Chemical burn | DermNet NZ

Author: Vanessa Ngan, Staff Writer, 2007.

What is a chemical burn?

Chemical burn is a burn to internal or external organs of the body caused by a corrosive or caustic chemical substance that is a strong acid or base (also known as alkali). Chemical burns are usually the result of an accident and can occur in the home, at school or more commonly, at work, particularly in manufacturing plants that use large quantities of chemicals.

Very mild chemical burns result in irritant contact dermatitis. Chemical burn from a strong acid or alkali is also known as a caustic burn.

What causes a chemical burn?

The main cause of chemical burn is contact with strong acids or bases.

• The strength of acids and bases is defined by the pH scale, which ranges from 1–14.
• A very strong acid has a pH of 1 and may cause a severe burn.
• A very strong base has a pH of 14 and may also cause a severe burn.
• A substance with a pH of 7 is considered neutral and does not burn. 

Common acids

Sulphuric acid – concentration ranges from 8% to almost pure acid

• Toilet bowl cleaners
• Drain cleaners
• Metal cleaners
• Car battery fluid
• Fertiliser manufacturing

Nitric acid

• Used in engraving, metal refining, electroplating and fertiliser manufacturing

Hydrofluoric acid – a weak acid and in a dilute form does not burn or cause pain on contact

• Rust removers
• Tyre cleaners
• Tile cleaners
• Glass etching
• Dental work
• Refrigerant

Hydrochloric acid – concentrations range from 5–44%

• Toilet bowl cleaners
• Metal cleaners
• Swimming pool cleaners
• Dye manufacturing
• Metal refining

Phosphoric acid

• Metal cleaners
• Rustproofing
• Disinfectants, detergents
• Fertiliser manufacturing

Common bases

Sodium hydroxide and potassium hydroxide — depending on the concentration — may be very corrosive

• Drain cleaners
• Oven cleaners
• Denture cleaners

Sodium and calcium hypochlorite

• Household bleach
• Pool chlorinating solution

Ammonia

• Cleaners and detergents used in dilute form are not highly corrosive
• Gaseous anhydrous ammonia used in fertilising manufacturing can cause severe burns

Phosphates

• Many household detergents and cleaners

What are the signs and symptoms of chemical burn?

The signs and symptoms of a chemical burn depend on several factors, including:

• pH of the agent
• Concentration of the agent
• Length of contact time
• Amount of agent involved
• Physical form of the agent (ie: solid, liquid, gas)
• Site of contact (e. g. eye, skin, mucous membrane)
• Whether swallowed or inhaled
• Whether or not skin is intact.

Swallowing a solid pellet of an alkaline substance highlights the importance of these factors. The solid pellet sits in the stomach for a longer period, thus more severe burns sustained. Another important factor is concentrated forms of some acids and bases generate a large amount of heat when diluted; this results in a thermal burn as well as a chemical burn.

Some signs and symptoms of chemical burns include:

• Redness, irritation, or burning at the site of contact
• Pain or numbness at the site of contact
• Formation of black dead skin (eschar) — this occurs particularly with acid chemical burns as they produce a coagulation necrosis by denaturing proteins
• Deep tissue injury to the skin is caused by alkali chemical burns, as they produce a liquefaction necrosis that involves denaturing of proteins as well as saponification of fats
• Vision changes or complete loss of vision if chemicals get into the eyes.

Chemical burns

In severe chemical burns where the agent has been swallowed, inhaled or absorbed into the bloodstream, the following systemic symptoms may occur.

• Cough or shortness of breath
• Low blood pressure
• Faintness, weakness, dizziness
• Headache
• Muscle twitching or seizures
• Cardiac arrest or irregular heartbeat

What is the management of a chemical burn?

Basic first aid should be administered as soon as a chemical burn has occurred. 

• Remove contaminated clothing
• Irrigate the affected area with copious amounts of water. Wash for at least 20 minutes, taking care not to allow runoff to contact unaffected areas. It has been shown that irrigation received within 10 minutes of the burn reduces the severity of the wound and time of stay in hospital.

Chemical burns involving elemental metals (lithium, potassium, sodium and magnesium) should not be irrigated with water as this can result in a chemical reaction that causes burns to worsen. These types of chemical burn should be soaked with mineral oil while waiting for medical attention.

People with minor chemical burns do not require hospitalisation. For more severe burns, patients should receive treatment as for a typical thermal burn patient. In some situations an antidote may be given to counteract the offending chemical agent. For example, hydrofluoric acid burns should be promptly treated with calcium gluconate gel applied every 15 minutes, so the gel should be kept at relevant work sites.

The main treatment aims of burn wound management are:

• Carefully monitor wound
• Keep wounds clean
• Prevent the wound drying out
• Manage secondary infection.

Commonly used topical antibacterials include 1% silver sulfadiazine cream, 0.5% silver nitrate solution and mafenide acetate 10% cream.

Chemical Burns – StatPearls – NCBI Bookshelf

Continuing Education Activity

Healthcare professionals should be knowledgeable about chemical burns from exposure to acids (pH less than 7), alkalis (pH greater than 7), and irritants to recognize, manage and care for these common types of injury. Chemical burns are the result of exposures to a variety of substances commonly found in the home, workplace, and surrounding environment. The burn may be obvious, for example, from a direct spill or other exposure, or more covert, especially in children. Chemical burns can cause short-term, long-term, and lifelong health problems, especially if undertreated. Occasionally, they can result in premature death, especially if ingested in an attempt to self-harm. This activity reviews the pathophysiology and presentation of chemical burns and highlights the role of the interprofessional team in its management.

Objectives:

• Summarize the various possible causes of chemical burns.

• Describe the physical exam and evaluation process of a patient with a suspected chemical burn

• Reviewe the treatment and management options available for patients presenting with chemical burns.

• Explain the importance of interprofessional team strategies for improving care coordination and communication to aid in prompt diagnosis of chemical burns and improving outcomes in patients diagnosed with the condition.

Earn continuing education credits (CME/CE) on this topic.

Introduction

Healthcare professionals should understand chemical burns from exposure to acids (pH less than 7), alkalis (pH greater than 7), and irritants to recognize, manage and care for these common types of injury.[1][2][3]

Etiology

Chemical burns are the result of exposures to a variety of substances commonly found in the home, workplace, and surrounding environment. The burn may be obvious, for example, from a direct spill or other exposure, or more covert, especially in children. Chemical burns can cause short-term, long-term, and lifelong health problems, especially if undertreated. Occasionally, they can result in premature death, especially if ingested in an attempt to self-harm.[4][5]

Common causes of chemical burns include the following:

• Acids: Sulfuric, nitric, hydrofluoric, hydrochloric, acetic acid, formic, phosphoric, phenols, and chloroacetic acid

• Bases: Sodium and potassium hydroxide, calcium hydroxide, sodium and calcium hypochlorite, ammonia, phosphates, silicated, sodium carbonate, lithium hydride

• Oxidants: Bleaches like chlorites used in the home, peroxides, chromates, magnates

• Miscellaneous: White phosphorus, metals, hair coloring agents, airbag injuries

• Vesicants like mustard gas

Epidemiology

Chemical burns occur commonly in children who explore at their “cruiser” level.  Many households keep toxic chemicals under the sink or in other low-lying locations where a child may access them. Additionally, in the workplace or home environment, an individual may contact one or more chemicals that have the potential to cause external or internal injury, either because of unawareness of exposure or casual contact. [6][7]

In the last few years in the United Kingdom, there have been many caustic chemical assaults on women.

Children tend to suffer chemical injuries in the home; whereas, adults suffer chemical injuries in the workplace.

Pathophysiology

Chemical burns cause damage as a result of irritant properties, acidity/alkalinity, concentration, form, amount of contact, the length of exposure, and location of contact. For example, contact with a mucosal surface such as the eye is likely to cause earlier and more extensive damage than contact with intact skin where there may be some barrier protection. After inadvertent or intentional ingestion, there will be prompt contact with the mucosal surface and both direct and absorptive toxicity.

Toxicokinetics

After exposure to an alkaline agent, the -OH moiety causes injury due to liquefaction necrosis (mnemonic tip: alkaline has an “L”), which leads to often irreversible changes in the protein matrix. Additionally, there is vascular damage that can create a local or systemic effect.

Acidic agents cause coagulation necrosis (mnemonic tip: acidic has a “C”), which leads to cytotoxicity. Additionally, there are mucosal or skin changes which may prevent further toxicity and limit absorption.

Overall, alkaline agents are more toxic than acidic agents, due to the irreversible changes in protein and tissue damage.

History and Physical

The most common findings represent structural changes to the tissue directly affected, for example, the eye, oral mucosa, skin, esophagus, and lower intestinal system, especially the stomach and pylorus, respiratory system, among others.  In children, ingestion is generally the most worrisome event, because of changes, both short-term and long-term, often leading to extensive tissue death. Eye exposure, either acid or alkali, represents a significant acute injury. Copious irrigation is necessary, and measuring pH is appropriate, although rarely informative.

Evaluation

Direct examination of external exposure sites is mandatory, and if there is ingestion, endoscopic evaluation is necessary. In the instance of Hydrofluoric (HF) acid exposure (see treatment below), monitoring of serum calcium and magnesium levels is critical to prevent chelation with the fluoride ion and cytotoxicity. With most other topical exposures, observation and serial monitoring of changes are sufficient.[8][9]

Any gastrointestinal (GI) exposure must be seen by an experienced endoscopist who may need to perform serial evaluations to document healing. Likewise, eye injuries must be examined by an experienced ophthalmologist who will follow-up with the patient sequentially and guide additional therapy.

With ingestions, especially when concerned about systemic absorption, laboratory evaluation (complete blood count [CBC], platelets, electrolytes, calcium, magnesium, arterial/venous blood gas, liver and kidney studies, lactic acid level, and, occasionally, coagulation studies) may be indicated. Radiographic studies, especially including an upright chest film, may help to determine if there is the presence of free air, which is suggestive of a perforation. Non-contrast CT may be used if there is concern about mediastinal free air, resulting from a perforation after exposure. Previously, a radio-opaque contrast was used, but this should be avoided in suspected perforation.

