Term
|
Definition
• Electrical/Lightning
• Thermal
• Chemical
• Radiation
• Friction |
|
|
Term
|
Definition
• Electrical burns happen when
the body comes in contact with
an electrical current
• Extension cords
• Children with non-insulated
cords and placing them in their
mouth, climbing trees or
electrical poles
• Lightning
• Work related-second leading
cause of occupation-related
deaths in the US |
|
|
Term
| Epidemiology for Electrical Burns |
|
Definition
• Account for 3-4% of burn
related injuries
• 1000 fatalities per year
• Up to 40% of serious
electrical injuries are
fatal
• Children and teenagers
are the most common
patients |
|
|
Term
|
Definition
• Stun gun and Taser gun
• Deliver bursts of high-voltage, low amperage
direct current
• Hook and wire system fired through
compressed gas-Taser
• Handheld device- stun gun
• No clinical evidence that they cause
dangerous laboratory abnormalities or
cardiac ischemia or arrhythmias;
HOWEVER-
• Fatal arrhythmias have been reported- possibly due to intoxication with cocaine,
meth, PCP, stimulants
• Injuries sustained after fall
• It is possible but rare to have cutaneous
burns, lacerations, rhabdomyolysis, testicular
torsion, ocular injury, and miscarriage |
|
|
Term
|
Definition
• Electricity: flow of electrons between
points of high concentration to points of
low concentration
• Type of current (volume of electrons)
– AC (alternating current)
– DC (direct current)-flow constant
• AC is worse than DC
• Voltage—force of electrons
• Amperage– measured volume of
electrons
• Resistance– hindrance of the flow
• Duration of exposure
• Pathway of the flow |
|
|
Term
|
Definition
– The direction of flow changes on
a cyclical basis
– Standard household items
– 3 Times more dangerous
– Repeatedly stimulates muscle
contraction
– Induces tetany
– Locks the person to the source:
often, the site of exposure is at the hand, and because the
flexors of the arm are stronger
than the extensors, the victim
may actually grasp the source,
prolonging the duration of
contact and perpetuating tissue
injury |
|
|
Term
|
Definition
Flow is constant
– Batteries, railway tracks,
automobile electrical
systems, lightning
– Causes a single muscle
Spasm
– Throws the victim
– Higher risk of blunt trauma |
|
|
Term
|
Definition
• The force that drives the electrons
across the potential difference is the
voltage (V).
• Resistance (R) describes the
hindrance to flow.
• The interrelationship amongst
current (I), voltage, and resistance is
described by Ohm's law:
• I = V/R
• Which means: current is directly
proportional to the voltage and
inversely proportional to resistance. |
|
|
Term
|
Definition
• >1000V
• Power lines greater than 100,000 V
• Lightning strikes are associated with a
potential difference between the
atmosphere and the ground in excess
of 10 million volts
• The skin damage is the “Tip of the
Iceberg”
• Have spotty internal damage
• Vascular structures are destroyed
• Thrombosis is common and can be
delayed
• Will see an entrance and exit wound |
|
|
Term
|
Definition
• <1000 volts
• Typical voltage delivered to homes is
either 110 V (North America) or 22 V
(Europe and Asia) |
|
|
Term
|
Definition
• Direct effect of electrical
current on body tissues
• Conversion of electrical energy
to thermal energy, resulting in
deep and superficial burns
• Blunt mechanical injury from
lightning strike, muscle
contraction, or as a
complication of a fall after
electrocution |
|
|
Term
| Four Classes of Electrical Injury |
|
Definition
• The body becomes part of a circuit and is
usually associated with entrance and exit
wounds.
– These wounds generally do not help predict the path
of the current, and the skin findings can
significantly underestimate the degree of internal
thermal injury.
• Flash (or arc) burns occur when the current arc
strikes the skin, but does not enter the body.
• Flame injuries from clothing catching fire in the
presence of an electrical source.
