Embed Size (px)
Citation preview
Chemical Burns
Isaac Tawil, MD
UNM Burn CenterAdults & Pediatrics from tragedy… hope!
Burn Symposium
STATION 1
Chemical Burns
Isaac Tawil MD
UNM Emergency Medicine &Trauma-Critical Care
UNM Burn Center
from tragedy… hope!
Chemical Burns…
• Ubiquitous:– Petroleum distillates– fertilizers– House cleaners– Industrial
applications– Chemical Warfare
Are chemical burns important?
• 3% of all burn patients• 30% of all burn deaths
Severity of chemical burns
• Strength = concentration• Quantity• Duration of contact• Penetration of agent• Mechanism of action
adult & pediatric injury…
Mechanisms of action
• Reduction: HCL, Nitric acid
• Oxidation: NA Hypochlorite (Clorox, Dakin’s)
• Corrosive agents: phenols, cresols, lyes
• Protoplasmic poisons: HF, acetic, formic acid
• Vesicants: DMSO, mustard gas, lewisite
• Desiccants: sulfuric acid, muriatic acid
Acids vs. Alkali
• Acids: Coagulation Necrosis
• Alkali: Liquefactive Necrosis
Treatment
• Removal of offending agent from patient– Removal of clothing– Brush off powders/ solids– Wash off liquids– Copious irrigation
• Protection of Health Care Providers– Irrigate to the floor / No tubs
Treatment
• Monitor pH of irrigation effluent
• Neutralizing solutions…??
• Be aware of antidotes– HF calcium gluconate– Chromic acid Na hyposulfite wash– Lewisite/ Phosgene
Dimercaprol
Case #1
• Construction worker presents with burns
• He was pouring a slab of concrete
Case #1: Cement burns
• Cement: Alkali & Dessicant
• Calcium Oxide +H2O Calcium Hydroxide
Treatment…?
Case #2
• 35 M presents w/ 16% TBSA burns from meth lab explosion.
• Complains of shortness of breath and burn pain
• Which of the following may cause a chemical inhalational injury, and how might this chemical contribute to tissue injury?
1. Ammonia2. Chlorine3. Ozone4. Phosgene5. Mustard gas
Case #2: Ammonia burns
• Key ingredient in methamphetamine production
• Causes serious lung injury (particularly upper airways)
• Ammonium + H2O = ammonium hydroxide
Treatment…?
Case #3
• 42 M present 24 hours after chemical exposure during glass etching
• Patient also c/o heart fluttering
• ECG: prolonged QT
Case #3: Hydrofluoric Acid Burn
• Lethal acid & metabolic poison
• Serum electrolytes & ECG monitoring are key.
• Treatment focus on neutralizing Fluoride ion– Calcium gluconate gel– Calcium gluconate SQ injections– Intra-arterial calcium
• Patient’s pain guides treatment
How can these help you?
Questions…
one child burned, is one child too many!
Isaac Tawil, MD
UNM Burn CenterAdults & Pediatrics
from tragedy… hope!
The New Mexico Burn Corps
Call 1-888-UNM-PALS to join our TEAM!
We need active VOLUNTEERS from all ages to help us meet the needs of New Mexico!
Isaac Tawil, MD