Treatment / Management

Copious irrigation of affected external areas is mandated. Endoscopic examination best explores internal injuries after ingestion. If there is concern about ingestion of disc or other flat batteries, radiographic assessment is mandated. It would be unusual that CT scanning would be needed, and MRI studies are interdicted. Ultrasonography in experienced hands may provide answers as to location as well.  [10][4][11]

It is not appropriate to introduce emetic agents or “neutralizing” agents into the treatment regimen after ingestion. There is high concern about aspiration, increased tissue damage with retching, and a strong possibility of exacerbating a bad situation. There is no current recommendation of systemic medications such as steroids, antibiotics, or prophylactic renal/hepatic therapies.

HF acid, among all the exposures mentioned above, can be treated with copious irrigation and application of a paste (commercially available and often supplied in an industrial setting where HF may be used commonly or made in the emergency department with powdered calcium gluconate and surgical lubricants). Some have recommended benzalkonium chloride solution. When applied, the treating clinician should use barrier protection. In some circumstances, intradermal or intraarterial injections of calcium (gluconate strongly preferred) have been used. Relief of pain is a good marker of efficacy of treatment. Monitoring of calcium and magnesium levels is important. Oral ingestion, often in the context of suicidal behavior, is likely to be fatal and may be treated with lavage. Monitoring of heart rhythms and electrolytes, including calcium and magnesium, is necessary. Lavage may be helpful, especially if calcium salts are used.

Disc batteries have the potential to leak alkali and cause local, generally esophageal, burns. This is typically seen in children and will require endoscopic management and radiographic tracking of location. Early removal is strongly recommended. If the battery has passed the pylorus, watchful waiting, and inspection of stool for passage is appropriate.

Prognosis

The prognosis depends on the type of chemical and extent of the injury. Most small lesions heal well, but larger wounds often do not heal and can develop into scars. Hydrofluoric acid burns have typically been associated with loss of digits.

Chemical injuries to the eye are the most serious, resulting in severe scarring and permanent loss of vision. 

Complications

The most common complications are pain and scarring.

Vision loss occurs when the eye is injured.

Most patients require multiple doctor visits, and many patients require skin grafts to alleviate the scars.

Postoperative and Rehabilitation Care

Except for first degree burns, all other burns require some type of followup. Skin burns need to be evaluated every 2-4 days until there are signs of healing. Patients with eye burns need to be seen in 24 hours.

For those who suffer a burn to the esophagus, endoscopy has to be repeated in 14-21 days to ensure that there is no stricture formation.

Consultations

Besides a general surgeon or a burn specialist, other consultants involved in the care of these patients include an ophthalmologist, ENT surgeon, Gastroenterologist and a pediatrician.

Deterrence and Patient Education

To avoid chemical injury in children, parents should keep all dangerous chemicals out of reach of the children.

Individuals who have attempted suicide with chemicals need a psychiatric referral.

Pearls and Other Issues

Chemical burns have the potential to impair short and long-term health and, especially when the eye or esophagus are involved, severely alter the individual’s well-being. The clinician must be vigilant to monitor even minor appearing burns, especially with HF acid, as what initially appears to be minor may have serious side effects.

Enhancing Healthcare Team Outcomes

Because burns can occur on almost any part of the body, specific guidelines in the management of each organ system are lacking. However, there is expert evidence on managing the patient as a whole. However, there still remain several gaps in the early management of chemical burns. What solution to rinse the skin or the eye and when to debride are two issues that continue to be debated. But there is no debate that the eye should be rinsed thoroughly, and the patient must be seen by the ophthalmologist. Because burns can affect all organ systems an interprofessional approach with interaction is necessary to avoid the high morbidity of the disorder.

Since most burn patients are managed in a burn unit, the role of the nurse is vital. Often these professionals are the first to identify burn-related complications like infections, melena, difficulty swallowing, eschar formation and declining urine output. The pharmacist should be closely involved when burns are caused by medications like podophyllotoxin, formic acid or topical salicylic acid. Knowledge in managing topical burns, especially in children can help prevent disability. [12] [13] (level III)

Outcomes

The outcomes following a chemical burn depend on the chemical, extent of burn, comorbidity of the patient and time to intervention. Some chemicals are more harmful than others, but chemical burns to the eye are always serious. Because chemical burns can cause poor cosmesis and functional disability, a team approach to management is vital.[14][15] (Level V)

Continuing Education / Review Questions

Figure

Severe alkali burn to the right eye. Being lipophilic, alkali solutions penetrate the eye more rapidly and have the potential to penetrate ocular tissues. Acids, on the other hand, cause precipitation of proteins which creates a barrier and prevents further (more…)

References

1.

Oseni OG, Olamoyegun KD, Olaitan PB. Paediatric burn epidemiology as a basis for developing a burn prevention program. Ann Burns Fire Disasters. 2017 Dec 31;30(4):247-249. [PMC free article: PMC6033472] [PubMed: 29983674]

2.

Vanzi V, Pitaro R. Skin Injuries and Chlorhexidine Gluconate-Based Antisepsis in Early Premature Infants: A Case Report and Review of the Literature. J Perinat Neonatal Nurs. 2018 Oct/Dec;32(4):341-350. [PubMed: 29782437]

3.

Rochlin DH, Rajasingh CM, Karanas YL, Davis DJ. Full-Thickness Chemical Burn From Trifluoroacetic Acid: A Case Report and Review of the Literature. Ann Plast Surg. 2018 Nov;81(5):528-530. [PubMed: 30059387]

4.

Stone Ii R, Natesan S, Kowalczewski CJ, Mangum LH, Clay NE, Clohessy RM, Carlsson AH, Tassin DH, Chan RK, Rizzo JA, Christy RJ. Advancements in Regenerative Strategies Through the Continuum of Burn Care. Front Pharmacol. 2018;9:672. [PMC free article: PMC6046385] [PubMed: 30038569]

5.

Malisiewicz B, Meissner M, Kaufmann R, Valesky E. [Physical and chemical emergencies in dermatology]. Hautarzt. 2018 May;69(5):376-383. [PubMed: 29500476]

6.

Otter J, D’Orazio JL. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 19, 2020. Blister Agents. [PubMed: 29083762]

7.

Schaefer TJ, Szymanski KD. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 10, 2020. Burn Evaluation And Management. [PubMed: 28613492]

8.

Friedstat J, Brown DA, Levi B. Chemical, Electrical, and Radiation Injuries. Clin Plast Surg. 2017 Jul;44(3):657-669. [PMC free article: PMC5488710] [PubMed: 28576255]

9.

Liu HF, Zhang F, Lineaweaver WC. History and Advancement of Burn Treatments. Ann Plast Surg. 2017 Feb;78(2 Suppl 1):S2-S8. [PubMed: 28079548]

10.

Baradaran-Rafii A, Eslani M, Haq Z, Shirzadeh E, Huvard MJ, Djalilian AR. Current and Upcoming Therapies for Ocular Surface Chemical Injuries. Ocul Surf. 2017 Jan;15(1):48-64. [PMC free article: PMC5191942] [PubMed: 27650263]

11.

Huang YF, Wang LL. [How to improve the prevention and treatment of ocular chemical burns in China: important elements]. Zhonghua Yan Ke Za Zhi. 2018 Jun 11;54(6):401-405. [PubMed: 29895113]

12.

Struck HG. [Chemical and Thermal Eye Burns]. Klin Monbl Augenheilkd. 2016 Nov;233(11):1244-1253. [PubMed: 27454309]

13.

Ferreira AL, Ferreira JM, da Silva PM, Constancio DF. Genitalia burn: accident or violence? Concerns that transcend injury treatment. Rev Paul Pediatr. 2014 Jun;32(2):286-90. [PMC free article: PMC4183022] [PubMed: 25119763]

14.

Lobeck I, Dupree P, Stoops M, de Alarcon A, Rutter M, von Allmen D. Interdisciplinary approach to esophageal replacement and major airway reconstruction. J Pediatr Surg. 2016 Jul;51(7):1106-9. [PubMed: 26995523]

Acid Burns | CS Mott Children’s Hospital

Topic Overview

Acid products include toilet cleaners, battery acid, bleach, chemicals used in industry for crystal etching, and chemicals that are added to gas. Acid solids and liquids can cause injury, depending on the type, the strength, and the length of time the acid is in contact with the body. The damage is usually kept to the area of contact and does not usually cause damage deep in the tissue.

When a chemical burn occurs, find out what chemical caused the burn.Call a Poison Control Center immediately for more information about how to treat the burn. When you call the Poison Control Center, have the chemical container with you, so you can read the contents label to the Poison Control staff member.

Most chemical burns are treated first by rinsing (flushing) the chemical off your body with a large amount of cool water, but not all chemicals are treated this way. It is important to treat the burn correctly to avoid further complications.

Chemical burns rinsed with water

• Immediately rinse with a large amount of cool water. Rinsing within 1 minute of the burn can reduce the risk of complications.
• Flush the area for at least 20 minutes.
  • Do not use a hard spray of water, because it can damage the burned area.
  • Have the person with the burn remove the chemical substance if he or she is able.
  • Put on gloves to protect yourself from the chemical, if you need to remove it.
• As you flush the area, take off any clothing or jewelry that has the chemical on it.
• If the area still has a burning sensation after 20 minutes, flush the area again with flowing water for 10 to 15 minutes.

Hydrofluoric acid is flushed with a large amount of water and treated with calcium gluconate. You need immediate medical care.

Chemical burns not rinsed with water

Some acid burns are made worse if rinsed (flushed) with water.

• Carbolic acid or phenol does not mix with water, so use alcohol first to flush the chemical off the skin and then flush with water. If alcohol is not available, flush with a large amount of water. Do not flush the eye with alcohol.
• Sulfuric acid is flushed with a mild, soapy solution if the burns are not severe. Sulfuric acid feels hot when water is added to the acid, but it is better to flush the area and not leave the acid on the skin.
• Metal compounds are covered with mineral oil.