• Lightning injury is caused by a DC current
exposure that lasts from 1/10 to 1/1000 of a
second, but often has voltages that exceed 10
million V
– Peak temperature within a bolt of lightning rises
within milliseconds to 30,000 Kelvin (five times
hotter than the sun), generating a shock wave of up
to 20 atmospheres induced by the rapid heating of
the surrounding air
– This shock wave then can be transmitted through
the body and result in mechanical trauma. |
|
|
Term
|
Definition
• Cardiac: arrhythmia, cardiac arrest, asystole
(usually due to DC current or lightning) or Vfib
(AC current), atrial dysrhythmias, 1st and 2nd
degree heart block, BBB, myocardial
contusion, coronary spasm, myocardial rupture
due to coagulation necrosis
• Respiratory: respiratory paralysis
• Renal: rhabdomyolysis, AKI, hypovolemia due
to extravascular extravasation of fluids leading
to prerenal azotemia and ATN
• Neurologic: LOC, weakness, paralysis, respiratory
depression, autonomic dysfunction and memory
disturbances. MAY BE DELAYED
• Skin: superficial, partial-thickness and full-thickness
thermal burns
– A unique type of burn seen with electrical injury is the
"kissing burn". This occurs at flexor creases, where the
flexor surfaces adjacent to a joint touch
– “Feather" lesions, also called Lichtenberg figures, which
fade rapidly but are pathognomonic of lightning injury
• Mouth-oral burns
• Musculoskeletal-periosteal burns,
destruction of bone matrix,
osteonecrosis, bones can fracture
from falls, blast injuries, or under
stress of repeated tetanic muscle
contractions, tissue necrosis, edema,
compartment syndrome,
rhabdomyolysis
• Vascular, coagulation system: from
acute compartment syndrome or the
coagulation of small blood vessels
• Other: trauma workup for those
thrown or who fall |
|
|
Term
|
Definition
• Bites cords or sucking on the
female end of the cord
• Coagulation necrosis from the
intense heat
• Painless as neural tissue is
destroyed
• Charred black center with
grey/white ring exterior
• Labial artery bleeds 5-14 Days
after the injury |
|
|
Term
|
Definition
• Airway, breathing, and circulation
• Cardiovascular function: assess cardiac rhythm; examine pulses
• Skin: Inspect for burns; look for blisters, charred skin, and other lesions;
pay attention to skin creases, areas around joints, and the mouth
(particularly in young children)
• Neurologic function: assess mental status, pupillary function, strength and
motor function, and sensation
• Ophthalmologic: assess visual acuity; inspect the eyes, including a
funduscopic examination
• Ear, nose, and throat: inspect the tympanic membranes; assess hearing
• Musculoskeletal: inspect and palpate for signs of injury (fracture, acute
compartment syndrome), and be certain to examine the spine |
|
|
Term
|
Definition
• Lab Tests
– CBC
– CPK
– Troponin
– Urine myoglobin
– UA
– BMP
– EKG
– Head CT
– C Spine Films
• EKG
• ECHO
• Radionuclide imaging
with technetium-99 to
identify nonviable
muscle
• MRI
• CT
• Trauma work-up |
|
|
Term
|
Definition
• Do the primary survey
• ACLS as indicated
• Transfer to a burn center-fasciotomy,
escharotomy, extensive skin
reconstruction or limb amputation
• Fluid resuscitation
• Give tetanus prophylaxis
• Due to vascular insult-watch for ileus,
abdominal pain or tenderness- mesenteric ischemia
• Gastric ulcers-Curlings Ulcers- prophylactic therapy
• Mainly supportive care-topical
antibiotics, cardiac monitoring
• Further examination of the eyes and
ears for TM rupture and cataracts (may
be delayed up to 2 years)
• PTSD
• PT |
|
|
Term
|
Definition
• Asymptomatic patients after a low- voltage exposure with a normal PE do
not require more diagnostic tests and
can be reassured and discharged
• Patients with mild persistent symptoms
or minor cutaneous burns and a normal
ECG and urinalysis (no hemoglobinuria)
can be observed for a few hours and
discharged with appropriate follow-up
based upon the severity of their wounds
and any comorbidities.
• Obstetric consultation for pregnant
patients is reasonable.
