Notes – Topical Chemical Burn

Topical Chemical Burn

Patient Safety Considerations

  1. Don PPE
  2. Take measures to prevent the patient from further contamination through decontamination
  3. Take measures to protect the EMS provider and others from contamination
  4. Do not attempt to neutralize an acid with an alkali or an alkali with an acid as an exothermic reaction will occur and cause serious thermal injury to the patient
  5. Expeditious transport or transfer to a designated burn center should be considered for burns that involve a significant percentage of total body surface area or burns that involve the eyes, face, hands, feet or genitals

Notes/Educational Pearls

Key Considerations

  1. IV fluid resuscitation should be guided by patient age, percentage of body surface area involved in burn, body habitus and calculated by the Parkland Formula [see Appendix VI]
  2. Since the severity of topical chemical burns is largely dependent upon the type, concentration, and pH of the chemical involved as well as the body site and surface area involved, it is imperative to obtain as much information as possible while on scene about the chemical substance by which the patient was exposed. The information gathering process will often include:
    1. Transport of the “sealed” container of the chemical to the receiving facility
    2. Transport of the original or a copy of the Material Safety Data Sheet (MSDS) of the substance to the receiving facility
    3. Contacting the reference agency to identify the chemical agent and assist in management (e.g. CHEMTREC®)
  3. Inhalation of HF should be considered in any dermal exposure involving the face and neck or if clothing is soaked in the product
  4. Decontamination is critical for both acid and alkali agents to reduce injury – removal of chemicals with a low pH (acids) is more easily accomplished than chemicals with a high pH (alkalis) because alkalis tend to penetrate and bind to deeper tissues
  5. Some chemicals will also manifest local and systemic signs, symptoms, and bodily damage

Pertinent Assessment Findings

  1. An estimate of the total body surface area that is involved
  2. Patient response to therapeutic interventions
  3. Patient response to fluid resuscitation
  4. Patient response to analgesia

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914213 – Injury-Topical Chemical Burn

Key Documentation Elements

  • Burn site
  • Body surface area involved
  • Identification of the chemical
  • Reported or measured pH of the chemical
  • Acquisition and transfer of MSDS, chemical container, or other pertinent substance information to the receiving the facility

Performance Measures

  • Accurate (overtriage/undertriage) triage of patients to designated burn centers
  • Early recognition of a topical chemical burn with appropriate treatment
  • Early recognition of hydrofluoric acid burns followed by expeditious initiation of treatment with calcium gluconate and/or calcium chloride and appropriate analgesia
  • Measures taken to prevent further contamination

References

  1. American Heart Association. Advanced Pediatric Life Support. Jones & Bartlett Learning LLC; 2013.
  2. Ferng M, Gupta R, Bryant SM. Hazardous Brick Cleaning. J Emergency Medicine. 2009;37(3):305-7.
  3. Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank’s Toxicologic Emergencies, 10th Edition. China: McGraw-Hill Education; 2015.
  4. Marx JA et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice, 2010 769-770
  5. O’Sullivan SB, Schmitz TJ. Physical Rehabilitation, 5th Edition. F.A. Davis; 2007: 1098.
  6. Recommended Medical Treatment for hydrofluoric Acid Exposure. Morristown, NJ: Honeywell Performance Materials and Technologies; October 2012.
  7. Tintinalli JE, ed. Tintinalli’s Emergency Medicine, 7th Edition. McGraw-Hill Education; 2011: 1297, 1351, 1381-1382.