The most important first aid for a chemical in the eye is to immediately flush the substance out with large amounts of water to reduce the chance of serious eye damage. For any chemical burn to the eye, see the topic Burns to the Eye.

Credits

Current as of:
February 26, 2020

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP – Emergency Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
H. Michael O’Connor MD – Emergency Medicine
Martin J. Gabica MD – Family Medicine

Current as of: February 26, 2020

Author:
Healthwise Staff

Medical Review:William H. Blahd Jr. MD, FACEP – Emergency Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & H. Michael O’Connor MD – Emergency Medicine & Martin J. Gabica MD – Family Medicine

Chemical Burns: Symptoms, Causes, Diagnosis, Treatment

Chemical burns—otherwise known as caustic burns—occur when the skin comes into contact with an acid, base, alkali, detergent, or solvent, or the fumes produced by these corrosive materials. They most commonly affect the eyes, face, arms, and legs, but can cause serious damage to the mouth and throat if a corrosive material is ingested.

Fortunately, most chemical burns don’t do major damage to the skin. In fact, many are caused by common household or workplace materials and can be treated in outpatient settings—only about 5 percent of patients seeking emergency medical care for a chemical burn are admitted to the hospital. Highly caustic materials, however, can hurt deep layers of tissue, and the damage isn’t always immediately apparent.

Because the materials that cause chemical burns are so prevalent in homes, schools, and workplaces, it’s important to know what to do if you, a loved one, or a coworker come into contact with caustic materials.

Verywell / Brianna Gilmartin

Symptoms of Chemical Burns

The symptoms of a chemical burn depend on a few basic but important factors:

1. What substance caused the chemical burn
2. Where the substance came into contact with living tissue
3. How long the tissue was exposed to the corrosive substance
4. Whether the substance was inhaled or ingested

Household bleach coming into contact with your skin, for example, will have a much different effect than bleach coming into contact with your eyes.

Although symptoms can vary widely, common signs and symptoms of a chemical burn include:

• Pain, redness, irritation, burning, or numbness at the site of contact
• The development of blisters or dead, blackened skin at the site of contact
• Blurry vision or total loss of vision if the materials came into contact with the eyes
• Coughing, wheezing, and shortness of breath if the substance was inhaled or ingested

In very severe chemical burns or if a corrosive substance was swallowed, you may experience symptoms like:

• Weakness, dizziness, or fainting
• Headache
• Muscle spasms or seizures
• Low blood pressure, irregular heartbeat, or even cardiac arrest

If you, a loved one, or a coworker comes into contact with a corrosive substance, seek medical care immediately. Even if the exposure seems minor—if a household cleaner splashes on your arms, for example—it’s a good idea to call your doctor or Poison Control Center to determine whether emergency treatment is needed.

If the caustic substance is ingested or if the chemical burn is very deep, more than 3 inches in diameter, or affects the eyes, face, groin, buttocks, or a joint, seek emergency medical care.

Causes

Chemical burns are most commonly caused by exposure to acids or bases in the home, workplace, or at school—they can occur in any place where caustic and corrosive materials are handled. Chemical burns can affect anyone, but people who work in manufacturing facilities, children, and older adults are at the highest risk of injury.

Some common products that can cause chemical burns include:

• Everyday household cleaners like bleach, ammonia, and drain or toilet cleaners
• Skin, hair, and nail care products, and teeth whitening kits
• Car batteries
• Pool chlorine and pool cleaning systems

If possible, read the warnings and medical information on the labels of corrosive products before handling. In many cases, consumer education and proper use can prevent a serious medical emergency.

Although most chemical burns are caused by the accidental misuse of a corrosive substance, they can also be used in assaults. Worldwide, attacks with caustic materials are more likely to occur against women. 

Diagnosis

Like symptoms of a chemical burn, diagnoses can vary widely. Your healthcare provider will conduct a physical exam to assess the immediate tissue damage caused by the chemical burn, and ask a series of questions to assess any potential damage. Be sure to tell your doctor about the substance that caused the chemical burn, how long it was in contact with the skin, and the affected body parts.

If you have a severe chemical burn, your doctor may conduct a blood test to determine whether or not hospitalization is required.

After a physical exam and interview, the chemical burn will be categorized as:

• A First-Degree or Superficial Burn: These types of burns affect only the epidermis or the outer layer of the skin. Minor discoloration of the skin is a common symptom of a first-degree burn.
• A Second-Degree or Partial Thickness Burn: Affecting the epidermis and dermis (second) layers of the skin, these burns can be very red, inflamed, and painful, and can blister.
• A Third-Degree or Full-Thickness Burn: The most severe, these burns cause extensive damage to the epidermis and dermis, as well as bones, tendons, muscles, and nerve endings.

Your doctor or healthcare provider will recommend treatment options based on the category of your chemical burns.

Treatment of Chemical and Acid Burns

Typically, chemical burns do not require hospitalization or specialized treatment. 

For a minor chemical burn, basic first aid can alleviate pain and reduce tissue damage. When treating a minor chemical burn, be sure to:

• Remove yourself, your loved one, or your coworker from the accident area.
• Remove any contaminated clothing.
• Flush the affected tissue with water for at least 20 minutes.
• Remove any foreign objects from the affected area, especially the eyes.

After first aid has been administered, most people with chemical burns simply need to talk to their doctor about follow-up care.

If you or the person affected by a chemical burn begins to experience dizziness, wheezing, difficulty breathing, or other severe symptoms, call 911 immediately.

Some treatments for serious chemical burns include:

• IV fluids to regulate heart rate and blood pressure, or IV medications or antibiotics to treat pain or prevent infection
• Antidotes to counteract the effects of the caustic substance
• Professional cleaning and bandaging
• Pain management through an IV or other pain medications
• A tetanus booster to prevent bacterial infections

Chemical burns rarely result in death, but it’s important to take the steps necessary to avoid infection and protect and heal damaged tissues. If you’ve been treated for a chemical burn, be sure to arrange follow-up care with your doctor or healthcare provider within 24 hours of sustaining the injury.

A Word From Verywell

Chemical and acid burns can be painful, but the good news is that most can be treated with basic first aid and follow-up care. Whenever you’re handling corrosive or caustic substances, be sure to read any warning labels and use extra care to avoid contact with your skin, eyes, or mouth. Oftentimes, proper consumer education can prevent serious medical emergencies.

Emergency Management of Chemical Burns

Chemical burns can be caused by acids, bases, organic and inorganic solutions. More than 25 000 products which can cause chemical burns are available for use in agriculture, household, industry and military forces [1]. Chemical burn accounts for 2.4%-10.7% of the overall percentage of burns with a mortality rate of 30% of all burn deaths [2,3]. The recognition of the causes, types and mechanisms of tissue destruction of the chemical agents can help in the management of this type of burns.

Knowing the cause of the burn is of paramount importance in the management. Sometimes this can be easily known if the patient or rescuers bring the name of the causative agent as in industrial burns in which a factory may be working on special types of chemicals or in domestic burns in which the material used may be known. On the other hand, the nature of the causative agent used may not be known as in criminal attacks and wars [4]. In some cases of domestic chemical burns a chemical material used for cleaning may be kept in a different container which can be attractive to children. There is another group of patients who know the chemical agent used but they do not declare it in the history as in suicidal actions and in some self inflicted cases which makes the task difficult for the clinician [5].

The increased use of chemical peeling in the last few years created a new category of chemical burn cases who can have serious complications [6]. Other causes of chemical burns can be due to extravasation of some drugs from the intravascular compartment to the surrounding tissues with the result of sustaining burns to these tissues [7].

Leakage of the hydrochloric acid around a PEG tube inserted in the stomach can cause burn in the surrounding skin (Figure 1).

Figure 1: (a) Chemical burn right side of the trunk, (b) Stomach acid leakage around a PEG tube.

The history should also include the duration of contact with the chemical agent, change of voice or difficulty in breathing in cases of inhalation of a chemical agent, the medical condition of the patient and past history of previous experience with chemical burns as in industrial workers.

The patients may complain of itching, burning sensation, difficulty in breathing and coughing of blood as in inhalation of a chemical gas and difficulty in swallowing in cases of ingestion of chemical agent by children and in suicidal attempts [8]. The patient may have bleaching or darkening of the skin. The chemical burn can take the shape of patches of skin burns in cases of immersion of part of the body in contact with a chemical agent. Streak lines going along the gravity direction and patches of burn as a result of splash of a chemical liquid are characteristic presentations of chemical burns (Figure 2).

Figure 2: (a) Streak lines of flow of the chemical liquid, (b) Splash of the chemical on the leg.

The burnt area may be superficial or deep depending on the type of the chemical, its concentration, its duration of contact and its penetration into the skin. Most acids produce a coagulation necrosis by denaturing proteins, forming a coagulum (eschar) that limits the penetration of the acid. Bases typically produce a more severe injury known as liquefaction necrosis. This involves denaturing proteins as well as saponification of fats which does not limit tissue penetration [8]. Depression of the burn area compared to the surrounding skin on presentation to the emergency department is another characteristic sign of deep chemical burn (Figure 3).

Figure 3: (a) Depression of burnt areas at the knee region, (b) Depressed chemical burn on forehead and eyelids.

Hazardous chemical materials can be harmful to the patients and to the emergency medical staff who attend them. Training of the emergency staff and the use of personal protective equipment in dealing with such situations can reduce that risk [9]. The ABC of trauma, primary and secondary assessment and all general principles of Trauma and Burn care apply to chemical burns [10]. The emergency doctor should be aware that chemical burn, in contrast to thermal burn, can continue in the emergency room especially if the clothes of the patient are soaked with the chemical material and kept on him. Another characteristic point of chemical burn is that it may act in a systemic fashion. Accordingly, the first aid management of the chemical burns should include several aspects as:

• Removal of the chemical agent.
• Treatment of the systemic toxicity if present and other side effects of the agent.
• General support of the patient.
• Consideration to specific areas of the body affected [10].