– Placental abruption may be associated
with minor trauma, including electrical
injuries. |
|
|
Term
|
Definition
• 100 total victims a year
• Approximately 30% struck-die
• Approximately 70% have
permanent disabilities
• 15% killed in groups of two or more
• Causes 55% more deaths than
tornadoes
• 41% more deaths than both floods
and hurricanes
• Most deaths occur within an hour
due to fatal arrhythmia or
respiratory failure |
|
|
Term
|
Definition
• Lightning strikes are always fatal
• Victims become “Crispy Critters”
• It never strikes the same place twice
• Victims remain electrified
• Victims are in “Suspended Animation”
• They are the same as high voltage injuries |
|
|
Term
| The Lightning Strike: Cloud to Ground Strike |
|
Definition
• Negative stepped leader stroke
– Weak, irregular, downward stroke that you see
• Upward stroke
– A positive upward stroke
• Return Stroke
– Ground to cloud stroke that carries the bulk of
the power. Very rapid |
|
|
Term
| Lightning Mechanism of Injury |
|
Definition
• Direct Hit
• Contact
• Side Flash
• Step Voltage
• Ground Potential
• Upward Streamers
• Also blunt trauma may occur |
|
|
Term
|
Definition
• Confusion, anterograde amnesia
• Patients may have fixed and
dilated or asymmetric pupils due
to automatic dysfunction- NOT A
REASON TO STOP
RESUCITATION
• Tympanic membrane rupture
• Sensorineural hearing loss,
tinnitus, vertigo
• Unconsciousness
• Muscular pain
• These patients should have
stable vital signs
• Prognosis: gradual complete
recovery |
|
|
Term
| Lightning Moderate Injuries |
|
Definition
• Keraunoparalysis
– Paralysis, mottled skin, extreme
vasoconstriction, absent pulses-temporary
• Cataracts, hyphema, vitreous hemorrhage and
optic nerve injury
• Temporary cardiac standstill
• Prolonged respiratory arrest
• Seizures
• 1st and 2nd degree burns
• Prognosis: 74% have permanent sequelae |
|
|
Term
| Lightning Permanent Sequelae |
|
Definition
• Cognitive defects
• Insomnia
• Storm anxiety
• Psychomotor defects
• Cataracts
– Type 1—Early from lens tears
– Type 2– Late from vacules replaced with
opacities |
|
|
Term
|
Definition
• Linear
• Punctate
• Thermal
• Contact
• Ferning
• Flash |
|
|
Term
| Lightning Severe Injuries |
|
Definition
• Cardiac arrest– asystole
• Hypoxic encephalopathy
• ICH
• Cerebral infarction
• Spinal fractures
• Direct brain injury
• Life threatening blunt trauma
• Prognosis: Poor |
|
|
Term
| Lightning Pregnant Victims |
|
Definition
• Have variable outcomes
• Are at risk of miscarriage or stillbirths
• Should be monitored initially
• OB should be involved |
|
|
Term
| Triage for Lightning Victims |
|
Definition
• Should use reverse triage
• Concentrate on the most
critical patients
• Triaging lightning strike
victims in mass casualty
incidents (MCIs) should
follow a “reverse triage”
method, whereby cardiac
arrest victims are treated
first—rather than “black
tagged”—giving the
optimum chances of survival |
|
|
Term
|
Definition
• Be aware of the weather
• Seek shelter or the shore
• Avoid windows, phones, or
electrical appliances
• Avoid metal objects-Do not
touch the metal on a car
• Avoid hilltops, flat open
spaces, trees
• Groups should spread out |
|
|
Term
| Lightning vs High voltage |
|
Definition
|
|
Term
|
Definition
– 1 Million patients a year
– 100,000 hospitalized
– 12,000 Deaths a year
– Male to female ratio of 2:1
– 2nd most common cause of accidental death
– Highest risk between ages 18-35 |
|
|
Term
|
Definition
• Hypermetabolic state
with muscle catabolism
• Endotoxin release from
gut or wound
colonization
• Decreased oncotic
pressure from plasma
loss
• Endothelial cell gaps
