9.4. LOCAL CHEMICAL BURNS

Related titles

Chemical burn.

Purpose of assistance

1. Quick recognition of a local chemical burn.
2. Initiation of urgent and appropriate intervention, as well as transportation of the patient.

Description of the patient

Inclusion criteria

1. Patients of all ages who have been exposed to a chemical that can cause local chemical burns that may be immediate or delayed.
2. Substances that cause chemical burns include alkalis, acids, mustard gas, Lewisite.

Exclusion criteria

Absent.

Management of the patient

1. Use suitable personal protective equipment (PPE).
2. Remove the patient’s clothing, if necessary.
3. Infected clothing must be placed in a double bag.
4. If necessary and sufficient human resources are available, the patient should be transported to the hospital by EMD workers and an ambulance that did not participate in the decontamination process, and in an immediate response vehicle that was not exposed to chemicals.
5. Information about the available chemicals should be documented at the scene, also, if available, a material safety form should be filled out.
6. Transfer all chemical information to the receiving department.

Status assessment

1. Clinical effects and severity of local chemical burns depend on:

a) class of substance (alkalis or acids);
b) concentration (the higher, the higher the risk of burns);
c) pH level of the chemical:

• • • • alkaline – increased risk of injury if the pH level is greater than or equal to 11;
      • acids – increased risk of injury if the pH level is less than or equal to 3;

d) manifestation of burn:

• • • • early;
      • late (for example, hydrofluoric acid).

2. Estimate the total area of the burn.

3. Prevent further infection.

4. Special attention when examining the eyes and oropharynx – assess airway patency due to spasm or direct trauma associated with oropharyngeal burns.

5. Some alkalis and acids can show systemic effects.

Treatment and intervention

1. When using dry chemicals, thoroughly clean the chemical residue before washing the area, as the chemical may react with water.
2. In case of exposure to liquids, wash the skin (as well as the eyes, if they are the patient’s) with plenty of water or saline solution.
3. Provide adequate analgesia according to the guideline “Pain control”).
4. Consider topical pain-relieving eye drops (eg, tetracaine) for chemical eye burns.
5. In case of eye damage, provide prolonged eye wash – Morgan lenses may facilitate insertion.
6. Early intervention for airway obstruction or spasm due to oropharyngeal burns.
7. Take measures to prevent hypothermia.
8. Initiate infusion therapy (if necessary) to control hemodynamics.

Hydrofluoric acid

Hydrofluoric acid (HF) is a highly corrosive substance that is mainly used in automotive cleaners, rust removers, porcelain cleaners, painting glass, cleaning cement or brick, or cleaning various types of steel from impurities. . HF acid easily penetrates the skin and can cause deep damage. The probability that a small concentration of HF acid will cause an immediate burn is very small, however, there may be a late manifestation of pain at the site of damage. High concentrations of HF acid can cause instant burns, outwardly they can appear from a slight erythema to a clear burn. Oral or large skin contact may result in severe systemic hypocalcemia with possible QT prolongation and cardiovascular disturbances.

1. All patients with suspected or actual injury from HF acid.

1.1. Actively wash infected areas with water or saline solution for at least 15 minutes.

1.2. Use cardiac monitoring in case of oropharyngeal or major burnsYanks skin.

1.3. Apply calcium preparations:

a) calcium prevents tissue damage due to the action of HF acid;
b) calcium preparations for local use:

• • • • commercial gels with calcium gluconate
      • if calcium gluconate gel is not available, a topical gel can be made by combining 150 ml of sterile water-soluble gel with: 35 ml of 10% calcium gluconate solution; 10 g of calcium gluconate in tablets; 3.5 g of calcium gluconate in powder form or
      • in the absence of calcium gluconate, mix 10 ml of 10% calcium chloride solution with 150 ml of sterile water-soluble gel
      • apply a large volume of the gel to the affected skin area to neutralize the pain from the action of HF acid and leave it on the surface of the skin for at least 20 minutes, then re-examine the area, the procedure can be repeated if necessary
      • although less effective, you can use an IV infusion of pain relievers at the same time as calcium gluconate gel for pain control
      • if the fingers are damaged, apply the gel to the hand, add additional gel to the surgical glove and put it on the affected hand
      • in patients who got into the mouth of HF acid or received burns of a large area of the skin, enter IV calcium gluconate, 1-2 ampoules of 10% calcium gluconate solution, since symptomatic hypocalcemia can quickly manifest in the form of muscle spasm, convulsions , hypotension, ventricular arrhythmia and prolongation of the QT interval.

Patient safety

1. Use personal protective equipment.
2. Carry out measures to limit further contamination through the decontamination procedure.
3. Take measures to ensure the safety of EMD employees and others from infection.
4. Do not attempt to neutralize the acid with alkali and vice versa due to the risk of an exothermic reaction that can cause serious thermal injury.
5. Expedited transport or transfer to a burn center should be considered if a large area of the body is involved or if the eyes, face, hands, feet, or genitals are burned.

Useful information for training

Key points

1. Infusion therapy should be based on the patient’s age, the percentage of body area affected by burns and be calculated according to the Parkland formula (see Appendix 2).

2. Because the severity of local burns depends on the type, concentration, and pH level of the chemical, as well as the area and area of damage, it is important to obtain as much information as possible while on the scene about the chemical that caused the damage. The collection of information usually includes:

a) transportation of a “closed” container with a chemical to the receiving department;
b) transportation of the original or a copy of the documentation on the safety of the substance to the receiving department;
c) referral to a reference agency for chemical identification and management assistance (eg, CHEMTREC®).

3. Inhalation of HF acid should be suspected in case of damage to the skin of the face and neck or if clothing is soaked with it.

4. Decontamination is important with both alkalis and acids to reduce damage – low pH chemicals (acids) are much easier to remove than high pH chemicals (alkalis) because alkalis penetrate and penetrate deeper into tissues.

5. Some chemicals also cause the manifestation of local and systemic signs, symptoms, and damage to the body.

Corresponding evaluation results

1. Determining the total area affected by burns.
2. The patient’s response to the intervention.
3. Response to liquid resuscitation.
4. Response to analgesia.

Key elements of documentation

1. Place of care.
2. Body area with burns.
3. Definition of the chemical.
4. Obtained or measured pH of the chemical.
5. Receiving and transferring documentation on the safety of the substance, chemical container, or other information about the substance being received by the facility.

Criteria for the effectiveness of aid provision

1. Determining the place of hospitalization of patients between the relevant burn centers.
2. Early recognition of a local chemical burn and appropriate treatment.
3. Early recognition of HF acid burn followed by rapid initiation of treatment with calcium gluconate and/or calcium chloride and appropriate analgesia.
4. Measures taken to prevent further contamination.