The chemical agent should be removed as early as possible. The involved clothes and foot wear should be removed. Irrigation of the chemical by water lavage should be started to dilute and even remove the chemical. Periods of 30 minutes of copious irrigation for acid burns and even longer periods for alkali burns may be required. Irrigation can be repeated if required. In case of burns from chemical powder irrigation should not be immediately started as the water can activate the chemical. The powder should be dusted off first and then the irrigation can take place. There is debate about the use of antidotes. Antidotes can produce an exothermic reaction that will superimpose a thermal injury on top of the chemical injury and they themselves can cause toxicity [11]. However, antidotes may be used in some special situations as in phenol burns which should be swabbed with polyethylene glycol sponges prior to a high-density shower. Muriatic and sulfuric acid burns should be neutralized with soap. Hydrofluoric acid dissociates into hydrogen and fluoride. The fluoride chelates the calcium in the body and the patient can develop hypocalcaemia. The patient is treated with a combination of water lavage, topical calcium gluconate gel and subcutaneous injection of 10% calcium gluconate to neutralize free fluoride ions. In some cases intra-arterial infusion of calcium gluconate may be required [11-13].

White phosphorous, used in the military, in fireworks and in some insecticides may ignite spontaneously on exposure to air. Recommended treatment includes lavage with 0.5% to 2% copper sulfate and copious water lavage. Copper sulfate also turns phosphorus particles black. This facilitates their identification and removal [10]. Toxicology consultation is preferred especially in cases of systemic toxicity which can be caused by some chemicals as hydrofluoric and foramic acids.

General support of the patient involves the use of conventional burn formulas for resuscitation when necessary, monitoring the vital signs and assessing the urine output. Blood gas and electrolyte analysis should be performed until metabolic stability has been assured. Hypothermia which may result from the copious irrigation has to be avoided by maintaining the room temperature between 28-31^oC and the lavage water temperature as near to the body temperature as possible.

Clinical assessment of the depth and extent of a chemical burn is required. The blisters have to be debrided and covered with chemotherapeutic agents and dressings [10]. Local debriding agents as debridase and Laser may be helpful [14]. Early excision and grafting of non-viable tissue is advocated as soon as possible (Figure 4).

Figure 4: Acid burn, a) Dorsum of the left hand, b) Volar aspect of the left forearm, c) 10 dyas after application of unmeshed skin graft of the dorsum of the left hand, d) Meshed graft of the volar aspect of the left forearm, e) 4 months later and f) 4 months later.

Concomitant respiratory injuries may occur when aerosolized chemical or smoke is inhaled. The practitioner must be aware of the possibility of inhalation injury in all cases of chemical burns. The diagnosis is usually made with the fiber optic bronchoscope. Chemical inhalation injuries, like smoke inhalation injuries, are managed with airway protection and supplemental oxygen, by mechanical ventilation with positive end-expiratory pressure and aggressive chest physiotherapy [12].

Chemical eye burns account for small but significant percentage of ocular trauma. The incidence of chemical and thermal injuries to the eye ranges from 7.7%-18% of all ocular trauma [15,16]. Alkali injuries occur more frequently than acid injuries. Irreversible damage occurs at a pH above 11.5 [16]. Acid causes less severe and more focal tissue injury [17]. The Hydrogen ion alters surface pH while the associated anion reacts with epithelial and superficial stromal cells to precipitate and denature surface proteins. Eye burns are classified into 4 grades; I and II are associated with hyperemia, small conjunctival ecchymosis and chemosis as well as erosion of the corneal epithelium. In mild acid burns, the coagulated corneal epithelium often has a “ground-glass” appearance. After removal of epithelium the clear corneal stroma is visible. Grade III and IV are accompanied by extensive and deep damage to the tissue. The visible blood vessels are thrombosed and appear dark. The corneal keratocytes are lost and hydration of the denatured proteins results in corneal opacification. Chemical injury to the iris and crystalline lens may produce mydriasis. The lysis of cells of the anterior chamber destroys the blood aqueous barrier and leads to iridocyclitis and fibrinous exudation [16].

The goal of the therapy is to restore a normal ocular surface and corneal clarity. Patients with a chemical injury will often present with sudden onset of severe pain, epiphora and blepharospasm after exposure to the inciting pain. Chemical agent should be identified but this should not delay the onset of the treatment. Immediate treatment should include copious irrigation prior to ophthalmic evaluation and pH testing [18]. Litmus paper is an easy way of determining the pH of the conjunctiva [19]. Early involvement of toxicologist or Poison Control Center is essential in such cases.

In initial ocular examination, there should be an examination of the fornices to ensure that there is no remaining alkaline material such as ammonia or lime. This can be done by sweeping the fornices with a glass rod. Irrigation with isotonic saline or lactated Ringer’s solution should be performed to change the pH to a physiologic level. Then ocular examination will proceed to visual acuity, intraocular pressure and perilimbal blanching/ischemia. If the injury is minor, preservative free artificial tears is used to promote reepithelization. A bandage contact lens may provide the patient with more comfort. Fourth generation topical antibiotic such as Fluoroquinolone can be used in large epithelial defect as prophylaxis. Aqueous suppression may be also used in elevated intraocular pressure. Close follow up is required. In severe cases in addition to conservative therapy, active surgical intervention may be required [18].

Although chemical burns constitute a small percentage of the overall burn affecting the human body, their morbidity and mortality rates are high. Proper history taking, clinical examination and early management of such cases can greatly reduce the morbidity and mortality rates of these patients.

Acid and chemical burns | NHS inform

Burns caused by acid, alkaline or caustic chemicals can be very damaging and need immediate medical attention.

Call 999 and ask for urgent help. 

Immediate first aid

After calling 999, to help prevent severe injuries from a chemical burn:

• try to carefully remove the chemical and any contaminated clothing
• rinse the affected area using as much clean water as possible

Remove the chemical and affected clothing

Try to remove the chemical and contaminated clothing from contact with the skin and eyes, but be very careful not to touch or spread the chemical as this could lead to further injuries to the victim or the person helping them.

Use gloves or other protective materials to cover hands and, if possible, carefully cut away clothing such as T-shirts, rather than pulling them off over the head.

Do not wipe the skin as this may spread contamination.

If the chemical is dry, brush it off the skin.

Rinse continuously with clean water

Rinse the affected area continuously with clean water as soon as possible to remove any residual chemical.

Try to make sure the water can run off of the affected area without pooling on the skin and potentially spreading the chemical to a wider area.

Only use water – do not rub or wipe the area.

Stay on the phone until the ambulance arrives and follow any other advice given by the 999 call handler to avoid further injury.

Treatment in hospital

Immediate treatment for chemical burns in hospital includes:

• continuing to wash off the corrosive substance with water until it’s completely removed
• cleaning the burn and covering it with an appropriate dressing
• pain relief
• a tetanus jab if necessary

Recovering from a chemical burn

Minor burns

Minor burns affecting the outer layer of skin and some of the underlying layer of tissue normally heal with good ongoing burn care, leaving minimal scarring.

Your dressing will need to be checked and changed regularly until the burn has completely healed to help prevent infection.

Severe burns

If the burn is severe, you may be referred to a specialist burns unit, which may be in a different hospital. You may stay in hospital for a number of days.

You may need surgery to remove the burnt area of skin and replace it with a section of skin (a graft) taken from another part of your body.

More severe and deeper burns can take months or even years to fully heal and usually leave some visible scarring. In some cases, the depth and location of the burn may also lead to problems such as sight loss or restricted use of limbs or muscles.

Specialist support

Specialist burns teams include occupational therapists, physiotherapists and mental health professionals who can support your recovery. For chemical burns affecting the eyes, you’re also likely to be urgently assessed by an eye specialist to help minimise the risk of lasting vision loss.

If you’ve been the victim of an attack and continue to feel upset, anxious or afraid several days after the incident, you can ask to be referred to the hospital’s mental health liaison team for support and treatment. Anyone with an existing mental health problem who has suffered an attack should also be referred to this team.

Burns support groups also provide practical and emotional support to victims and their families. Your care team should be able to signpost you to local groups, and the following national organisations can also help:

• Changing Faces provides support for people whose condition or injury affects their appearance
• Victim Support provides help and advice to victims and witnesses of crimes
• Katie Piper Foundation provides specific help for victims and families of acid attacks and other burns

Chemical Burns: How to Treat and Prevent Them

Chemical burns can occur at home, work, school, and almost any place you go. Burns from everyday products you handle regularly can have a serious impact. When you work with strong bases or acids, it’s always a good idea to know what to do when a chemical burn happens to you. Your ability to act quickly could keep the degree of the burn to a minimum.

Chemical Burn Treatment

Step 1: Always Use Protective Gear

Prevention is always the best approach to chemical burns. Start by using the right safety gear to create a barrier between the chemical and your skin. Wear the appropriate gloves, lab coat, apron, or other safety gear to keep chemicals from coming into contact with your skin.

Safety glasses are also an essential weapon against chemical burns. Regular glasses and sunglasses don’t offer adequate protection or coverage. Also, keep your feet and legs covered. Shorts and sandals are not appropriate gear for working with any kind of dangerous chemical.

Step 2: Rinse with Clear, Cool Water

Use clear, cool water to flood the area for a minimum of twenty minutes. Make sure the flow of water goes away from you or anyone else, and preferably down a drain. Use enough water to cover the area effectively without using a strong stream.

Some chemicals react with water and shouldn’t be flushed after contact. These include dry lime, elemental metals and phenols. You should brush dry lime off your skin before flushing with water while you need to remove elemental metals and metal compounds like lithium, potassium, and titanium tetrachloride with dry forceps and place them in non-water solutions such as mineral oil.

Step 3: Remove Exposed Clothing and Jewelry

While still flushing with water, remove clothing and/or jewelry that has the chemical on them. If the chemical causes these items to stick to your body, leave them in place.

Step 4: Follow the Instructions on the Chemical Label

OSHA requires any work setting where chemicals are present to have OSHA labels that list first aid instructions. Once you flush the burn, look for the instructions on the label, if available. These instructions pertain to the specific chemical and may differ from that of other chemicals.