• Increased interstitial
oncotic pressure
• Cardiac output is
decreased
• Decreased renal blood
flow
• Decreased IgG and IgA
• The T Lymphocytes do
not function normally
• Systemic edema &
inflammation with more
than 20-25% TBSA
burns |
|
|
Term
|
Definition
• Remove from Source
• Remove Clothing
• CAB’s/ABC’s of
Trauma
• Cool Soaks
• Sterile Sheets
• 100% Oxygen
• Analgesia |
|
|
Term
|
Definition
• The burning agent
• Temperature
– >113F causes denaturation of cell proteins
• Duration of exposure |
|
|
Term
|
Definition
• Mechanism
• Time of exposure
• Toxins
• Smoke at site
• Enclosed space
• Possible blast injury
• Chemicals involved
• Voltage & current
type involved |
|
|
Term
Estimate the Burn Size
• TWO WAYS: |
|
Definition
– Rule of Nines
– Back of Patient’
s
Hand is 1% of TBSA |
|
|
Term
|
Definition
|
|
Term
| estimating child burn area |
|
Definition
|
|
Term
|
Definition
• First degree
• Second Degree
• Third Degree
• Fourth Degree
• Remember that the Depth of the Burn
can Increase over a 24-48 hour period! |
|
|
Term
|
Definition
• Involves the epidermis only (superficial)
• Reddened & warm & edematous
• Can blister within 24 hours
• Most common cause is UV light
• Heals within 7 days with NO Scarring |
|
|
Term
|
Definition
• Superficial partial thickness:
– Epidermis & papillary dermis
– Painful
– Hot liquids common cause
– No scarring
– Heal in 7-20 days |
|
|
Term
|
Definition
• Deep partial thickness
• Down to the subcutaneous fat- all dermis
• Capillary layer destroyed
• Leathery & white appearance
• Insensate (lacks feeling)
• Flame, steam & hot oil
• Requires skin grafting
• >21 days to heal |
|
|
Term
|
Definition
• Full thickness
• Devastating injuries
• Burn extends down to &
including the fascia,
muscle & bone |
|
|
Term
|
Definition
• Zone of Coagulation
– Most severe, inner zone
– Tissue destroyed
– Blood vessels thrombosed
• Zone of Stasis
– Stagnant but not
clotted blood
– Can become more
ischemic & hypoxic
• Zone of Hyperemia
– Increased blood flow
– Minimal damage,
peripheral area |
|
|
Term
| Airway Concerns and burn s |
|
Definition
• May have delayed swelling
• Hints to possible damage – Soot in nares & pharynx, carbon
deposits
– Singed nasal hair
– Sooty sputum
– Hoarseness
– Blistering or edema of oropharynx
– Persistent cough, stridor, or
wheezing
– Neck burns (circumferential)
– Hypoxia or hypercapnia
– Elevated carbon monoxide and/or
cyanide levels
– Depressed mental status including
evidence of drug or alcohol use
– High CO levels
• Mechanical ventilation
difficulties
– Pulmonary damage
– Airway swelling
– Decreased chest wall compliance
– Hypoxia with 100% O2
– Low Peak Flow
• C-spine maintenance |
|
|
Term
|
Definition
• Injury from the inhalation of
hot gases generally occurs
above the vocal cords and can
cause significant edema.
• Flash burns often harm the
face but rarely involve the
airway, unlike severe burns
from prolonged heat exposure
associated with smoke
inhalation |
|
|
Term
|
Definition
• MAINTAIN the AIRWAY!!!
• Non-rebreather vs. CPAP vs.
intubation vs cricothyrotomy
• High CO level consider hyperbaric
oxygen
• Consider inhaled heparin and N- acetylcysteine (NAC) to remove
bronchopulmonary casts due to lung
injury coagulation studies have
shown significant benefit
• Inhaled Nitric Oxide to treat hypoxic
vasoconstriction |
|
|
Term
| Carbon Monoxide & Cyanide Toxicity |
|
Definition
• Carboxyhemoglobin level
obtained in all moderate or
severe burns
• Pulse oximetry not sufficient
• ABG helpful
• Cyanide level
• Serum lactate
– Cyanide toxicity poisons
mitochondria forcing cells to
use anaerobic metabolism.
