns of the esophagus is based not only on clinical symptoms, but primarily on the data of objective research, in particular, diagnostic esophagoscopy. It allows you to visually assess the condition of the esophageal mucosa throughout.

The first esophagoscopy makes it possible to reliably exclude those cases when, after taking the chemical, the esophagus did not burn, which is observed in almost 60% of children.Further, it makes it possible to differentiate a burn of the first degree, in which there is only hyperemia and increased vulnerability of the mucous membrane, and deeper burns. With burns of II-III degree, in contrast to a burn of I degree in the esophagus, during esophagoscopy, fibrinous overlays are determined in areas of greater or lesser extent. After 8-14 days, this study is repeated to monitor the healing process of the burn surface. Diagnosis of a severe burn becomes possible only 3 weeks after injury.With burns of the II degree, by this time, complete epithelization of the burn surfaces occurs. With deep burns of the III degree, granulation and ulcerative surfaces in the areas of the burn can be seen at this time.

The first thing to do in case of a burn of the esophagus is to dial the ambulance number. Look around and find the bottle with the chemical that caused the burn. It is very important to know what exactly and in what quantity the baby has swallowed. This will allow the doctor to determine the severity of the injury and first aid methods.

Treatment of a patient in the acute period of a burn of the esophagus and stomach should begin with careful removal of caustic substances from the mouth, pharynx, esophagus and stomach in a strictly defined sequence. If it is not respected, the damage to the esophagus and stomach can be aggravated.

Gastric lavage – first aid for burns of the esophagus .

If the baby is burned by acid or alkali, wash the stomach with chilled water (boiled if possible).

• If the house does not have the necessary rinsing solution and there is no time to boil and cool the water, then first aid for a burn of the esophagus can be provided with ordinary milk.

Give your child a quick drink as much liquid as his stomach can hold.

• For a child from 6 months to a year – about 200 ml,
• For a child from 3 to 5 years old – 300-400 ml,
• For a child from 4 to 7 years old – 600-800 ml,
• For a child over 10 years old – about 1 liter.

After providing first aid at home, the victim is taken to the hospital, where, as a rule, repeated lavage of the esophagus and stomach is performed. After hospitalization, regardless of the general condition of the patient, infusion therapy is being established, since the general reaction to an aggressive substance at the time of the child’s admission may not yet be pronounced, but over time it may deteriorate sharply.

Nutrition of a patient with a burn of the esophagus in the first days is carried out parenterally, but if enteral nutrition is possible, it is carried out. Food should be cold and runny.

Burns of the esophagus and stomach of the 2-3rd degree require more intensive treatment with anti-shock measures; detoxification, anti-inflammatory therapy, as well as prevention of esophageal stenosis. It is imperative to use corticosteroids to improve the regeneration of the mucous membrane of damaged areas.

Those children who can take liquid food by mouth are prescribed high-calorie foods: meat broths, raw eggs, sour cream, butter, liquid cottage cheese, jelly, juices from natural fruits and berries, sugar, cocoa.

As acute inflammation subsides, edema, pain decreases, in the absence of dysphagia, liquid food is replaced with coarser food. On the 5-8th day, the child receives a normal table, corresponding to age.

Patients with only fluid permeability or complete obstruction of the esophagus are shown urgently to impose a gastrostomy tube with parenteral nutrition.The gastrostomy tube will later be used for bougienage of the esophagus by the thread.

Burns of the esophagus in children – a real danger!

Therefore, the first rule that all parents must follow is: all chemicals, all medicines, any household chemicals, technical means, powders – all this must be carefully hidden and locked away from the inquisitive crumbs. Do not underestimate the ability of children to find unfamiliar objects.

When giving medicine to a child, read the label carefully, always, every time.There have been cases when the parents themselves caused a burn of the esophagus in children, accidentally confusing drops from a cold and ammonia.

One more point – you should explain to the child that this is not allowed, it is dangerous. Household chemicals today are made in the same colorful packaging as baby food. Of course, a kid watching how his mother pours powder into the washing machine will be interested in a bright box. At this moment, one should say: it is impossible, it is dangerous, it will hurt!

Let the baby not immediately understand the words, but he will surely catch mother’s emotions, her anxiety.This sense of danger can provide additional protection for the baby if suddenly he is alone with a dangerous substance.

Protect your child from pain, fear and anguish …

What needs to be done for this?

Check that all strong cleaning agents are out of the reach of the child.