Never try to neutralize the burn using an acid or alkali. You could cause a chemical reaction that results in more severe burns. Don’t apply antibiotic ointment, first aid cream, or any other ointment to the burn unless directed to do so by a healthcare provider.

Step 5: Wrap Small Areas

Loosely wrap small burn areas. If the burn area is larger than 3 inches wide or long, go to the hospital immediately. Seek emergency care if the burn is on your hands, feet, face, buttocks, groin, or over a major joint. If the burn is so severe that it causes symptoms of shock such as shallow breathing, low blood pressure, and/or dizziness, you should also go to the hospital.

Step 5: Follow Your Healthcare Provider’s Treatment Instructions

Chemical burns vary a great deal in severity. Treatment ranges from over-the-counter pain medications and anti-itch creams to the use of IV fluids, cosmetic surgery, skin grafts, and counseling & occupational therapy. The treatments your doctor provides will help prevent your burns from developing complications and speed up the healing process.

Minor burns usually heal fairly quickly if you follow the instructions given. People with major chemical burns often have complications including permanent disfigurement, scarring, infection, and depression. Deep burns that affect the tissue and organs below the surface can result in limb loss or permanent muscle and tissue damage.

What Is a Chemical Burn?

A chemical burn is the irritation and destruction of tissue resulting from exposure to a chemical, either directly or from the fumes it produces. Strong acids or bases are most likely to cause damage when they come into contact with the skin. The best way to avoid chemical burns at home is to familiarize yourself with the products you use and follow the instructions carefully.

Most people think that only the chemicals in a laboratory or work environment pose a risk to their well-being. While many of your typical home cleaning, maintenance and personal products are not strong enough to cause severe burns, they sometimes cause irritation or burns to the skin, particularly with misuse or overexposure. Common chemical sources at home include products to dye hair or whiten teeth, rust removers, salt used to clean snow and ice, household cleaners, and drain clog removal products.

Death resulting from chemical exposure in the home is rare but it does happen. It is much more of a risk in laboratory and work settings where strong chemicals are used in large volumes. These chemicals require labeling to reflect their potential risk and to guide you on safe use.

The appropriate treatment for any chemical burn depends on the area where it occurs and the type of chemical involved. Once exposure to the chemical occurs, you need to act quickly to minimize the severity of the burn as much as possible. If you work with strong chemicals daily, become familiar with the properties of each so you know what to do if you or someone else in your work environment spills them.

Chemical Burn Symptoms

You might imagine that spilling a strong acid on your body will result in immediate burning and pain but that isn’t always the case. First-degree burns that only affect the top layer of skin usually cause reddening of the skin and localized pain. First-degree chemical burns often look and feel similar to sunburns.

Second-degree burns are deeper, reaching to the lower layer of skin. These burns often cause more severe pain, blistering of the skin, and swelling. The deepest burns are third-degree which go beyond the lower layer of skin and into the deeper tissue. Third-degree chemical burns often have a charred appearance or whitened or blackened skin that is also numb.

Most chemical burns are first-degree unless you leave them on the skin long enough to go deeper. Because of the various natures of chemicals that cause burns, additional symptoms sometimes occur. These include shortness of breath, severe cough, abdominal pain, muscle twitching or seizures, headache, bluish lips, hives, irregular heartbeat, or cardiac arrest. Any symptom you develop after a chemical burn requires immediate medical evaluation.

Preventing Chemical Burns

Children are much more susceptible to chemical burns than adults, making it imperative to keep them away from dangerous chemicals. At work and at home, always keep chemicals in their original container. At home, keep cleaning supplies, beauty products, and other products containing chemicals in locked cabinets.

At work or school, chemicals should always be kept in the original containers with the OSHA label intact. Always place a label on the new container when pouring a chemical from one container to another. Wear proper safety gear when working with chemicals and keep them stored in the appropriate containers and cabinets as specified by the labels.

Any facility that deals with strong acids and bases or caustic substances should have an eye wash station at intervals, according to OSHA standards. Chemical exposure to any area of the eye or eyelid may result in permanent damage and varying degrees of eyesight loss. Chemical burns that extend deeper into the eye than the cornea often lead to cataracts and glaucoma.

Rinsing the eye is the first course of action just as it is with burns on any other area of the body. When cleaners or other chemicals get into your eye at home, get into the shower immediately and rinse your eye for at least ten minutes. Keep your eye opened as far as possible to rinse out any chemical underneath the eyelid.

The Potential Outcome for Patients with Chemical Burns

Prompt wound irrigation is the most critical step in reducing the extent of a chemical burn. The final outcome for any burn victim depends on the type of chemical, the severity of the burn, the occurrence of any complications, and whether they follow their treatment plan consistently.

People who incur minor chemical burns usually heal quickly and without any significant interruption to their daily routine. Those with more severe burns may have extensive hospital stays, multiple surgeries, and medical treatment for infection and pain. Every person is different and every burn is unique in some way.

If you work with strong chemicals in any aspect of your job, your employer has the responsibility of supplying you with the necessary safety equipment to protect you from chemical burns. You should never dismiss the issue of safety when using strong chemicals. Taking the right precautions will go a long way towards protecting you and preventing you from experiencing the lifelong impact of a severe burn.

Whether chemical burns occur due to negligence in the workplace or due to an intentional act by another person, you have the right to file a personal injury claim to get justice. Contact Ingerman & Horwitz to schedule an evaluation so we can discuss your burn injury case.

90,000 first aid at home, treatment, degrees, symptoms, complications

A chemical burn develops as a result of exposure to the skin and mucous membrane of aggressive substances. Such burns are dangerous because caustic substances slowly penetrate the tissues, for a long time having a negative effect on the entire body, in some cases causing poisoning. The degree of damage depends on the time of exposure, the type and concentration of the substance, as well as the individual characteristics of the victim’s body.

Reasons

Chemical burns of hands (most often palms and fingers), as well as eyes, often occur in production due to inaccurate handling of equipment or in emergency situations. Less commonly, the legs and other parts of the body are affected. Lesions of the mouth, esophagus and stomach are more common in everyday life as a result of accidents and attempts to commit suicide.

Degree of chemical burns

I degree – the surface layer of the skin is affected.Redness, swelling, and slight soreness are characteristic.

II degree – the deep layers of the epidermis are damaged, white blisters with transparent contents appear on the skin.

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

With IV degree burns, soft tissues, muscles, bones are affected.

Burns with chemicals are most often III and IV degrees.

Symptoms

Symptoms depend on the type of substances that caused the burn. So, as a result of exposure to acids and salts of heavy metals, coagulation and dehydration of proteins occurs, which leads to superficial necrotization of the epidermis and the formation of a crust, which protects deeply located tissues from further damage.

An alkali burn is a great danger, since as a result of such damage, the proteins do not fold, but dissolve, and the caustic substance penetrates deep into the tissue.A soft white scab forms in the burn area.

By the type of the affected area, it is possible to determine which substance caused the burn, if it is not possible to find out from the victim.

Diagnostics of the lesion depth

In case of burns with caustic substances, it is not always possible to immediately determine the depth of the lesion, since the chemical reaction is extended over time. It is sometimes possible to establish the true degree of tissue damage only after 7-10 days, when purulent processes develop in the superficial crust.

Diagnostic measures include visual examination, ultrasound, fluoroscopy, general urine and blood tests.

First aid

At the pre-medical stage, you need to carry out a number of sequential actions.

1. First aid in case of chemical burns should always begin by removing clothing and accessories from the injured person that have been exposed to an aggressive substance.
2. Then you need to remove the remnants of the caustic substance from the skin as soon as possible.
3. At the next stage of providing 1 help for chemical burns, it is necessary to rinse the affected area with cold water for at least 20 minutes.
4. To reduce pain, it is permissible to apply cold to the affected area.
5. You can then cover the affected area with a dry, sterile dressing.

If you correctly provide first aid for a chemical burn, the likelihood of a favorable prognosis increases.

What not to do

When providing first aid for chemical burns, do not smear the affected area with oil, ointment and fatty cream.When interacting with water, these substances enter into an exothermic reaction, so that a thermal burn can be added to a chemical burn. It is impossible to independently use means for treating wounds, so as not to provoke a spontaneous chemical reaction.

Do not rinse the skin with water in case of burns with aluminum, since aluminum ignites in contact with it, as well as in case of burns with lime and sulfuric acid. In all these cases, it is first necessary to remove the remnants of the substance from the affected area with a dry cloth and only then proceed to rinsing.

In case of eye damage, do not rub under any circumstances, but immediately rinse with plenty of water. Aggressive substances cannot be removed with a damp swab, so you will only rub them deeper into the affected area.

What to do in case of burns at home in the first place

Above, we told what to do with a chemical burn, so as not to aggravate the situation. However, if you are not sure which substance caused the burn, or the volume of the lesion is large enough, first of all call the doctors and do not take any additional measures at home other than washing and cooling.If the victim complains of severe pain, over-the-counter medications can be given to help relieve pain or at least reduce the intensity of the pain.

Seek medical attention immediately if the victim is an elderly person or child, or if a caustic substance has entered the eyes or esophagus!

Treatment options

What actions are necessary for a chemical burn is determined by its degree. In the first degree, specific treatment is not required.For the treatment of chemical burns of the II degree, you should see a doctor, since it is likely that you will need to open the blisters that have formed and treat the lesion with an antiseptic. The doctor will also prescribe medications to speed up healing and prevent infection.

In the treatment of a chemical burn of the skin of the III degree, skin grafts are resorted to, and in the case when soft tissues, bones, tendons, nerve endings are affected, the doctor will select an individual treatment method.

Possible complications

Systemic and local complications can be the consequences of chemical burns.The latter include scars, scars, contractures. Of the systemic complications, the following are especially dangerous:

• Bacterial infections that can lead to sepsis;
• hypovolemia, or a decrease in blood volume, which occurs with multiple lesions of the blood vessels;
• hypothermia – dangerously low body temperature that occurs with a large area of ​​skin lesions;
• Joint and bone problems caused by overgrowth of scar tissue.