This results in a lactic acidosis
and a compensatory drop in
EtCO2. |
|
|
Term
|
Definition
• Large bore IV’s in non-Injured tissue
• Initial fluid use normal saline or Lactated
Ringers
• Avoid central lines if possible
• Analgesia-Morphine/Opiates
• Benzodiazepines for anxiety
• Tetanus
• Bronchodilators
• NSAIDS controversial if useful
• No prophylactic antibiotics
• Avoid corticosteroids-raises risk of infection |
|
|
Term
|
Definition
• 4ml/Kg/Total Body Surface area
burned plus maintenance
• One half in the first 8 Hours
from the time of the burn
• The second half over the next
16 Hours
• Adjust the amount to the vital
signs (HR, BP, distal pulses,
capillary refill, color, turgor),
urine output (0.5 ml/kg an hour)
and mental status
• Watch for compartment
syndrome |
|
|
Term
|
Definition
• Another alternative method for
estimating initial fluid requirements in
adults with severe burns
• Simple method involves two or three
steps, depending on patient size:
– Estimate burn area (TBSA) to the
nearest 10 percent.
– Multiply the percent TBSA x 10 – The
result gives the initial fluid rate
in mL/hour for adults weighing 40 to 80
kg.
– For patients who weigh more than 80 kg,
increase the rate by 100 mL/hour for
every additional 10 kg of body weight. |
|
|
Term
| Labs & Interventions for burns |
|
Definition
• CBC
• Chemistry electrolytes/glucose
• BUN/Cr
• Carbon Monoxide
(Carboxyhemoglobin)
• Methemoglobin (cyanide)
• Lactate-cyanide
• CPK
• Urine Analysis
• Type and Cross Match
• Serial peak expiratory flow
rates
• Pulse ox or capnography/end- tidal CO2
• Chest X-Ray
• Fiber optic
Bronchoscopy/laryngoscopy
• Early Intubation if any Airway
Concern
• ABG/VBG
• EKG
• Escharotomy |
|
|
Term
| GI Interventions for burns |
|
Definition
• Mesenteric vasoconstriction
• Gastric distension, ulceration (Curling's ulcer),
and aspiration.
• Nasogastric tube should be placed in patients
with moderate or severe burns >20 percent
TBSA
• High-risk patients receive medication to reduce
gastric acid secretion
• Enteral feedings within 24 hours |
|
|
Term
|
Definition
• Broken Down in Groups:
– Minor
– Moderate
– Major
• Open management
• Closed management |
|
|
Term
|
Definition
• Partial thickness<10% TBSA (children/elderly) or
<15% TBSA in healthy adults
• Gentle cleaning leaving blister intact
• Debridement of flaccid tissue
• Manage as an outpatient |
|
|
Term
|
Definition
• Partial thickness 15-20% in adults or 10-15% in
children or elderly
• Full thickness <10% TBSA
• Requires hospitalization
• Possible transfer to a burn unit
• This includes high risk elderly or very young or
diabetics |
|
|
Term
|
Definition
• Full thickness >10%TBSA
• Partial Thickness > 25% TBSA
in Adults or > 20% TBSA in
Children
• Immunosuppression or
diabetes
• High voltage electrical injuries
• Major trauma or inhalation
injuries
• Cosmetic or functional
disfigurement |
|
|
Term
|
Definition
• Cleanse the wound
• Use topical antibiotics
• No Silvadene on the face
• Can use a combination or Aloe Vera and
Bacitracin on face
• Ruptured blisters should be removed, but the management of
clean, intact blisters is controversial.
• Needle aspiration of blisters should never be performed as this
increases the risk of infection.
• A fine, non-adherent, mesh gauze (Telfa) typically is applied, after
the burn is cleansed and a thin layer of topical antibiotic is applied.
