Chemical burns can cause extensive tissue damage. They differ from thermal burns and require a specific approach. This includes taking a modified 5-point history and considering different treatment options.
Assess the chemical burn with a 5-point history
Medical history is the most important step in the assessment of chemical burns, as some agents require a specific treatment.
The depth of a chemical burn depends on the type of chemical, concentration, amount, duration of exposure and first aid provided. You will need to ask different questions when taking the 5-point history to assess the extent of a chemical burn.
- What was the causative agent and what was its concentration? If possible, read the label or packaging of the causative agent.
- What was the quantity of the causative agent?
- What was the duration of skin contact with the causative agent?
- What was the condition of the skin at the time of exposure? For example, was the skin intact or macerated?
- What were the circumstances during skin contact, and what treatment has been administered already?
First aid options for specific chemical agents
Different types of chemicals have different impacts on the skin, and therefore some causative agents have specific first aid approaches.
Acids cause coagulating necrosis and therefore must be irrigated with plenty of lukewarm water. Early excision of these burns is required.
Alkalis are found commonly in the form of caustic soda, which is present in many households as drain unblocker. These chemicals penetrate the skin easily. Therefore, immediate prolonged irrigation (> 1hr) with water is required.
Burns caused by hydrofluoric acid are not immediately noticeable. To treat these burns, firstly remove all clothing and immediately irrigate with copious amounts of water.
Treat hydrofluoric acid burns fast
Speed and thorough washing of the acid is most important for hydrofluoric acid burn wounds.
Immediate treatment with calcium-gluconate gel (a specific treatment) is required: massage the gel into the skin until the pain has subsided. If the nailbed of must be removed and the nail bed must then be treated with calcium-gluconate gel. If the TBSA burned is >1%, hypocalcemia may occur; arrhythmias may occur subsequently.
Contact of the skin with cement (lime) does not immediately cause a burn. However, prolonged exposure (> 45 minutes) to this substance occurs when clothing becomes impregnated, and this can then become a significant issue.
Petrol and diesel
Petrol and diesel will only cause burns after prolonged exposure. Be aware of the systemic effects of these substances, as the endothelial cell damage caused my lead to liver, lung, spleen or kidney damage.
Grenades used in warfare contain white phosphorous, and therefore associated wounds may occur in combat. Injuries from white phosphorus may also occur in industrial accidents or from accidents with fireworks. White phosphorus ignites when it comes into contact with air and can be extinguished with water. Wounds caused by this should be kept under running water and irrigated until definitive treatment can be provided.