Memo for first aid in case of burns – MAUZ OZP GKB No. 8

First aid for burns

1. First aid to victims of burns should be provided immediately, already at the scene and begins with the termination of the thermal agent and removal (removal) of the affected person from the fire. In this case, no manipulations are carried out on burn wounds. Do not pierce and remove bubbles, separate adhering objects (clothing, bitumen, splashes of metal, plastic, etc.)etc.). The adhered clothing should not be torn off the burned surface; it is better to cut it off around the wound.

2. Call an ambulance (03 or 103).

3. Immediate, no later than 10-15 minutes after the injury, cooling of the burned surface reduces the time of tissue overheating, preventing the spread of the effect of the thermal agent to the deep-lying tissues. Cooling reduces swelling and relieves pain, has a beneficial effect on the further healing of burn wounds, preventing the deepening of damage.Cooling should not delay the transportation of the victim to the hospital.

4. At local burns up to 10% of the body surface, it is necessary to cool the damaged skin areas for at least 15-20 minutes by irrigation or immersion in cold water, using cold objects or special cooling gels. It is undesirable to use ice, it is better to cool it under the shower or under running water, directing the stream to the burned surface and adjusting the temperature of the water so that the patient feels local relief.The ideal water temperature for cooling is 15 ° C. The goal is to cool the burn wound, not the patient. It is necessary to pay special attention to the risk of hypothermia. Therefore, cooling is not recommended for extensive burns.

5. For hot tar, tar or asphalt burns rinsing with cold water is recommended for cooling. In the future, in order to soften and remove them, use mineral oil (for example, vaseline ointment), vegetable or butter.

6. In case of chemical skin lesions , clothing and powdered chemicals must be carefully removed from the surface of the body. To prevent the person providing assistance from getting burned, it is possible to use protective equipment (gloves, protective clothing, gas mask, etc.). Do not rub the affected area of ​​the skin with napkins moistened with water. All, with some exceptions, chemical burns should be washed with plenty of running water for at least 30-40 minutes. You can take a shower. At the stage of the first medical aid, if necessary, additional rinsing with water.Exceptions are burns with aluminum compounds (diethyl aluminum hydride, triethyl aluminum, etc.), which ignite when interacting with water; as well as burns with concentrated sulfuric acid or quicklime – if water gets in, the surface is very hot, which can lead to additional thermal damage. Sulfuric acid, before washing, it is advisable to dry with a dry cloth, and in case of burns with lime, first remove its remnants dry, and then rinse the skin with running water or treat with any vegetable oil.Antidotes and neutralizing liquids for chemical burns are not recommended.

7. Emergency aid to the victim of electric trauma – rapid cessation of the electric current. Immediately after the elimination of the effect of the current, if the victim has signs of clinical death, resuscitation measures are carried out directly at the scene of the incident. With signs of general electrical injury, hospitalization is indicated, regardless of the extent of the lesion and the condition of the victim.Patients with general electrical trauma should be evacuated in a supine position, since cardiac disorders are possible. Patients with general electrical trauma without local lesions in satisfactory condition are hospitalized for a period of at least 3 days. All victims undergo ECG monitoring without fail.

11.2.3. Chemical burns / ConsultantPlus

In case of chemical burns, the affected area is immediately washed with a large amount of running cold water from the tap, from a rubber hose or bucket for 15 – 20 minutes.

If acid or alkali gets on the skin through clothing, first rinse it off with water, and then carefully cut and remove the wet clothing from the victim, then rinse the skin.

If sulfuric acid or alkali in the form of a solid comes into contact with the body, remove it with dry cotton wool or a piece of cloth. And then rinse the affected area thoroughly with water.

After washing, the affected area must be treated with appropriate neutralizing solutions used in the form of lotions (bandages).

Further help for chemical burns is the same as for thermal burns.

In case of acid burns of the skin, lotions (dressings) are made with a solution of baking soda (one teaspoon of soda per glass of water).

If acid in the form of liquid, vapors or gases gets into the eyes and mouth, rinse them with plenty of water, and then with a solution of baking soda (half a teaspoon of soda in a glass of water).

In case of skin burns with alkali, lotions (dressings) are made with a solution of boric acid (one teaspoon of acid per glass of water) or a weak solution of acetic acid (one teaspoon of vinegar per glass of water).

In case of splashes of alkali or its vapors into the eyes and mouth, it is necessary to rinse the affected areas with plenty of water, and then with a solution of boric acid (half a teaspoon of acid in a glass of water).

In case of contact with the skin of a polyurethane or epoxy composition or their constituent components, they should be removed first with paper towels or gauze or cotton swabs moistened with ethyl alcohol (when removing the polyurethane composition or its components) or acetone (when removing the epoxy composition or its components).Then rinse the skin area with copious amounts of water, then rinse with warm water and soap. After washing, the skin should be dried with a disposable paper towel. The skin is lubricated with a soft greasy ointment based on lanolin, petroleum jelly or castor oil (if adhesives based on epoxy resins or their components get in) or an alcohol-glycerin mixture (if polyurethane adhesive compositions or their components get in) of the following composition: 1 part of alcohol; 1 part distilled glycerin; 1 part of water with the addition of 3 ml of 25% ammonia solution per 1 liter of the finished mixture.

In case of contact with the eyes of a polyurethane or epoxy composition or their constituent components, the eyes should be immediately rinsed with plenty of cold water, and then wiped with a cotton swab with freshly prepared saline (aqueous 1% sodium chloride solution) or 25% bicarbonate solution soda. After that, you should consult a doctor.

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first aid and treatment at home “- Yandex.Kew

Any chemical burn, like a thermal burn itself, is characterized by damage to the human body upon contact with chemicals that can cause tissue destruction.

These are, in most cases, acid, alkali, volatile oils, bitumen, kerosene and gasoline, phosphorus, etc. Moreover, most often the affected areas belong to the upper limbs, less often to the lower ones, and even less often to the trunk. But sometimes the eyes, face or organs of the esophagus and the oral cavity suffer from such a burn.

It should be borne in mind that the consequences of such a burn depend on the depth, severity of penetration and concentration of the chemical, as well as on the quality of the timely treatment provided.In this material, we will consider the types of chemical burns, their photos, and also find out what first aid should be given to a person at home with a chemical burn of the skin.

Degree of chemical burns

These burns most often affect the skin of the face, hands, esophagus and stomach. The main substances that cause burns are acids (sulfuric, hydrochloric, nitric, hydrofluoric, etc.), alkalis (caustic soda, caustic potash, etc.), gasoline, kerosene, heavy metal salts (zinc chloride, silver nitrate, etc.).), some volatile oils, phosphorus, bitumen.

The severity of damage to the skin and mucous membranes in a chemical burn depends on the concentration of the substance and the duration of its action on the tissue. In total, it is customary to distinguish 4 degrees of severity of burns with chemicals:

• 4 degree. All tissues are affected, including the skin, muscles, and tendons.
• 3 degree. Those layers of the skin that are located near the adipose subcutaneous tissue are affected. The characteristic features inherent in a burn of this degree are the appearance of bubbles with a liquid of an unclear shade or with an admixture of blood.In the area of ​​the lesion, sensitivity is disturbed, that is, the victim does not feel pain within it.
• 2 degree. In this case, the lesion affects, in addition to the upper layer of the skin, its deeper layers. A burn of this degree is characterized by manifestations in the form of puffiness and redness, in addition, bubbles filled with transparent liquid also appear.
• 1 degree. Only the upper layer of the skin is affected. Among the main manifestations that accompany this type of burn, there is a slight swelling and redness of the skin.In addition, mild painful sensations also occur in the affected area.

It is noteworthy that the signs of a chemical burn do not fully manifest themselves immediately, therefore, their degree can be assessed only after first aid has been provided. The first symptom is a burning pain at the site where the chemical has entered, and mild redness. If you do not immediately begin to provide assistance, the burn will go from degree 1 to 2 and even 3, as the substance continues to act, penetrating deeper and deeper into the layers of tissue.

First aid for chemical burns

At home, first aid for chemical burns of the skin includes: prompt removal of the chemical from the affected surface, reducing the concentration of its residues on the skin due to abundant rinsing with water for 15-30 minutes, cooling the affected areas in order to reduce pain.

1. In case of chemical burns with acid, a 2-3% solution of baking soda is used to neutralize.
2. For burns with alkalis – 1-2% solution of citric, boric or acetic acid.
3. In case of lime burns, first remove lime residues dry and only then wash off the affected area for a long time and vigorously.
4. For phosphorus burns, discard burning clothing or cover the burning surface with any cloth dampened with water. The phosphorus flame is extinguished with a stream of tap water or a 1-2% solution of copper sulfate.With tweezers, remove all visible particles of phosphorus, after which a bandage is applied to the burnt surface, abundantly moistened with a 2% solution of copper sulfate, 5% solution of bicarbonate of soda or 3-5% solution of potassium permanganate.

A sterile gauze bandage can then be applied, but not cotton wool – it cannot be used. In the process of neutralizing the chemical agent, clothes in contact with the burned area, watches and jewelry are carefully removed from the victim. To reduce the inflammatory process, the affected area of ​​the skin is washed with cool water, and the victim must be given a strong analgesic (pain can be up to loss of consciousness).

For chemical burns, seek emergency medical attention if:

1. The victim has signs of shock (loss of consciousness, pallor, shallow breathing).
2. The victim feels severe pain that cannot be relieved with

   over-the-counter analgesics

   eg acetaminophen or ibuprofen.

3. The chemical burn has spread deeper than the first layer of the skin and covers an area with a diameter of more than 7.5 cm.
4. Affected eyes, arms, legs, face, groin, buttocks or large joints, as well as the mouth and esophagus (if the victim drank the chemical).

When going to the emergency room, bring a container with a chemical or a detailed description for identification. The known nature of the chemical makes it possible to neutralize it in hospital care, which is usually difficult to do in a domestic environment.