• Circulatory impairment is minimized by applying this non-adherent
dressing in successive strips rather than wrapping it around the
wound
• Tubular net bandage or gauze wraps lightly applied |
|
|
Term
|
Definition
• With deep dermal and full thickness burns, the dermis
can become stiff and unyielding, and this tissue is
referred to as an eschar
• Incision of an eschar (escharotomy) may be necessary
to preserve respiratory function or prevent ischemia
• Circumferential burns
• May develop compartment syndrome and need
fasciotomy |
|
|
Term
Special Consideration
• Coal Tar Burns |
|
Definition
– Heated up to apply to roads &
roofs
– Adheres to the skin
– Rarely causes full thickness
burns
– Cools quickly to allow peeling
or
mechanical debridement
– Use cool water and mineral
oil
– Do not debride
– Polymyxin-B, bacitracin zinc ointment emulsifies residual
tar |
|
|
Term
| Secondary Survey and Management |
|
Definition
• Full physical exam
– Corneal abrasions
– Perineal wounds
• Ongoing pulse ox and cardiac monitoring |
|
|
Term
|
Definition
• Less than 5% of burn center admissions
• Work related
• 60,000 new chemicals a year
• Smaller burn surface areas
• Longer healing time
• Lower mortality
• Common areas of involvement are face,
extremities, eyes ,mouth and GI tract |
|
|
Term
|
Definition
• Chemical burns differ from thermal burns in that
they continue to cause damage as long as some
active component of the chemical remains in the
wound
• Chemical burns heal slowly and generally require
a hospitalization period that is 30 percent longer
than a thermal burn of comparable surface area
and depth
• May lead to fluid shifts and need aggressive IVF
• Topical antibiotics may be necessary to prevent
spread |
|
|
Term
| Ensure Protection , chemical burn |
|
Definition
• Ensure protection of rescuers
and health care workers from
exposure.
• Remove the patient from the
area of exposure.
• Remove all clothing and
jewelry.
• Brush any dry chemicals off the
patient; any suitable instrument
may be used (dry brush,
towel). |
|
|
Term
| First Step: Decontamination- chemical burn |
|
Definition
• Copious irrigation
• Among the few chemical toxins
that should NOT be irrigated
immediately with water are dry
lime, phenols, and elemental
metals (sodium, potassium,
calcium oxide, magnesium,
lithium, phosphorous)
• Alkali burns rinse longer, may
use vinegar
• May be performed pre-hospital:
EMS, HAZMAT teams,
decontamination hospital team |
|
|
Term
| Protection of Providers, chemcial burns |
|
Definition
• Level A: Maximal protection includes encapsulation
boots and gloves and a self-contained breathing
apparatus (SCBA).
• Level B: Non-encapsulating splash protective suit that
is not airtight but provides full respiratory protection and
SCBA.
• Level C: Splash suit and full or half-face respirator.
• Level D: Work clothes, boots, safety goggles, and
gloves; no respiratory protection. |
|
|
Term
| chemical burns osha recommendations |
|
Definition
• Powered air-purifying respirator
(PAPR) that provides a protection
factor of 1000 combined with a
99.97 percent high-efficiency
particulate
air (HEPA)/organic vapor/acid gas
respirator cartridges.
• Double layer protective gloves.
• Chemical resistant suit; suit
openings are sealed with tape.
• Head covering with eye and face
protection (if not part of
respirator).
• Chemical protective boots. |
|
|
Term
| General Management, chemical burns |
|
Definition
Irrigation
– The solution to the pollution is dilution
– Moderately warm water in high volumes at low pressures
should be used for irrigation
– High pressure irrigation should be avoided as it can splash
chemicals on to unexposed areas and drive them deeper
into tissue
– During cold weather, warmer water is needed to prevent
hypothermia
– Either a shower or a hose can be used.
• Fluid resuscitation
• Acidosis is mainly from Hypovolemia
• If pH is < 7.1 than can use Bicarb
• Activated charcoal is not recommended
• Upright chest X-ray in ingestions
• Sodium metals should be excised or covered
with mineral oil
• Tetanus should be given
• Antimicrobial ointments |
|
|
Term
| Antidotes for chemical burns |
|
Definition
• Do not play a major role in chemical burns
• Hydrofluoric acid-calcium salts
• White Phosphorus (military explosives,
fireworks)-copper sulfate solution but this
may be toxic so not fully recommended-but
you may hear mentioned |
|
|
Term
| Burn Assessment for chemical burns |
|
Definition
Difficult to assess
• Burns may appear superficial but may be
very deep |
|
|
Term
| Common Household Chemicals |
|
Definition
• Lye
• Phenols
• Sodium Hypochlorite
• Sulfuric Acid
• Hydrofluoric Acid
• Freon |
|
|
Term
| Ingestion, chemcial burns |
|
Definition
• If dysphagia, stridor, or drooling than
should have endoscopic evaluation
with or without oral burns
• Expectant intubation if stridor or
hoarseness
• Blind naso-tracheal is
contraindicated
• Esophageal injury give pain with
swallowing
• Gastric injury causes burning like
pain |
|
|
Term
| Complications of Oral Burns |
|
Definition
• Dentition destruction
• Microstomia
• Dental arches develop abnormally
• Speech difficulties
• Labial adhesions |
|
|
Term
|
Definition
• Injury from coagulation necrosis
• A scar forms and prevents deep
penetration
• When ingested it injures the stomach
• It is readily absorbed
• pH 2 causes corrosive injury
• Creates electrolyte abnormalities
• Acetic acids most common acid burn
in women |
|
|
Term
| What Happens w chemical burns, acids |
|
Definition
• Initial tissue injury
• Further necrosis
• 2-3 days have superficial healing &
sloughing of tissue
• 3-6 days is the initiation of healing &
increased risk of perforation |
|
|
Term
Epidemiology Of
Hydrogen Fluoride Acid |
|
Definition
• Found in rust removers,
glass etching chemicals
& semi conductor
industry
• >50% concentration
causes immediate pain
• <20% concentration will
cause symptoms 12-24
hours post exposure
• Acts like an alkali |
|
|
Term
| Pathophysiology of HF Acid |
|
Definition
• Lipophilic so penetrates the skin
• Fluoride is released in the cell causing destruction
• Fluoride precipitates calcium
• Hypocalcemia may stimulate an efflux of potassium
ions from cells resulting in hyperkalemia, and
predisposing to cardiotoxicity
• QTc interval prolongation, due to hypokalemia,
hypomagnesemia, and/or hypocalcemia may be
seen. Tissue injury leading to hemorrhage
• Can cause death from MI and V Fib |
|
|
Term
| Signs & Symptoms of HF Acid |
|
Definition
• Mild initial irritation
• Up to 12 hours later they develop severe
pain and redness
• Can progress to deep tissue or bone injury
• May have a blue grey appearance |
|
|
Term
| Treatment of HF Acid Burns |
|
Definition
Copious irrigation may be all that is needed
• Epsom salts in the field
• Calcium gluconate (1Gram) in a water soluble
jelly
• Subcutaneous injection at site
• Intrarterial calcium gluconate |
|
|
Term
| Specific Treatments for HF acid systemic burns |
|
Definition
• Calcium is administered intravenously for
systemic toxicity
• Calcium gluconate can be given as 1000 mg (10
mL of a 10 percent solution) infused slowly over
two to three minutes; several repeat doses may
be necessary if profound hypocalcemia is present.
• In cases of systemic toxicity, magnesium
replacement (4 g IV over 20 minutes) |
|
|
Term
|
Definition
• Phenol is a colorless or white solid but is often sold in
liquid form.
• Strong sweet odor and is widely used in disinfectants
and in the production of resins and plastics.
• Readily absorbed through the skin and across the
lungs when its vapor form is inhaled.
• Severe dermal burns from phenol can cause severe
systemic toxicity and death.
• Moderately soluble in water and swabbing merely
spreads the chemical, increasing the area of
absorption and thereby toxicity.
• The solvent polyethylene glycol (PEG) is used to
remove phenol from the skin
• Isopropanol or glycerol may be substituted if PEG is
unavailable
• Systemic toxicity most often manifests as central
nervous system or cardiac abnormalities
• CNS dysfunction can manifest as agitation, seizures,
or coma, while cardiac dysfunction generally
manifests as hypotension or dysrhythmia.