Chemical burn of the esophagus

It may happen that a chemical has entered the esophagus and stomach.This could be done on purpose or it could be an accident. Very often, such substances are battery electrolyte and vinegar essence.

More rare cases are the ingestion of alkalis or concentrated acids into the esophagus and stomach. The victim develops severe pain in the mouth, pharynx, esophagus, larynx and stomach. If the larynx is affected, the patient may feel short of breath. Vomiting appears with bloody mucus and pieces of gastric mucosa, which is separated due to a burn.

Since this kind of burns spreads very quickly, the patient needs immediate first aid, which includes, first of all, gastric lavage. It can be washed with a solution of baking soda, if we are talking about a burn with acids, or with a weak solution of acetic acid for a burn with alkalis. In this case, a person needs to be given to drink not just a large, but a really huge amount of liquid, which will make it possible to completely get rid of the chemical component.

In case of such burns, you should call an ambulance as soon as possible or take the patient to the hospital yourself.

Chemical eye burn

A chemical burn of the eye is always considered a difficult situation from the point of view of treatment in ophthalmology. It all depends on the degree of damage, on the agent, on the depth of penetration. Such a burn can sometimes lead not only to a weakening of vision, but even to its complete loss.

• Chemical eye burn with acid is the easiest to treat in comparison with other types of agents.
• A chemical burn of the eye with alkali is difficult to treat because it causes hydrolysis of the protein structure itself, which destroys cells and can quickly lead to wet necrosis. This can affect the intraocular fluid and significantly increase the intraocular pressure.

In case of a chemical burn of the eye, as a first aid, it is necessary to make abundant rinsing and urgently contact a specialist, it is better to call an ambulance.

Thermal skin burn

Thermal burns are caused by exposure to fire, steam, hot water (boiling water), sunlight, etc.The most common thermal burns are caused by fire, they account for 84 per 1000 victims. The second place is taken by thermal burns received from hot liquids, the third place – by electric burns.

These burns are of three degrees:

• I degree – redness of the skin, swelling of the skin;
• II degree – the appearance at the site of the burn of bubbles filled with a transparent liquid;
• III degree – thermal burns of the third degree are divided into two types: IIIA (dermal, damage to the upper layers of the skin) and IIIB (necrosis of all layers of the skin when a necrotic scab forms).

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First aid for chemical burns: skin and other organs

Chemical burns or chemical damage to tissues, both skin and any other organs, pose a serious danger to the human body. Consequences vary depending on the nature of the chemical that caused the burn, the severity of the injury, and the location of the burn.

Types of chemical burns

Chemical burn – damage to the tissues of the human body when exposed to aggressive substances that have certain destructive properties in relation to organic matter.Both organic and inorganic substances in different states of aggregation (gaseous, liquid, solid) are capable of causing a burn. Such substances include alkalis, heavy metal salts, acids, corrosive liquids.

The victim’s symptoms vary depending on the following factors:

• Mechanism of action of the chemical and the degree of its “aggressiveness”;
• Quantitative ratio and concentration of the chemical with which the contact has occurred;
• Duration of exposure to the chemical on body tissues and its penetrating ability.

According to statistics, among all types of injuries, about 12-20% are accounted for by chemical burns. Such injuries occur, in contrast to thermal or electrical burns, as a result of physicochemical disturbances in the area of ​​contact of a chemical with body tissues.

Classification of chemical burns

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Classification

by severity

If we talk about the classification of chemical burns, they are divided according to their severity:

• 1 degree – the lightest, in which the upper layers of the epidermis are affected.In this case, slight redness appears on the skin, there is a burning sensation, and slight swelling is possible. On contact with acid, surface spots and crusts are formed on the skin. Upon contact with alkali, against the background of general hyperemia, weeping areas are formed, which are subsequently covered with a crust, the edema is more pronounced than with acid lesions. Traces of damage disappear on their own within 4-5 days.

• 2 degree – differs in the defeat of the deeper layers of the epidermis, in this case the main symptoms are traces of necrosis, severe hyperemia, a watery blister may subsequently form on the affected area (rarely).There is an uneven deformation of the sweat glands, the hair bags and sebaceous glands are partially affected. The patient notes an increase in painful sensations, a pronounced burning sensation, the likelihood of edema is higher. With timely assistance and adequate treatment, scarring can be avoided. With acid damage, scab-covered areas are formed, which are rejected after 3-4 weeks, exposing a de-pigmented pink area with traces of scarring. Alkali burns are accompanied by the formation of a soft scab, which thickens after 3-4 days.In the future, the scab suppurates, and after its rejection (after 3-4 weeks) a festering wound opens.

• 3rd degree – characterized by the passage of subcutaneous tissues with their partial death together with hair follicles, sweat and sebaceous glands. At the site of the burn, a deep bladder is formed, filled with exudate, possibly with bloody blotches, as well as a scab, which later turns black. There is a violation of sensitivity in the affected area, which is revealed by the absence of pain.

• 4th degree – the most severe, and not only the subcutaneous fat layers are affected, but also muscle tissues (with prolonged contact with an aggressive chemical, the burn can reach the bone). Such tissue damage is characterized by intense pain, the degree of danger is high, and you cannot do without professional help in a hospital. If the burn reaches the bone, the periosteum and the surface layers of the cat tissue die. Such severe burn injuries are rare, occurring in only 1% of patients.

With a chemical burn of internal organs, the identification of the degree of damage is significantly complicated. An immediate visit to a doctor is required, who will conduct an examination using special equipment (endoscope, etc.)

for chemical substance

Types of chemical burns are also classified according to the characteristics of the chemical:

• Acid burn – caused by liquid acids such as sulfuric, nitric and others.
• Phosphorus – characterized by the inevitable combustion of phosphorus when it comes into contact with the skin.
• Burn with alkali – the main chemical compounds in this case are ammonia solution, caustic soda, quicklime, etc.
• Phenols – obtained by contact with phenolic chemicals, phenylacetic acids and phenol alcohols are prominent examples.
• Fluorine – occurs when the skin comes into contact with hydrofluoric acid.

An important feature of chemical burns is that the destructive effect of contact with the chemical does not stop when it is removed from the skin. It is necessary to inactivate the chemical, only in this case the reaction will be interrupted.

First aid algorithm for victims

First aid depends on the direction of the burn. Therefore, it is necessary to ask the victim about the circumstances of the chemical burn.

Important: If possible, save the substance that caused the burn.

The basic principle of first aid to a victim in case of contact of a chemical substance on the skin is its immediate and complete removal. To do this, you should immediately begin to remove the trapped substance from the burn site.

Chemical burns require urgent patient care. How deep and heavy the defeat will be depends on the correctness and promptness of actions.

To begin with, we will briefly consider the main recommendations on how to provide first aid correctly:

• Remove chemical from skin surface as soon as possible.If contact with a chemical occurs through a cloth, quickly remove the “soiled” clothing.
• In the case of a powder chemical such as quicklime, remove the powder before rinsing (shake it off or use whatever is available).
• Do not try to remove an aggressive substance with a napkin, sponge, cloth, and even more so with your hand (even when rinsing with water). Even minor strokes promote deeper penetration of the chemical, which will exacerbate the effects.
• To eliminate the residues of the chemical, the affected area must be rinsed with running cold water for 15-20 minutes. With a delayed reaction and intense pain, the duration of the rinsing increases to 40-45 minutes (for alkali burns up to several hours). If washing does not give positive results, the procedure is repeated.

In case of a chemical burn, it is highly likely that the chemical will penetrate into the internal structures of tissues.This can lead to toxic damage to the body. For this reason, after providing first aid, the person must be taken out into the fresh air or immediately open the windows in the room.

After the burn site has been thoroughly rinsed and the chemical neutralized, pain can be relieved prior to the arrival of a doctor or hospitalization. To do this, it is enough to moisten a towel with cold water and apply to the damaged area. This simple technique can reduce soreness and may prevent swelling from developing.

Treatment of chemical burns is carried out in accordance with the same principles as thermal.

If chemical burns are deep, they require treatment in a hospital setting using surgical methods.

First aid for chemical burns of the skin

In cases of chemical burns (with damage to internal organs) or other organs, in addition to the skin, first of all it is necessary to call emergency help , since you cannot do without qualified medical assistance.

Each organ has its own methods of first aid.

In case of a chemical burn of the eye – immediately start rinsing with running water, while opening the eyelids. Rinsing takes at least 10 minutes, the water jet should be weak.

It is important to remember that in some cases contact with water of a chemical on the skin can aggravate the situation. For example, organic aluminum compounds tend to ignite due to chemical reaction with h3O.You must be sure of the type of burn before using the water for rinsing.

First aid equipment

Before using any means for carrying out anti-burn therapy, , you should consult a doctor . Be sure to read the instructions for the drugs and contraindications.

Medical devices:

• Ointment with bactericidal and bacteriostatic effect, as well as stimulating tissue regeneration in the affected area.
• Panthenol – Healing and enhancing tissue repair.

Folk remedies for chemical burns are used mainly after the provision of medical care . They are necessary for the healing of affected skin or mucous membranes of the gastrointestinal tract.

Depending on the type of burn and the stage of healing, traditional methods of treatment include various healing and healing herbs, aloe and other compresses.

Precautions and Preventions

To prevent chemical burns of the skin or other organs, it is enough to follow simple rules:

1. When working with any harsh chemicals, it is necessary to wear rubber gloves (in some cases a rubber apron).Protection of eyes and internal organs is also provided; for this, glasses and a respirator are worn.
2. Do not leave chemicals open or store in close proximity to food.
3. Dishes and containers in which chemicals are stored must be affixed with appropriate identification marks.
4. After using any chemical, even a minimal hazard, thoroughly ventilate the area to avoid inhaling harmful fumes.
5. Do not mix different chemicals (even household cleaners) unless you are sure of the effects of combining them.
6. Always keep chemicals out of reach of children.

Precautions against chemical burns

Due to the peculiarities of chemical burns, in particular, the likelihood of deep tissue damage, such pathological conditions often have to be treated in a hospital setting.

Sources:

• Burns.Paramonov B.A. A practical guide.
• First aid: section “Burns”. Velichenko V.M., Yumashev G.S.
• First aid for injuries and other life-threatening situations. Simonov I.A. –SPb .: DNA, 2001.
• Burns and frostbite. Study guide. Mikhin I.V., Kukhtenko Yu.V. –Volgograd, 2012.

Treatment and first aid for chemical burns

This article is for informational purposes only. Our specialists do not provide medical advice.See your healthcare professional.

Chemical burns of the skin are not as common as thermal burns, but everyone has a risk of getting such damage even in everyday life. A common pipe cleaner, vinegar essence, “potassium permanganate”, some medicines – all of this, if handled carelessly, can cause a serious chemical burn to the skin.

Each substance causes a specific type of burn:

• Organic and inorganic acids. In a small amount, they form an extensive, but not the deepest wound, since due to the action of acid, the proteins of the skin coagulate, forming a scab, which prevents further penetration of fluid.But the severity of the burn depends on the amount of acid.
• Alkalis. They completely dissolve organic matter, so even a small amount of alkali is enough for a deep skin burn that is difficult to treat.
• Metals, salts. These include potassium permanganate, phosphorus, mercury. In addition to severe chemical burns, they cause body poisoning.
• Gases. These include mustard gas, vapors of concentrated acids or alkalis, gasoline, methyl bromide. They cause burns to both skin and mucous membranes.
• Metrogyl, Zenerit, Baziron, ointments and creams with mustard powder, red pepper – topical drugs. Causes light burns in case of overdose.

Classification by degree

The choice of treatment for chemical burns depends not only on the substance that caused the injury, but also on the degree of damage. The degree of burn is determined by the depth of the wound, there are 4 of them in total:

• The first is the mildest degree of chemical burns, in which only the surface layer is destroyed.No treatment is required, recovery occurs in a few days.
• In the second degree, the deep layers of the dermis are destroyed, but the basal layer does not suffer, which makes it possible for tissue regeneration. Medical care consists in the use of drugs that accelerate healing, prevent infection of the wound.
• The third degree is more serious – the basal layer of the dermis is damaged, therefore, conservative methods of treatment for chemical burns of this type are ineffective.
• The most serious, severe degree – the tissues of the skin, subcutaneous fat, muscles are destroyed. Help with chemical burns in such cases is not always effective in terms of tissue repair.

First aid for chemical burns

Sufficient amount of water for first aid. The more thoroughly the wound is washed, the less the effect of the reagent on the tissue. In the future, help with chemical burns consists in applying a sterile bandage and transporting the victim to the nearest clinic.

Many people think that it is necessary to neutralize the acid with alkali or vice versa. Yes, a neutralization reaction will occur, but at home it is difficult to determine the right amount of reagent for the reaction to occur completely. In addition, the neutralization reaction is always accompanied by the release of heat, that is, thermal damage will also join chemical damage.

Therefore, in case of chemical burns, it is necessary to thoroughly rinse the wound with water and seek medical help. At home, it is allowed to apply a bandage, but in the event that an ambulance call is not planned.

Treatment

How to treat a chemical burn at home? First of all, you need to remember that conservative treatment is possible only with 1 and 2 degrees of burn. In the first degree, as such, therapy is not required. It is possible to use Dexpanthenol or Bepanten ointment to prevent inflammation, moisturize and speed up tissue regeneration.

How to treat a chemical burn of the skin of the 2nd degree, the doctor should decide, since it is often necessary to open the resulting blisters, treat them with an antiseptic.Antimicrobial ointments Levomekol, Argosulfan or the like are predominantly prescribed. To speed up healing, Dexpanthenol or Bepanten is indicated.

Gauze dressings are impregnated with medicinal preparations, which the patient must change every two to three days. The duration of the course depends on the characteristics of the damage. Oral antibiotics are often prescribed to prevent infection.

An operation is required to treat a severe chemical burn. We are talking about 3 and 4 degrees.At grade 3, skin transplantation, which is taken from the patient’s body, helps. In severe injuries, when the tissues of muscles, tendons and nerves are destroyed, the capabilities of surgeons are limited, so it is difficult to predict how complete the recovery will be. However, medicine is developing, and every year the operations are becoming more successful.

Burn disease

Medical care in case of burns consists in the treatment of burn disease. The destruction of tissues is accompanied by the release of toxins that poison the body.As a result, the work of internal organs, primarily the liver, spleen, kidneys, and heart, is disrupted. A massive infusion therapy is required, aimed at the earliest possible elimination of decay products, maintaining the performance of internal organs.

Regardless of the area and depth of the burn, the injury itself does not pose a danger to human life. But with extensive and deep lesions, there may be a deterioration in the quality of life. The greatest danger is precisely the burn disease, therefore, the greatest attention should be paid to its treatment and prevention.

Chemical burns of the esophagus and stomach

Full text of the article:

Alkalis

Unfortunately, alkalis are tasteless and practically odorless, making them more likely to be consumed accidentally. Burns of the oral cavity are typical for the use of alkali, but their absence in no way indicates the absence of damage to the esophagus, in 25% of cases in children with no pathology in the oral cavity after the use of alkalis, severe damage to the esophagus was observed.The stomach is affected in 20-25% of cases. When alkali is exposed to the mucous membrane of the esophagus, colliquation necrosis occurs, which rapidly spreads to the underlying layers until the alkali is neutralized by tissue fluid. Accordingly, the higher the concentration of alkali, the deeper the damage it causes, up to perforation. There are three stages of the action of alkali on the esophagus: the stage of colliquation necrosis, the stage of repair and the stage of scarring. Repair begins on the 5-6th day and can last up to 2-3 weeks or more.In this phase, the scab is rejected, the appearance of granulation tissue and re-epithelialization. Massive collagen deposition in the third phase leads to scarring strictures.

Acids

Acids have a distinct taste and smell and are less likely to be consumed accidentally. They cause coagulation necrosis. Because for acids, a longer exposure is required for a pathological effect on tissues; the esophagus, when consumed, is usually less affected than in the case of alkalis.According to various sources, when acid is swallowed, the esophagus is damaged in 6-20% of cases.

Clinic

The following symptoms predominate in the clinical picture: pain (retrosternal or epigastric), difficulty breathing, salivation, dysphagia, refusal to take fluids, vomiting. The clinical picture does not always predict the extent of damage to the esophagus. One study investigating the correlation between the severity of esophagitis and the presence of three symptoms such as nausea, salivation and difficulty breathing showed that in the absence of all three symptoms, as in the presence of only one of them, significant lesions of the esophagus were not observed, while the combination of two symptoms has always been associated with severe damage to it.

Classification

We use the following classification of caustic damage to the esophagus:

90 076 90 039 0 – no damage

There are more detailed classifications:

• Grade 1 – erythema and edema (the lesion is limited to the superficial layers of the mucous membrane, their rejection is possible, followed by epithelialization without scarring).
• 2a degree – vulnerability, hemorrhages, erosion, exudate, blistering (mucous, submucous and muscle layers are involved).
• 2c degree – the same as 2a plus deep or circular ulcers.
• Grade 3a – deep ulcers, “gray or black esophagus” (transmural lesion).
• Grade 3 – extensive necrosis.

Related articles:

When to perform an endoscopic examination?

Initial endoscopic examination should be performed within the first 2-3 days after injury.Contraindications to it are: shock, respiratory distress, perforation, mediastinitis.

In the period from 5 days to 3 weeks, at the stage of repair, the esophageal wall is the thinnest and the risk of perforation during endoscopy is very high, therefore, at this time it is highly undesirable. After three weeks, dense fibrous tissue usually forms and endoscopy becomes safer. In addition to endoscopic examination, chest and abdominal radiographs, CBC, urea, and liver tests are shown.

Treatment and prognosis

The prognosis is largely determined by the extent of the damage. Thus, two independent studies carried out in the 70s of the last century showed that at 0-1 degrees of damage the probability of stricture formation is 0, at 2 degrees it reaches 17-23%, and at 3 degrees – 100%. More recent data also suggest that mortality in the acute period and the percentage of stricture formation in stages 1-2a are minimal, burns 2c-3a lead to strictures in 70-100% of cases, and the degree of damage 3b is associated with mortality of 65%.The pH of the product also plays an important role, if it is greater than 12.5 or less than 2.0, the likelihood of severe damage is very high.

Treatment of caustic lesions of the esophagus is difficult and easier to prevent than to cure. First of all, it is necessary to establish the type of caustic agent. At the pre-hospital stage, treatment should be directed towards maintaining vital functions. Previously recommended attempts to neutralize the caustic agent with weak acids (in the case of alkali) and weak alkalis (in the case of an acid) are now considered harmful, i.e.because increased heat generation as a result of a chemical reaction can further damage the tissue. In addition, it has been experimentally proven that a 3.8% alkali solution affects the mucous and submucous layer within 10 seconds after administration (a higher concentration of alkali damages the muscle layer for approximately the same period of time), which makes attempts to neutralize it senseless. The only exception is the use of 200-250 ml of water or milk within 30 minutes after consuming the granulated alkali, but even then the risk of vomiting must be taken into account.Attempts to “dilute” the acid with water are contraindicated. lead to an increase in heat generation as a result of a chemical reaction. Vomiting is also contraindicated. lead to repeated exposure of the agent to the esophageal mucosa. You can allow the patient to rinse their mouth with water (spitting it out).

It is imperative to start feeding as soon as possible. Patients with grade 1-2a lesions begin to feed in the first 24 hours (of course, the food should not be rough, hot or cold).In more severely injured patients, follow-up for 48 hours is necessary to rule out perforation, then feeding can be initiated carefully. For grade 2 to 3 esophageal damage during endoscopy, it is prudent to leave the nasogastric tube for enteral feeding (but not more than 2 weeks). The same probe can be useful for conducting a string for bougienage of the resulting esophageal strictures. Anesthetic liquid products such as Almagel A can be used to relieve chest pain (in patients who can take fluids).