• Phenol also demyelinates peripheral nerves and
causes lysis of erythrocytes. |
|
|
Term
|
Definition
• Solid element that spontaneously ignites
in air forming phosphorus pentoxide
• White phosphorus is used as an
incendiary agent in weapons and
fireworks.
• Produces a combined chemical and
thermal burn
• Systemic toxicity can lead to severe
hypocalcemia or hyperphosphatemia and
hepatic necrosis.
• Copper sulfate solution is no longer
considered an antidote for white
phosphorus burns and is potentially
dangerous: it is readily absorbed via the
wound and can cause acute renal failure,
cardiovascular collapse, and death |
|
|
Term
|
Definition
• Damage from Liquefaction
Necrosis
• Lipophilic & will continue to
penetrate
• Liquids will injure the esophagus
& stomach
• Solids will injure the oropharynx
• pH > 12.5 is associated with
significant injury
• Most frequently ingested is
household bleach
• Most gastrointestinal burns are
from alkalis |
|
|
Term
|
Definition
• Anhydrous ammonia is a colorless, pungent gas used
extensively as a fertilizer and in the manufacturing of
synthetic fibers and methamphetamine labs
• Stored at -28F
• Combination of cold injury and alkali burn
• Repeat irrigation should be performed every four to six
hours for the first 24 hours.
• Eye exposures are treated with topical analgesics
(Proparacaine 1-2drops of 0.5 percent) and copious
water irrigation.
• Damages the lung parenchyma via collagen degradation
and other means and can produce laryngospasm and
glottic edema.
• Mild pulmonary insults produce coughing, laryngitis,
pharyngitis, or tracheobronchitis.
• Severe pulmonary injury results in pulmonary edema
and bronchiectasis.
• Early intubation |
|
|
Term
|
Definition
• Wet cement is a poorly recognized and
under-reported cause of alkali burns
• A cement mixture has an initial pH of 10
to 12 that may rise as high as 14 as
hydrolysis occurs and the cement sets.
• Occur several hours after exposure and
include burning sensations, erythema,
pain, and vesicle formation.
• Twelve to 48 hours later, partial to full
thickness burns become evident
• Treatment consists of copious water
irrigation.
• Skin protection |
|
|
Term
|
Definition
• Several case reports document
burns resulting from automobile
airbag deployment. Airbags may
occasionally perforate and release
sodium azide or sodium hydroxide
resulting in alkali chemical burns
• When treating patients with burns
following airbag deployment,
clinicians should ask the patient
and paramedics whether the airbag
was perforated. |
|
|
Term
|
Definition
• They can be found in a wide range of
kitchen cleaning products, chemical
solvents, and automobile products.
• Contact with gasoline and other
hydrocarbons may cause dermatitis,
itching, and inflammation. Significant
burns and systemic toxicity may occur,
especially in the setting of trauma,
such as industrial or motor vehicle
accidents.
• Removal from the scene and
decontamination, including copious
water irrigation. |
|
|
Term
|
Definition
• True emergency
• Commonly industrial accidents
• Airbag explosions is new problem
• Acids are limited to the surface
• Alkali penetrate deeply |
|
|
Term
| Ocular Chemical Burns Signs and Symptoms |
|
Definition
• Tearing
• Rubbing
• Redness
• Pain
• Blephorospasm
• Conjunctivitis
• Corneal swelling
• Clouding of anterior
chamber
• Corneal ulceration |
|
|
Term
|
Definition
• Cancer patients undergoing radiation
therapy may suffer from an injury
known as radiation burn.
• High-energy radiation is used to
shrink or kill cancerous cells, and
when it passes through the body, skin
cells may be damaged.
• Skin cells may not have enough time
to regenerate, and sores or ulcers
may develop
• Not a true burn but feels like one
• Cleaning and moisturizing wounds
• Avoiding sunlight
• Wearing loose clothing or bandages
over the wound |
|
|
Term
|
Definition
• May occur when skin repeatedly
rubs against another surface or is
scraped against a hard surface.
Like other burns, friction burns are
categorized into degrees.
• Many friction burns are first degree
and often heal on their own within
three to six days.
• Moisturizing cream at home to
care for it. |
|
|
